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Neuroepidemiological study of childhood epilepsy by application of international classification of epilepsies and epileptic syndromes (ILAE, 1989).

A population-based survey of childhood epilepsy was made in 1975 on the total population of children aged < 10 years living in Okayama Prefecture (n = 2,378 patients). Using the data obtained, we attempted to reclassify the various types of epilepsy according to the international classification (ILAE, 1989). Reclassification was possible in 1,872 (78.7%) of the 2,378 cases. The 1,872 cases consisted of 1,045 (55.8%) with localization-related epilepsies, 824 (44.0%) with generalized epilepsies, and 3 (0.2%) with epilepsies undetermined whether focal or generalized. Classification of the epilepsies in a population-based survey using the international classification involves difficulties, because both clinical and EEG findings are essential. However, if an appropriate area is selected, classification of epilepsies and epileptic syndromes in a population-based survey is possible by referring to all medical records stored at every hospital and practitioner's clinic that administers treatment to patients with epilepsy in the area.

Age Factors↗

Unravelling the population turnaround in rural Canada.

"This paper attempts to unravel the rural population turnaround in Canada through a disaggregation and analysis of rural growth rates by (1) two decades, 1961-71 and 1971-81, (2) the farm and non-farm components of rural population, (3) provincially based regions, and (4) area types based on proximity to urban centres. Following a discussion of the various definitional and boundary-matching issues arising from the use of the Census of Canada, results are presented in tabular and map form. Although rural growth rates did in all likelihood exceed urban rates in the 1970s, the extent of this turnaround is undoubtedly exaggerated in the census data, primarily because of definitional and reclassification effects. Moreover, setting aside data-related anomalies, there is strong evidence that much of this rural population growth was in fact 'spillover' from urban centres." (SUMMARY IN FRE)

Americas↗

The evolutionary history of the genus Acanthamoeba and the identification of eight new 18S rRNA gene sequence types.

The 18S rRNA gene (Rns) phylogeny of Acanthamoeba is being investigated as a basis for improvements in the nomenclature and taxonomy of the genus. We previously analyzed Rns sequences from 18 isolates from morphological groups 2 and 3 and found that they fell into four distinct evolutionary lineages we called sequence types T1-T4. Here, we analyzed sequences from 53 isolates representing 16 species and including 35 new strains. Eight additional lineages (sequence types T5-T12) were identified. Four of the 12 sequence types included strains from more than one nominal species. Thus, sequence types could be equated with species in some cases or with complexes of closely related species in others. The largest complex, sequence type T4, which contained six closely related nominal species, included 24 of 25 keratitis isolates. Rns sequence variation was insufficient for full phylogenetic resolution of branching orders within this complex, but the mixing of species observed at terminal nodes confirmed that traditional classification of isolates has been inconsistent. One solution to this problem would be to equate sequence types and single species. Alternatively, additional molecular information will be required to reliably differentiate species within the complexes. Three sequence types of morphological group 1 species represented the earliest divergence in the history of the genus and, based on their genetic distinctiveness, are candidates for reclassification as one or more novel genera.

Acanthamoeba↗

Pneumocystis and Trypanosoma cruzi: nomenclature and typifications.

Published phylogenetic reclassifications of Pneumocystis as a fungus resulted in a nomenclatural shift from the Zoological Code to the International Code of Botanical Nomenclature. The same may be true for all microsporidians and sundry other organisms. This resulted in the invalidation of names and subsequently precipitated changes to the botanical code to accommodate Pneumocystis and microsporidian names. The repercussions following application of the 2005 Vienna Code to Pneumocystis nomenclature are detailed. Validity of the name for the human pathogen, Pneumocystis jirovecii, is re-established from its 1976 publication under the Zoological Code, contrary to interpretation of validity under earlier botanical codes. Pneumocystis jirovecii is lectotypified and epitypified. The rat parasite, Pneumocystis carinii, is neotypified, separating it from Pneumocystis wakefieldiae. The original 1909 description of Trypanosoma cruzi, type species for Schizotrypanum, and causal agent of Chagas' disease, included parts of the life cycle of Pneumocystis. Trypanosoma cruzi is neotypified by the true Trypanosoma elements, thereby completing the nomenclatural separation from Pneumocystis and ensuring that Schizotrypanum is not applicable to Pneumocystis as an earlier name. The neotypes for P. carinii and T. cruzi represent the strains currently being investigated by their two respective genome projects. They were selected in light of their medical importance, physiological characterizations, and absence of lectotypifiable materials. The classification and nomenclature of Pneumocystis is reviewed and guidelines given for the publication of new species.

Animals↗

Consumer usage patterns of nonprescription histamine2-receptor antagonists.

OBJECTIVE: Prescription to over-the-counter (OTC) drug switches are increasingly common. Yet little is known about how the public uses these reclassified products. Histamine2-receptor antagonists (H2RAs) are popular examples, although they may be supplanted by OTC proton pump inhibitors (PPIs). We examined the extent to which consumers substitute OTC H2RAs for physician care and/or engage in off-label use of these medications. METHODS: Self-administered anonymous survey of 1,116 adult OTC H2RA consumers in a random sample of 20 Los Angeles pharmacies from a major retail chain. Off-label use was defined by FDA warning label (e.g., bloody stools, dysphagia). Substitution was defined by intent to use H2RA instead of going to a physician. RESULTS: Forty-six percent engaged in off-label use of OTC H2RAs. Off-label use was independently associated with lower income, substitution for physician care, prior gastrointestinal disease, and past prescription H2RA use. Thirty-four percent substituted OTC H2RA use for physician care, and 54% of these met the criteria for off-label use. Substitution was associated with lack of health insurance, lack of time to see a physician, the belief that OTC H2RA was cheaper than clinic visits, and nonwhite race. CONCLUSION: Almost one-half of adult consumers reported using OTC H2RAs in a manner inconsistent with FDA labeling, and this off-label use was associated with substitution for physician care. Traditionally vulnerable populations were more prone to off-label use and to substituting H2RAs for physician care. Further studies are needed to assess patient outcomes, identify remedies, and explore implications for the reclassification of PPIs.

Cross-Sectional Studies↗

The value of brain stem auditory, visual and somatosensory evoked potentials and blink reflexes in the diagnosis of multiple sclerosis.

Cervical and cortical somatosensory evoked potentials (SEP) following electrical stimulation of the median nerve and blink reflexes (BR) following electrical stimulation of the supraorbital nerve were recorded in 30 normal subjects aged 20-49 years. Subjects aged 40-49 had longer SEP latencies than subjects aged 20-39 years. A total of 29 slightly affected patients with multiple sclerosis (MS) aged 26-49 years, including four patients without clinical signs (suspected MS) and 19 patients with signs indicating only one lesion (possible MS) were examined by low-rate random-stimulated brain stem auditory (BAEP), checkerboard pattern-reversal visual evoked potentials (VEP), SEP and BR. Abnormal recordings by at least one of the examinations were found in all but three patients, and by all four tests in five patients. In patients with definite or probably MS, demonstration of clinically recognized or subclinical lesions was of minor diagnostic value, in contrast to the importance such findings had in patients with suspected or possible MS. Silent lesions were shown by at least one of the tests in the four suspected and in 13 of the possible MS patients, so these 17 patients could be transferred to a more certain diagnostic category. This reclassification was most often due to the BAEP recording. In patients with spinal signs, the combination of BAEP and VEP recording was sufficiently efficient. In patients with optic neuritis a combination of BAEP and SEP was preferred. No abnormal recordings were found in 15 normal subjects examined by all four tests.

Adult↗

Classification of fine-motoric disturbances in Wilson's disease using artificial neural networks.

Patients suffering from Wilson's disease are divided into several types according clinical symptoms only at time of manifestation. Thereby two main subgroups exist: neurologic and non-neurologic types. After long-term therapy the neurological symptoms occurring in hepatolenticular degeneration may be improved but frequently with remaining fine-motoric disturbances which should be used for evaluation of the actual patient state. These disturbances are difficult to assess in an exact and objective manner by clinical examination. Therefore we measured fine-motoric passive and active abilities based on a standardized test set using the VSCOPE-system. The parallel evaluation of all fine-motoric data using an artificial neural network leads to a reclassification of these patients based on actual fine-motoric abilities but not reflecting the clinical classification at time of manifestation.

Adult↗

Clinico-pathological correlations in the Kiel classification of non-Hodgkin's lymphomata in children.

The rapid development of chemotherapy and radiotherapy during the last decade makes an increasing demand for a reliable classification of malignant non-Hodgkin's lymphomas. This is especially important in children since in this age group the lymphomas show a much worse prognosis than in adults. An attempt at a modern classification is offered by the so-called Kiel classification. 38 children with non-Hodgkin's lymphomas previously classified according to Rappaport were re-evaluated according to the Kiel system. Reclassification was technically feasible in 26 patients. There was good agreement on typing between the two independently working cytopathologists. 3 patients proved to be cases of histiocytic medullary reticulosis. Among the remaining patients, a much larger variety of histological subgroups was seen than in the one published paediatric series of Lennert. 17 patients had high-grade malignant lymphomas with lymphoblastic lymphomas predominating. Some clinical correlations not detectable with the Rappaport classification were found using the Kiel system. 6 patients were judged as having low-grade malignant lymphomas but in this group the survival was poorer than expected and 1 patient showed leukaemic transformation. The Kiel classification makes high demands for adequate surgical techniques and preparatory routines. It seems to represent a step forward in the classification of non-Hodgkin's lymphomas but much more experience is needed, especially in children, in order to evaluate its role as a guide to differentiated therapy.

Child↗

Children and adults with acute lymphoblastic leukaemia have similar gene expression profiles.

OBJECTIVES: To compare the gene expression pattern in children and adults with acute lymphoblastic leukaemia (ALL) in order to improve our understanding of the difference in disease biology and prognosis. METHODS: The gene expression profiles in diagnostic samples from 29 children and 15 adults with ALL were analysed using the oligonucleotide chip Hu95ver2a, produced by Affymetrix. RESULTS: Unsupervised hierarchical cluster analysis revealed that, in spite of differences in outcome, patients clustered irrespective of age, first by T-cell or B-precursor immunophenotype, and second by cytogenetic changes within the B-precursor group. The expression pattern analysis allowed the reclassification of some samples into the proper cytogenetic group. We also showed that separate clustering of samples with the BCR/ABL translocation could be explained by different breakpoint regions in the BCR. No significant difference in gene expression was observed between samples with and without CDKN2A deletion within the B-precursor group. Analysis of different age groups revealed a similarity in expression profiles when infants with the MLL translocation and adults over 40 yr of age were compared irrespective of karyotype. CONCLUSIONS: In spite of the difference in clinical outcome, the gene expression pattern in children and adults with ALL is very similar and is primarily dependent on immunophenotype and cytogenetic aberrations. However, when age groups are compared, the expression patterns of infants and adults over 40 show a remarkable similarity.

Adult↗

Differential diagnosis of jaundice: applicability of the Copenhagen Pocket Chart proved in Stockholm patients.

This paper shows that an algorithm for differential diagnosis of jaundice developed in Denmark has been successfully transferred for use in a Swedish hospital. The algorithm, which is based on data from nearly 1000 patients, utilises 21 items of information from the medical history, physical examination and blood chemistry. The algorithm recognises four diagnostic groups: benign obstructive jaundice, malignant obstructive jaundice, acute non-obstructive jaundice, and chronic non-obstructive jaundice. To each item of information, a score is attached reflecting its weight of evidence. Summing the scores for the symptoms and signs that are present leads to a probabilistic statement about the diagnosis. Because of missing data in the Swedish patient material, three of the items were excluded from the original algorithm. Corrections were made for differences in the distribution of diseases. In reclassification of 985 Danish patients the modified algorithm's "best bid", i.e. the diagnosis given the highest probability, was correct in 78% of cases. More important, 93% of the cases given a "confident" diagnosis (probability greater than 0.80) were correct. The corresponding figures when the algorithm was applied to Swedish patients were 76% and 93%, respectively. In both series the predicted probabilities were matched by a corresponding proportion of actual diagnostic hits. It is concluded that the algorithm leads to reliable estimates of diagnostic probabilities in jaundice and that the algorithm seems to work well in Sweden also.

Adult↗

DNA flow cytometry of reclassified subtypes of malignant salivary gland tumors.

Malignant salivary gland tumors are rare, constitute a heterogeneous group and are often difficult to diagnose histologically. This is borne out by the fact that in the present study 43.2% of 118 salivary gland tumors originally diagnosed as mucoepidermoid, acinic cell and adenoid cystic carcinomas had their original diagnosis altered upon reclassification. Patients with confirmed adenoid cystic carcinomas had a much worse prognosis than those with mucoepidermoid and acinic cell carcinomas. DNA flow cytometry showed that very few of the above mentioned three types of malignant neoplasms revealed aneuploid DNA stemlines, indicating that this is not a relevant prognostic tumor marker within the groups. However, several of the tumors that had their diagnosis changed, mostly to undifferentiated adeno- or squamous cell carcinomas, showed aneuploid DNA stemlines. The survival time of patients with aneuploid tumors was considerably reduced compared to those with diploid tumors. Among confirmed acinic cell, mucoepidermoid and adenoid cystic carcinomas the S-phase fraction was a significant prognostic factor, as it was among all tumors examined. This indicates that DNA aneuploidy and S-phase fractions are potential prognostic factors for malignant salivary gland tumors, and that DNA flow cytometry may assist the characterization of such tumors.

Aneuploidy↗

The homogeneity of hidradenitis suppurativa lesions. A histological study of intra-individual variation.

Recent data suggest that hidradenitis suppurative is a disease of the follicle, but the histological homogeneity of findings over time and in different anatomical regions has not been verified. Its description may help towards a better classification of the follicular diseases. Correct classification provides both knowledge by interference and a way of generalizing with respect to the significance of specific findings. The intra-individual variation of hidradenitis was described through classification of specimens taken from patients with multiple simultaneous or consecutive excisions. A total of 51 specimens from 11 patients were examined; of these 30 were from synchronous biopsies, and 21 from consecutive biopsies (range 2 months to 6 years). The majority of specimens (44/51) contained poral occlusion, sinus tracts or cysts. This pattern was present in 50-85% of the specimens from any given patient with hidradenitis. No primary apocrine involvement was seen. Fibrosis occurred often (33/51 specimens), and eccrine involvement was seen more often than apocrine involvement (10 vs 7 specimens). The homogeneous histology of hidradenitis supports its reclassification as a follicular disease. The reproducibility of the findings further suggests that the changes are specific and that hidradenitis is therefore a definite disease entity within the spectrum of follicular diseases. Additional functional studies may help classify hidradenitis more precisely in relation to other follicular diseases.

Adult↗

Intermandibular malignant mesenchymoma in a crossbreed dog.

A 12-year-old German shepherd crossbreed dog was presented with a submandibular mass that was initially diagnosed as myxosarcoma on incisional biopsy. Chest radiographs were taken for staging, and magnetic resonance imaging was performed to assess the feasibility of cytoreductive surgery before adjuvant radiotherapy. The dog underwent debulking surgery, and histology permitted reclassification of the tumour as a malignant mesenchymoma (with myxosarcomatous and osteosarcomatous differentiation). The dog was subsequently treated with four fractions of radiotherapy given at seven-day intervals and three doses of carboplatin. The dog remained stable following therapy until its condition acutely deteriorated, and it was euthanased 153 days after surgery. On postmortem examination, there were no signs of local tumour recurrence, but metastases were observed both in the thorax and in the abdomen.

Animals↗

Basal cell tumor or cutaneous basilar epithelial neoplasm? Rethinking the cytologic diagnosis of basal cell tumors.

A 1-cm-diameter, red, raised, cutaneous mass over the dorsal surface of the left third metacarpal of a 6-year-old neutered male yellow Labrador Retriever was aspirated. The aspirate contained cohesive clusters of cells, some containing cells with increased pleomorphism. Cellular debris (some keratinized), melanin, large numbers of macrophages, a few neutrophils, and fibroblasts were also observed. The cytologic interpretation was malignant neoplasia with histiocytic inflammation. Differentials included a carcinoma or, given the melanin pigment and variable morphology of the cells, possibly malignant melanoma. Histologically, the tumor was diagnosed as a basal cell epithelioma. Neoplasms that once were lumped into the broad histologic diagnosis of basal cell tumors have since been split into distinct entities, dependent on evidence of differentiation into epidermis, trichofollicular epithelium, or sweat or sebaceous glands. Although histologic reclassification has resulted in removal of most of these entities from the original basal cell tumor category, a cytologic diagnosis of basal cell tumor continues to be used to represent the large, heterogeneous group of epidermal, trichofollicular, and adnexal skin tumors with basal cell characteristics. The case in this report demonstrates the heterogeneity of neoplasms that may be diagnosed cytologically as basal cell tumors and supports the need for cytologic criteria and nomenclature that better reflect potential variation in tissue differentiation.

Animals↗

Chromosome-specific centromeric patterns define the centeny map of the human genome.

Centromeres are epigenetically specified by distinct chromatin, whereas their DNA varies between species and individuals. This extensive sequence divergence makes comparative analyses between centromeres challenging. In this study, we identified a chromosome-specific architectural pattern across the human genome, defined by the conserved spacing of a functionally relevant centromeric DNA motif. The distribution of these sites along chromosome arms constitutes the human "centeny map." By using a custom Genomic Centromere Profiling (GCP) pipeline, we leveraged the motif's position, orientation, and organization to construct structural models that enable reclassification of human chromosomal clusters, detection of centromere expansion, and identification of structural variants and misassembled regions. The high-resolution maps derived from this pattern not only provide a framework for comparative analysis of centromeres across evolution and disease but also offer a new dimension for chromosome annotation, assembly, and characterization.

Humans↗

Phylogeny and classification of bacteria in the genera Clavibacter and Rathayibacter on the basis of 16s rRNA gene sequence analyses.

A phylogenetic analysis by parsimony of 16S rRNA gene sequences (16S rDNA) revealed that species and subspecies of Clavibacter and Rathayibacter form a discrete monophyletic clade, paraphyletic to Corynebacterium species. Within the Clavibacter-Rathayibacter clade, four major phylogenetic groups (subclades) with a total of 10 distinct taxa were recognized: (I) species C. michiganensis; (II) species C. xyli; (III) species R. iranicus and R. tritici; and (IV) species R. rathayi. The first three groups form a monophyletic cluster, paraphyletic to R. rathayi. On the basis of the phylogeny inferred, reclassification of members of Clavibacter-Rathayibacter group is proposed. A system for classification of taxa in Clavibacter and Rathayibacter was developed based on restriction fragment length polymorphism (RFLP) analysis of the PCR-amplified 16S rDNA sequences. The groups delineated on the basis of RFLP patterns of 16S rDNA coincided well with the subclades delineated on the basis of phylogeny. In contrast to previous classification systems, which are based primarily on phenotypic properties and are laborious, the RFLP analyses allow for rapid differentiation among species and subspecies in the two genera.

Actinomycetales↗

Saprotrophic and mycoparasitic components of aggressiveness of Trichoderma harzianum groups toward the commercial mushroom Agaricus bisporus.

We examined the mycoparasitic and saprotrophic behavior of isolates representing groups of Trichoderma harzianum to establish a mechanism for the aggressiveness towards Agaricus bisporus in infested commercial compost. Mycoparasitic structures were infrequently observed in interaction zones on various media, including compost, with cryoscanning electron microscopy. T. harzianum grows prolifically in compost in the absence or presence of A. bisporus, and the aggressive European (Th2) and North American (Th4) isolates produced significantly higher biomasses (6.8- and 7.5-fold, respectively) in compost than did nonaggressive, group 1 isolates. All groups secreted depolymerases that could attack the cell walls of A. bisporus and of wheat straw, and some were linked to aggressiveness. Growth on mushroom cell walls in vitro resulted in rapid production of chymoelastase and trypsin-like proteases by only the Th2 and Th4 isolates. These isolates also produced a dominant protease isoform (pI 6.22) and additional chitinase isoforms. On wheat straw, Th4 produced distinct isoforms of cellulase and laminarinase, but there was no consistent association between levels or isoforms of depolymerases and aggressiveness. Th3's distinctive profiles confirmed its reclassification as Trichoderma atroviride. Proteases and glycanases were detected for the first time in sterilized compost colonized by T. harzianum. Xylanase dominated, and some isoforms were unique to compost, as were some laminarinases. We hypothesize that aggressiveness results from competition, antagonism, or parasitism but only as a component of, or following, extensive saprotrophic growth involving degradation of wheat straw cell walls.

Agaricus↗

Evaluation of Sellers medium in identification of some gram-negative bacteria.

The agar-slant medium of Sellers was evaluated as an identification aid in the differentiation between gram-negative bacilli of medical interest (Enterobacteriaceae excluded) and some of their saprophytic associates. With Sellers medium, a larger number of bacterial species and genera could be differentiated than with the oxidation-fermentation medium of Hugh and Leifson. Some species whose reclassification was recently suggested reacted on Sellers medium accordingly. Sellers medium (in a single tube) was found to be a distinct aid in the identification of a number of gram-negative bacteria which usually required several tests and an assortment of media.

Actinobacillus↗