Detection of Language Lateralization Using Spectral Analysis of EEG.

PURPOSE: Language lateralization relies on expensive equipment and can be difficult to tolerate. We assessed if lateralized brain responses to a language task can be detected with spectral analysis of electroencephalography (EEG). METHODS: Twenty right-handed, neurotypical adults (28 ± 10 years; five males) performed a verb generation task and two control tasks (word listening and repetition). We measured changes in EEG activity elicited by tasks (the event-related spectral perturbation [ERSP]) in the theta, alpha, beta, and gamma frequency bands in two language (superior temporal and inferior frontal [ST and IF]) and one control (occipital [Occ]) region bilaterally. We tested whether language tasks elicited (1) changes in spectral power from baseline (significant ERSP) at any region or (2) asymmetric ERSPs between matched left and right regions. RESULTS: Left IF beta power (-0.37±0.53, t = -3.12, P = 0.006) and gamma power in all regions decreased during verb generation. Asymmetric ERSPs (right > left) occurred between the (1) IF regions in the beta band (right vs. left difference of 0.23±0.37, t(19) = -2.80, P = 0.0114) and (2) ST regions in the alpha band (right vs. left difference of 0.48±0.63, t(19) = -3.36, P = 0.003). No changes from baseline or hemispheric asymmetries were noted in language regions during control tasks. On the individual level, 16 (80%) participants showed decreased left IF beta power from baseline, and 16 showed ST alpha asymmetry. Eighteen participants (90%) showed one of these two findings. CONCLUSIONS: Spectral EEG analysis detects lateralized responses during language tasks in frontal and temporal regions. Spectral EEG analysis could be developed into a readily available language lateralization modality.

Novel quantitative digital image analysis methodology for assessment of inflammatory changes in MRI data in a post-hoc analysis of data acquired from a phase IIb study of baricitinib in patients with active rheumatoid arthritis.

PURPOSE: To evaluate a novel quantitative methodology to assess inflammatory changes in magnetic resonance imaging (MRI) data from patients with rheumatoid arthritis (RA) and the impact of image quality on imaging outcomes compared to the RA Magnetic Resonance Imaging Score (RAMRIS). METHODS: Three-dimensional, T1-weighted, fat-suppressed MRI sequences of the hand/wrist before and after intravenous Gadolinium contrast from patients with RA in a placebo-controlled clinical trial (NCT01185353) were re-evaluated post hoc. The methodology was integrated into proprietary software (DYNAMIKA®) and assessed inflammation through pixelated measurements of the contrast-enhancing (inflammatory) volume. A semi-automatic approach outlined contrast-enhancing synovial tissue in the wrist and second to fifth metacarpophalangeal joints with a rough region of interest (ROI); quantitative imaging biomarkers were generated by means of quantitative total volume of inflammation and quantitative degree of inflammation relative to the signal in a 1 cm in diameter ROI in the center of the thenar or lumbrical muscle for internal reference. The time from Gadolinium injection to finalization of the post-contrast images was calculated from the images' Digital Imaging and Communications in Medicine header. An experienced reader graded image quality as poor, acceptable, or good. RESULTS: Results from this quantitative methodology, especially when excluding images with poor quality scores (14-32%), provided a more pronounced and monotonically increasing dose-response than the original RAMRIS results on synovitis and osteitis. CONCLUSIONS: This computer-aided quantitative scoring method provided continuous measures of inflammatory changes relative to muscle and may be more sensitive and interpretable concerning dose/response separation between RA treatment groups.

Pre-Transplant Marital Status and Hematopoietic Cell Transplantation Outcomes

Background: Evidence about the impact of marital status before hematopoietic cell transplantation (hct) on outcomes after hct is conflicting. Methods: We identified patients 40 years of age and older within the Center for International Blood and Marrow Transplant Research registry who underwent hct between January 2008 and December 2015. Marital status before hct was declared as one of: married or living with a partner, single (never married), separated or divorced, and widowed. We performed a multivariable analysis to determine the association of marital status with outcomes after hct. Results: We identified 10,226 allogeneic and 5714 autologous hct cases with, respectively, a median follow-up of 37 months (range: 1-102 months) and 40 months (range: 1-106 months). No association between marital status and overall survival was observed in either the allogeneic (p = 0.58) or autologous (p = 0.17) setting. However, marital status was associated with grades 2-4 acute graft-versus-host disease (gvhd), p < 0.001, and chronic gvhd, p = 0.04. The risk of grades 2-4 acute gvhd was increased in separated compared with married patients [hazard ratio (hr): 1.13; 95% confidence interval (ci): 1.03 to 1.24], and single patients had a reduced risk of grades 2-4 acute gvhd (hr: 0.87; 95% ci: 0.77 to 0.98). The risk of chronic gvhd was lower in widowed compared with married patients (hr: 0.82; 95% ci: 0.67 to 0.99). Conclusions: Overall survival after hct is not influenced by marital status, but associations were evident between marital status and grades 2-4 acute and chronic gvhd. To better appreciate the effects of marital status and social support, future research should consider using validated scales to measure social support and patient and caregiver reports of caregiver commitment, and to assess health-related quality of life together with health care utilization.

Development of an Insulin-Prescribing Chart for Paediatric Diabetes

Aim Our aim was to design a new insulin prescribing tool in compliance with the Irish Medicines Safety Network recommendations. Methods In 2015, we undertook a review of the existing paediatric subcutaneous insulin-prescribing sheet introduced to Cork University Hospital in 2013. This involved a retrospective analysis of 15 consecutive in-patient insulin prescribing charts and a questionnaire distributed to health professionals. Following this a new insulin prescribing chart was designed and implemented in 2016 and a re-audit was performed in 2017. Results The 2017 re-audit demonstrated that the new insulin chart was viewed as easier (95% of previous users n=18) and safer (n=16) to use. There was less confusion (2017: 28%, n=11/39 vs 2015: 50%, n=17/34 2015) and the ALERT system helped staff standardise hypo/hyperglycaemia management (71%, n=28). Conclusion The new paediatric insulin prescribing chart has improved safety and ease of prescribing insulin. The colour coded quasi graph and ALERT system has made it easier to appreciate capillary blood glucose trends and manage them safely.

Patient eligibility for hematopoietic stem cell transplantation: a review of patient-associated variables.

Assessing patient eligibility for hematopoietic stem cell transplantation (HSCT) remains a complex, multifaceted challenge. Among these challenges, the paucity of comprehensive clinical data to guide decision making remains problematic coupled with unclear trade-offs between patient, disease and local HSCT center factors. Moreover, it is unclear that the modification of poor patient characteristics will improve post-HSCT outcomes. However, the use of Comorbidity Indices and Comprehensive Geriatric Assessments helps meet this challenge, but may be limited by overlapping patient characteristics. The increasing consideration for pre-HSCT psychosocial assessments and interventions remains to be studied. Ultimately, the decision to proceed with a HSCT remains interdisciplinary while considering the available evidence discussed in this review.

Towards High Capacity Li-ion Batteries Based on Silicon-Graphene Composite Anodes and Sub-micron V-doped LiFePO4 Cathodes.

Lithium iron phosphate, LiFePO4 (LFP) has demonstrated promising performance as a cathode material in lithium ion batteries (LIBs), by overcoming the rate performance issues from limited electronic conductivity. Nano-sized vanadium-doped LFP (V-LFP) was synthesized using a continuous hydrothermal process using supercritical water as a reagent. The atomic % of dopant determined the particle shape. 5 at. % gave mixed plate and rod-like morphology, showing optimal electrochemical performance and good rate properties vs. Li. Specific capacities of >160 mAh g-1 were achieved. In order to increase the capacity of a full cell, V-LFP was cycled against an inexpensive micron-sized metallurgical grade Si-containing anode. This electrode was capable of reversible capacities of approximately 2000 mAh g-1 for over 150 cycles vs. Li, with improved performance resulting from the incorporation of few layer graphene (FLG) to enhance conductivity, tensile behaviour and thus, the composite stability. The cathode material synthesis and electrode formulation are scalable, inexpensive and are suitable for the fabrication of larger format cells suited to grid and transport applications.

Observation of the Leggett-Rice effect in a unitary Fermi gas.

We observe that the diffusive spin current in a strongly interacting degenerate Fermi gas of (40)K precesses about the local magnetization. As predicted by Leggett and Rice, precession is observed both in the Ramsey phase of a spin-echo sequence, and in the nonlinearity of the magnetization decay. At unitarity, we measure a Leggett-Rice parameter γ=1.08(9) and a bare transverse spin diffusivity D(0)(⊥)=2.3(4)ℏ/m for a normal-state gas initialized with full polarization and at one-fifth of the Fermi temperature, where m is the atomic mass. One might expect γ=0 at unitarity, where two-body scattering is purely dissipative. We observe γ→0 as temperature is increased towards the Fermi temperature, consistent with calculations that show the degenerate Fermi sea restores a nonzero γ. Tuning the scattering length a, we find that a sign change in γ occurs in the range 0<(k(F)a)(-1)≲1.3, where k(F) is the Fermi momentum. We discuss how γ reveals the effective interaction strength of the gas, such that the sign change in γ indicates a switching of branch between a repulsive and an attractive Fermi gas.

Transverse demagnetization dynamics of a unitary Fermi gas.

Understanding the quantum dynamics of strongly interacting fermions is a problem relevant to diverse forms of matter, including high-temperature superconductors, neutron stars, and quark-gluon plasma. An appealing benchmark is offered by cold atomic gases in the unitary limit of strong interactions. Here, we study the dynamics of a transversely magnetized unitary Fermi gas in an inhomogeneous magnetic field. We observe the demagnetization of the gas, caused by diffusive spin transport. At low temperatures, the diffusion constant saturates to the conjectured quantum-mechanical lower bound ≃ h/m, where m is the particle mass. The development of pair correlations, indicating the transformation of the initially noninteracting gas toward a unitary spin mixture, is observed by measuring Tan's contact parameter.

A test of engagement versus disengagement in catastrophe models.

The present study explored the interactive effects of self-efficacy and increasing/decreasing task difficulty upon engagement and disengagement within a cusp-catastrophe model framework. Using a closed motor skill aiming task participants (N=60) were required to compete in conditions where task difficulty increased and then decreased (or vice versa) where they were rewarded for good performance but penalized for bad. Participants who reported low levels of self-efficacy disengage at an earlier level of task difficulty than their high self-efficacy counterparts. Furthermore, this group did not re-engage with the task until task difficulty had significantly decreased. Although task disengagement occurred with high difficulty in the high self-efficacy group, this group re-engaged in a similar manner in which they disengaged. Findings support and extend those of previous tests of catastrophe models by directly allowing for task disengagement.

Oligonucleotide-based gene correction strategies: applications to neuromuscular and cardiovascular diseases.

Gene augmentation is an attractive and viable approach in treatment of inherited diseases, despite its limitations, ie, the amount of viral genome in replication-defective viral vectors is often too small for larger copy DNAs to be inserted. In addition, most viral vectors, when assessed in vivo, can elicit a host immune response, especially in cases of introduction of a gene copy where protein is completely absent, may have potential mutagenic effect on the host genome, or may be down-regulated. Therefore, alternative therapeutic approaches are being investigated, such as chimeraplasty, in which a mutated allele that already exists in an affected individual can be corrected. Although the only gene defects that can be corrected by chimeraplasty are point mutations, and the correction frequencies are variable, it has been observed that intracellular delivery of oligonucleotides is likely to be more efficient than that of plasmid DNA or viral vectors, because corrected genes are expressed from their autologous promoters, ensuring thus correct spatial and temporal expression, and host immune response is not elicited. Another strategy in the therapy of inherited diseases, such as Duchenne muscular dystrophy, is the application of antisense RNA oligonucleotides, or splicomers, to the exclusion of exons whose mutation leads to production of deficient essential proteins. Here we report the recent progress made and problems encountered in each of these fields, and discuss the potential of nucleotide-based gene correction strategies in treatment of neuromuscular and cardiovascular diseases.

Involvement of CD 8+ and CD 3+ lymphocytes in the transport of Eimeria necatrix sporozoites within the intestinal mucosa of chickens.

The phenotype of cells transporting sporozoites of Eimeria necatrix during a primary infection was determined using a panel of six monoclonal antibodies to various chicken lymphocyte surface markers. Sporozoites and cells harboring them were examined at 8, 12 and 18 h postinfection using two-color immunoflorescence and confocal microscopy. The majority of parasites observed within lymphocytes were found in CD 8 + (15%) or CD 3+ (13-22%) cells at all time periods examined. Smaller numbers were found within deltagamma TCR+ (5%) and alphabeta TCR+ (5%) lymphocytes. No sporozoites were found within CD 4+ or IgM+ lymphocytes at any of the time periods.

A comparison of sporozoite transport after homologous and heterologous challenge in chickens immunized with the Guelph strain or the Florida strain of Eimeria maxima.

The two strains of Eimeria maxima, Guelph and Florida, used in this study were previously shown to only partially cross-protect immunologically with respect to lesion scores, weight gains and feed conversions after heterologous challenge. In this paper, we provide evidence that this partial lack of cross-protection is manifested at the level of sporozoite transport. In birds immunized and challenged with the homologous strain, sporozoites accumulated in the lamina propria and were blocked from further movement into the crypts by 72 h post-challenge, unlike the situation observed in naive birds. Fewer than 5% of sporozoites were found in the crypts by 72 h post-challenge. In immunized birds challenged with the heterologous strain, fewer sporozoites reached the crypts than in naive birds but at least four times as many sporozoites successfully migrated to the crypts, when compared with birds challenged with the homologous strain. The degree of cross-protection afforded by the heterologous strain as measured by sporozoite transport success was not equally reciprocal.

Heart failure with preserved LV function: pathophysiology, clinical presentation, treatment, and nursing implications.

The syndrome of congestive heart failure occurring secondary to diastolic dysfunction accounts for the major pathophysiologic mechanism in up to one-third of patients who present with dyspnea on exertion and pulmonary congestion. Diastolic dysfunction is characterized by an alteration in the normal diastolic pressure-volume relationship while systolic function may be normal. It is manifested by impairment in the left ventricle's ability to relax and fill completely during diastole at normal low ventricular pressures. This subset of heart failure is most commonly associated with concentric left ventricular hypertrophy and ischemic states. Symptom presentation is similar to that associated with systolic dysfunction as are rates of rehospitalization. Diagnosis is made based on data obtained from invasive and noninvasive procedures. Unlike in the setting of systolic dysfunction, however, there are no large-scale randomized clinical trials evaluating drug efficacy that could be used to guide treatment for the management of diastolic dysfunction. Treatment recommendations, therefore, are empiric. Identifying and aggressively treating potentially reversible causes is a priority. Many of the same drugs used in the management of heart failure associated with systolic dysfunction are also used in the setting of diastolic impairment; however, dosages and rationale for administration may differ. Nursing interventions too are similar. Monitoring response to medications, especially in the acute setting, and comprehensive patient education are paramount. Much is yet to be learned about the management of diastolic dysfunction.

HpSA: assessment of a new non-invasive diagnostic assay for Helicobacter pylori infection in an Irish population.

BACKGROUND: The diagnosis of Helicobacter pylori is an essential element in the management of many common gastrointestinal pathologies. Previously diagnosis was dependent on the availability of endoscopic biopsy samples. The advent of non invasive assays such as the C13Urea breath test and Elisa serology have enabled diagnosis and treatment to be undertaken in the primary care setting. The isolation of Helicobacter pylori antigen from stool has led to the development of a new non-invasive test. AIM: A prospective study was designed to assess and compare the performance of Premier Platinum HpSA with current gold standard tests. METHODS: Consecutive patients undergoing a gastroscopy for investigation of dyspepsia at the Meath and Adelaide hospitals were enrolled. At endoscopy gastric biopsies were taken for histology, microbiology and rapid urease testing. In addition all subjects had C13UBT, serology and stool tests performed. Individuals who were H. pylori positive received standard proton pump inhibitor based triple therapy. Following treatment all tests, apart from serology were repeated. RESULTS: 54 patients were enrolled, 46 per cent were H. pylori positive. HpSA had a sensitivity and specificity and positive and negative predicted values of 96 per cent, 75 per cent and 80.6 per cent, 75.8 per cent respectively and compared favourably with all other tests. The sensitivity and specificities of the other tests were, histology 79.2 per cent and 100 per cent, culture 68 per cent and 100 per cent, rapid urease test 75 per cent and 100 per cent, serology 75 per cent and 96 per cent and C13 urea breath test 100 per cent and 96.6 per cent. CONCLUSION: The detection of H. pylori antigen in stool by means of a HpSA assay is a new and effective non-invasive means of diagnosis which can be performed in a routine laboratory setting. It is simple to perform and has possible advantages over other non-invasive tests, detecting actual antigen indicating current active infection.

Management of chronic stable angina.

Coronary artery disease (CAD) remains the number one cause of death and disability in men and women in the United States and all industrialized societies. The prevalence of CAD is increasing as the population ages. The predominant presenting symptom is angina, classified as chronic stable, microvascular, Prinzmetal's, or unstable. Chronic stable angina is the form most often encountered in the primary care setting. With appropriate management, long-term prognosis is good. Because anginal thresholds vary, treatment must address individual patients' needs. Patients should be counseled throughout follow-up and educated about modifying risk factors and managing routine activities. Most patients can be treated pharmacologically with single or combination therapy including long-acting nitrates, beta-blockers, and calcium channel blockers. Consultation with a cardiologist during follow-up may also be warranted.

Detection of toxigenic strains of Bacillus cereus and other Bacillus spp. with an improved cytotoxicity assay.

An improved qualitative cell cytotoxicity assay for the detection of Bacillus cereus emetic and enterotoxin is described. The presence of toxin in culture supernatant fluids was detected by measurement with the tetrazolium salt MTT, as it adversely affects the metabolic status of cultured CHO cells. Psychrotrophic B. cereus isolates (65) were assessed for toxin production using the cytotoxicity assay, and 91% of culture supernatant fluids were cytotoxic. Toxin assessment using BCET-RPLA and ELISA immunoassays indicated that 51% and 85% of the cultures, respectively, were toxigenic. There were pronounced strain differences in the amount of toxin produced by the B. cereus isolates. Some isolates of B. circulans, B. laterosporus/cereus, B. lentus, B. licheniformis, B. mycoides, B. subtilis and B. thuringiensis were also toxigenic.

Cut the risks for cardiac cath patients.

As the list of interventions performed with the aid of femoral catheterization grows, so does the number of patients at risk for developing post-procedure problems. Here's a primer on how to recognize and prevent complications like pseudoaneurysm, arteriovenous fistulas, and retroperitoneal hematoma.