Science 6 June 2008: Vol. 320. no. 5881, pp. 1352 - 1355
High Impulsivity Predicts the Switch to Compulsive Cocaine-Taking
Both impulsivity and novelty-seeking have been suggested to be behavioral markers of the propensity to take addictive drugs. However, their relevance for the vulnerability to compulsively seek and take drugs, which is a hallmark feature of addiction, is unknown. We report here that, whereas high reactivity to novelty predicts the propensity to initiate cocaine self-administration, high impulsivity predicts the development of addiction-like behavior in rats, including persistent or compulsive drug-taking in the face of aversive outcomes. This study shows experimental evidence that a shift from impulsivity to compulsivity occurs during the development of addictive behavior, which provides insights into the genesis and neural mechanisms of drug addiction.

Science 6 June 2008: Vol. 320. no. 5881, pp. 1355 - 1359
Patches with Links: A Unified System for Processing Faces in the Macaque Temporal Lobe
The brain processes objects through a series of regions along the ventral visual pathway, but the circuitry subserving the analysis of specific complex forms remains unknown. One complex form category, faces, selectively activates six patches of cortex in the macaque ventral pathway. To identify the connectivity of these face patches, we used electrical microstimulation combined with simultaneous functional magnetic resonance imaging. Stimulation of each of four targeted face patches produced strong activation, specifically within a subset of the other face patches. Stimulation outside the face patches produced an activation pattern that spared the face patches. These results suggest that the face patches form a strongly and specifically interconnected hierarchical network.

Nature 453, 726-727 (5 June 2008)
Science & Music: Talk of the tone
To appreciate how our species makes sense of sound we must study the brain's response to a wide variety of music, languages and musical languages, urges Aniruddh D. Patel.
Music engages much of the brain, and coordinates a wide range of processing mechanisms. This naturally invites consideration of how music cognition might relate to other complex cognitive abilities.

JAMA. 2008;299(21):2494.
Studies Reveal Underlying Mechanism for Chemotherapy’s Adverse Effects on Brain
Advances in cancer chemotherapy have brought longer and more active lives for many patients but have left some with a mysterious and troubling burden. In some instances, the first sign may be subtle: a slow, almost imperceptible development of forgetfulness or loss of concentration. In other cases, patients experience a sudden onset of severe cognitive dysfunction many months after treatment has stopped.
Although some clinicians have been skeptical that such adverse effects—coined "chemobrain" by some—are associated with anticancer drugs, over the years others have been documenting the phenomenon. Now, researchers are beginning to understand how these effects arise and are hopeful that ongoing research will help to prevent them.

JAMA. 2008;299(21):2497-2498.
Dealing With Pediatric Sleep Disorders Can Call for a Wide Range of Expertise
Amelia Island, Fla—Poor sleep in a child's early years may not only interfere with normal growth and development, but also strain family life. At the fourth annual pediatric sleep medicine conference, sponsored by the Warren Alpert Medical School of Brown University, Providence, RI, talks and workshops explored the translation of basic research to clinical practice.

The diversity of attendees at the meeting—which included pediatricians, pulmonologists, otolaryngologists, neurologists, psychiatrists, dentists, and others—"reflects burgeoning multidisciplinary and interdisciplinary activity in our field," said conference cochair Judith Owens, MD, MPH, associate professor of pediatrics at Brown and director of pediatric sleep disorders at Hasbro Children's Hospital, also in Providence.

JAMA. 2008;299(21):2500.
Prion Sensor
A newly developed nanosized sensor can detect minuscule levels of prion proteins that cause bovine spongiform encephalopathy (mad cow disease), Creutzfeldt-Jakob disease, and other diseases in animals and humans (Varshney M et al. Anal Chem. 2008;80[6]:2141-2148). The sensor, developed by scientists at Cornell University in Ithaca and Innovative Biotechnologies International Incorporated, in Grand Island, NY, resembles a tiny tuning fork that changes vibrational resonant frequency when prions bind to it.

JAMA. 2008;299(21):2500.
Parkinson Treatment
Cells reprogrammed to become induced pluripotent stem cells can develop into neurons and alleviate a Parkinsonlike movement disorder in rodents, according to new research (Wernig M et al. Proc Natl Acad Sci U S A. 2008;105[15]:5856-5861).
A team of scientists led by investigators at the Massachusetts Institute of Technology in Cambridge, Mass, generated these pluripotent stem cells by adding 4 genes to mouse fibroblasts. The researchers then differentiated the cells into neural progenitor cells and injected them into the brains of fetal mice. There, the cells developed into several types of brain cells, including dopamine-producing neurons that might be used to treat parkinson disease.

JAMA. 2008;299(21):2500.
Sleeping Sickness Marker
In a step toward providing an early diagnosis of African sleeping sickness, or trypanosomiasis, researchers have identified chemical changes in the urine and blood of mice infected with a trypanosome closely related to the strains that infect humans (Wang Y et al. Proc Natl Acad Sci U S A. 2008;105[16]:6127-6132).
A team led by scientists at the Imperial College London, in England, detected an imbalance in the concentration of several amino acids in the blood of infected mice as early as 1 day after infection. They also noted elevated concentrations of lactate and certain other plasma components. Metabolic disturbance of gut microbial activity also was associated with infection, as indicated by changes detected in the animals' urine.

The Lancet Vol: 371 Issue: 9627, May, 31 - June, 6 2008    pp: 1818-1820
Steroid and antiviral treatment for Bell's palsy
Bell's palsy is an acute peripheral unilateral facial paralysis of unknown cause. It is the most common acute facial paralysis, with an incidence of 20–30 per 100.000 people annually. In our series of 3385 patients with acute facial paralysis over the past 30 years, Bell's palsy accounted for 2097 cases (62%). PCR usually identifies fragments of DNA of herpes simplex virus in clinical samples from patients with Bell's palsy. These fragments were detected more often in saliva from patients with Bell's palsy than in saliva from healthy volunteers. Such DNA fragments were also identified in the endoneural fluid of the facial nerve during facial-nerve decompression surgery in 11 of 14 patients (79%) with Bell's palsy. Thus we speculate that reactivation of herpes simplex virus might lead to Bell's palsy: herpes simplex virus is involved in about 31–79% of cases of Bell's palsy.

The Lancet Vol: 371 Issue: 9627, May, 31 - June, 6 2008    pp: 1861-1871
Tick-borne encephalitis
We review the epidemiological and clinical characteristics of tick-borne encephalitis, and summarise biological and virological aspects that are important for understanding the life-cycle and transmission of the virus. Tick-borne encephalitis virus is a flavivirus that is transmitted by Ixodes spp ticks in a vast area from western Europe to the eastern coast of Japan. Tick-borne encephalitis causes acute meningoencephalitis with or without myelitis. Morbidity is age dependent, and is highest in adults of whom half develop encephalitis. A third of patients have longlasting sequelae, frequently with cognitive dysfunction and substantial impairment in quality of life. The disease arises in patchy endemic foci in Europe, with climatic and ecological conditions suitable for circulation of the virus. Climate change and leisure habits expose more people to tick-bites and have contributed to the increase in number of cases despite availability of effective vaccines. The serological diagnosis is usually straightforward. No specific treatment for the disease exists, and immunisation is the main preventive measure.

The Lancet Vol: 371 Issue: 9627, May, 31 - June, 6 2008    pp: 1886
Case Report
A combined presentation of Graves' disease and Miller-Fisher syndrome
In April, 2007, a 42-year-old woman was admitted to hospital with periorbital swelling, double vision, hyperosmia, and dizziness. Recent history included a gastrointestinal infection (February, 2007), bilateral ear pain, and a sore throat. Systolic blood pressure was 150 mmHg, heart rate was 80 beats per min, and temperature was 37·4°C. Laboratory tests showed a low concentration of thyroid-stimulating hormone (0·04 mU/L, normal value 0·27–4·2 mU/L) and raised values of free T3 (12·1 pmol/L; 3·1–6·8 pmol/L) and free T4 (36·1 pmol/L; 12·0–22·0 pmol/L). TSH-receptor antibodies (1·9 U/L; normal <1·0 U/L) and microsomal antibodies (139 kU/L; <60 kU/L) were slightly raised. MRI of the head showed minor swelling of the periorbital muscles. Graves' disease with ophthalmopathy was diagnosed, and the patient received carbimazole (20 mg daily), propranolol (80 mg daily), and prednisolone (starting dose of 100 mg daily). However, her condition deteriorated and she was referred to our unit.

NEJM Volume 358:2447-2456  June 5, 2008  Number 23
Hypothermia Therapy after Traumatic Brain Injury in Children
Background Hypothermia therapy improves survival and the neurologic outcome in animal models of traumatic brain injury. However, the effect of hypothermia therapy on the neurologic outcome and mortality among children who have severe traumatic brain injury is unknown.

Methods In a multicenter, international trial, we randomly assigned children with severe traumatic brain injury to either hypothermia therapy (32.5°C for 24 hours) initiated within 8 hours after injury or to normothermia (37.0°C). The primary outcome was the proportion of children who had an unfavorable outcome (i.e., severe disability, persistent vegetative state, or death), as assessed on the basis of the Pediatric Cerebral Performance Category score at 6 months.

Results A total of 225 children were randomly assigned to the hypothermia group or the normothermia group; the mean temperatures achieved in the two groups were 33.1±1.2°C and 36.9±0.5°C, respectively. At 6 months, 31% of the patients in the hypothermia group, as compared with 22% of the patients in the normothermia group, had an unfavorable outcome (relative risk, 1.41; 95% confidence interval [CI], 0.89 to 2.22; P=0.14). There were 23 deaths (21%) in the hypothermia group and 14 deaths (12%) in the normothermia group (relative risk, 1.40; 95% CI, 0.90 to 2.27; P=0.06). There was more hypotension (P=0.047) and more vasoactive agents were administered (P<0.001) in the hypothermia group during the rewarming period than in the normothermia group. Lengths of stay in the intensive care unit and in the hospital and other adverse events were similar in the two groups.

Conclusions In children with severe traumatic brain injury, hypothermia therapy that is initiated within 8 hours after injury and continued for 24 hours does not improve the neurologic outcome and may increase mortality. (Current Controlled Trials number, ISRCTN77393684 [controlled-trials.com] .)

NEJM Volume 358:2495  June 5, 2008  Number 23
Ethmoid Mucocele Causing Visual Impairment
A 74-year-old man was referred because of left exophthalmos and outward displacement of the orbit (Panel A). His symptoms had progressed slowly over a 4-year period but had worsened rapidly during the preceding 2 days, causing diplopia, impaired ocular movement, orbital pain, and decreased visual acuity (0.8 in the right eye and 0.2 in the left eye, corresponding to Snellen equivalents of 20/25 and 20/100, respectively).