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1.
Brain ; 147(5): 1914-1925, 2024 May 03.
Article in English | MEDLINE | ID: mdl-38181433

ABSTRACT

Autologous bone marrow mononuclear cells (BMMNCs) infused after severe traumatic brain injury have shown promise for treating the injury. We evaluated their impact in children, particularly their hypothesized ability to preserve the blood-brain barrier and diminish neuroinflammation, leading to structural CNS preservation with improved outcomes. We performed a randomized, double-blind, placebo-sham-controlled Bayesian dose-escalation clinical trial at two children's hospitals in Houston, TX and Phoenix, AZ, USA (NCT01851083). Patients 5-17 years of age with severe traumatic brain injury (Glasgow Coma Scale score ≤ 8) were randomized to BMMNC or placebo (3:2). Bone marrow harvest, cell isolation and infusion were completed by 48 h post-injury. A Bayesian continuous reassessment method was used with cohorts of size 3 in the BMMNC group to choose the safest between two doses. Primary end points were quantitative brain volumes using MRI and microstructural integrity of the corpus callosum (diffusivity and oedema measurements) at 6 months and 12 months. Long-term functional outcomes and ventilator days, intracranial pressure monitoring days, intensive care unit days and therapeutic intensity measures were compared between groups. Forty-seven patients were randomized, with 37 completing 1-year follow-up (23 BMMNC, 14 placebo). BMMNC treatment was associated with an almost 3-day (23%) reduction in ventilator days, 1-day (16%) reduction in intracranial pressure monitoring days and 3-day (14%) reduction in intensive care unit (ICU) days. White matter volume at 1 year in the BMMNC group was significantly preserved compared to placebo [decrease of 19 891 versus 40 491, respectively; mean difference of -20 600, 95% confidence interval (CI): -35 868 to -5332; P = 0.01], and the number of corpus callosum streamlines was reduced more in placebo than BMMNC, supporting evidence of preserved corpus callosum connectivity in the treated groups (-431 streamlines placebo versus -37 streamlines BMMNC; mean difference of -394, 95% CI: -803 to 15; P = 0.055), but this did not reach statistical significance due to high variability. We conclude that autologous BMMNC infusion in children within 48 h after severe traumatic brain injury is safe and feasible. Our data show that BMMNC infusion led to: (i) shorter intensive care duration and decreased ICU intensity; (ii) white matter structural preservation; and (iii) enhanced corpus callosum connectivity and improved microstructural metrics.


Subject(s)
Bone Marrow Transplantation , Brain Injuries, Traumatic , Transplantation, Autologous , Humans , Child , Brain Injuries, Traumatic/therapy , Male , Female , Adolescent , Double-Blind Method , Child, Preschool , Bone Marrow Transplantation/methods , Transplantation, Autologous/methods , Magnetic Resonance Imaging , Treatment Outcome , Leukocytes, Mononuclear/transplantation , Bayes Theorem
2.
Br J Haematol ; 202(2): 267-278, 2023 07.
Article in English | MEDLINE | ID: mdl-37221131

ABSTRACT

Unicentric Castleman disease (UCD) is a lymphoproliferative disease of unknown cause. Paraneoplastic pemphigus (PNP) is a major complication shown to be associated with a poor prognosis, with particular severity in patients with bronchiolitis obliterans (BO). This study describes the clinical and biological characteristics of UCD-PNP patients in a large Western cohort. A total of 148 patients diagnosed with UCD were identified, including 14 patients with a defined PNP. PNP was significantly associated with myasthenia gravis (MG) and FDC sarcoma during follow-up (FDCS). PNP was also significantly associated with reduced survival. These data, together with a multivariate analysis by principal components, led to the identification of UCD-PNP as a group at risk of MG, FDCS and death. PDGFRB sequencing performed on UCD lesions from six patients found the gain-of-function p.N666S variant in two. Interestingly, both patients had hyaline-vascular UCD subtype, were in the UCD-PNP subgroup and had FDCS. Sera from 25 UCD-PNP patients and 6 PNP patients without UCD were tested for PNP-associated autoantibodies. Sera from UCD-PNP patients had a strong reactivity against the N-terminal domain of recombinant periplakin (rPPL, 82%) and showed reactivity against at least two domains of rPPL. These features were not found in patients with UCD alone or in the PNP group without UCD. These data indicate that UCD-PNP patients belong to a subgroup sharing strong clinical and biological identity that might help to decipher the different dynamics of UCD natural history.


Subject(s)
Castleman Disease , Myasthenia Gravis , Paraneoplastic Syndromes , Pemphigus , Humans , Pemphigus/diagnosis , Pemphigus/etiology , Castleman Disease/pathology , Autoantibodies , Myasthenia Gravis/diagnosis , Paraneoplastic Syndromes/etiology , Paraneoplastic Syndromes/diagnosis
3.
J Biol Chem ; 295(52): 18065-18075, 2020 12 25.
Article in English | MEDLINE | ID: mdl-33082141

ABSTRACT

TNF is a highly pro-inflammatory cytokine that contributes not only to the regulation of immune responses but also to the development of severe inflammatory diseases. TNF is synthesized as a transmembrane protein, which is further matured via proteolytic cleavage by metalloproteases such as ADAM17, a process known as shedding. At present, TNF is mainly detected by measuring the precursor or the mature cytokine of bulk cell populations by techniques such as ELISA or immunoblotting. However, these methods do not provide information on the exact timing and extent of TNF cleavage at single-cell resolution and they do not allow the live visualization of shedding events. Here, we generated C-tag TNF as a genetically encoded reporter to study TNF shedding at the single-cell level. The functionality of the C-tag TNF reporter is based on the exposure of a cryptic epitope on the C terminus of the transmembrane portion of pro-TNF on cleavage. In both denatured and nondenatured samples, this epitope can be detected by a nanobody in a highly sensitive and specific manner only upon TNF shedding. As such, C-tag TNF can successfully be used for the detection of TNF cleavage in flow cytometry and live-cell imaging applications. We furthermore demonstrate its applicability in a forward genetic screen geared toward the identification of genetic regulators of TNF maturation. In summary, the C-tag TNF reporter can be employed to gain novel insights into the complex regulation of ADAM-dependent TNF shedding.


Subject(s)
ADAM Proteins/metabolism , Genes, Reporter , Image Processing, Computer-Assisted/methods , Molecular Imaging/methods , Protein Kinase C/metabolism , Tumor Necrosis Factor-alpha/metabolism , ADAM Proteins/genetics , HEK293 Cells , Humans , Protein Kinase C/genetics , Proteolysis , Tumor Necrosis Factor-alpha/genetics
4.
Cogn Emot ; 34(8): 1561-1572, 2020 12.
Article in English | MEDLINE | ID: mdl-32576091

ABSTRACT

Previous long-term memory (LTM) research found that angry faces were more poorly recognised when encoded with averted vs. direct gaze, while memory for happy faces was unaffected by gaze. Contrastingly, working memory (WM) accuracy for angry faces was unaffected by gaze, but WM was enhanced for happy faces with averted vs. direct gaze. Because the LTM study was conducted in an Eastern culture (Japan) with Japanese faces, while the WM study was conducted in a Western culture (UK) with Caucasian faces, here we investigated WM further to examine whether gaze effects diverge due to cultural variation between the faces and participants. When Western participants viewed Japanese faces (Experiment 1), the happy-averted gaze advantage in WM was replicated. In contrast, Japanese participants viewing Caucasian faces (Experiment 2a) showed poorer WM for angry faces with averted vs. direct gaze, and no influence of gaze on WM for happy faces. When Japanese participants viewed Japanese faces (Experiment 2b), gaze did not modulate WM. Therefore, the way in which expression and gaze interact to influence face WM does not appear to rely on the specific memory system engaged, but instead may be attributed to cultural differences in display rules between Eastern and Western cultures.


Subject(s)
Anger/physiology , Cross-Cultural Comparison , Facial Expression , Fixation, Ocular/physiology , Happiness , Memory, Short-Term/physiology , Adult , Female , Humans , Japan/ethnology , Male , United Kingdom/ethnology , Young Adult
5.
Ann Surg ; 270(3): 519-527, 2019 09.
Article in English | MEDLINE | ID: mdl-31415304

ABSTRACT

INTRODUCTION: Early cholecystectomy shortly after admission for mild gallstone pancreatitis has been proposed based on observational data. We hypothesized that cholecystectomy within 24 hours of admission versus after clinical resolution of gallstone pancreatitis that is predicted to be mild results in decreased length-of-stay (LOS) without an increase in complications. METHODS: Adults with predicted mild gallstone pancreatitis were randomized to cholecystectomy with cholangiogram within 24 hours of presentation (early group) versus after clinical resolution (control) based on abdominal exam and normalized laboratory values. Primary outcome was 30-day LOS including readmissions. Secondary outcomes were time to surgery, endoscopic retrograde cholangiopancreatography (ERCP) rates, and postoperative complications. Frequentist and Bayesian intention-to-treat analyses were performed. RESULTS: Baseline characteristics were similar in the early (n = 49) and control (n = 48) groups. Early group had fewer ERCPs (15% vs 29%, P = 0.038), faster time to surgery (16 h vs 43 h, P < 0.005), and shorter 30-day LOS (50 h vs 77 h, RR 0.68 95% CI 0.65 - 0.71, P < 0.005). Complication rates were 6% in early group versus 2% in controls (P = 0.613), which included recurrence/progression of pancreatitis (2 early, 1 control) and a cystic duct stump leak (early). On Bayesian analysis, early cholecystectomy has a 99% probability of reducing 30-day LOS, 93% probability of decreasing ERCP use, and 72% probability of increasing complications. CONCLUSION: In patients with predicted mild gallstone pancreatitis, cholecystectomy within 24 hours of admission reduced rate of ERCPs, time to surgery, and 30-day length-of-stay. Minor complications may be increased with early cholecystectomy. Identification of patients with predicted mild gallstone pancreatitis in whom early cholecystectomy is safe warrants further investigation.


Subject(s)
Cholangiopancreatography, Endoscopic Retrograde/methods , Cholecystectomy, Laparoscopic/methods , Gallstones/complications , Length of Stay , Pancreatitis/etiology , Pancreatitis/surgery , Adult , Age Factors , Bayes Theorem , Cholangiography/methods , Female , Gallstones/diagnostic imaging , Gallstones/surgery , Humans , Intraoperative Care/methods , Male , Middle Aged , Pancreatitis/physiopathology , Patient Admission , Prognosis , Reference Values , Risk Assessment , Severity of Illness Index , Sex Factors , Time-to-Treatment , Treatment Outcome
6.
Stem Cells ; 35(4): 1065-1079, 2017 04.
Article in English | MEDLINE | ID: mdl-27800660

ABSTRACT

Preclinical studies using bone marrow derived cells to treat traumatic brain injury have demonstrated efficacy in terms of blood-brain barrier preservation, neurogenesis, and functional outcomes. Phase 1 clinical trials using bone marrow mononuclear cells infused intravenously in children with severe traumatic brain injury demonstrated safety and potentially a central nervous system structural preservation treatment effect. This study sought to confirm the safety, logistic feasibility, and potential treatment effect size of structural preservation/inflammatory biomarker mitigation in adults to guide Phase 2 clinical trial design. Adults with severe traumatic brain injury (Glasgow Coma Scale 5-8) and without signs of irreversible brain injury were evaluated for entry into the trial. A dose escalation format was performed in 25 patients: 5 controls, followed 5 patients in each dosing cohort (6, 9, 12 ×106 cells/kg body weight), then 5 more controls. Bone marrow harvest, cell processing to isolate the mononuclear fraction, and re-infusion occurred within 48 hours after injury. Patients were monitored for harvest-related hemodynamic changes, infusional toxicity, and adverse events. Outcome measures included magnetic resonance imaging-based measurements of supratentorial and corpus callosal volumes as well as diffusion tensor imaging-based measurements of fractional anisotropy and mean diffusivity of the corpus callosum and the corticospinal tract at the level of the brainstem at 1 month and 6 months postinjury. Functional and neurocognitive outcomes were measured and correlated with imaging data. Inflammatory cytokine arrays were measured in the plasma pretreatment, posttreatment, and at 1 and 6 month follow-up. There were no serious adverse events. There was a mild pulmonary toxicity of the highest dose that was not clinically significant. Despite the treatment group having greater injury severity, there was structural preservation of critical regions of interest that correlated with functional outcomes. Key inflammatory cytokines were downregulated. Treatment of severe, adult traumatic brain injury using an intravenously delivered autologous bone marrow mononuclear cell infusion is safe and logistically feasible. There appears to be a treatment signal as evidenced by central nervous system structural preservation, consistent with previous pediatric trial data. Inflammatory biomarkers are downregulated after cell infusion. Stem Cells 2016 Video Highlight: https://youtu.be/UiCCPIe-IaQ Stem Cells 2017;35:1065-1079.


Subject(s)
Bone Marrow Cells/cytology , Brain Injuries, Traumatic/therapy , Leukocytes, Mononuclear/transplantation , Adult , Behavior , Biomarkers/blood , Brain Injuries, Traumatic/blood , Brain Injuries, Traumatic/pathology , Corpus Callosum/pathology , Cytokines/blood , Female , Gray Matter/pathology , Humans , Inflammation Mediators/metabolism , Male , Pyramidal Tracts/pathology , Treatment Outcome
7.
J Sex Med ; 15(12): 1698-1706, 2018 12.
Article in English | MEDLINE | ID: mdl-30527053

ABSTRACT

INTRODUCTION: Few treatments are available for men with premature ejaculation (PE); oxytocin (OT) receptor antagonism in the central nervous system (CNS) is a potential new approach. AIM: To determine if cligosiban selectively inhibits human OT receptors, penetrates the CNS, shows pharmacology in the CNS, and effects ejaculatory physiology in pre-clinical systems. METHODS: Experiments complied with United Kingdom legislation and were subject to local ethical review. In vitro potency and selectivity of cligosiban was assessed using recombinant and native OT receptor systems including both neuronal and non-neuronal cell types. Selectivity was determined over neighboring V1A, V1B, and V2 vasopressin receptors using a combination of recombinant and native vasopressin receptor assay systems. To determine an effect on central OT receptors and on ejaculation, cligosiban was evaluated in 2 anesthetized rat models-the electromyography model of ejaculatory physiology and a model of OT-mediated CNS neuronal firing. The CNS penetration of cligosiban was also determined by measuring cerebrospinal fluid and plasma drug concentrations following an intravenous (IV) infusion in rats. MAIN OUTCOME MEASURE: These were functional measures of pharmacology in vitro, in cell lines and tissues, and in vivo in rats. RESULTS: Cligosiban is a potent OT receptor antagonist, with a base dissociation constant of 5.7 nmol/L against native human uterine smooth muscle cell OT receptors. Cligosiban displays similar antagonistic potency against human recombinant and rat native OT receptors, including neuronal OT receptors. Cligosiban demonstrates >100-fold selectivity over human V1A, V1B, and V2 vasopressin receptors. In the electromyography model, cligosiban (0.9 mg/kg, IV bolus) reduced the bulbospongiosum burst pattern and contraction amplitude associated with ejaculation. In the anesthetized CNS neuronal firing model, the same dosing regimen of cligosiban (0.9 mg/kg IV bolus) modulated the OT-mediated response in the nucleus tractus solitarius. After systemic dosing to rats, cligosiban showed good CNS penetration. CLINICAL IMPLICATIONS: As the first highly selective and centrally penetrant OT receptor antagonist, cligosiban represents a promising compound to test the clinical hypothesis that antagonism of central OT receptors may be of therapeutic benefit in the treatment of PE. STRENGTH & LIMITATIONS: The pharmacology and selectivity of cligosiban is determined using functional assays in recombinant cell lines, native cell lines, and tissue. Functional outcomes in in vivo systems are linked to CNS measures of pharmacology. The translation of the animal models of ejaculation to PE in man is unproven. CONCLUSION: Cligosiban, a potent, selective OT receptor antagonist, demonstrated CNS penetration and pharmacology and, using the same dosing regimen, inhibited apomorphine-induced ejaculation in rats. Cligosiban is a promising compound to test the clinical hypothesis that antagonism of central OT receptors may be of therapeutic benefit in the treatment of PE. Wayman C, Russell R, Tang K, et al. Cligosiban, A Novel Brain Penetrant Selective Oxytocin Receptor Antagonist, Inhibits Ejaculatory Physiology in Rodents. J Sex Med 2018;15:1698-1706.


Subject(s)
Ejaculation/drug effects , Oxytocin/pharmacology , Premature Ejaculation/drug therapy , Receptors, Oxytocin/antagonists & inhibitors , Receptors, Vasopressin/drug effects , Animals , Brain/metabolism , Dose-Response Relationship, Drug , Hormone Antagonists/pharmacology , Humans , Male , Rats , Rodentia , United Kingdom
8.
Cogn Emot ; 32(4): 719-728, 2018 06.
Article in English | MEDLINE | ID: mdl-28665181

ABSTRACT

Previous research has shown that angry and happy faces are perceived as less emotionally intense when shown with averted versus direct gaze. Other work reports that long-term memory (LTM) for angry (but not happy) faces was poorer when they were encoded with averted versus direct gaze, suggesting that threat signals are diluted when eye contact is not engaged. The current study examined whether gaze modulates working memory (WM) for angry and happy faces. In stark contrast to LTM effects, WM for angry faces was not significantly modulated by gaze direction. However, WM for happy faces was significantly enhanced when gaze was averted versus direct. These findings suggest that in WM - when rapid processing and an immediate response is required - averted gaze may alter the meaning behind a smile, and make this kind of expression particularly salient for short-term processing.


Subject(s)
Anger/physiology , Facial Expression , Fixation, Ocular/physiology , Happiness , Memory, Short-Term/physiology , Female , Humans , Male , Young Adult
9.
J Surg Res ; 214: 38-48, 2017 06 15.
Article in English | MEDLINE | ID: mdl-28624058

ABSTRACT

BACKGROUND: No treatment is available to reverse injury associated with traumatic brain injury (TBI). Progenitor cell therapies show promise in both preclinical and clinical studies. We conducted a meta-analysis of preclinical studies using progenitor cells to treat TBI. METHODS: EMBASE, MEDLINE, Cochrane Review, Biosis, and Google Scholar were searched for articles using prespecified search strategies. Studies meeting inclusion criteria underwent data extraction. Analysis was performed using Review Manager 5.3 according to a fixed-effects model, and all studies underwent quality scoring. RESULTS: Of 430 abstracts identified, 38 met inclusion criteria and underwent analysis. Average quality score was 4.32 of 8 possible points. No study achieved a perfect score. Lesion volume (LV) and neurologic severity score (NSS) outcomes favored cell treatment with standard mean difference (SMD) of 0.86 (95% CI: 0.64-1.09) and 1.36 (95% CI: 1.11-1.60), respectively. Rotarod and Morris water maze outcomes also favored treatment with improvements in SMD of 0.34 (95% CI: 0.02-0.65) and 0.46 (95% CI: 0.17-74), respectively. Although LV and NSS were robust to publication bias assessments, rotarod and Morris water maze tests were not. Heterogeneity (I2) ranged from 74%-85% among the analyses, indicating a high amount of heterogeneity among studies. Precision as a function of quality score showed a statistically significant increase in the size of the confidence interval as quality improved. CONCLUSIONS: Our meta-analysis study reveals an overall positive effect of progenitor cell therapies on LV and NSS with a trend toward improved motor function and spatial learning in different TBI animal models.


Subject(s)
Brain Injuries, Traumatic/therapy , Models, Animal , Stem Cell Transplantation , Animals , Models, Statistical , Treatment Outcome
10.
Hum Mol Genet ; 23(1): 247-58, 2014 Jan 01.
Article in English | MEDLINE | ID: mdl-23962720

ABSTRACT

We present the analysis of a prospective multicentre study to investigate genetic effects on the prognosis of newly treated epilepsy. Patients with a new clinical diagnosis of epilepsy requiring medication were recruited and followed up prospectively. The clinical outcome was defined as freedom from seizures for a minimum of 12 months in accordance with the consensus statement from the International League Against Epilepsy (ILAE). Genetic effects on remission of seizures after starting treatment were analysed with and without adjustment for significant clinical prognostic factors, and the results from each cohort were combined using a fixed-effects meta-analysis. After quality control (QC), we analysed 889 newly treated epilepsy patients using 472 450 genotyped and 6.9 × 10(6) imputed single-nucleotide polymorphisms. Suggestive evidence for association (defined as Pmeta < 5.0 × 10(-7)) with remission of seizures after starting treatment was observed at three loci: 6p12.2 (rs492146, Pmeta = 2.1 × 10(-7), OR[G] = 0.57), 9p23 (rs72700966, Pmeta = 3.1 × 10(-7), OR[C] = 2.70) and 15q13.2 (rs143536437, Pmeta = 3.2 × 10(-7), OR[C] = 1.92). Genes of biological interest at these loci include PTPRD and ARHGAP11B (encoding functions implicated in neuronal development) and GSTA4 (a phase II biotransformation enzyme). Pathway analysis using two independent methods implicated a number of pathways in the prognosis of epilepsy, including KEGG categories 'calcium signaling pathway' and 'phosphatidylinositol signaling pathway'. Through a series of power curves, we conclude that it is unlikely any single common variant explains >4.4% of the variation in the outcome of newly treated epilepsy.


Subject(s)
Epilepsy/diagnosis , Epilepsy/genetics , Genome-Wide Association Study , Adult , Anticonvulsants/therapeutic use , Calcium Signaling/genetics , Chromosomes, Human, Pair 15 , Chromosomes, Human, Pair 6 , Chromosomes, Human, Pair 9 , Epilepsy/drug therapy , Female , Genetic Predisposition to Disease , Genetic Variation , Humans , Male , Middle Aged , Phosphatidylinositols/genetics , Polymorphism, Single Nucleotide , Prognosis , Prospective Studies , Treatment Outcome , Young Adult
11.
Trop Med Int Health ; 20(9): 1171-1179, 2015 Sep.
Article in English | MEDLINE | ID: mdl-25940786

ABSTRACT

OBJECTIVE: To assess the contribution of neurocysticercosis (NCC) to the burden of epilepsy in a rural Tanzanian population. METHODS: We identified adult people with epilepsy (PWE) in a door-to-door study in an established demographic surveillance site. PWE and community controls were tested for antibodies to Taenia solium, the causative agent of NCC, and all PWE were offered a computed tomography (CT) head scan. Data on household occupancy and sanitation, pig-keeping and pork consumption were collected from PWE and controls and associations with epilepsy were assessed using chi-square or Fisher's exact tests. RESULTS: Six of 218 PWE had antibodies to T. solium (2.8%; 95% CI 0.6-4.9), compared to none of 174 controls (Fisher's exact test, P = 0.04). Lesions compatible with NCC were seen in eight of 200 CT scans (4.0%; 95% CI 1.3-6.7). A total of 176 PWE had both investigations of whom two had positive serology along with NCC-compatible lesions on CT (1.1%; 95% 0.3-4.0). No associations between epilepsy and any risk factors for NCC were identified. CONCLUSIONS: Neurocysticercosis is present in this population but at a lower prevalence than elsewhere in Tanzania and sub-Saharan Africa. Insights from low-prevalence areas may inform public health interventions designed to reduce the burden of preventable epilepsy.

12.
Postgrad Med J ; 91(1081): 655-61, 2015 Nov.
Article in English | MEDLINE | ID: mdl-26399267

ABSTRACT

Non-convulsive status epilepticus (NCSE) presents with minimal seizure activity clinically, but with evidence on EEG. It is a recognised cause of delirium in older people, but prevalence estimates vary widely. As delirium is a common presentation in older people and because NCSE is potentially reversible, an improved diagnostic ability in this group could be highly beneficial. EEG testing is required to make a definitive diagnosis, but this may be difficult due to access to testing, patient adherence and result interpretation. NCSE has two commonly recognised forms: complex partial status epilepticus (CPSE) and absence status epilepticus (ASE). Clinical features associated with NCSE in older people presenting with confusion include a reduction in level of arousal; aphasia or interrupted speech; myoclonus or subtle jerking; staring; automatisms; perseveration or echolalia; increased tone; nystagmus or eye deviation; emotional lability; disinhibition and anosagnosia. Risk factors include female sex, a history of epilepsy or a tonic-clonic seizure around the time of onset, and recent discontinuation of benzodiazepines. A practical approach to the diagnosis of NCSE in older people is suggested based upon the presence of clinical features suggestive of NCSE and local access to EEG testing.


Subject(s)
Anticonvulsants/therapeutic use , Confusion , Status Epilepticus/diagnosis , Aged , Aged, 80 and over , Diagnosis, Differential , Electroencephalography , Female , Health Services for the Aged , Humans , Male , Sex Factors , Status Epilepticus/drug therapy , Status Epilepticus/epidemiology , United Kingdom/epidemiology
13.
Clin Med (Lond) ; 14(4): 422-7, 2014 Aug.
Article in English | MEDLINE | ID: mdl-25099847

ABSTRACT

This concise guidance comprises a distillation of recommendations for the diagnosis and management of epilepsies for non-specialists and is based on updated clinical guideline 137 published by the National Institute of Health and Care Excellence (NICE). It is intended to provide the generalist at the front line (particularly but not exclusively in the acute hospital setting) with an accessible and up-to-date outline of key guidance on assessment, clinical management, communication and referral. Recommendations abstracted verbatim from the guideline are highlighted. Brief explanatory or supporting comment is given where appropriate.


Subject(s)
Epilepsy/diagnosis , Guidelines as Topic , Adolescent , Adult , Child , Epilepsy/therapy , Humans
14.
Cogn Emot ; 28(2): 278-97, 2014.
Article in English | MEDLINE | ID: mdl-23895082

ABSTRACT

Visual working memory (WM) for face identities is enhanced when faces express negative versus positive emotion. To determine the stage at which emotion exerts its influence on memory for person information, we isolated expression (angry/happy) to the encoding phase (Experiment 1; neutral test faces) or retrieval phase (Experiment 2; neutral study faces). WM was only enhanced by anger when expression was present at encoding, suggesting that retrieval mechanisms are not influenced by emotional expression. To examine whether emotional information is discarded on completion of encoding or sustained in WM, in Experiment 3 an emotional word categorisation task was inserted into the maintenance interval. Emotional congruence between word and face supported memory for angry but not for happy faces, suggesting that negative emotional information is preferentially sustained during WM maintenance. Our findings demonstrate that negative expressions exert sustained and beneficial effects on WM for faces that extend beyond encoding.


Subject(s)
Anger , Facial Expression , Memory, Short-Term , Mental Recall , Adult , Emotions , Female , Humans , Male , Photic Stimulation , Recognition, Psychology , Visual Perception , Young Adult
15.
Article in English | MEDLINE | ID: mdl-38421789

ABSTRACT

Visuospatial working memory (VSWM) helps track the identity and location of people during social interactions. Previous work showed better VSWM when all faces at encoding displayed a happy compared to an angry expression, reflecting a prosocial preference for monitoring who was where. However, social environments are not typically uniform, and certain expressions may more strongly compete for and bias face monitoring according to valence and/or arousal properties. Here, we used heterogeneous encoding displays in which two faces shared one emotion and two shared another, and asked participants to relocate a central neutral probe face after a blank delay. When considering the emotion of the probed face independently of the co-occurring emotion at encoding, an overall happy benefit was replicated. However, accuracy was modulated by the nonprobed emotion, with a relocation benefit for angry over sad, happy over fearful, and sad over happy faces. These effects did not depend on encoding fixation time, stimulus arousal, perceptual similarity, or response bias. Thus, emotional competition for faces in VSWM is complex and appears to rely on more than simple arousal- or valence-biased mechanisms. We propose a "social value (SV)" account to better explain when and why certain emotions may be prioritized in VSWM. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

16.
Drug Metab Dispos ; 41(8): 1470-9, 2013 Aug.
Article in English | MEDLINE | ID: mdl-23653442

ABSTRACT

4-(3-(Benzyloxy)phenyl)-2-(ethylsulfinyl)-6-(trifluoromethyl)pyrimidine (BETP) represents a novel small-molecule activator of the glucagon-like peptide-1 receptor (GLP-1R), and exhibits glucose-dependent insulin secretion in rats following i.v. (but not oral) administration. To explore the quantitative pharmacology associated with GLP-1R agonism in preclinical species, the in vivo pharmacokinetics of BETP were examined in rats after i.v. and oral dosing. Failure to detect BETP in circulation after oral administration of a 10-mg/kg dose in rats was consistent with the lack of an insulinotropic effect of orally administered BETP in this species. Likewise, systemic concentrations of BETP in the rat upon i.v. administration (1 mg/kg) were minimal (and sporadic). In vitro incubations in bovine serum albumin, plasma, and liver microsomes from rodents and humans indicated a facile degradation of BETP. Failure to detect metabolites in plasma and liver microsomal incubations in the absence of NADP was suggestive of a covalent interaction between BETP and a protein amino acid residue(s) in these matrices. Incubations of BETP with glutathione (GSH) in buffer revealed a rapid nucleophilic displacement of the ethylsulfoxide functionality by GSH to yield adduct M1, which indicated that BETP was intrinsically electrophilic. The structure of M1 was unambiguously identified by comparison of its chromatographic and mass spectral properties with an authentic standard. The GSH conjugate of BETP was also characterized in NADPH- and GSH-supplemented liver microsomes and in plasma samples from the pharmacokinetic studies. Unlike BETP, M1 was inactive as an allosteric modulator of the GLP-1R.


Subject(s)
Pyrimidines/chemistry , Receptors, Glucagon/metabolism , Allosteric Regulation/drug effects , Animals , CHO Cells , Cricetinae , Cricetulus , Drug Stability , Glucagon-Like Peptide-1 Receptor , Glutathione/chemistry , Humans , Male , Mice , Microsomes, Liver/metabolism , Pyrimidines/metabolism , Pyrimidines/pharmacology , Rats , Rats, Wistar
17.
Bioorg Med Chem Lett ; 23(19): 5410-4, 2013 Oct 01.
Article in English | MEDLINE | ID: mdl-23953189

ABSTRACT

The optimization for selectivity and central receptor occupancy for a series of spirocyclic azetidine-piperidine inverse agonists of the ghrelin receptor is described. Decreased mAChR muscarinic M2 binding was achieved by use of a chiral indane in place of a substituted benzylic group. Compounds with desirable balance of human in vitro clearance and ex vivo central receptor occupancy were discovered by incorporation of heterocycles. Specifically, heteroaryl rings with nitrogen(s) vicinal to the indane linkage provided the most attractive overall properties.


Subject(s)
Central Nervous System/drug effects , Receptors, Ghrelin/antagonists & inhibitors , Amino Acid Sequence , Animals , Binding Sites , Drug Inverse Agonism , Heterocyclic Compounds/chemistry , Heterocyclic Compounds/pharmacology , Humans , Indans/chemistry , Indans/pharmacology , Inhibitory Concentration 50 , Isomerism , Molecular Structure , Protein Binding/drug effects , Rats , Structure-Activity Relationship
18.
Neuropsychobiology ; 67(2): 84-92, 2013.
Article in English | MEDLINE | ID: mdl-23295962

ABSTRACT

BACKGROUND: Genetic susceptibility to schizophrenia (SZ) has been suggested to influence the cortical systems supporting working memory (WM) and face processing. Genetic imaging studies link the SZ risk variant rs1344706 on the ZNF804A gene to psychosis via alterations in functional brain connectivity during WM, but no work has looked at the effects of ZNF804A on WM with face-processing components. METHODS: We therefore investigated healthy controls that were genotyped for rs1344706 with a face WM task during functional magnetic resonance imaging. We suggested that variation at the rs1344706 locus would be associated with similar alterations as patients previously tested using the same WM task for faces. RESULTS: The rs1344706 risk allele was indeed associated with altered activation in the right dorsolateral prefrontal (rDLPFC) cortex. We established that the rDLPFC was activated in a task-dependent manner, suggesting that the differences in activation between rs1344706 genotype groups reflected alterations in task processing. Furthermore, we demonstrated that the rDLPFC region showed significant volumetric overlap with the rDLPFC which had previously been reported to be altered during task processing for patients with SZ. CONCLUSIONS: The findings support an association between rs1344706 and alterations in DLPFC activity during WM for faces. We further suggest that WM for faces may be a useful intermediate phenotype in the investigation of genetic susceptibility to psychosis.


Subject(s)
Brain Mapping , Face , Kruppel-Like Transcription Factors/genetics , Memory, Short-Term/physiology , Polymorphism, Single Nucleotide/genetics , Prefrontal Cortex/physiology , Adult , Analysis of Variance , Emotions/physiology , Female , Functional Laterality , Genotype , Humans , Image Processing, Computer-Assisted , Magnetic Resonance Imaging , Male , Oxygen/blood , Pattern Recognition, Visual , Photic Stimulation , Prefrontal Cortex/blood supply , Recognition, Psychology/physiology , Young Adult
19.
Q J Exp Psychol (Hove) ; 76(7): 1696-1709, 2023 Jul.
Article in English | MEDLINE | ID: mdl-36062351

ABSTRACT

This study investigated the role of attentional resources in processing emotional faces in working memory (WM). Participants memorised two face arrays with the same emotion but different identities and were required to judge whether the test face had the same identity as one of the previous faces. Concurrently during encoding and maintenance, a sequence of high- or low-pitched tones (high load) or white noise bursts (low load) was presented, and participants were required to count how many low-tones were heard. Experiments 1 and 2 used an emotional and neutral test face, respectively. The results revealed a significant WM impairment for sad and angry faces in the high-load versus low-load condition but not for happy faces. In Experiment 1, participants remembered happy faces better than other emotional faces. In contrast, Experiment 2 showed that performance was poorer for happy than sad faces but not for angry faces. This evidence suggests that depleting attentional resources has less impact on WM for happy faces than other emotional faces, but also that differential effects on WM for emotional faces depend on the presence or absence of emotion in the probe face at retrieval.


Subject(s)
Emotions , Memory, Short-Term , Humans , Anger , Attention , Happiness , Facial Expression
20.
iScience ; 26(12): 108367, 2023 Dec 15.
Article in English | MEDLINE | ID: mdl-38025776

ABSTRACT

Cellular crosstalk in the tumor microenvironment (TME) is still largely uncharacterized, while it plays an essential role in shaping immunosuppression or anti-tumor response. Large-scale analyses are needed to better decipher cell-cell communication in cancer. In this work, we used original and publicly available single-cell RNA sequencing (scRNAseq) data to characterize in-depth the communication networks in human clear cell renal cell carcinoma (ccRCC). We identified 50 putative communication channels specifically used by cancer cells to interact with other cells, including two novel angiogenin-mediated interactions. Expression of angiogenin and its receptors was validated at the protein level in primary ccRCC. Mechanistically, angiogenin enhanced ccRCC cell line proliferation and down-regulated secretion of IL-6, IL-8, and MCP-1 proinflammatory molecules. This study provides novel biological insights into molecular mechanisms of ccRCC, and suggests angiogenin and its receptors as potential therapeutic targets in clear cell renal cancer.

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