The elicitation of audiovisual steady-state responses: multi-sensory signal congruity and phase effects.

Most ecologically natural sensory inputs are not limited to a single modality. While it is possible to use real ecological materials as experimental stimuli to investigate the neural basis of multi-sensory experience, parametric control of such tokens is limited. By using artificial bimodal stimuli composed of approximations to ecological signals, we aim to observe the interactions between putatively relevant stimulus attributes. Here we use MEG as an electrophysiological tool and employ as a measure the steady-state response (SSR), an experimental paradigm typically applied to unimodal signals. In this experiment we quantify the responses to a bimodal audio-visual signal with different degrees of temporal (phase) congruity, focusing on stimulus properties critical to audiovisual speech. An amplitude modulated auditory signal ('pseudo-speech') is paired with a radius-modulated ellipse ('pseudo-mouth'), with the envelope of low-frequency modulations occurring in phase or at offset phase values across modalities. We observe (i) that it is possible to elicit an SSR to bimodal signals; (ii) that bimodal signals exhibit greater response power than unimodal signals; and (iii) that the SSR power at specific harmonics and sensors differentially reflects the congruity between signal components. Importantly, we argue that effects found at the modulation frequency and second harmonic reflect differential aspects of neural coding of multisensory signals. The experimental paradigm facilitates a quantitative characterization of properties of multi-sensory speech and other bimodal computations.

Eltrombopag for thrombocytopenia in patients with cirrhosis associated with hepatitis C.

BACKGROUND: Eltrombopag is a new, orally active thrombopoietin-receptor agonist that stimulates thrombopoiesis. We evaluated its ability to increase platelet counts and facilitate treatment for hepatitis C virus (HCV) infection in patients with thrombocytopenia associated with HCV-related cirrhosis. METHODS: Seventy-four patients with HCV-related cirrhosis and platelet counts of 20,000 to less than 70,000 per cubic millimeter were randomly assigned to receive eltrombopag (30, 50, or 75 mg daily) or placebo daily for 4 weeks. The primary end point was a platelet count of 100,000 per cubic millimeter or more at week 4. Peginterferon and ribavirin could then be initiated, with continuation of eltrombopag or placebo for 12 additional weeks. RESULTS: At week 4, platelet counts were increased to 100,000 per cubic millimeter or more in a dose-dependent manner among patients for whom these data were available: in 0 of the 17 patients receiving placebo, in 9 of 12 (75%) receiving 30 mg of eltrombopag, in 15 of 19 (79%) receiving 50 mg of eltrombopag, and in 20 of 21 (95%) receiving 75 mg of eltrombopag (P<0.001). Antiviral therapy was initiated in 49 patients (in 4 of 18 patients receiving placebo, 10 of 14 receiving 30 mg of eltrombopag, 14 of 19 receiving 50 mg of eltrombopag, and 21 of 23 receiving 75 mg of eltrombopag) while the administration of eltrombopag or placebo was continued. Twelve weeks of antiviral therapy, with concurrent receipt of eltrombopag or placebo, were completed by 36%, 53%, and 65% of patients receiving 30 mg, 50 mg, and 75 mg of eltrombopag, respectively, and by 6% of patients in the placebo group. The most common adverse event during the initial 4 weeks was headache; thereafter, the adverse events were those expected with interferon-based therapy. CONCLUSIONS: Eltrombopag therapy increases platelet counts in patients with thrombocytopenia due to HCV-related cirrhosis, thereby permitting the initiation of antiviral therapy. (ClinicalTrials.gov number, NCT00110799.)