Celebrating 35 Years of the AJNR: January 1983 edition.
AJNR Am J Neuroradiol. 2018 Jan;39(1):205
PMID: 29326236 [PubMed - in process]
from Imaging via alkiviadis.1961 on Inoreader http://ift.tt/2D83XhV
Celebrating 35 Years of the AJNR: January 1983 edition.
AJNR Am J Neuroradiol. 2018 Jan;39(1):205
PMID: 29326236 [PubMed - in process]
Carotid Artery Wall Imaging: Perspective and Guidelines from the ASNR Vessel Wall Imaging Study Group and Expert Consensus Recommendations of the American Society of Neuroradiology.
AJNR Am J Neuroradiol. 2018 Jan 11;:
Authors: Saba L, Yuan C, Hatsukami TS, Balu N, Qiao Y, DeMarco JK, Saam T, Moody AR, Li D, Matouk CC, Johnson MH, Jäger HR, Mossa-Basha M, Kooi ME, Fan Z, Saloner D, Wintermark M, Mikulis DJ, Wasserman BA, Vessel Wall Imaging Study Group of the American Society of Neuroradiology
Identification of carotid artery atherosclerosis is conventionally based on measurements of luminal stenosis and surface irregularities using in vivo imaging techniques including sonography, CT and MR angiography, and digital subtraction angiography. However, histopathologic studies demonstrate considerable differences between plaques with identical degrees of stenosis and indicate that certain plaque features are associated with increased risk for ischemic events. The ability to look beyond the lumen using highly developed vessel wall imaging methods to identify plaque vulnerable to disruption has prompted an active debate as to whether a paradigm shift is needed to move away from relying on measurements of luminal stenosis for gauging the risk of ischemic injury. Further evaluation in randomized clinical trials will help to better define the exact role of plaque imaging in clinical decision-making. However, current carotid vessel wall imaging techniques can be informative. The goal of this article is to present the perspective of the ASNR Vessel Wall Imaging Study Group as it relates to the current status of arterial wall imaging in carotid artery disease.
PMID: 29326139 [PubMed - as supplied by publisher]
Cerebellar Hypoperfusion in Migraine Attack: Incidence and Significance.
AJNR Am J Neuroradiol. 2018 Jan 11;:
Authors: Kellner-Weldon F, El-Koussy M, Jung S, Jossen M, Klinger-Gratz PP, Wiest R
BACKGROUND AND PURPOSE: Patients diagnosed with migraine with aura have an increased lifetime risk of ischemic stroke. It is not yet clear whether prolonged cortical hypoperfusion during an aura increases the immediate risk of cerebellar infarction because it may induce crossed cerebellar diaschisis and subsequent tissue damage. To address this question, we retrospectively analyzed potential relationships between cortical oligemia and cerebellar hypoperfusion in patients with migraine with aura and their potential relation to small infarct-like cerebellar lesions.
MATERIALS AND METHODS: One hundred six migraineurs who underwent MR imaging, including DSC perfusion, were included in the study. In patients with apparent perfusion asymmetry, we used ROI analysis encompassing 18 infra- and supratentorial ROIs to account for differences in regional cerebral blood flow and volume. The presence of cerebellar hypoperfusion was calculated using an asymmetry index, with values of >10% being considered significant.
RESULTS: We observed perfusion asymmetries in 23/106 patients, 22 in patients with migraine with aura (20.8%). Cerebellar hypoperfusion was observed in 12/23 patients (52.2%), and crossed cerebellar diaschisis, in 9/23 patients (39.1%) with abnormal perfusion. In none of the 106 patients were DWI restrictions observed during migraine with aura.
CONCLUSIONS: Cerebellar hypoperfusion and crossed cerebellar diaschisis are common in patients with migraine with aura and cortical perfusion abnormalities. Crossed cerebellar diaschisis in migraine with aura may be considered a benign phenomenon because we observed no association with DWI restriction or manifest cerebellar infarctions, even in patients with prolonged symptom-related perfusion abnormalities persisting for up to 24 hours.
PMID: 29326138 [PubMed - as supplied by publisher]
Expression Changes in Lactate and Glucose Metabolism and Associated Transporters in Basal Ganglia following Hypoxic-Ischemic Reperfusion Injury in Piglets.
AJNR Am J Neuroradiol. 2018 Jan 11;:
Authors: Zheng Y, Wang XM
BACKGROUND AND PURPOSE: The neonatal brain has active energy metabolism, and glucose oxidation is the major energy source of brain tissue. Lactate is produced by astrocytes and released to neurons. In the central nervous system, lactate is transported between neurons and astrocytes via the astrocyte-neuron lactate shuttle. The aim of this study was to investigate the regulatory mechanisms of energy metabolism in neurons and astrocytes in the basal ganglia of a neonatal hypoxic-ischemic brain injury piglet model.
MATERIALS AND METHODS: A total of 35 healthy piglets (3-5 days of age; 1.0-1.5 kg) were assigned to a control group (n = 5) or a hypoxic-ischemic model group (n = 30). The hypoxic-ischemic model group was further divided into 6 groups according to the 1H-MR spectroscopy and PET/CT scan times after hypoxia-ischemia (0-2, 2-6, 6-12, 12-24, 24-48, and 48-72 hours; n = 5/group). 1H-MR spectroscopy data were processed with LCModel software. Maximum standard uptake values refer to the maximum standard uptake values for glucose (or FDG). The maximum standard uptake values of the basal ganglia-to-occipital cortex ratio were analyzed. The expression levels of glucose transporters and monocarboxylate transporters were detected by immunohistochemical analysis.
RESULTS: Lactate levels decreased after an initial increase, with the maximal level occurring around 2-6 hours following hypoxia-ischemia. After hypoxia-ischemia, the maximum standard uptake values of the basal ganglia and basal ganglia/occipital cortex initially increased then decreased, with the maximum occurring at approximately 6-12 hours. The lactate and glucose uptake (basal ganglia/occipital cortex maximum standard uptake values) levels were positively correlated. The expression levels of glucose transporter-1 and glucose transporter-3 were positively correlated with the basal ganglia/occipital cortex. The expression levels of monocarboxylic acid transporter-2 and monocarboxylic acid transporter-4 were positively correlated with lactate content.
CONCLUSIONS: The results indicate that lactate and glucose transporters have a synergistic effect on the energy metabolism of neurons and astrocytes following hypoxic-ischemic reperfusion brain injury.
PMID: 29326137 [PubMed - as supplied by publisher]
Using Correlative Properties of Neighboring Pixels to Improve Gray-White Differentiation in Pediatric Head CT Images.
AJNR Am J Neuroradiol. 2018 Jan 11;:
Authors: Madaelil TP, Sharma A, Hildebolt C, Parsons M
BACKGROUND AND PURPOSE: A lower radiation dose can have a detrimental effect on the quality of head CT images. The aim of this study performed in a pediatric population was to test whether an image-processing algorithm (Correlative Image Enhancement) based on the correlation among intensities of neighboring pixels can improve gray-white differentiation in head CTs.
MATERIALS AND METHODS: Sixty baseline head CT images with normal findings obtained from scans of 30 children were processed using Correlative Image Enhancement to produce corresponding enhanced images. Gray-white differentiation in baseline and enhanced images was assessed quantitatively by calculating the contrast-to-noise ratio and conspicuity in equivalent ROIs in gray and white matter. Two masked readers rated the images for visibility of gray-white differentiation on a 5-point Likert scale. Differences in both quantitative and qualitative measures of gray-white differentiation between baseline and enhanced images were tested for statistical significance. P values < .05 were considered significant.
RESULTS: Image processing resulted in improvement in the contrast-to-noise ratio (from 1.86 ± 0.94 to 2.26 ± 1.00, P = .02) as well as conspicuity (from 37.28 ± 11.56 to 46.4 ± 11.5, P < .001). This was accompanied by improved subjective visibility of gray-white differentiation as reported by both readers (P < .01).
CONCLUSIONS: Image processing using Correlative Image Enhancement had a beneficial effect on quantitative measures of gray-white differentiation. This translated into improved perception of gray-white differentiation by readers. Further studies are needed to assess the effect of such image processing on the detection of disease processes using head CTs.
PMID: 29326136 [PubMed - as supplied by publisher]
Considerations in the diagnosis of oral hairy leukoplakia-an institutional experience.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Nov 15;:
Authors: Flores-Hidalgo A, Lim SO, Curran AE, Padilla RJ, Murrah V
OBJECTIVE: We report here the 10-year experience with oral hairy leukoplakia (OHL) at the Division of Oral and Maxillofacial Pathology at the University of North Carolina at Chapel Hill, NC, USA.
STUDY DESIGN: All the associated hematoxylin and eosin and Epstein-Barr virus encoding region in situ hybridization slides of OHL cases between January 1, 2008, and February 1, 2017, were retrieved and reviewed. Collected demographic characteristics, clinical presentation, medical and social histories were reviewed and reported.
RESULTS: Six OHL cases with confirmed in situ hybridization showed predilection for the lateral tongue. The study included 3 females and 3 males (mean age 50.5 years; age range 29-70 years). One patient had known HIV-positive status before biopsy was performed. Three patients had reported a history of heavy smoking. Other medical conditions reported were history of breast cancer, a long history of corticosteroid inhaler use for asthma treatment, high cholesterol, diabetes, and hypertension.
CONCLUSIONS: The findings of this study indicate the need to include OHL as a potential entity in the differential diagnosis of leukoplakic tongue lesions, regardless of the patient's HIV status. In addition, the presence of OHL in the patient requires investigation of various explanations for EBV infection, including immunosuppression caused by HIV infection or chronic steroid use.
PMID: 29325854 [PubMed - as supplied by publisher]
Relationship between sjögren syndrome and periodontal status: A systematic review.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Dec 11;:
Authors: de Goés Soares L, Rocha RL, Bagordakis E, Galvão EL, Douglas-de-Oliveira DW, Falci SGM
OBJECTIVE: This study aimed to examine whether Sjögren syndrome (SS) is related to periodontal status.
STUDY DESIGN: A systematic review was performed on the basis of PRISMA (PROSPERO: CRD42017055202). A search was performed in the PubMed/MEDLINE, LILACS, Web of Science, and Science Direct databases. Hand searches and review of the gray literature were also performed. Three researchers independently selected studies, extracted data, and assessed methodologic quality. Studies that correlated primary and/or secondary SS with plaque index, gingival index, probing depth, and bleeding on probing were included. The risk of bias was estimated on the basis of the Newcastle-Ottawa scale.
RESULTS: Seventeen studies were included in the review and 9 included in the meta-analysis, with a total of 518 and 544 patients, with or without SS, respectively. The mean difference of plaque index (0.29; 95% confidence interval [CI] 0.17-0.41), gingival index (0.52; 95% CI 0.14-0.89), and bleeding on probing (9.92; 95% CI 4.37-15.47) were larger in patients with SS than in controls. In primary SS (0.47; 95% CI 0.10-0.83) and secondary SS (0.74; 95% CI 0.10-1.38), only the mean gingival index was larger compared with that in control group. The majority of the included studies were judged as having a high risk of bias.
CONCLUSIONS: The present review did not provide strong evidence that periodontal status is affected by SS.
PMID: 29325853 [PubMed - as supplied by publisher]
Quality and readability of internet-based information on halitosis.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Dec 08;:
Authors: Jo JH, Kim EJ, Kim JR, Kim MJ, Chung JW, Park JW
OBJECTIVE: To evaluate quality and readability of Internet-based information on halitosis.
STUDY DESIGN: An Internet search through 3 engines (Google, Yahoo, and Bing) was done with the terms ("bad breath," "halitosis," "oral malodor," "foul breath," "mouth malodor," "breath malodor," "fetor ex ore," "fetor oris," "ozostomia," and "stomatodysodia"). The first 50 websites from each engine resulting from each search term were screened. Included websites were evaluated using Health on the Net (HON) criteria, Journal of American Medical Association (JAMA) benchmarks, DISCERN, Ensuring Quality Information for Patients (EQIP), Flesch Reading Ease (FRE) score, and Flesch-Kincaid Grade level.
RESULTS: A total of 101 websites were included. HON, DISCERN, EQIP, and FRE score were 42.9%, 37.6%, 37.4%, and 51.9% of the maximum score, respectively. Fewer than 50% of sites displayed attribution, disclosure, and currency according to JAMA benchmarks. HON score, DISCERN score, and EQIP score had significant correlation with each other and were significantly higher in sites displaying the HON seal.
CONCLUSION: The current quality and readability of informative websites on halitosis are generally low and poorly organized. Clinicians should be able to assess the Internet-based information on halitosis, as well as give accurate advice and guide patients concerning this issue.
PMID: 29325852 [PubMed - as supplied by publisher]
Microbial population changes in patients with medication-related osteonecrosis of the jaw treated with systemic antibiotics.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Dec 11;:
Authors: De Bruyn L, Coropciuc R, Coucke W, Politis C
OBJECTIVE: This study aimed to investigate the bacterial population in patients with medication-related osteonecrosis of the jaw (MRONJ) after treatment with doxycycline and metronidazole.
STUDY DESIGN: A total of 38 patients with MRONJ (age range 55-88, mean age 73 + 8.82 standard deviation) treated with doxycycline first and with metronidazole second were enrolled in this study. Two swabs were taken at the margin of the infected MRONJ lesion after applying pressure on the marginal mucosa, and visible pus was secreted. Real-time polymerase chain reaction was used to analyze 20 periopathogenic and commensal species and the total bacterial level. Bacterial counts were compared between antibiotic treatments and with a control group of orally healthy patients who didn't have periodontal pockets of more than 3 mm (n = 29) by means of a Mann-Whitney U test. Comparisons between the two antibiotic treatments were performed by a paired Wilcoxon signed rank test.
RESULTS: The total bacterial level was significantly higher in the MRONJ patients treated with systemic antibiotics compared with the control group. However, significant lower bacterial amounts were found for 12 of the 20 investigated bacteria. We couldn't establish a significant advantage of metronidazole administration after doxycycline treatment.
CONCLUSION: Our findings suggest that the total bacterial level in MRONJ patients is higher even when treated with systemic antibiotics. The significantly different bacterial amounts of the selected species suggest an alteration in the microbial population.
PMID: 29325851 [PubMed - as supplied by publisher]
Viruses, Vol. 10, Pages 36: Interferons: Reprogramming the Metabolic Network against Viral Infection
Viruses doi: 10.3390/v10010036
Authors: Kavita Raniga Chen Liang
Viruses exploit the host and induce drastic metabolic changes to ensure an optimal environment for replication and the production of viral progenies. In response, the host has developed diverse countermeasures to sense and limit these alterations to combat viral infection. One such host mechanism is through interferon signaling. Interferons are cytokines that enhances the transcription of hundreds of interferon-stimulated genes (ISGs) whose products are key players in the innate immune response to viral infection. In addition to their direct targeting of viral components, interferons and ISGs exert profound effects on cellular metabolism. Recent studies have started to illuminate on the specific role of interferon in rewiring cellular metabolism to activate immune cells and limit viral infection. This review reflects on our current understanding of the complex networking that occurs between the virus and host at the interface of cellular metabolism, with a focus on the ISGs in particular, cholesterol-25-hydroxylase (CH25H), spermidine/spermine acetyltransferase 1 (SAT1), indoleamine-2,3-dioxygenase (IDO1) and sterile alpha motif and histidine/aspartic acid domain-containing protein 1 (SAMHD1), which were recently discovered to modulate specific metabolic events and consequently deter viral infection.
Viruses, Vol. 10, Pages 34: Biomarkers of Progression after HIV Acute/Early Infection: Nothing Compares to CD4+ T-cell Count?
Viruses doi: 10.3390/v10010034
Authors: Gabriela Turk Yanina Ghiglione Macarena Hormanstorfer Natalia Laufer Romina Coloccini Jimena Salido César Trifone María Ruiz Juliana Falivene María Holgado María Caruso María Figueroa Horacio Salomón Luis Giavedoni María Pando María Gherardi Roberto Rabinovich Pedro Pury Omar Sued
Progression of HIV infection is variable among individuals, and definition disease progression biomarkers is still needed. Here, we aimed to categorize the predictive potential of several variables using feature selection methods and decision trees. A total of seventy-five treatment-naïve subjects were enrolled during acute/early HIV infection. CD4+ T-cell counts (CD4TC) and viral load (VL) levels were determined at enrollment and for one year. Immune activation, HIV-specific immune response, Human Leukocyte Antigen (HLA) and C-C chemokine receptor type 5 (CCR5) genotypes, and plasma levels of 39 cytokines were determined. Data were analyzed by machine learning and non-parametric methods. Variable hierarchization was performed by Weka correlation-based feature selection and J48 decision tree. Plasma interleukin (IL)-10, interferon gamma-induced protein (IP)-10, soluble IL-2 receptor alpha (sIL-2Rα) and tumor necrosis factor alpha (TNF-α) levels correlated directly with baseline VL, whereas IL-2, TNF-α, fibroblast growth factor (FGF)-2 and macrophage inflammatory protein (MIP)-1β correlated directly with CD4+ T-cell activation (p < 0.05). However, none of these cytokines had good predictive values to distinguish “progressors” from “non-progressors”. Similarly, immune activation, HIV-specific immune responses and HLA/CCR5 genotypes had low discrimination power. Baseline CD4TC was the most potent discerning variable with a cut-off of 438 cells/μL (accuracy = 0.93, κ-Cohen = 0.85). Limited discerning power of the other factors might be related to frequency, variability and/or sampling time. Future studies based on decision trees to identify biomarkers of post-treatment control are warrantied.
Viruses, Vol. 10, Pages 35: Human Cytomegalovirus Nuclear Capsids Associate with the Core Nuclear Egress Complex and the Viral Protein Kinase pUL97
Viruses doi: 10.3390/v10010035
Authors: Jens Milbradt Eric Sonntag Sabrina Wagner Hanife Strojan Christina Wangen Tihana Lenac Rovis Berislav Lisnic Stipan Jonjic Heinrich Sticht William Britt Ursula Schlötzer-Schrehardt Manfred Marschall
The nuclear phase of herpesvirus replication is regulated through the formation of regulatory multi-component protein complexes. Viral genomic replication is followed by nuclear capsid assembly, DNA encapsidation and nuclear egress. The latter has been studied intensely pointing to the formation of a viral core nuclear egress complex (NEC) that recruits a multimeric assembly of viral and cellular factors for the reorganization of the nuclear envelope. To date, the mechanism of the association of human cytomegalovirus (HCMV) capsids with the NEC, which in turn initiates the specific steps of nuclear capsid budding, remains undefined. Here, we provide electron microscopy-based data demonstrating the association of both nuclear capsids and NEC proteins at nuclear lamina budding sites. Specifically, immunogold labelling of the core NEC constituent pUL53 and NEC-associated viral kinase pUL97 suggested an intranuclear NEC-capsid interaction. Staining patterns with phospho-specific lamin A/C antibodies are compatible with earlier postulates of targeted capsid egress at lamina-depleted areas. Important data were provided by co-immunoprecipitation and in vitro kinase analyses using lysates from HCMV-infected cells, nuclear fractions, or infectious virions. Data strongly suggest that nuclear capsids interact with pUL53 and pUL97. Combined, the findings support a refined concept of HCMV nuclear trafficking and NEC-capsid interaction.
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Body image issues in Lithuanian females before and during pregnancy.
Anthropol Anz. 2018 Jan 12;:
Authors: Tutkuviene J, Juskaite A, Katinaite J, Silove S, Drasutis J, Sargautyte R, Ramasauskaite D, Drasutiene G
ABSTRACT: There is a risk that during pregnancy a woman's changing physique might result in stronger concerns about her appearance and may lead to negative consequences both for mother and foetus. The aim of the present study was to assess women's self-esteem, body image and weight control before and during pregnancy. A cross-sectional study was carried out at the Centre of Obstetrics and Gynaecology of Vilnius University Hospital. In total, 234 pregnant women were investigated. The Self-esteem was measured by Rosenberg's scale (1965), while the attitude towards the body size - by Stunkard's figure rating scale (1983). When rating their actual body size and the preferred body shape using Stunkard's figures, the investigated females chose, on average, 3.40 and 2.93 (respectively) size figures for the period before pregnancy (p < 0.05), while they picked 4.38 and 3.44 (respectively) figures during pregnancy (p < 0.05). Women's efforts not to gain weight during pregnancy were not determined by their opinion of their body size during pregnancy (rs(232) = 0.136,p > 0.05). Regardless of their body shape assessment during pregnancy, pregnant women did not restrict their diet (rs(232) = 0.064,p > 0.05). Conclusions: during pregnancy women assessed their weight gain adequately, pregnant women chose larger body sizes as an ideal physique if compared to the ones of the period before pregnancy, women's efforts not to gain weight during pregnancy were not determined by their body size perception during pregnancy, pregnant women, despite their body shape assessment during pregnancy, did not restrict their diet, i.e. pregnant women became psychologically adapted to their body changes during pregnancy, and the maternity became a much more important factor than the beauty ideals associated with slender figures.
PMID: 29328348 [PubMed - as supplied by publisher]
Responsible innovation in human germline gene editing: Background document to the recommendations of ESHG and ESHRE.
Eur J Hum Genet. 2018 Jan 12;:
Authors: De Wert G, Heindryckx B, Pennings G, Clarke A, Eichenlaub-Ritter U, van El CG, Forzano F, Goddijn M, Howard HC, Radojkovic D, Rial-Sebbag E, Dondorp W, Tarlatzis BC, Cornel MC, European Society of Human Genetics and the European Society of Human Reproduction and Embryology
Technological developments in gene editing raise high expectations for clinical applications, including editing of the germline. The European Society of Human Reproduction and Embryology (ESHRE) and the European Society of Human Genetics (ESHG) together developed a Background document and Recommendations to inform and stimulate ongoing societal debates. This document provides the background to the Recommendations. Germline gene editing is currently not allowed in many countries. This makes clinical applications in these countries impossible now, even if germline gene editing would become safe and effective. What were the arguments behind this legislation, and are they still convincing? If a technique could help to avoid serious genetic disorders, in a safe and effective way, would this be a reason to reconsider earlier standpoints? This Background document summarizes the scientific developments and expectations regarding germline gene editing, legal regulations at the European level, and ethics for three different settings (basic research, preclinical research and clinical applications). In ethical terms, we argue that the deontological objections (e.g., gene editing goes against nature) do not seem convincing while consequentialist objections (e.g., safety for the children thus conceived and following generations) require research, not all of which is allowed in the current legal situation in European countries. Development of this Background document and Recommendations reflects the responsibility to help society understand and debate the full range of possible implications of the new technologies, and to contribute to regulations that are adapted to the dynamics of the field while taking account of ethical considerations and societal concerns.
PMID: 29326429 [PubMed - as supplied by publisher]
Human germline gene editing: Recommendations of ESHG and ESHRE.
Eur J Hum Genet. 2018 Jan 12;:
Authors: de Wert G, Pennings G, Clarke A, Eichenlaub-Ritter U, van El CG, Forzano F, Goddijn M, Heindryckx B, Howard HC, Radojkovic D, Rial-Sebbag E, Tarlatzis BC, Cornel MC, European Society of Human Genetics and the European Society of Human Reproduction and Embryology
Technological developments in gene editing raise high expectations for clinical applications, first of all for somatic gene editing but in theory also for germline gene editing (GLGE). GLGE is currently not allowed in many countries. This makes clinical applications in these countries impossible now, even if GLGE would become safe and effective. What were the arguments behind this legislation, and are they still convincing? If a technique can help to avoid serious genetic disorders, in a safe and effective way, would this be a reason to reconsider earlier standpoints? The European Society of Human Reproduction and Embryology (ESHRE) and the European Society of Human Genetics (ESHG) together developed a Background document and Recommendations to inform and stimulate ongoing societal debates. After consulting its membership and experts, this final version of the Recommendations was endorsed by the Executive Committee and the Board of the respective Societies in May 2017. Taking account of ethical arguments, we argue that both basic and pre-clinical research regarding GLGE can be justified, with conditions. Furthermore, while clinical GLGE would be totally premature, it might become a responsible intervention in the future, but only after adequate pre-clinical research. Safety of the child and future generations is a major concern. Future discussions must also address priorities among reproductive and potential non-reproductive alternatives, such as PGD and somatic editing, if that would be safe and successful. The prohibition of human germline modification, however, needs renewed discussion among relevant stakeholders, including the general public and legislators.
PMID: 29326428 [PubMed - as supplied by publisher]
Routinely collected data for randomized trials: promises, barriers, and implications.
Trials. 2018 Jan 11;19(1):29
Authors: Mc Cord KA, Al-Shahi Salman R, Treweek S, Gardner H, Strech D, Whiteley W, Ioannidis JPA, Hemkens LG
BACKGROUND: Routinely collected health data (RCD) are increasingly used for randomized controlled trials (RCTs). This can provide three major benefits: increasing value through better feasibility (reducing costs, time, and resources), expanding the research agenda (performing trials for research questions otherwise not amenable to trials), and offering novel design and data collection options (e.g., point-of-care trials and other designs directly embedded in routine care). However, numerous hurdles and barriers must be considered pertaining to regulatory, ethical, and data aspects, as well as the costs of setting up the RCD infrastructure. Methodological considerations may be different from those in traditional RCTs: RCD are often collected by individuals not involved in the study and who are therefore blinded to the allocation of trial participants. Another consideration is that RCD trials may lead to greater misclassification biases or dilution effects, although these may be offset by randomization and larger sample sizes. Finally, valuable insights into external validity may be provided when using RCD because it allows pragmatic trials to be performed.
METHODS: We provide an overview of the promises, challenges, and potential barriers, methodological implications, and research needs regarding RCD for RCTs.
RESULTS: RCD have substantial potential for improving the conduct and reducing the costs of RCTs, but a multidisciplinary approach is essential to address emerging practical barriers and methodological implications.
CONCLUSIONS: Future research should be directed toward such issues and specifically focus on data quality validation, alternative research designs and how they affect outcome assessment, and aspects of reporting and transparency.
PMID: 29325575 [PubMed - in process]
Evidence-Based Medicine: Current Practices in Rhinoplasty.
Plast Reconstr Surg. 2018 01;141(1):137e-151e
Authors: Tanna N, Nguyen KT, Ghavami A, Calvert JW, Guyuron B, Rohrich RJ, Gruber RP
LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Perform aesthetic and functional nasal analysis to guide septorhinoplasty. 2. Recognize common complications associated with rhinoplasty. 3. Select appropriate septorhinoplasty techniques to refine nasal aesthetics and treat nasal airway obstruction. 4. Identify factors leading to poor patient satisfaction following rhinoplasty.
SUMMARY: Septorhinoplasty is among the most technically challenging procedures in the realm of plastic and reconstructive surgery. Moreover, it is a constantly evolving topic with extensive background literature. Surgeons must be comfortable with the traditional knowledge base and the current practices in the field. This article reviews the latest thinking on patient selection, functional indications, aesthetic analysis, and operative techniques in septorhinoplasty, with an emphasis on key cartilage grafting and tip suture techniques.
PMID: 29280883 [PubMed - indexed for MEDLINE]
The coordination of plural logics of action and its consequences: Evidence from plural medical systems.
PLoS One. 2017;12(12):e0189841
Authors: Shim JM
Drawing on the theory of social action in organizational and institutional sociology, this paper examines the behavioral consequences of plural logics of action. It addresses the question based on the empirical case of plural medical systems that are composed of both biomedicine and alternative medicine. Applying mixed methods of a cross-national panel data analysis and a content analysis of medical journal articles, it finds that plural systems affect health outcomes negatively when tensions between biomedicine and alternative medicine are unaddressed. In contrast, plural systems produce tangible health benefits when biomedicine and alternative medicine are coordinated through government policies or by health care organizations/professionals. This paper proposes plurality coordination as an important mechanism that modifies the behavioral consequences of plural logics. This proposition contributes to providing theoretical answers to the sociological puzzle that plural logics of action produce inconsistent behavioral consequences.
PMID: 29253867 [PubMed - indexed for MEDLINE]
Symptom burden profile in myelofibrosis patients with thrombocytopenia: Lessons and unmet needs.
Leuk Res. 2017 Dec;63:34-40
Authors: Scotch AH, Kosiorek H, Scherber R, Dueck AC, Slot S, Zweegman S, Boekhorst PAWT, Commandeur S, Schouten H, Sackmann F, Fuentes AK, Hernández-Maraver D, Pahl HL, Griesshammer M, Stegelmann F, Döhner K, Lehmann T, Bonatz K, Reiter A, Boyer F, Etienne G, Ianotto JC, Ranta D, Roy L, Cahn JY, Harrison CN, Radia D, Muxi P, Maldonado N, Besses C, Cervantes F, Johansson PL, Barbui T, Barosi G, Vannucchi AM, Paoli C, Passamonti F, Andreasson B, Ferrari ML, Rambaldi A, Samuelsson J, Birgegard G, Xiao Z, Xu Z, Zhang Y, Sun X, Xu J, Kiladjian JJ, Zhang P, Gale RP, Mesa RA, Geyer HL
Myelofibrosis is a myeloproliferative neoplasm associated with progressive cytopenias and high symptom burden. MF patients with thrombocytopenia have poor prognosis but the presence of thrombocytopenia frequently precludes the use of JAK2 inhibitors. In this study, we assessed quality of life and symptom burden in 418 MF patients with (n=89) and without (n=329) thrombocytopenia using prospective data from the MPN-QOL study group database, including the Myeloproliferative Neoplasm Symptom Assessment Form (MPN-SAF) and Total Symptom Score (MPN10). Thrombocytopenia, defined as platelet count <100×109/L (moderate 51-100×109/L; severe ≤50×109/L), was associated with anemia (76% vs. 45%, p<0.001), leukopenia (29% vs. 11%, p<0.001), and need for red blood cell transfusion (35% vs. 19%, p=0.002). Thrombocytopenic patients had more fatigue, early satiety, inactivity, dizziness, sad mood, cough, night sweats, itching, fever, and weight loss; total symptom scores were also higher (33 vs. 24, p<0.001). Patients with severe thrombocytopenia were more likely to have anemia (86% vs. 67%, p=0.04), leukopenia (40% vs. 20%, p=0.04), and transfusion requirements (51% vs. 20%, p=0.002) but few differences in symptoms when compared to patients with moderate thrombocytopenia. These results suggest that MF patients with thrombocytopenia experience greater symptomatic burden than MF patients without thrombocytopenia and may benefit from additional therapies.
PMID: 29096334 [PubMed - indexed for MEDLINE]
[Evaluation of effect of indacaterol (Onbrez) and/or glycopyrronium (Seebri) treatment on Quality of Life of COPD patients in medical practice in Poland - observational study (OSQO)].
Pol Merkur Lekarski. 2017 Oct 23;43(256):158-162
Authors: Płusa T, Physicians From Medical Centers In Poland GO
Indacaterol, as well glycopyronium has been reimbursed lately in Poland, so patients have a greater access to this treatment in medical practice. Physicians do not realize the potential benefit of once daily ultra-LABA indacaterol and/or modern LAMA with fast-acting glycopyrronium on treatment results.
AIM: The aim of the study was to evaluate the impact of routinely administered treatment with either indacaterol (Onbrez) or glycopyrronium (Seebri) or both on patient reported outcomes in form of the health status (CCQ score - clinical COPD questionnaire) and level of dyspnoea (mMRC - modified Medical Research Council) in treatment naive COPD patients after the change of treatment as addon from any other COPD treatment in "real life" settings.
MATERIALS AND METHODS: This study was designed as an observational, non-interventional and multicenter project in COPD patients being treated with Onbrez and/or Seebri in 32 medical centers in Poland. The observation period covered 6 months from the first taking of Onbrez and/or Seebri. No diagnostic or monitoring or treatment procedures have been applied to the patients, other than those which are applied in the course of standard, current practice. The total number of enrolled patients was 633. Because of inability of verification the medical records or failure to meet data collection requirements 587 patients enrolled to the registry has been evaluated. Within this number of patients 171 had delayed the time of visits or they had not second visit. Due to therapy change additional 20 patients has been withdrawn. 396 patients were taken for the final analysis.
RESULTS: Improvement of mMRC and CCQ scores was observed in all treatment groups e.g. indacaterol solely, glycopyrronium solely and combination therapy of indacaterol and glypyrronium.
CONCLUSIONS: The study revealed that the best results can be achieved with combination therapy accordingly with clinical recommendation for COPD treatment (GOLD). The results have been achieved in the real world settings, showing that this treatment may be used in daily routine practice by general practitioners.
PMID: 29084188 [PubMed - indexed for MEDLINE]
[Qi Runs Through Acupuncture Needle Stimulation and Pulse Diagnosis:Our Considerations About Connotations of Qi in Acupuncture-Diagnosis-Treatment Scriptures in Yellow Emperor's Inner Canon].
Zhen Ci Yan Jiu. 2017 Feb 25;42(1):76-8
Authors: Jiang S, Zhao JS
The ancient classic work Yellow Emperor's Inner Canon has abundant expositions about the relationship between the acupuncture needle manipulation and pulse diagnosis. However, the relevant imparting and inheritance situations are relatively weaker nowadays probably due to the rapid development of modern diagnosis-therapeutic techniques and some faults or careless omission in understanding classical medical works. Qi, a core concept of the abundant expositions in Inner Canon, has seldom been thoroughly interpreted about its connotations. For this reason, in the present paper, the authors make a careful explanation about the connotations of Qi in Inner Canon from 1) the concept of Qikou (a superficial window of the body reflecting the functional state of internal organs), 2) pulse conditions, 3) its relationship with meridian-collateral diagnosis, and 4) the link between acupuncture needle stimulation and pulse diagnosis based on the scriptures and words description in combination with many scholars' doctrines, trying to explore its profound significance. In addition, the authors also expound its association with the effectiveness of distant treatment of acupuncture and the characteristics in relation to ancient medical scholars' thoughts.
PMID: 29072003 [PubMed - indexed for MEDLINE]
[Characteristics of Deqi Induced by Needling Zusanli (ST 36) in 527 Healthy Volunteers with Different Constitutions].
Zhen Ci Yan Jiu. 2016 Dec 25;41(6):535-9
Authors: Liu F, Yang XG, Li XZ, Fu NN, Xi XF, Ren Y
OBJECTIVE: To explore the relationship between the theory of constitution in terms of Chinese medicine and clinical efficacy of acupuncture treatment via analyzling the characteristics of Deqi during acupuncture stimulation of Zusanli (ST 36) in healthy volunteers with different constitutions.
METHODS: In the present study, a total of 527 healthy undergraduate student volunteers (267 girls and 260 boys) were recruited. They received questionnaire first about their constitutions in accordance with Professor WANG Qi's Classification and Determination of Constitution in terms of Chinese medicine. Then, the subjects were asked to take a supine position on a check-bed, a qualified acupuncturist held a sterilized fifiform needle to rapidly insert it into ST 36 and manipulated the acupuncture needle with uniform reinforcing-reducing technique at a frequency of about 60-90 times/min and an amplitude of 0.3-0.5 cm. The status of Deqi was assessed by using visual analogue scale (VAS).
RESULTS: Needling sensations mainly involve soreness, numbness, heaviness, distension, dull pain and propagated sensations along meridian (PSC). During acupuncture stimulation, most subjects experienced distension sensation, accounting for 90.3%, followed by soreness, accounting for 45.9%. Except for PSC reaction, the rest 5 needling sensations had no statistical difference in their occurrence rates in those subjects with different constitutions (P>0.05). The PSC appeared a higher incidence in yin-yang harmony(balanced) constitution subjects than in qi- deficiency, yang-deficiency, blood-stagnation and qi-stagnation constitution subjects (P<0.05). The intensity of soreness was obviously stronger in the balanced constitution subjects than in qi-deficiency, yang-deficiency, yin-deficiency, phlegm-damp, damp-heat and qi-stagnation constitution subjects (P<0.05), while the intensity of distension sensation was apparently stronger in the balanced constitution subjects than in simpleyang-deficiency subjects (P<0.05).
CONCLUSIONS: Except for PSC, the Deqi sensations of soreness, numbness, heaviness, distension and dull pain induced by acupuncture stimulation of ST 36 are comparable in the occurrence rates in healthy volunteer subjectswith different (9 types of) constitutions in terms of Chinese medicine, whereas the intensity of soreness may be the important factor for acupuncture induced pain relief. A certain correlation between the constitution and acupuncture effectiveness exists, suggesting that acupuncture treatment should vary from patient to patientin clinical practice.
PMID: 29071897 [PubMed - indexed for MEDLINE]
[Effect of Electroacupuncture at "Zusanli"(ST 36) on the Expression of Ghrelin/cAMP/PKA in the Jejunum in Rats with Spleen Qi Deficiency Syndrome].
Zhen Ci Yan Jiu. 2016 Dec 25;41(6):497-501
Authors: Yong RL, Qu Y, Li XX, Wang JB, Xue YN, Zhang LD
OBJECTIVE: To observe the effect of electroacupuncture (EA) at "Zusanli"(ST 36) on Ghrelin/cAMP/PKA expression in the jejunum in rats with spleen qi deficiency syndrome, so as to reveal its underlying mechanism in improving energy metabolism.
METHODS: Forty male SD rats were randomly divided into 4 groups:normal group, spleen qi deficiency syndrome (model) group, EA group and non-acupoint group (n=10 in each group).The model of spleen qi deficiency syndrome was established by improper diet and overstrain. EA (2 Hz/15 Hz, 0.5 mA) was applied to bilateral "Zusanli" (ST 36) in the EA group and non-acupoint in non-acupoint group for 20 min, once a day for 6 days. The pathologic changes of the jejunum tissue were detected by H&E staining. Ghrelin, ATP and cAMP levels in jejunum tissue were determined by ELISA. The expression levels of PKA protein in jejunum tissue were determined by Western blot.
RESULTS: H&E staining showed that the intestinal villi of the model group were swelling, shortening and thickening, with a damaged or broken top-part in the model group, and basically restored to normal after EA treatment. ELISA results showed that the contents of Ghrelin, ATP and cAMP in the jejunum tissue were significantly lower in the model group than in the normal group (P<0.05), while significantly higher in the EA group than in the model group (P<0.05). Western blot results showed that the expression of PKA protein in the jejunum tissue was significantly lower in the model group than in the normal group (P<0.05), and significantly higher in the EA group than in the model group and non-acupoint group (P<0.05).
CONCLUSIONS: EA at ST 36 can improve the morphological changes in the jejunum of spleen qi deficiency rats, which may be associated with its effects in increasing Ghrelin, ATP and cAMP contents, and up-regulating PKA expression, leading to an increase of energy metabolism and spleen qi at last.
PMID: 29071891 [PubMed - indexed for MEDLINE]
Cancer-related pain: a nationwide survey of patients' treatment modification and satisfaction in Taiwan.
Jpn J Clin Oncol. 2017 Nov 01;47(11):1060-1065
Authors: Rau KM, Chen JS, Wu HB, Lin SF, Huang ML, Tai CJ, Hwang WL, Lu YC, Wang CC, Kuen Hsieh R
Background: We have limited knowledge about cancer patients' pain control satisfaction in outpatient departments in Taiwan and doctors' practice of adjusting analgesics according to their pain status. This survey examined pain management and satisfaction among cancer outpatients with pain and obtained information on their quality of life and treatment management for different pain intensities.
Methods: The Short version of the Brief Pain Inventory was used as the outcome questionnaire. Participants comprised 2075 patients with different cancers and disease statuses at 14 oncological outpatient departments, of which 1051 reported pain within the week prior to testing. The impact of pain management on physical and psychological functioning, and satisfaction with doctors were evaluated. Information about doctors' prescriptions was collected. Logistic regression analyses were conducted to evaluate whether the interference scale performed identically in the different analgesic ladders.
Results: Pain was significantly linked to disease status and affected patients' physical and psychiatric functioning. Almost 100% of patients were satisfied with their pain control, but more than 70% of doctors did not change analgesics based on patients' current pain status. The results show that although patients were satisfied with their physicians, treatment of cancer pain was still suboptimal.
Conclusion: Pain assessment and treatment need to be more thorough and management guidelines should be revised to improve pain control in patients with cancer.
PMID: 28973687 [PubMed - indexed for MEDLINE]
Inflammatory bowel disease-specific health-related quality of life instruments: a systematic review of measurement properties.
Health Qual Life Outcomes. 2017 Sep 15;15(1):177
Authors: Chen XL, Zhong LH, Wen Y, Liu TW, Li XY, Hou ZK, Hu Y, Mo CW, Liu FB
BACKGROUND: This review aims to critically appraise and compare the measurement properties of inflammatory bowel disease (IBD)-specific health-related quality of life instruments.
METHODS: Medline, EMBASE and ISI Web of Knowledge were searched from their inception to May 2016. IBD-specific instruments for patients with Crohn's disease, ulcerative colitis or IBD were enrolled. The basic characteristics and domains of the instruments were collected. The methodological quality of measurement properties and measurement properties of the instruments were assessed.
RESULTS: Fifteen IBD-specific instruments were included, which included twelve instruments for adult IBD patients and three for paediatric IBD patients. All of the instruments were developed in North American and European countries. The following common domains were identified: IBD-related symptoms, physical, emotional and social domain. The methodological quality was satisfactory for content validity; fair in internal consistency, reliability, structural validity, hypotheses testing and criterion validity; and poor in measurement error, cross-cultural validity and responsiveness. For adult IBD patients, the IBDQ-32 and its short version (SIBDQ) had good measurement properties and were the most widely used worldwide. For paediatric IBD patients, the IMPACT-III had good measurement properties and had more translated versions.
CONCLUSIONS: Most methodological quality should be promoted, especially measurement error, cross-cultural validity and responsiveness. The IBDQ-32 was the most widely used instrument with good reliability and validity, followed by the SIBDQ and IMPACT-III. Further validation studies are necessary to support the use of other instruments.
PMID: 28915891 [PubMed - indexed for MEDLINE]
Xerostomia Quality of Life Scale (XeQoLS) questionnaire: validation of Italian version in head and neck cancer patients.
Radiol Med. 2018 Jan;123(1):44-47
Authors: Lastrucci L, Bertocci S, Bini V, Borghesi S, De Majo R, Rampini A, Gennari PG, Pernici P
AIM: To translate the Xerostomia Quality-of-Life Scale (XeQoLS) into Italian language (XeQoLS-IT). Xerostomia is the most relevant acute and late toxicity in patients with head and neck cancer treated with radiotherapy (RT). Patient-reported outcome (PRO) instruments are subjective report on patient perception of health status. The XeQoLS consists of 15 items and measures the impact of salivary gland dysfunction and xerostomia on the four major domains of oral health-related QoL.
METHODS: The XeQoLS-IT was created through a linguistic validation multi-step process: forward translation (TF), backward translation (TB) and administration of the questionnaire to 35 Italian patients with head and neck cancer. Translation was independently carried out by two radiation oncologists who were Italian native speakers. The two versions were compared and adapted to obtain a reconciled version, version 1 (V1). V1 was translated back into English by an Italian pro skilled in teaching English. After review of discrepancies and choice of the most appropriate wording for clarity and similarity to the original, version 2 (V2) was reached by consensus. To evaluate version 2, patients completed the XeQoLS-IT questionnaire and also underwent a cognitive debriefing.
RESULTS: The questionnaire was considered simple by the patients. The clarity of the instructions and the easiness to answer questions had a mean value of 4.5 (± 0.71) on a scale from 1 to 5.
CONCLUSION: A valid multi-step process led to the creation of the final version of the XeQoLS-IT, a suitable instrument for the perception of xerostomia in patients treated with RT.
PMID: 28861706 [PubMed - indexed for MEDLINE]
Family perception of unmet support needs following a diagnosis of congenital coronary anomaly in children: Results of a survey.
Congenit Heart Dis. 2017 Dec;12(6):721-725
Authors: Agrawal H, Wright OK, Carberry KE, Sexson Tejtel SK, Mery CM, Molossi S
BACKGROUND: Long-term outcome data on patients with anomalous aortic origin of coronary arteries (AAOCA) is sparse and they are often managed in a nonuniform manner. There is subjective perception of anxiety and unmet needs in these patients and families.
METHODS: An online survey of 13 questions was sent to 74 families of patients with AAOCA between May and October 2015. Descriptive statistics were performed.
RESULTS: A total of 31 (47%) families responded. Of these, 27 expressed the need to interact with other patients/families with AAOCA. The majority were interested in either face-to-face meetings (77%) or online support groups (71%). Regarding content of the meeting, 74% were interested in brief talks by medical personnel/families, 58% suggested informal interactions with families, 55% proposed a structured discussion with a moderator and 39% mentioned fun activities/games. Regarding participants in these meetings, 90% would like to include healthcare providers, 61% suggested including family friends, 58% wished to include psychologists and 16% mentioned including social workers. The families currently use various social media including Facebook (87%), YouTube (39%), Google+ (36%), and LinkedIn (32%). For future online resources, 77% of families would like a Facebook site, an informative website (58%), a blog (52%), or an open forum (29%). The majority of the families (77%) were interested in attending a dedicated AAOCA meeting.
CONCLUSION: There appears to be an unmet need for family support in those affected by AAOCA, a substantial life changing diagnosis for patients and families. Further research is needed to assess quality of life in this population.
PMID: 28493446 [PubMed - indexed for MEDLINE]
Measurement of Health-Related Quality of Life in Primary Antibody-Deficient Patients.
Immunol Invest. 2017 May;46(4):329-340
Authors: Ataeinia B, Montazeri A, Tavakol M, Azizi G, Kiaee F, Tavakolinia N, Negahdari B, Mohammadi J, Abolhassani H, Rezaei N, Aghamohammadi A
BACKGROUND: Primary immunodeficiency diseases are a group of disorders that result from a variety of defects of the immune system. Primary antibody deficiencies (PADs) are the most common forms of these disorders. Occurrence of recurrent infections, autoimmune diseases, cancers, and lymphoproliferative disorders is higher in PAD patients. Chronicity of these diseases, delayed diagnosis, inadequate treatment, and treatment side effects may affect the quality of life (QoL) of PAD patients. Evaluating QoL is important for patient care, understanding the burden of these diseases, and finding the patients' major health problems. We investigated the QoL in a group of PAD patients undergoing regular follow-up and treatment at the Children's Medical Center Hospital in Tehran, Iran.
METHODS: Seventy patients with a diagnosis of PAD in two age groups (younger and older than 18 years) were included. QoL was measured using PedsQL and SF-36 questionnaires. Correlation of demographic, clinical, and immunological parameters with QoL scores was assessed and patients' scores were compared with the normal population, using nonparametric tests of SPSS software.
RESULTS: Patients expressed significantly reduced scores in some mental and physical components. Patients with longer follow-up periods had higher scores in mental components but physical component scores were still low. There was no significant correlation between sex, age, and disease types with scores.
CONCLUSIONS: PAD patients had significantly lower scores in mental and physical components compared to normal population. By early diagnosis and long-term follow-up periods, we may be able to prevent complications and help patients to have a better QoL.
PMID: 28358233 [PubMed - indexed for MEDLINE]
Telerehabilitation for COPD: Could pulmonary rehabilitation deliver on its promise?
Respirology. 2017 05;22(4):626-627
Authors: Holland AE, Cox NS
PMID: 28345290 [PubMed - indexed for MEDLINE]
Compulsive buying and quality of life: An estimate of the monetary cost of compulsive buying among adults in early midlife.
Psychiatry Res. 2017 Jun;252:208-214
Authors: Zhang C, Brook JS, Leukefeld CG, De La Rosa M, Brook DW
The aims of this study were to examine the associations between compulsive buying and quality of life and to estimate the monetary cost of compulsive buying for a cohort of men and women at mean age 43. Participants came from a community-based random sample of residents in two New York counties (N=548). The participants were followed from adolescence to early midlife. The mean age of participants at the most recent interview was 43.0 (SD=2.8). Fifty five percent of the participants were females. Over 90% of the participants were white. Linear regression analyses showed that compulsive buying was significantly associated with quality of life, despite controlling for relevant demographic and psychosocial factors. The estimated monetary cost of compulsive buying for this cohort was significant. The fact that the monetary cost of CB is not trivial suggests that individuals are both consciously and unconsciously plagued by their CB. The findings are important for interventionists and clinicians for cost-effective intervention and treatment programs.
PMID: 28285247 [PubMed - indexed for MEDLINE]
Stress management training should be an integral component of cardiac rehabilitation.
Evid Based Med. 2017 04;22(2):65
Authors: Murphy BM
PMID: 28130388 [PubMed - indexed for MEDLINE]
IJMS, Vol. 19, Pages 240: Hypoxia and Hormone-Mediated Pathways Converge at the Histone Demethylase KDM4B in Cancer
International Journal of Molecular Sciences doi: 10.3390/ijms19010240
Authors: Jun Yang Adrian Harris Andrew Davidoff
Hormones play an important role in pathophysiology. The hormone receptors, such as estrogen receptor alpha and androgen receptor in breast cancer and prostate cancer, are critical to cancer cell proliferation and tumor growth. In this review we focused on the cross-talk between hormone and hypoxia pathways, particularly in breast cancer. We delineated a novel signaling pathway from estrogen receptor to hypoxia-inducible factor 1, and discussed the role of this pathway in endocrine therapy resistance. Further, we discussed the estrogen and hypoxia pathways converging at histone demethylase KDM4B, an important epigenetic modifier in cancer.
IJMS, Vol. 19, Pages 241: Improvement of Verticillium Wilt Resistance by Applying Arbuscular Mycorrhizal Fungi to a Cotton Variety with High Symbiotic Efficiency under Field Conditions
International Journal of Molecular Sciences doi: 10.3390/ijms19010241
Authors: Qiang Zhang Xinpeng Gao Yanyun Ren Xinhua Ding Jiajia Qiu Ning Li Fanchang Zeng Zhaohui Chu
Arbuscular mycorrhizal fungi (AMF) play an important role in nutrient cycling processes and plant stress resistance. To evaluate the effect of Rhizophagus irregularis CD1 on plant growth promotion (PGP) and Verticillium wilt disease, the symbiotic efficiency of AMF (SEA) was first investigated over a range of 3% to 94% in 17 cotton varieties. The high-SEA subgroup had significant PGP effects in a greenhouse. From these results, the highest-SEA variety of Lumian 1 was selected for a two-year field assay. Consistent with the performance from the greenhouse, the AMF-mediated PGP of Lumian 1 also produced significant results, including an increased plant height, stem diameter, number of petioles, and phosphorus content. Compared with the mock treatment, AMF colonization obviously inhibited the symptom development of Verticillium dahliae and more strongly elevated the expression of pathogenesis-related genes and lignin synthesis-related genes. These results suggest that AMF colonization could lead to the mycorrhiza-induced resistance (MIR) of Lumian 1 to V. dahliae. Interestingly, our results indicated that the AMF endosymbiont could directly inhibit the growth of phytopathogenic fungi including V. dahliae by releasing undefined volatiles. In summary, our results suggest that stronger effects of AMF application result from the high-SEA.
Bilateral symmetrical comparison of the proximal femur using 3D-CT models.
Surg Radiol Anat. 2018 Jan 10;:
Authors: Dolatowski FC, Temmesfeld MJ, Pierre-Jerome C, Borthne A, Hoelsbrekken SE
PURPOSE: Superimposed three-dimensional (3D)-models obtained from CT-images have been used to evaluate displacement of femoral neck fractures, but this method assumes symmetrical anatomy of normal femurs. The present study aimed to compare the spatial orientation of the left and right proximal femur, thus establishing if 3D models can be used as a reference standard for the evaluation of fracture displacement.
METHODS: We generated 3D-CT-models of 20 patients with no skeletal pathology of the proximal femurs. Three observers independently determined the positions of the fovea and the femoral head, and a vector intersecting the centre points of the fovea and the femoral head defined the rotation. Differences in positions and rotations were determined by superimposing the 3D-CT-models of both femurs.
RESULTS: The mean distance (95% CI) between positions of the left and right fovea was 3.1 mm (2.7-3.4) and between the left and right femoral head 2.8 mm (2.6-3.0). The minimal detectable change was 2.8 for the fovea and 2.3 for the femoral head, and the repeatability coefficients between 2.1-2.7 and 1.0-2.9, respectively. Mean difference in rotation of the femoral head was 6° (5.3-6.6) with a minimal detectable change of 8.8 and repeatability coefficients ranging from 5.8 to 10.0.
CONCLUSIONS: Distances between the left and right femoral heads were larger than what could be explained by measurement error alone, suggesting that there may be minor side-to-side differences. However, these differences are small, and 3D-CT-models can be used as a reference standard to evaluate displacement of femoral neck fractures.
PMID: 29322292 [PubMed - as supplied by publisher]
Clinical Value of 99mTc-3PRGD2 SPECT/CT in Differentiated Thyroid Carcinoma with Negative 131I Whole-Body Scan and Elevated Thyroglobulin Level.
Sci Rep. 2018 Jan 11;8(1):473
Authors: Gao R, Zhang GJ, Wang YB, Liu Y, Wang F, Jia X, Liang YQ, Yang AM
The aim of this study was to assess the usefulness of integrin imaging with 99mTc-PEG4-E[PEG4-c(RGDfK)]2 (99mTc-3PRGD2) single photon emission computed tomography (SPECT)/computed tomography (CT) in detecting recurrent disease in patients with differentiated thyroid cancer (DTC), negative radioiodine whole-body scan (WBS) and high serum thyroglobulin (Tg). Thirty-seven patients who underwent total thyroidectomy followed by radioactive iodine ablation and had negative radioiodine WBS but elevated Tg levels were included. 99mTc-3PRGD2 SPECT/CT was performed 1 week after the negative diagnostic 131I WBS. Diagnostic performance indicators, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), for 99mTc-3PRGD2 SPECT/CT was calculated. The correlations between SPECT/CT results and clinic-pathological characteristics were examined. In 30 (81.1%) of the 37 patients, 99mTc-3PRGD2 SPECT/CT showed positive uptake. The sensitivity, specificity, PPV, and NPV of SPECT/CT to detect recurrent disease at follow-up were 96.6%, 75%, 93.3% and 85.7%, respectively. The sensitivity and PPV of SPECT/CT increased with increasing serum Tg levels. 99mTc-3PRGD2 SPECT/CT showed high sensitivity and PPV in the detection of recurrence among DTC patients with higher Tg levels and negative WBS, and the probability of obtaining a positive SPECT/CT result was related with the level of Tg.
PMID: 29323252 [PubMed - in process]
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High Heritability of Adolescent Sleep-Wake Behavior on Free, but not School Days: A Long-Term Twin Study.
Sleep. 2018 Jan 10;:
Authors: Inderkum AP, Tarokh L
Adolescence development is characterized by significant changes in sleep biology. Despite an overall decline in sleep duration and a delay in bedtime, significant inter-individual variation in sleep has been reported. The aim of the current study was to examine genetic and environmental influences on sleep in adolescence using long-term (6-month) actigraphy measurements, differentiating between school and free days. Sixteen monozygotic (MZ; n = 32) and 10 dizygotic (DZ; n = 20) twin pairs (mean age 12.8 ± 1.0 years; 25 female) participated in the study. Structural equation modeling was used to compute genetic, shared environmental and unique environmental contributors to sleep behavior. We found significantly more genetic influence on sleep timing (sleep midpoint; school: 14%, free: 90%) and duration (school: 15%; free: 68%) on free as compared to school days. On the other hand, the genetic influence on measures of sleep quality (sleep efficiency and sleep onset latency) was high (> 60%) and less dependent on the day of measurement. Only wake after sleep onset (WASO) exhibited a strong shared environmental influence (> 52%) on both school and free days, suggesting that behavioral/environmental interventions may help reduce WASO. In addition, self-reported chronotype was also highly genetically influenced (75%). Disrupted, ill-timed and insufficient sleep in adolescence is associated with poor mental and physical health outcomes. Our findings of a strong genetic contribution to sleep in adolescence suggest that sleep may mark a genetic vulnerability to poor outcomes.
PMID: 29329461 [PubMed - as supplied by publisher]
Development and early validation of a patient reported outcome measure to assess sleep amongst people experiencing problems with alcohol or other drugs.
Sleep. 2018 Jan 10;:
Authors: Neale J, Vitoratou S, Lennon P, Meadows R, Nettleton S, Panebianco D, Strang J, Marsden J
Study Objectives: To develop a patient reported outcome measure to assess sleep amongst people experiencing problems with alcohol or other drugs.
Methods: Item development included secondary analyses of qualitative interviews with drug/alcohol users in residential treatment, a review of validated sleep measures, focus groups with drug/alcohol users in residential treatment, and feedback from drug/alcohol users recruited from community and residential settings. An initial version of the measure was completed by 549 current and former drug/alcohol users (442 in person [IP] and 107 online [OL]). Analyses comprised classical test theory methods, exploratory and confirmatory factor analysis, measurement invariance assessment, and item response theory (IRT).
Results: The initial measure (30 items) had good content and face validity, and was named the Substance Use Sleep Scale (SUSS) by addiction service users. After 7 items were removed due to low item-factor loadings, 2 factors were retained and labelled: 'Mind and Body Sleep Problems' (14 items) and 'Substance Related Sleep Problems' (9 items). Measurement invariance was confirmed with respect to gender, age, and administration format. IRT (information) and classical test theory (internal consistency, stability) indicated measure reliability. Standard parametric and non-parametric techniques supported convergent and discriminant validity.
Conclusions: SUSS is an easy-to-complete patient reported outcome measure of sleep for people with drug/alcohol problems. It can be used by those concerned about their own sleep, and by treatment providers and researchers seeking to better understand, assess, and potentially treat sleep difficulties amongst this population. Further validity testing with larger and more diverse samples is now required.
PMID: 29329423 [PubMed - as supplied by publisher]
Automatic, ECG-based detection of autonomic arousals and their association with cortical arousals, leg movements, and respiratory events in sleep.
Sleep. 2018 Jan 10;:
Authors: Olsen M, Schneider LD, Cheung J, Peppard PE, Jennum PJ, Mignot E, Sorensen HBD
Study objectives: The current definition of sleep arousals neglects to address the diversity of arousals and their systemic cohesion. Autonomic arousals (AA) are autonomic activations often associated with cortical arousals (CA), but they may also occur in isolation in relation to a respiratory event, a leg movement event or spontaneously, without any other physiological associations. AA should be acknowledged as essential events to understand and explore the systemic implications of arousals.
Methods: We developed an automatic AA detection algorithm based on intelligent feature selection and advanced machine learning using the electrocardiogram. The model was trained and tested with respect to CA systematically scored in 258 (181 training size/77 test size) polysomnographic recordings from the Wisconsin Sleep Cohort.
Results: A precision value of 0.72 and a sensitivity of 0.63 were achieved when evaluated with respect to CA. Further analysis indicated that 81% of the non-CA-associated AAs were associated with leg movement (38%) or respiratory (43%) events.
Conclusions: The presented algorithm shows good performance when considering that more than 80% of the false positives (FP) found by the detection algorithm appeared in relation to either leg movement or respiratory events. This indicates that most FP constitute autonomic activations that are indistinguishable from those with cortical cohesion. The proposed algorithm provides an automatic system trained in a clinical environment, which can be utilized to analyse the systemic and clinical impacts of arousals.
PMID: 29329416 [PubMed - as supplied by publisher]
Subjective and objective sleep discrepancy in symptomatic bipolar disorder compared to healthy controls.
J Affect Disord. 2018 Jan 03;229:247-253
Authors: Krishnamurthy V, Mukherjee D, Reider A, Seaman S, Singh G, Fernandez-Mendoza J, Saunders E
BACKGROUND: Bipolar disorder (BD) is associated with sleep misperception. The objective of this study was to investigate the correlation between subjective and objective measures of sleep in persons with symptomatic bipolar disorder (BDS) compared to healthy controls (HC).
METHODS: We studied 24 BDS and 30 HC subjects similar in age, race and sex. Subjective sleep was measured with Pittsburgh Sleep Quality Index (PSQI) and objective sleep with 7-days of actigraphy. Absolute discrepancy variables were calculated by subtracting objective sleep latency (SL) and total sleep time (TST) on actigraphy from their respective subjective estimates from PSQI. Mood symptoms were measured with Young Mania Rating Scale and Hamilton Depression Rating Scale.
RESULTS: In the BDS group, subjective TST did not significantly correlate with objective TST, while it correlated in the HC group. The BDS group had significantly higher absolute discrepancy between subjective and objective SL and TST compared to the HC group. Multivariable regression analysis showed that severity of depression was associated with greater absolute discrepancy between subjective and objective TST within the BDS group.
LIMITATIONS: Subjects are from a tertiary care center and were on medications for treatment of BD symptoms.
CONCLUSION: There is low correlation between subjective and objective TST in BDS subjects and more severe depressive symptoms are associated with greater absolute discrepancy in TST. Objective rather than subjective measures of sleep, such as actigraphy, may be needed to evaluate sleep in BD subjects. Cognitive-behavioral interventions to address sleep misperception and associated depressed mood may be indicated in BD.
PMID: 29329056 [PubMed - as supplied by publisher]
Relationship between sedentary behavior and depression: A mediation analysis of influential factors across the lifespan among 42,469 people in low- and middle-income countries.
J Affect Disord. 2018 Jan 03;229:231-238
Authors: Stubbs B, Vancampfort D, Firth J, Schuch FB, Hallgren M, Smith L, Gardner B, Kahl KG, Veronese N, Solmi M, Carvalho AF, Koyanagi A
BACKGROUND: Sedentary behavior (SB) is associated with diabetes, cardiovascular disease and low mood. There is a paucity of multi-national research investigating SB and depression, particularly among low- and middle-income countries. This study investigated the association between SB and depression, and factors which influence this.
METHODS: Cross-sectional data were analyzed from the World Health Organization's Study on Global Ageing and Adult Health. Depression was based on the Composite International Diagnostic Interview. The association between depression and SB (self-report) was estimated by multivariable linear and logistic regression analyses. Mediation analysis was used to identify influential factors.
RESULTS: A total of 42,469 individuals (50.1% female, mean 43.8 years) were included. People with depression spent 25.6 (95%CI8.5-42.7) more daily minutes in SB than non-depressed participants. This discrepancy was most notable in adults aged ≥ 65y (35.6min more in those with depression). Overall, adjusting for socio-demographics and country, depression was associated with a 1.94 (95%CI1.31-2.85) times higher odds for high SB (i.e., ≥ 8h/day). The largest proportion of the SB-depression relationship was explained by mobility limitations (49.9%), followed by impairments in sleep/energy (43.4%), pain/discomfort (31.1%), anxiety (30.0%), disability (25.6%), cognition (16.1%), and problems with vision (11.0%). Other health behaviors (physical activity, alcohol consumption, smoking), body mass index, and social cohesion did not influence the SB-depression relationship.
CONCLUSION: People with depression are at increased risk of engaging in high levels of SB. This first multi-national study offers potentially valuable insight for a number of hypotheses which may influence this relationship, although testing with longitudinal studies is needed.
PMID: 29329054 [PubMed - as supplied by publisher]
Respiratory Phenotypes for Preterm Infants, Children, and Adults: Bronchopulmonary Dysplasia and More.
Ann Am Thorac Soc. 2018 Jan 12;:
Authors: Collaco JM, McGrath-Morrow SA
Ongoing advancements in neonatal care since the late 1980's have led to increased numbers of premature infants surviving well beyond the neonatal period. As a result of increased survival, many individuals born preterm manifest chronic respiratory symptoms throughout infancy, childhood and adult life. The archetypical respiratory disease of prematurity, bronchopulmonary dysplasia (BPD), is the second most common chronic pediatric respiratory disease after asthma. However, there are several commonly held misconceptions. These misconceptions include that BPD is rare, that BPD resolves within the first few years of life, and that BPD does not impact respiratory health in adult life. This focused review article describes a spectrum of respiratory conditions that individuals born prematurely may experience throughout their lifespan. Specifically, this review provides quantitative estimates of the number of individuals with alveolar, airway, and vascular phenotypes associated with BPD as well as non-BPD respiratory phenotypes such as airway malacia, obstructive sleep apnea, and control of breathing issues. Furthermore, this review illustrates what is known about the potential for progression and/or lack of resolution of these respiratory phenotypes in childhood and adult life. Recognizing the spectrum of respiratory phenotypes associated with individuals born preterm and providing comprehensive and personalized care to these individuals may help to modulate adverse respiratory outcomes in later life. .
PMID: 29328889 [PubMed - as supplied by publisher]
OSA and the bariatric patient.
J Perioper Pract. 2017 Jul;27(7-8):167-168
Authors: De Silva S
Mrs NH is a 49-year-old lady who presented for assessment prior to weight reduction surgery.
PMID: 29328763 [PubMed - in process]
Fatigue and related comorbidities, active component, U.S. Armed Forces, 2007-2016.
MSMR. 2017 Dec;24(12):23-33
Authors: Guido RM, Stahlman S, Ying S
Fatigue is a common complaint in the civilian population and may be a presenting symptom of more serious physical and mental disorders. Data from the Defense Medical Surveillance System (DMSS) were utilized to characterize the incidence and burden of fatigue in active component military members from 1 January 2007 through 31 December 2016. A subanalysis of 3 years within this surveillance period (2012-2014) was also conducted to assess the burden of comorbidities related to incident fatigue and the strength of the association between fatigue and selected comorbidities. The study identified 211,213 incident cases of fatigue with an overall incidence rate of 18.1 per 1,000 person-years between 2007 and 2016. Mental disorders and musculoskeletal disease accounted for about 35% of all medical encounters and about 40% of all hospital days within a year for those diagnosed with fatigue in 2013. The adjusted odds ratio for fatigue was highest in those with male hypogonadism, thyroid disorder, and sleep problems. These results show that fatigue is a common diagnosis with high incidence and burden among active component U.S. military. By focusing on the conditions that frequently occur and are highly associated with fatigue, more rapid diagnosis and treatment of the underlying cause of service member fatigue is possible.
PMID: 29328683 [PubMed - in process]
Insomnia and motor vehicle accident-related injuries, active component, U.S. Armed Forces, 2007-2016.
MSMR. 2017 Dec;24(12):2-11
Authors: Erickson EA, Stahlman S, McNellis MG
Insomnia is the most common sleep disorder in adults, and its incidence is increasing in the U.S. Armed Forces. A potential consequence of insomnia (including medications used to treat it) is increased risk of motor vehicle accidents (MVAs), which cause significant morbidity and mortality in service members. To examine the relationship between insomnia and MVA-related injuries in the U.S. Armed Forces, this retrospective cohort study compared incidence rates of MVA-related injuries from 2007 through 2016 between service members with diagnosed insomnia and an unexposed cohort. After adjustment for multiple covariates, service members with insomnia had more than double the rate of MVA-related injuries, compared to service members without insomnia (adjusted incidence rate ratio: 2.08; 95% CI: 1.95-2.22). A subanalysis of service members with insomnia during 2014-2016 found no difference in risk of MVA-related injury based on days' supply of sleep aid medications prescribed in 365 days following insomnia diagnosis. Insomnia is an important potential risk factor for MVAs in the military. Sleep health should be a component of MVA prevention efforts.
PMID: 29328680 [PubMed - in process]
Phenotyping Pharyngeal Pathophysiology Using Polysomnography in Patients with Obstructive Sleep Apnea.
Am J Respir Crit Care Med. 2018 Jan 12;:
Authors: Sands SA, Edwards BA, Terrill PI, Taranto-Montemurro L, Azarbarzin A, Marques M, Hess L, White DP, Wellman A
RATIONALE: Therapies for obstructive sleep apnea (OSA) could be administered based on a patient's own phenotypic causes ("traits") if a clinically-applicable approach were available. Here we present a novel approach to quantify two key contributors to OSA-pharyngeal collapsibility and compensatory muscle responsiveness-that is applicable to diagnostic polysomnography.
METHODS: Based on physiological definitions, pharyngeal collapsibility determines the ventilation at normal (eupneic) ventilatory drive during sleep, and pharyngeal compensation determines the rise in ventilation accompanying a rising ventilatory drive. Thus, measuring ventilation and ventilatory drive (e.g. during spontaneous cyclic events) should reveal a patient's phenotypic traits without specialized intervention. We demonstrate this concept in OSA patients (N=29) using a novel automated non-invasive method to estimate ventilatory drive (polysomnographic method) and using gold standard ventilatory drive (intraesophageal diaphragm EMG) for comparison. Specialized physiological measurements using CPAP manipulation were employed for further comparison. The validity of nasal pressure as a ventilation surrogate was also tested (N=11).
RESULTS: Polysomnography-derived collapsibility and compensation estimates correlated favorably with those quantified using gold standard ventilatory drive (R=0.83, P<0.0001; R=0.76, P<0.0001 respectively) and using CPAP manipulation (R=0.67, P<0.0001; R=0.64, P<0.001 respectively). Polysomnographic estimates effectively stratified patients into high versus low subgroups (accuracy 69-86% vs. ventilatory drive measures, P<0.05). Traits were near-identical using nasal pressure versus pneumotach (N=11, R≥0.98 both traits, P<0.001).
CONCLUSIONS: Phenotypes of pharyngeal dysfunction in OSA are evident from spontaneous changes in ventilation and ventilatory drive during sleep, enabling non-invasive phenotyping in the clinic. Our approach may facilitate precision therapeutic interventions for OSA.
PMID: 29327943 [PubMed - as supplied by publisher]
Orthopaedic treatment effects of functional therapy on the sagittal pharyngeal dimensions in subjects with sleep-disordered breathing and Class II malocclusion.
Acta Otorhinolaryngol Ital. 2017 Dec;37(6):479-485
Authors: Pavoni C, Cretella Lombardo E, Lione R, Bollero P, Ottaviani F, Cozza P
The purpose of this cephalometric study was to evaluate the craniofacial changes induced by functional treatment of mandibular advancement with special regard to pharyngeal sagittal airway dimensions, tongue and hyoid bone position in subjects with sleep-disordered breathing (SDB) and dentoskeletal Class II malocclusions compared with an untreated Class II control group. 51 subjects (24 female, 27 male; mean age 9.9 ± 1.3 years) with Class II malocclusion and SDB consecutively treated with a functional appliance (Modify Monobloc, MM) were compared with a control group of 31 subjects (15 males, 16 females; mean age 10.1 ± 1.1) with untreated Class II malocclusion. For the study group, mode of breathing was defined by an otorhinolaryngologist according to complete physical examination. The parents of all participants completed a modified version of the paediatric sleep questionnaire, PSQ-SRBD Scale, by Ronald Chervin (the Italian version in 22 items form) before and after the trial. Lateral cephalograms were available at the start and end of treatment with the MM. Descriptive statistics were used for all cephalometric measurements in the two groups for active treatment changes. Significant, favourable skeletal changes in the mandible were observed in the treated group after T2. Significant short-term changes in sagittal airway dimensions, hyoid position and tongue position were induced by functional therapy of mandibular advancement in subjects with Class II malocclusion and SDB compared with untreated controls. After orthodontic treatment, a significant reduction in diurnal symptoms was observed in 45 of the 51 participants who had received an oral appliance. Orthodontic treatment is considered to be a potential therapeutic approach for SDB in children. Orthodontists are playing an increasingly important role in managing snoring and respiratory problems by oral mandibular advancement devices and rapid maxillary expansion.
PMID: 29327733 [PubMed - in process]
Electronic Registry for the Management of Childhood Obesity in Greece.
Eur J Clin Invest. 2018 Jan 11;:
Authors: Kassari P, Papaioannou P, Billiris A, Karanikas H, Eleftheriou S, Thireos E, Manios Y, Chrousos GP, Charmandari E
BACKGROUND: Obesity in childhood and adolescence represents a major health problem in our century. In Greece, more than 30-35% of children and adolescents are either overweight or obese.
MATERIALS AND METHODS: Using information and communication technologies, we developed a "National Registry for the Prevention and Management of Overweight and Obesity in Childhood and Adolescence" for guidance and training of Pediatricians and General Practitioners. The application supports interoperability with other national infrastructures and multi-layered security spanning preventive, detective and administrative controls. The Patient Summary dataset includes information on medical history, family history, medications, immunizations, clinical examination and laboratory findings, and appointment booking service.
RESULTS: The application was launched in September 2015 and is accessible by: h t t p : //app.childhood-obesity. gr/. Based on the data that the doctor registers, the system calculates a personalized therapeutic algorithm that provides information on diet, physical exercise and sleep, as well as guidance on laboratory investigations and referral to specialized centres. A pilot study performed in 1,270 children and adolescents indicated that using this system resulted in a reduction of obesity rates by 30% and overweight rates by 35% within one year.
CONCLUSIONS: This National eHealth System appears to be effective in the management of overweight and obesity in childhood and adolescence. This article is protected by copyright. All rights reserved.
PMID: 29327339 [PubMed - as supplied by publisher]
Generalized nonmotor (absence) seizures-What do absence, generalized, and nonmotor mean?
Epilepsia. 2018 Jan 11;:
Authors: Unterberger I, Trinka E, Kaplan PW, Walser G, Luef G, Bauer G
OBJECTIVE: Clinical absences are now classified as "generalized nonmotor (absence) seizures" by the International League Against Epilepsy (ILAE). The aim of this paper is to critically review the concept of absences and to put the accompanying focal and motor symptoms into the context of the emerging pathophysiological knowledge.
METHODS: For this narrative review we performed an extensive literature search on the term "absence," and analyzed the plethora of symptoms observed in clinical absences.
RESULTS: Arising from the localization and the involved cortical networks, motor symptoms may include bilateral mild eyelid fluttering and mild myoclonic jerks of extremities. These motor symptoms may also occur unilaterally, analogous to a focal motor seizure with Jacksonian march. Furthermore, electroencephalography (EEG) abnormalities may exhibit initial frontal focal spikes and consistent asymmetries. Electroclinical characteristics support the cortical focus theory of absence seizures. Simultaneous EEG/functional magnetic resonance imaging (fMRI) measurements document cortical deactivation and thalamic activation. Cortical deactivation is related to slow waves and disturbances of consciousness of varying degrees. Motor symptoms correspond to the spike component of the 3/s spike-and-wave-discharges. Thalamic activation can be interpreted as a response to overcome cortical deactivation. Furthermore, arousal reaction during drowsiness or sleep triggers spikes in an abnormally excitable cortex. An initial disturbance in arousal mechanisms ("dyshormia") might be responsible for the start of this abnormal sequence.
SIGNIFICANCE: The classification as "generalized nonfocal and nonmotor (absence) seizure" does not covey the complex semiology of a patient's clinical events.
PMID: 29327337 [PubMed - as supplied by publisher]