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Quality of life in ALS is maintained as physical function declines.

OBJECTIVES: To study patients with ALS to determine how physical function, quality of life (QOL), and spirituality or religiousness change over time, and what relationship these changes have to one another. METHODS: Sixty patients with ALS were studied prospectively. They were assessed at baseline, 3 months, and 6 months, using questionnaires designed to measure general quality of life (McGill Quality of Life questionnaire), religiosity (Idler Index of Religiosity), ALS-specific health-related quality of life (SIP/ALS-19), and ALS-specific function (ALS functional rating scale). RESULTS: A two-way repeated measures multivariate analysis of variance revealed that both the passage of time and the specific QOL scales used were factors in predicting patient quality of life (F[1, 59]= 9.87, p < 0.003 and F[3, 177]= 16.90, p < 0.001) Despite a progressive decline in physical function as measured by the ALS-specific function score, the general QOL and religiosity scores changed little. In contrast, the ALS-specific health-related QOL score declined in parallel with the ALS-specific function score. CONCLUSIONS: QOL in patients with ALS appears to be independent of physical function, which agrees with a previous cross-sectional study. The ALS-specific health-related QOL score is primarily a measure of physical function. QOL instruments that assess spiritual, religious, and psychological factors produce different results than those obtained using measures of physical function alone.

Adult↗

Volumetric analysis reveals corticospinal tract degeneration and extramotor involvement in ALS.

BACKGROUND: Pathologic changes in the motor cortex and corticospinal tracts in ALS may be reflected by abnormal signal intensities on conventional MRI. The sensitivity of these changes in detecting underlying pathology remains unclear. METHOD: The authors used automated image analysis to quantify volumes of cerebral gray and white matter in 16 patients with ALS (eight limb onset, eight bulbar onset) and eight normal controls. Previously they had demonstrated a reduction in N-acetyl aspartate/creatine + phosphocreatine (NAA/[Cr + PCr]) measured by (1)H-MRS in the subcortical white matter in the motor cortex region in the patients with bulbar-onset ALS. To determine whether this resulted from axonal degeneration, they also compared gray and white matter volumes in the patients with limb- and bulbar-onset ALS. RESULTS: There were no differences in the total brain volumes of gray or white matter for the three subject groups (p > 0.23). Comparison of the total ALS group and controls revealed localized deficits in gray matter volume centered on Brodmann areas 8, 9, and 10 bilaterally. Comparison of the patients with limb- and bulbar-onset ALS revealed deficits in the white matter volume in the bulbar-onset group, extending bilaterally from the precentral gyrus into the internal capsule and brainstem, consistent with the course of the corticospinal tract. There was no loss in gray matter volume in the precentral gyri. CONCLUSIONS: The loss of gray matter in the frontal regions (total ALS group) provides further support that ALS is a multisystem disorder. In addition, there is in vivo evidence of axonal degeneration in the subcortical white matter in the motor region in patients with bulbar-onset ALS. This is consistent with a "dying back" process affecting cortical motoneurons in bulbar-onset ALS.

Adult↗

Acid-labile subunit (ALS) measurements in children.

Almost all of the serum IGFs are found in a ternary complex composed of IGF, IGFBP-3 and acid-labile subunit (ALS). It was reported that ALS levels were age- and sex-dependent. In the present study we measured serum ALS levels in 264 normal children (145 boys and 119 girls) aged from 5 days to 16 years, and 15 patients with growth hormone deficiency (GHD) aged from 11 months to 13 years. Serum ALS levels increased during childhood, and reached peak values in mid to late puberty. ALS levels reached their highest levels 2 years earlier in girls than in boys. Serum ALS levels were significantly correlated with serum IGF-I levels and IGFBP-3 levels. Serum ALS levels were below -2SD in 6 out of 7 children with complete GHD (CGHD), while serum ALS levels were below -2SD in 1 out of 8 patients with partial GHD (PGHD). These results indicate that serum ALS levels are regulated by GH, and that the measurement of ALS is useful for the diagnosis of CGHD in children.

Adolescent↗

Cytotoxic activity of serum and cerebrospinal fluid of amyotrophic lateral sclerosis (ALS) patients against acetylcholinesterase.

The activity of acetylcholinesterase (AChE) was tested in serum of 20 cases of amyotrophic lateral sclerosis (ALS), 4 "disease controls" and 20 age-matched healthy normals. The AChE activity has been tested also in cerebrospinal fluid (CSF) of 20 ALS patients, 2 "disease controls" and 10 normal subjects. An increase in serum AChE was present in the majority of ALS patients with a mild course of the disease, in the severe ALS group elevated serum AChE activity was a rare finding. Serum ACHE was also increased in multifocal motor neuropathy (MMN). In the majority of mild and severe ALS the CSF AChE activity was decreased. No AChE changes were found in CSF of the "disease controls". Serum and CSF ultrafiltrates of ALS patients and "disease controls" were modifying in vitro the spinal cord AChE activity. In the mild ALS group serum and CSF ultrafiltrates with high molecular weight compounds were decreasing the AChE activity. On the other hand in the severe ALS group serum and CSF ultrafiltrates with low molecular weight compounds were increasing the AChE activity. AChE was modified also in some of the "disease controls", especially in MMN and Guillain-Barré syndrome (GBS) by serum ultrafiltrates containing high molecular weight compounds. The AChE activity in serum and CSF is the consequence of the enzyme leakage from brain, degenerating cholinergic neurons and neuromuscular junctions. We suggest that because of the evoked peripherally divergent changes of the enzyme activity, the AChE values in serum and CSF in ALS do not equal to the degree of the changes in the affected tissues and cannot be taken into account in the prognosis of the disease in particular ALS cases.

Acetylcholinesterase↗

[Polarization characteristic of Al + MgF2 film at VUV].

Polarization characteristic of Al + MgF2 is researched theoretically and experimentally. According to the theory of electromagnetism, the reflectance perpendicular and parallel to the incident plane of Al + MgF2 is calculated in the way of matrix optics. The effect of incident conditions and thickness of MgF2 is considered on the reflectance of Al + MgF2 coatings. The MgF2 not only prevents the oxidation of aluminum but also increases the reflectance of Al + MgF2 by interference. The polarization of Al + MgF2 is analyzed using the concept of ratio of extinction based on above mentioned calculations. The polarization character of Al + MgF2 and single Al coating is compared. The reflectances perpendicular and parallel to the incident plane of Al + MgF2 film are measured at VUV range, using LiF polarizer as a VUV polarizer. So the polarization character of Al + MgF2 is researched experimentally. Both theoretical and experimental results of the polarization character of Al + MgF2 are coincident.

Aluminum↗

Evaluation of the Beckman Coulter AcT 5 diff AL hematology analyzer in a hospital setting.

The Coulter AcT 5-part differential (5 diff) autoloader (AL) hematology analyzer from Beckman Coulter (Fullerton, CA, USA) was evaluated at the Florida Medical Center in Fort Lauderdale, Florida, an acute care hospital facility. The AcT 5 diff AL is a new, fully automated bench-top 5-part differential hematology analyzer with automatic loading and sampling. It is designed as a front-line instrument for small- to medium-sized laboratories or as a backup in larger laboratories. We evaluated the performance of the AcT 5 diff AL for complete blood counts (CBCs). The Coulter Onyx AL was used as the reference instrument and the 5-part differential against the reference 400-cell manual differential count (2 operators x 200 cells). A total of 140 patient samples were analyzed in the study, with most of the samples obtained from our own laboratory workload. We supplemented this dataset with pediatric and oncology samples from nearby practices. All samples were analyzed within 4 hours of collection, and the AcT 5 diff AL demonstrated excellent accuracy with correlation values (r) > 0.98 for all directly measured CBC parameters (white blood cell count, red blood cell count, hemoglobin, mean corpuscular volume, and platelets). Reproducibility studies on the AcT 5 diff AL also showed excellent results, with coefficients of variation much lower than the manufacturer's specifications. Initial differential comparisons showed good correlations for neutrophils, lymphocytes, and eosinophils (r = 0.84, 0.96, and 0.88, respectively) with a lower correlation for monocytes (r = 0.43). On subsequent review and data analysis we found differential discrepancies in 39 of the 140 samples, for which all showed multiple morphological flags, R diff flags, or poor scatterplot separations indicating that the AcT 5 diff AL differential was likely to be inaccurate and that a morphological assessment and differential was necessary. Given the acutecare setting that our laboratory serves and the skewing of the dataset of our study because of the addition of abnormal pediatric and oncology cases, these abnormal sample results were not surprising. These 39 samples all had markedly abnormal differentials with either increased numbers of immature and/or abnormal cells due to such conditions as end-stage liver disease, respiratory failure, renal failure, sepsis and pneumonia, high white blood cell leukemias, and a variety of other acute illnesses. Reanalysis of the differential data, excluding these 39 grossly abnormal samples with R flags and multiple flags, showed the AcT 5 diff AL differential gave very good correlations for neutrophils, lymphocytes, monocytes, and eosinophils (r = 0.93, 0.97, 0.66, and 0.85, respectively). Our technologists were also impressed with the reliability of the AcT 5 diff AL, its ease of use and transfer from stand-by to ready mode, the user friendliness of the software, and the clarity of the printed report. We concluded that the AcT 5 diff AL gives accurate and precise CBC and 5-part differential results and is an excellent, easy-to-use instrument ideally suited for small- to moderate-sized hospital laboratories, as a back-up in a large hospital laboratory, or for use in physician office laboratories.

Automation↗

Assessment of thoracic paraspinal muscles in the diagnosis of ALS.

The distribution of muscle involvement, assessed clinically and electromyographically, was analyzed prospectively in 55 consecutive amyotrophic lateral sclerosis (ALS) patients and in 54 patients with other predominantly motor syndromes, some of whom were referred with suspected ALS. In ALS patients, distal limb muscles and thoracic paraspinal muscles were affected most frequently, more so than proximal limb and cranial muscles. The incidence of bulbar symptoms in ALS was greater in women than in men. These patterns suggest selective vulnerability of specific neuronal populations. The vulnerability of truncal muscles, illustrated by thoracic paraspinal wasting or head and shoulder drooping, was a helpful differential sign in diagnosing ALS. Thoracic paraspinal electromyography was especially valuable in distinguishing ALS from other disorders, such as combined cervical and lumbar spondylotic amyotrophy or polymyositis, which may masquerade as ALS. The finding of denervation atrophy on biopsy of thoracic paraspinal muscles was diagnostic in difficult cases. Because the thoracic paraspinal muscles are frequently affected in ALS and spared in spondylotic amyotrophy, their assessment provides a practical strategy in differentiating ALS from other motor syndromes.

Aged↗

Effect of creatine supplementation on metabolite levels in ALS motor cortices.

Mitochondrial pathology is an early observation in motor neurons and skeletal muscle of patients with amyotrophic lateral sclerosis (ALS). To clarify the relevance of this finding, we determined the effects of a 1-month oral administration of creatine on (1)H NMR-visible metabolites in the motor cortices of 15 controls and 15 patients with sporadic ALS, most of whom had mitochondrial pathology in skeletal muscle. In the motor cortex of the ALS group the N-acetylaspartate (NAA)/creatine (Cr(t)) metabolite ratio was lower than in our control group, indicating NAA loss. Upon creatine supplementation we observed in the controls a decline in the NAA/Cr(t), NAA/choline (Cho), glutamate + glutamine (Glx)/Cr(t), and Glx/Cho metabolite ratios. In contrast, in the ALS patient group the NAA/Cr(t) and the NAA/Cho metabolite ratios remained unchanged, while the Glx/Cr(t) and Glx/Cho metabolite ratios decreased. These data are compatible with the interpretation that creatine supplementation causes an increase in the diminished NAA levels in ALS motor cortex as well as an increase of choline levels in both ALS and control motor cortices. Because NAA is synthesized by mitochondria in an energy-dependent manner and the NAA/Cho metabolite ratios in the ALS motor cortices were found to be correlated to the degree of mitochondrial pathology in ALS skeletal muscle, our results can be explained by a deficiency of enzymes of mitochondrial respiratory chain in the ALS motor cortex which might affect motor neuron survival.

Adult↗

The Influence of Alkali Metal Ions on Homogeneous Nucleation of Al(OH)(3) Crystals from Supersaturated Caustic Aluminate Solutions.

Homogeneous nucleation of Al(OH)(3) crystals from synthetic, optically clear, caustic aluminate solutions and the influence of alkali metal ion (Na(+) versus K(+)) have been investigated under isothermal, batch crystallization conditions. The nucleation kinetics showed a seventh-order dependence upon Al(III) relative supersaturation and a strong temperature effect. Activation energy of 160 kJ mol(-1) and interfacial energy of 33 mJ m(-2) were estimated and found to be independent of alkali ion, as was the Al(OH)(3) equilibrium solubility. The nucleation rate, however, was faster in aging sodium than in potassium aluminate solutions. It appears that Na(+) ions provide greater stability for the formation and densification of Al(III)-containing, supramolecular clusters which grow more rapidly into Al(OH)(3) crystallites than do K(+) ions. The development of the Al-OH octahedral structure of Al(OH)(3) nuclei is an alkali metal ion-mediated, chemical reaction-controlled condensation process, displaying specific gibbsite (gamma-Al(OH)(3))-bayerite (alpha-Al(OH)(3)) dimorphism. Furthermore, significant differences in the level of alkali ion incorporation, reflecting in the purity and morphology of the crystalline product, were observed. Copyright 2000 Academic Press.

Journal Article↗

Compartmentation of aluminium in leaves of an Al-accumulator, Fagopyrum esculentum Moench.

Buckwheat (Fagopyrum esculentum Moench.) is an Al-accumulating plant, but the internal mechanism(s) of detoxification of Al is not fully understood. We investigated the subcellular localization of Al in the leaves of this plant (cv. Jianxi) by directly isolating protoplasts and vacuoles. Pure protoplasts and vacuoles from the leaves of buckwheat, grown hydroponically in Al solution, were obtained based on light-microscopic observation and the activities of marker enzymes of cytosol and vacuoles. More than 80% of total Al in the leaves was present in the protoplasts, and was identified as an Al-oxalate complex (1:3 ratio) by (27)Al-nuclear magnetic resonance. Oxalate and Al in the protoplasts was localized in the vacuoles. These results suggest that internal detoxification of Al in the buckwheat leaves is achieved by both complexation with oxalate and sequestration into vacuoles.

Aluminum↗

Factors controlling spatial distribution of soil acidification and Al forms in forest soils.

Soil acidification and Al release in forest soils is controlled by a number of factors, like acid deposition, forest type, parent rock, altitude, etc. This paper studies the principal stand factors affecting spatial distribution of the content of KCl-extractable Al (Al(KCl), mainly exchangeable), Na4P2O7-extractable Al (Al(Na4P2O7), mainly organically bound), and other soil characteristics related to acidification in surface organic (O) and subsurface mineral (B) horizons in the Jizera Mountains region. Geostatistical methods were exploited. The highest Al(KCl) contents in the O horizons were related to high S and N content, low pH and low Ca and Mg content in soil. Liming decreased Al(KCl) contents in the O horizons. Al(Na4P2O7) in the O horizons was more abundant under spruce than under beech; in both horizons it was increased on the immission clear-cut areas populated by grass. Surface horizons are more sensitive to external influence (acid deposition, liming) and their spatial variation is stronger. In the mineral horizons, the effect of pedogenetic processes is more important. The effect of stand factors on Al behaviour is complex and often indirect, mediated for example by organic matter or soil reaction. It is difficult to clearly distinguish the effects of the particular factors.

Journal Article↗

Al(3+)-mediated changes in membrane physical properties participate in the inhibition of polyphosphoinositide hydrolysis.

We investigated the possible involvement of Al(3+)-induced alterations in membrane physical properties in Al(3+)-mediated inhibition of polyphosphoinositide (PPI) hydrolysis by the enzyme phosphatidylinositol-specific phospholipase C (PI-PLC). Liposomes composed of brain phosphatidylcholine (PC) or of PC and a mixture of brain PPI (PC:PPI) were incubated in the presence of Al(3+) (1-100 microM). We evaluated: (1) the amount of membrane-bound Al(3+), (2) the effects of Al(3+) on key membrane physical properties (surface potential, lipid fluidity, and lipid arrangement), and (3) the hydrolysis of PPI. Al(3+) binding to PC:PPI (60:40 mol/mol) liposomes was 1.3 times higher than to PC:PPI (90:10 mol/mol) liposomes and did not change after treatment with Triton X-100. Al(3+) increased membrane surface potential, promoted the loss of membrane fluidity, and caused lateral phase separation in PC:PPI liposomes. Phosphatidylinositol and phosphatidylinositol monophosphate hydrolysis in the presence of PI-PLC was not affected by Al(3+), but a significant and concentration-dependent inhibition of PIP(2) hydrolysis was observed, an effect that was prevented by previous bilayer disruption with Triton X-100. The obtained results support the hypothesis that Al(3+) binding to liposomes promotes the formation of rigid clusters enriched in PPI, restricting the accessibility of the enzyme to the substrate and subsequently inhibiting PIP(2) hydrolysis by PI-PLC.

Aluminum↗

Mitochondrial DNA from platelets of sporadic ALS patients restores normal respiratory functions in rho(0) cells.

Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease, which affects the anterior horn cells of the spinal cord and cortical motor neurons. A pathophysiological role for mtDNA mutations was postulated based on the finding that cybrids obtained from mitochondria of sporadic ALS patients exhibited impaired respiratory chain activities, increased free radical scavenging enzymes, and altered calcium homeostasis. To date, however, no distinct mtDNA alterations associated with ALS have been reported. Therefore, we reexamined the hypotheses that mtDNA mutations accumulate in ALS and that cybrids generated from ALS patients' blood have impaired mitochondrial respiration. Cybrid cell lines were generated from 143B osteosarcoma rho(0) cells and platelet mitochondria of sporadic ALS patients or age-matched controls. We found no statistically significant differences in mitochondrial respiration between ALS and control cybrids, even when the electron transport chain was stressed with low concentrations of respiratory chain inhibitors. Mitochondrial respiratory chain enzyme activities were also normal in ALS cybrids, and there was no increase in free radical production. Therefore, we showed that mtDNA from platelets of ALS patients was able to restore normal respiratory function in rho(0) cells, suggesting that the presence of mtDNA mutations capable of affecting mitochondrial respiration was unlikely.

Amyotrophic Lateral Sclerosis↗

Visible-spectroscopy study of the adsorption of alizarinate by Al-montmorillonite in aqueous suspensions and in solid state.

The adsorption of the monovalent anionic dye alizarinate onto Na- and Al-montmorillonite was carried out by adding the dye into aqueous clay suspensions. Electronic spectra of aqueous suspensions and of air-dried dye-clay complexes were studied. Na-montmorillonite adsorbed only part of the added dye. With total amount of alizarinate up to 5 mmol dye per 100 g clay the adsorption of the dye takes place on the broken bonds, leading to peptization of the clay. Al-montmorillonite adsorbed alizarinate completely up to 10 mmol per 100 g clay. Above this loading there was a partition of the dye between the clay and the supernatant. The maximum adsorption for Na- and Al-clay was 4 and 25 mmol dye per 100 g clay, respectively. Absorption bands in the spectrum of Al-montmorillonite suspensions (488-504 nm) appear at longer wavelengths than in the spectrum of air-dried Al-montmorillonite (415-455 nm). Thermo-X-ray study of these clay-alizarinate complexes suggests that the organic compound was located in the interlayer space in Al-montmorillonite but was not located there in Na-montmorillonite. In Al-montmorillonite alizarinate formed a coordination complex with exchangeable Al(3+). In Na-montmorillonite it formed bonds with Al exposed on the broken-bonds sites.

Adsorption↗

Recent progress in the research of external Al detoxification in higher plants: a minireview.

Aluminum (Al) is highly toxic to plant growth. The toxicity is characterized by rapid inhibition of root elongation. However, some plant species and cultivars have evolved some mechanisms for detoxifying Al both internally and externally. In this review, the recent progress made in the research of external detoxification of Al is described. Accumulating evidence has shown that organic acids play an important role in the detoxification of Al. Some plant species and cultivars respond to Al by secreting citrate, malate or oxalate from the roots. Recently, the anion channel of malate and citrate in the plasma membrane has been characterized and a gene encoding the malate channel has been cloned. The metabolism of organic acids seems to be poorly correlated with the Al-induced secretion of organic acid anions. A number of QTLs (quantitative trait loci) for Al resistance have been identified in rice, Arabidopsis, and other species. Transgenic plants with enhanced resistance to Al have also been reported, but introduction of multiple genes may be required to gain high Al resistance in future.

Adaptation, Physiological↗

The ALS gene family of Candida albicans.

The ALS gene family of Candida albicans encodes large cell-surface glycoproteins that are implicated in the process of adhesion to host surfaces. ALS genes are also found in other Candida species that are isolated from cases of clinical disease. Genes in the ALS family are differentially regulated by physiologically relevant mechanisms. ALS genes exhibit several levels of variability including strain- and allele-specific size differences for the same gene, strain-specific differences in gene regulation, the absence of particular ALS genes in certain isolates, and additional ALS coding regions in others. The differential regulation and genetic variability of the ALS genes results in a diverse cell-surface Als protein profile that is also affected by growth conditions. The ALS genes are one example of a gene family associated with pathogenicity mechanisms in C. albicans and other Candida species.

Candida albicans↗

Decreased acid-labile subunit (ALS) levels by endotoxin in vivo and by interleukin-1beta in vitro.

The production by the liver of the three subunits of the growth hormone (GH)-dependent 150 kDa complex (IGF-I, IGF-binding protein-3 and acid-labile subunit or ALS) is primarily under the control of GH. Recent data have shown that, besides GH, endotoxin (LPS) and cytokines may regulate the liver IGF-I gene. To investigate the potential regulation of ALS by LPS, we measured serum ALS by immunoblot, 5 and 10 h after IP injection of LPS (250 or 750 microg/100 g BW vs saline), in 4-week-old female Wistar rats (four per group). Ten hours after injection, serum ALS levels were reduced by 57% (delta%) with the lower dose (P<0.05) and by 81% with the higher dose (P<0.01) by comparison with saline-treated rats. The decrease in ALS levels in response to LPS was not prevented by exogenous GH. To investigate the role of interleukin (IL)-1beta in the regulation of ALS, primary cultured rat hepatocytes were exposed to increasing concentrations of IL-1beta. Cell exposure to IL-1beta markedly decreased both basal and GH-stimulated ALS levels (-70%; P<0.01) in a dose-dependent fashion, with the half-maximal inhibitory effect at concentrations of 0.1 ng/ml. Our results show that endotoxin induces a rapid decline in circulating ALS that is potentially mediated through IL-1beta. By limiting the formation of the 150 kDa complex, this reduction in circulating ALS might contribute to the rapid decline in serum IGF-I observed in sepsis.

Animals↗

Electron affinities of Al(n) clusters and multiple-fold aromaticity of the square Al4(2-) structure.

The concept of aromaticity was first invented to account for the unusual stability of planar organic molecules with 4n + 2 delocalized pi electrons. Recent photoelectron spectroscopy experiments on all-metal MAl(4)(-) systems with an approximate square planar Al(4)(2-) unit and an alkali metal led to the suggestion that Al(4)(2-) is aromatic. The square Al(4)(2-) structure was recognized as the prototype of a new family of aromatic molecules. High-level ab initio calculations based on extrapolating CCSD(T)/aug-cc-pVxZ (x = D, T, and Q) to the complete basis set limit were used to calculate the first electron affinities of Al(n)(), n = 0-4. The calculated electron affinities, 0.41 eV (n = 0), 1.51 eV (n = 1), 1.89 eV (n = 3), and 2.18 eV (n = 4), are all in excellent agreement with available experimental data. On the basis of the high-level ab initio quantum chemical calculations, we can estimate the resonance energy and show that it is quite large, large enough to stabilize Al(4)(2-) with respect to Al(4). Analysis of the calculated results shows that the aromaticity of Al(4)(2-) is unusual and different from that of C(6)H(6). Particularly, compared to the usual (1-fold) pi aromaticity in C(6)H(6), which may be represented by two Kekulé structures sharing a common sigma bond framework, the square Al(4)(2-) structure has an unusual "multiple-fold" aromaticity determined by three independent delocalized (pi and sigma) bonding systems, each of which satisfies the 4n + 2 electron counting rule, leading to a total of 4 x 4 x 4 = 64 potential resonating Kekulé-like structures without a common sigma frame. We also discuss the 2-fold aromaticity (pi plus sigma) of the Al(3)(-) anion, which can be represented by 3 x 3 = 9 potential resonating Kekulé-like structures, each with two localized chemical bonds. These results lead us to suggest a general approach (applicable to both organic and inorganic molecules) for examining delocalized chemical bonding. The possible electronic contribution to the aromaticity of a molecule should not be limited to only one particular delocalized bonding system satisfying a certain electron counting rule of aromaticity. More than one independent delocalized bonding system can simultaneously satisfy the electron counting rule of aromaticity, and therefore, a molecular structure could have multiple-fold aromaticity.

Journal Article↗