An Objective Measurement of Lacunar Infarct Location from the Middle Cerebral Artery Stem.

BACKGROUND: There is emerging interest in the relationship between neuroimaging location of lacunar infarcts and underlying stroke risk factors. Recent methods used for localization of lacunar infarcts are affected by high inter-rater variability. We used a novel algorithm-driven method that provided quantitative assessment of the distance of the lacunar infarct from the origins of the lenticulostriate arteries. METHODS: We conducted a retrospective analysis of patients who presented with lacunar infarcts between 2007 and 2011. Diffusion-weighted imaging and magnetic resonance angiography were used to manually mark the infarct lesion and the ipsilateral origins of lenticulostriate arteries. A 3-dimensional distance formula computed the distance between the infarct and the arterial region of interest. All distances were adjusted for brain volumes. Agreement testing using 2 blinded assessors was used to determine reproducibility of this method. RESULTS: One hundred and ten patients were included in our study, with a median age of 72 years (interquartile range 58-81); 67 (61%) were male and 33 (30%) had hypertension and other vascular risk factors including hypercholesterolemia 45 (41%), smoking 33 (30%), diabetes 24 (22%), ischemic heart disease 18 (16%), and atrial fibrillation 9 (8%). The agreement test for 33 patients demonstrated an intraclass correlation of .89 and Lin's correlation coefficient of .89 (95% confidence interval .816-.963). The median distance for the study cohort was 24.5 mm, with shorter median distances of 13.7 mm observed in patients with atrial fibrillation (P value < .005). CONCLUSION: Our study used a novel method to calculate a distance measurement, which has high inter-rater correlation.

The discarded cow from the flowered desert: revalidation of Gyriosomus crispaticollis Fairmaire, 1886 stat. rev. (Coleoptera: Tenebrionidae) in Southern Atacama, Chile.

Gyriosomus crispaticollis Fairmaire, 1886 is revalidated from the synonymy of Gyriosomus luczotii Guérin-Méneville, 1831 based on the study of G. crispaticollis syntypes and comparative morphological and genetic analyses. Our results suggest that G. crispaticollis is morphologically closer to Gyriosomus multigranulosus Pizarro-Araya & Flores, 2004 than G. luczotii, but genetically barely closer to G. luczotii. Also habitat preferences, field observations and lectotype designation are provided for G. crispaticollis.

Taxonomic and systematic implications of the revision of the phylogenetic relations in the genus Ectinogonia Spinola 1837 (Coleoptera: Buprestidae) of Central Chile.

Ectinogonia Spinola 1837 is composed of 22 species to date, but its taxonomic history has been complex and is still unresolved. The species of the Santiagan Province of Central Chile are particularly complex because they show important morphological variability and overlapping traits, making species identification and delimitation difficult. The main goal of the present study is to show the phylogenetic relationships among species of Ectinogonia of the Santiagan province and discuss the taxonomic and systematic implications of our findings. Phylogeny reconstructions as well as a haplotype network disclosed four groups, partially inconsistent with the traditional taxonomy. Actually, the two Ectinogonia speciosa subspecies (E. speciosa speciosa (Germain 1856) and E. speciosa oscuripennis Cobos 1954) belong to two distinct clades, which are not reciprocally monophyletic, meaning that Ectinogonia speciosa is polyphyletic. On the other hand, the two other clades each contain, two nominal species (E. buquetii (Spinola 1837) and E. vidali Moore Guerrero 2017, and E. isamarae Moore 1994 and E. speciosa oscuripennis Cobos 1954) without reciprocal haplotype sorting. These results suggest that: (1) E. speciosa oscuripennis should be raised to species level and (2) the following new synonymies are proposed: E. isamarae Moore 1994 is synonymised with E. oscuripennis Cobos 1954 and E. vidali Moore Guerrero 2017 is synonymised with E. buquetii (Spinola 1837).

Comparison between site and central radiological assessments for patients with recurrent glioblastoma on a clinical trial.

AIM: Assessment of magnetic resonance imaging (MRI) in glioblastoma can be challenging. For patients with recurrent glioblastoma managed on the CABARET trial, we compared disease status assessed at hospitals and subsequent blinded central expert radiological review. METHODS: MRI results and clinical status at specified time points were used for site and central assessment of disease status. Clinical status was determined by the site. Response Assessment in Neuro-Oncology (RANO) criteria were used for both assessments. Site and central assessments of progression-free survival (PFS) and response rates were compared. Inter-rater variability for central review progression dates was assessed. RESULTS: Central review resulted in shorter PFS in 45% of 89 evaluable patients (n = 40). Median PFS was 3.6 (central) versus 3.9 months (site) (hazard ratio 1.5, 95% confidence interval 1.3-1.8, P < 0.001). Responses were documented more frequently by sites (n = 16, 18%) than centrally (n = 11, 12%). Seven of 120 patients continued on trial without site-determined progression for more than 6 months beyond the central review determination of progression. Of scans reviewed by all three central reviewers, 33% were fully concordant for progression date. CONCLUSION: While the difference between site and central PFS dates was statistically significant, the 0.3-month median difference is small. The variability within central review is consistent with previous studies, highlighting the challenges in MRI interpretation in this context. A small proportion of patients benefited from treatment well beyond the centrally determined progression date, reinforcing that clinical status together with radiology results are important determinants of whether a therapy is effective for an individual.

Imaging selection in ischemic stroke: feasibility of automated CT-perfusion analysis.

BACKGROUND: Advanced imaging may refine patient selection for ischemic stroke treatment but delays to acquire and process the imaging have limited implementation. AIMS: We examined the feasibility of imaging selection in clinical practice using fully automated software in the EXTEND trial program. METHODS: CTP and perfusion-diffusion MRI data were processed using fully-automated software to generate a yes/no 'mismatch' classification that determined eligibility for trial therapies. The technical failure/mismatch classification error rate and time to image and treat with CT vs. MR-based selection were examined. RESULTS: In a consecutive series of 776 patients from five sites over six-months the technical failure rate of CTP acquisition/processing (uninterpretable maps) was 3·4% (26/776, 95%CI 2·2-4·9%). Mismatch classification was overruled by expert review in an additional 9·0% (70/776, 95%CI 7·1-11·3%) due to artifactual 'perfusion lesion'. In 154 consecutive patients at one site, median additional time to acquire CTP after non-contrast CT was 6·5 min. Subsequent RAPID processing time varied from 3-10 min across 20 trial centers (median 5 min 20 s). In the EXTEND trial, door-to-needle times in patients randomized on the basis of CTP (n = 47) were median 78 min shorter than MRI-selected (n = 16) patients (P < 0·001). CONCLUSIONS: Automated CTP-based mismatch selection is rapid, robust in clinical practice, and associated with faster treatment decisions than MRI. This technological advance has the potential to improve the standardization and reproducibility of interpretation of advanced imaging and extend use to practice settings beyond highly specialized academic centers.

Alterations in dorsal and ventral posterior cingulate connectivity in APOE ε4 carriers at risk of Alzheimer's disease.

BACKGROUND: Recent evidence suggests that exercise plays a role in cognition and that the posterior cingulate cortex (PCC) can be divided into dorsal and ventral subregions based on distinct connectivity patterns. AIMS: To examine the effect of physical activity and division of the PCC on brain functional connectivity measures in subjective memory complainers (SMC) carrying the epsilon 4 allele of apolipoprotein E (APOE ε4) allele. METHOD: Participants were 22 SMC carrying the APOE ε4 allele (ε4+; mean age 72.18 years) and 58 SMC non-carriers (ε4-; mean age 72.79 years). Connectivity of four dorsal and ventral seeds was examined. Relationships between PCC connectivity and physical activity measures were explored. RESULTS: ε4+ individuals showed increased connectivity between the dorsal PCC and dorsolateral prefrontal cortex, and the ventral PCC and supplementary motor area (SMA). Greater levels of physical activity correlated with the magnitude of ventral PCC-SMA connectivity. CONCLUSIONS: The results provide the first evidence that ε4+ individuals at increased risk of cognitive decline show distinct alterations in dorsal and ventral PCC functional connectivity. DECLARATION OF INTEREST: D.A. has served on scientific advisory boards for Novartis, Eli Lilly, Janssen, Prana and Pfizer, and as Editor-in-Chief for International Psychogeriatrics; received speaker honoraria from Pfizer and Lundbeck, and research support from Eli Lilly, GlaxoSmithKline, Forest Laboratories, Novartis, and CSIRO. C.L.M. has received consulting fees from Eli Lilly and Prana Biotechnology, and has stock ownership in Prana Biotechnology. C.C.R. has received consultancy payments from Roche and Piramal, and research support from Avid Radiopharmaceuticals, Eli Lilly, GE Healthcare, Piramal and Navidea for amyloid imaging. C.S. has provided clinical consultancy and been on scientific advisory committees for the Australian CSIRO, Alzheimer's Australia, University of Melbourne and other relationships, which are subject to confidentiality clauses; she has been a named Chief Investigator on investigator-driven collaborative research projects in partnership with Pfizer, Merck, Piramal, Bayer and GE Healthcare. Her research programme has received support from the National Health and Medical Research Council Alzheimer's Association, Collier Trust, Scobie and Claire McKinnon Foundation, JO and JR Wicking Trust, Shepherd Foundation, Brain Foundation, Mason Foundation, Ramaciotti Foundation, Alzheimer's Australia and the Royal Australian College of Physicians. COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.