The concentrations of phenobarbitone, albumin, bile acids and cholesterol, and the activities of alkaline phosphatase (AP), alanine aminotransferase (ALT), gamma glutamyl transferase (GGT) and glutamate dehydrogenase (GLDH) were measured in the serum of 95 epileptic dogs whose clinical signs were controlled with phenobarbitone. The dogs were divided into groups on the basis of the concentration of phenobarbitone in their serum, the dose administered and the duration of the treatment. The concentration of phenobarbitone in serum was directly related to the activities of ALT, AP, GGT and GLDH and inversely related to the concentration of albumin. There was no significant relationship between the duration of treatment and the serum concentration of phenobarbitone, but there was a significant relationship between the duration of treatment and the activities of ALT, AP and GLDH. Thirty-five of the dogs (37 per cent) had serum activities of AP above the normal range, 19 had abnormally high activities of ALT, and 15 had high activities of GLDH, but these incidences were not related to the serum concentration of phenobarbitone. The dogs receiving higher doses for longer periods had the highest incidence of high activities of AP, ALT and GLDH. The concentration of bile acids in seven of the dogs was above the normal range but there was no relationship between the concentration and either the serum concentration, dose or duration of treatment with phenobarbitone.

The objective of this prospective study was to determine the prevalence of hyperlipidemia in our pediatric renal transplant patients and to treat those with persistently elevated cholesterol and/or low-density lipoprotein (LDL) levels. All patients with a functioning renal allograft for greater than 6 months were studied (n = 18). Patients with cholesterol and/or LDL levels greater than the 95th percentile (n = 9) were commenced on an HMG-CoA reductase inhibitor, Atorvastatin and monitoring was performed for efficacy and adverse effects. Total serum cholesterol was elevated in 11 of 18 (61%) and triglyceride (TG) was elevated in 12 of 18 (67%) patients. Atorvastatin treatment was effective with a mean percentage reduction of total cholesterol of 41 +/- 10% (p < 0.01 vs. before treatment), LDL 57 +/- 7% (p < 0.01 vs. before treatment) and TG 44 +/-25% (p = 0.05 vs. before treatment). No adverse effects on allograft function or cyclosporin levels were experienced. Hyperlipidemia is a common problem and Atorvastatin is a safe and effective treatment in pediatric renal transplant recipients.

A major problem for patients with cystic fibrosis (CF) is the maintenance of adequate nutrition to maintain normal growth. The hypotheses that poor nutrition could be due to smell and/or taste dysfunction has been pursued in several studies with contradictory results. None, however, investigated whether inadequate nutrition is due to CF patients having different liking for foods compared to healthy children and whether liking can be linked to specific changes in smell or taste function. Here, the relationships between food liking, BMI, and smell and taste function in 42 CF and 42 healthy 5- to 18-year olds is pursued. A three-choice 16-item odor identification test and a gustatory identification test involving five concentrations of sweet, sour, bitter, and salty tastes, were used to assess chemosensory function. Food liking was assessed using a 94-item questionnaire. Patients identified significantly fewer odors than controls (89.8% vs. 95.7% correct; P < 0.001). However, only a few patients were affected and their loss of olfactory function was not substantial and unlikely to affect their liking for foods. Taste identification was similar for the two groups (patients 92.6% vs. controls 94.2% correct). There was no correlation between age and odor identification ability, but taste performance improved with age (r = 0.39, P < 0.05), suggesting cognition was the cause. Patients liked several types of foods and high-fat foods more than the controls. Both groups had a similar liking for low-fat foods and both liked high-fat foods more than low-fat foods. No significant relationships existed between FEV(1) and smell or taste function or liking for foods, the BMI of the groups were similar and there was no relationship between BMI and smell or taste function. The results indicate that the abnormal eating behavior reported for many CF patients is not due to changes in chemosensory function which remains normal in most CF patients at least to 18 years of age.

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Objective The onset of neurological signs in experimental autoimmune encephalomyelitis is tightly associated with infiltration and reactivation of T cells in the central nervous system. The anatomic localization of the initial T cell‐antigen‐presenting cell (APC) interactions leading to reactivation of T cells in the central nervous system is, however, still unclear. We hypothesized that activated CD4+ T cells gain direct access to the subarachnoid space and become reactivated on encounter with cognate antigen in this compartment. Methods C57Bl/6 mice were immunized with MOG35‐55, and interactions between CD4+ T cells and major histocompatibility class II+ APCs in the subarachnoid space were investigated using flow cytometry, confocal microscopy of leptomeningeal whole‐mount preparations, time‐lapse microscopy of leptomeningeal explants, and in vitro proliferation assays. Results CD4+ T cells, polarized to produce Th1/Th17 cytokines, accumulated in the subarachnoid space early during the course of experimental autoimmune encephalomyelitis, before CD4+ T cells were detected in the spinal cord parenchyma. At this time point, leptomeningeal but not parenchymal CD4+ T cells incorporated bromodeoxyuridine, indicating local proliferation of CD4+ T cells in the subarachnoid space. Time‐lapse microscopy indicated that these CD4+ T cells actively scanned the tissue and interacted with local major histocompatibility class II+ APCs, resulting in long‐lasting interactions between CD4+ T cells and major histocompatibility class II+ APCs, suggestive of immunological synapses. Interpretation These results support the concept that immune surveillance of the central nervous system involves the subarachnoid space and indicate that the leptomeninges play an important role in experimental autoimmune encephalomyelitis initiation. Ann Neurol 2009;65:457–469