Charles Silva

Properly prepared, standarized, and stored fluorescent treponemal antibody-absorption (FTA-ABS) reagents have been shown to have stabilities equal to other biological reagents. A liquid antigen over 10 years old has been shown to give a satisfactory reaction. Newer preparations have now been shown to be stable for over 5 years, and the tests on each are being continued. The very new liquid antigens which were originally standardized by the FTA-ABS method have shown no decrease in potency over a 20-month period. Stability studies on antigens dried on slides are now in their eighth month, with no apparent loss in potency. The stability of the conjugate is constant when stored frozen at −20 C or lyophilized. When stored as a liquid at 4 C, the stability is governed by the p H and the molarity of the buffer. The standardized and lyophilized sorbent has been shown to be stable for over 1 year.

Seizures and movement disorders (MDs) are distinct neurological conditions presenting with abnormal movements. Despite sharing an overlap in phenomenology, these movements have different origins. In order to explore the overlaps and the narrow boundaries between these two conditions, we performed a review of the literature to explore the risk of seizures in MDs. We discussed the mimics and chameleons including MDs that look like seizure (eg, paroxysmal dyskinesia, status dystonicus) and seizures that look like MDs (eg, epilepsia partialis continua, nocturnal frontal lobe epilepsy). Additionally, we examined the therapeutic challenges as well as the anatomical and chemical pathways relevant in the interplay between epilepsy and MDs. Finally, we proposed an algorithm to guide clinicians towards the final diagnosis of conditions characterised by the co-occurrence of MDs and seizures.

Background: Hepatic myelopathy is a rare complication of advanced-phase liver dysfunction (1). The most common presentation is spastic paraparesis, which is associated with variable sensory deficits (2). Hepatic myelopathy is a progressive, disabling condition that may reverse if normal liver function is restoredfor example, after transplantation (Appendix Table) (2). Sofosbuvir is a novel nucleotide analogue that inhibits the NS5B polymerase of hepatitis C virus (HCV). Sofosbuvir produces a high rate of sustained virologic response when used to treat HCV infection (3). Appendix Table. Outcome of Reported Patients With Hepatic Myelopathy Objective: To report the course of hepatic myelopathy in a patient with HCV infection who was treated with sofosbuvir and ribavirin. Case Report: A 61-year-old man was diagnosed with genotype 2 HCV infection in 2004 and developed cirrhosis and liver failure 8 years later. In April 2013, he started having spells of hepatic encephalopathy that were managed with lactulose and protein restriction. In April 2014, after a 2-month episode of confusion, he developed a subacute shuffling gait that steadily progressed to spastic paraparesis. In May 2015, the patient required a wheelchair for mobility and was diagnosed with hepatic myelopathy. He had bilateral ankle clonus, Babinski sign, diffuse brisk reflexes, mild generalized bradykinesia, mild upper-limb rigidity, fine tremor of the hands during posture, and distal sensory deficit of the lower extremities. Magnetic resonance imaging in July 2013 and May 2015 showed moderate to severe brain atrophy with multifocal areas of remote infarctions and a normal thoracic and lumbosacral spine. In October 2014, blood tests showed an HCV viral load of 469 IU/mL, cryoglobulins, alanine aminotransferase level of 21 U/L, aspartate aminotransferase level of 39 U/L, low platelet count (79109 cells/L), high international normalized ratio (1.54), low albumin level (25 g/L), and high bilirubin level (59 mol/L [3.4 mg/dL]). Between October 2014 and January 2015, the patient was treated with sofosbuvir, 400 mg/d, plus ribavirin, 1000 mg/d, and achieved a sustained virologic response. In May 2015, blood tests showed no cryoglobulins, stability of other hepatic function tests, and a slightly elevated manganese level (393 nmol/L) (not previously measured). In June 2015, episodes of confusion dramatically decreased and dietary proteins were reintroduced. The patient's gait slowly improved, and at the time of the last evaluation in October 2015 he was able to walk a few steps with a walker. The patient's functionality and level of autonomy did not improve and kept fluctuating, particularly during rare and mild episodes of confusion. Discussion: Hepatic myelopathy is resistant to the treatments typically used for portosystemic encephalopathy. Liver transplantation is the only treatment recognized to be effective (Appendix Table), and transplantation within 18 months of the onset of hepatic myelopathy is associated with a better neurologic outcome (2). To our knowledge, this is the first report of stabilization of motor autonomy and improvement in hepatic myelopathy unrelated to liver transplantation, except for 1 patient with a transjugular intrahepatic portosystemic shunt who improved when the shunt occluded (4).

The sintering behaviour of Y-TZP ceramics, their resulting microstructures and properties are influenced not only by the characteristics of the raw materials but also were found to be dependent on the thermal history during the fabrication process. It is generally understood that fracture toughness increases as grain size increases up to a certain limit but in the present investigation, the