Discriminating between bipolar and major depressive disorder using a machine learning approach and resting-state EEG data.

OBJECTIVE: Distinguishing major depressive disorder (MDD) from bipolar disorder (BD) is a crucial clinical challenge as effective treatment is quite different for each condition. In this study electroencephalography (EEG) was explored as an objective biomarker for distinguishing MDD from BD using an efficient machine learning algorithm (MLA) trained by a relatively large and balanced dataset. METHODS: A 3 step MLA was applied: (1) a multi-step preprocessing method was used to improve the quality of the EEG signal, (2) symbolic transfer entropy (STE), an effective connectivity measure, was applied to the resultant EEG and (3) the MLA used the extracted STE features to distinguish MDD (N = 71) from BD (N = 71) subjects. RESULTS: 14 connectivity features were selected by the proposed algorithm. Most of the selected features were related to the frontal, parietal, and temporal lobe electrodes. The major involved regions were the Broca region in the frontal lobe and the somatosensory association cortex in the parietal lobe. These regions are near electrodes FC5 and CPz and are involved in processing language and sensory information, respectively. The resulting classifier delivered an evaluation accuracy of 88.5% and a test accuracy of 89.3%, using 80% of the data for training and evaluation and the remaining 20% for testing, respectively. CONCLUSIONS: The high evaluation and test accuracies of our algorithm, derived from a large balanced training sample suggests that this method may hold significant promise as a clinical tool. SIGNIFICANCE: The proposed MLA may provide an inexpensive and readily available tool that clinicians may use to enhance diagnostic accuracy and shorten time to effective treatment.

A Machine Learning Algorithm to Discriminating Between Bipolar and Major Depressive Disorders Based on Resting EEG Data.

Distinguishing major depressive disorder (MDD) from bipolar disorder (BD) is a crucial clinical challenge due to the lack of known biomarkers. Conventional methods of diagnosis rest exclusively on symptomatic presentation, and personal and family history. As a result, BD-depressed episode (BD-DE) is often misdiagnosed as MDD, and inappropriate therapy is given. Electroencephalography (EEG) has been widely studied as a potential source of biomarkers to differentiate these disorders. Previous attempts using machine learning (ML) methods have delivered insufficient sensitivity and specificity for clinical use, likely as a consequence of the small training set size, and inadequate ML methodology. We hope to overcome these limitations by employing a training dataset of resting-state EEG from 71 MDD and 71 BD patients. We introduce a robust 3 steps ML technique: 1) a multi-step preprocessing method is used to improve the quality of the EEG signal 2) symbolic transfer entropy (STE), which is an effective connectivity measure, is applied to the resultant EEG signals 3) the ML algorithm uses the extracted STE features to distinguish MDD from BD patients. Clinical Relevance--- The accuracy of our algorithm, derived from a large sample of patients, suggests that this method may hold significant promise as a clinical tool. The proposed method delivered total accuracy, sensitivity, and specificity of 84.9%, 83.4%, and 87.1%, respectively.

Climate and weather factors affecting winter sheltering by shoreline Copper Rockfish Sebastes caurinus in Howe Sound, British Columbia.

We monitored winter sheltering behavior of Copper Rockfish (Sebastes caurinus) in layered boulders at a shoreline in British Columbia and identified possible links to climate change and evolutionary adaptation. During late autumn and winter, these fish were inside the interstices of the boulder pile (termed "winter sheltering"); these fish were actively swimming above the boulders during spring through early fall. Sheltering duration did not vary between normal and most El Niño years (154-177 days). Sheltering longer than 6 months occurred during strong La Niña winters (197-241 days). Additionally, the proximate stimulus for entry into sheltering was intense Arctic outflow windstorms. Emergence from sheltering appears linked to water temperatures, occasionally related more to spring river flooding (snowmelt). The winter sheltering behavior we describe may be unique to shoreline populations in inland seas. Sheltering may confer a fitness advantage by conserving energy or reducing mortality from predation, thus increasing longevity and chances for successful reproduction. Our observations suggest that an ONI threshold of 0.8 °C or greater would be better suited than the current 0.5 °C threshold used to define ONI events.

A systematic review/meta-analysis of primary research investigating swine, pork or pork products as a source of zoonotic hepatitis E virus.

The objectives of our study were to identify and categorize primary research investigating swine/pork as a source of zoonotic hepatitis E virus (HEV) using the relatively new technique of scoping study, and to investigate the potential association between human exposure to swine/pork and HEV infection quantitatively using systematic review/meta-analysis methodology. From 1890 initially identified abstracts, 327 were considered for the review. Five study design types (cross-sectional, prevalence, genotyping, case-report and experimental transmission studies) were identified. A significant association between occupational exposure to swine and human HEV IgG seropositivity was reported in 10/13 cross-sectional studies. The association reported between pork consumption and HEV IgG seropositivity was inconsistent. The quantification of viral load in swine and retail pork, viral load required for infection in primates, cohort and case-control studies in humans, and formal risk assessment are recommended before specific public-health policy actions are taken.

Simultaneous detection of Staphylococcus aureus and coagulase-negative staphylococci in positive blood cultures by real-time PCR with two fluorescence resonance energy transfer probe sets.

A real-time PCR assay that uses two fluorescence resonance energy transfer probe sets and targets the tuf gene of staphylococci is described here. One probe set detects the Staphylococcus genus, whereas the other probe set is specific for Staphylococcus aureus. One hundred thirty-eight cultured isolates, which contained 41 isolates of staphylococci representing at least nine species, and 100 positive blood cultures that contained gram-positive cocci in clusters were tested. This assay was 100% sensitive and 100% specific for the detection of the Staphylococcus genus and of S. aureus.

The effects of sustained release doxycycline on the anaerobic flora and antibiotic-resistant patterns in subgingival plaque and saliva.

BACKGROUND: The purpose of this study was to determine the effects of periodontal treatment with a sustained-release, biodegradable gel containing 8.5% doxycycline on the anaerobic flora and on antibiotic susceptibility patterns associated with subgingival plaque and saliva. METHODS: Forty-five subjects with adult periodontitis were entered into a parallel design, single-blind study of 6 months' duration. The subjects were randomized to receive either doxycycline treatment (n = 23) or oral hygiene instruction/reinforcement (n = 22). Saliva and subgingival plaque samples were collected prior to and at 7, 21, 91, and 182 days after initiation of treatment. The proportion of the cultivable flora resistant to 10 microg doxycycline/ml was determined relative to total anaerobic counts, and the 3 most predominant colony types resistant to doxycycline were individually enumerated. A representative of each was subcultured, identified to genus and species level, and tested for its susceptibilities to 6 antibiotics. RESULTS: A significant decrease (P <0.01) in total anaerobic counts following doxycycline treatment caused a transient increase in the proportion, but not in the actual counts, of doxycycline-resistant bacteria recovered from both plaque and saliva at 7 and 21 days but not at 91 or 182 days. The same doxycycline-resistant taxa were recovered at all sample periods including baseline. Regardless of treatment, the isolates were similarly distributed and belonged to the same bacterial groups. CONCLUSIONS: Doxycycline treatment significantly reduced the anaerobic population in plaque but did not result in a change in either the number of resistant bacteria present or the acquisition of antibiotic resistance.

Clinical effectiveness of essential oil-containing dentifrices in controlling oral malodor.

PURPOSE: To assess the efficacy of two essential oil-containing dentifrices in the reduction of human intrinsic oral malodor ("morning bad breath"). MATERIALS AND METHODS: Two clinical trials were conducted which used observer-blind, negative control, parallel designs. To insure a homogeneous test population with similar oral odor characteristics, subjects followed instructions that included toothbrushing with a standard ADA-accepted fluoride dentifrice the night before. On odor evaluation days, subjects refrained from all oral hygiene procedures and from eating or drinking any food or beverage or smoking prior to and during the odor evaluations. Eighty healthy adult subjects in the first trial and 90 in the second trial with qualifying baseline levels of oral malodor participated. Odor ratings of each subject's breath were made by 4-5 trained judges using a nine point hedonic scale, i.e., 1 = most pleasant, 5 = neutral, 9 = most unpleasant. Qualifying subjects were randomly assigned one of two essential oil dentifrices or a negative control dentifrice. Subjects brushed with their assigned dentifrice for 60 s, rinsed with 20 ml of water for 10 s, and received post-treatment hedonic odor ratings at 30, 60, 90, 120, 180, and 240 min. Data were analyzed using an ANCOVA to adjust for baseline scores. RESULTS: The essential oil dentifrices were significantly more effective (P < or = 0.033) than the control in reducing intrinsic oral malodor from 90 to 120 min.

A biomechanical evaluation of one-stage vs two-stage bilateral knee arthroplasty patients.

In this study the functional abilities of eight one-stage bilateral total knee replacement (TKR) patients were compared to five two-stage bilateral TKR and nine control subjects. The TKR individuals were an average of 62 months post-operative. Based on gait analysis, ground reaction force profiles during walking and isometric knee strength assessment, the one-stage individuals did not differ significantly from the control subjects. The two-stage individuals had significantly less knee range of motion during gait and smaller vertical ground reaction forces during the braking phase than the control and one-stage individuals. To compare left and right sides, a symmetry index was computed and there were no significant differences among the three groups. Based on the variables tested in this biomechanical evaluation it can be concluded that for individuals facing bilateral knee replacement a one-stage procedure can result in functional capabilities at least comparable to a two-stage procedure.

GABA transporter heterogeneity: pharmacology and cellular localization.

gamma-Aminobutyric acid (GABA) is the major inhibitory neurotransmitter in the mammalian brain. GABA is cleared from the synaptic cleft by specific, high-affinity, sodium- and chloride-dependent transporters, which are thought to be located on presynaptic terminals and surrounding glial cells. While early studies suggested a distinction between neuronal and glial GABA transport, molecular cloning has revealed the existence of genes for four distinct GABA transporters (termed GAT-1, GAT-2, GAT-3 and BGT-1), thus revealing a greater heterogeneity than previously suspected. Heterologous expression has allowed a detailed characterization of their pharmacological properties, and has revealed that GAT-1 is the site of action of the anticonvulsant drug, Tiagabine. In-situ hybridization and immunocytochemistry demonstrate that each transporter has a unique regional distribution in the brain; in conjunction with experiments utilizing cell cultures, the neuronal vs glial localization of the various transporters is being elucidated. Future studies will be directed at determining the role of each transporter in the regulation of GABAergic transmission, and in the design of additional subtype-specific inhibitors, which may serve as novel therapeutic agents for the treatment of neuropsychiatric disorders.

Characterization of debris adjacent to failed knee implants of 3 different designs.

Wear debris particles have been associated with bone resorption and loosening of total joint implants. To characterize the wear particles around failed knee prostheses, tissues adjacent to 47 implants of 3 different designs were evaluated: 29 were posterior cruciate ligament retention type (Group I), 12 were posterior cruciate ligament sacrificing or substituting (Total Condylar, Insall-Burstein), (Group II), and 6 were mobile bearing (posterior cruciate ligament retaining LCS), (Group III). Wear particles were isolated and evaluated using electronic particle quantitation and scanning electron microscopy. The corresponding implants were also evaluated, and the surface damage quantified. The number of particles smaller than 10 microm ranged from 8.9 to 45.8 x 10(9) per gram of tissue (dry weight). Particle number directly correlated with duration of implantation. Group I implants had larger particles, and showed greater surface damage than the other 2 designs. Polyethylene surface damage significantly correlated with particle size more than 10 microm in length. Particle number showed a significant inverse correlation with the thickness of the polyethylene. These results support previous mechanical and retrieval studies suggesting that increased wear may be associated with thinner polyethylene, and there are differing degrees and patterns of wear based on implant design.

Localization of messenger RNAs encoding three GABA transporters in rat brain: an in situ hybridization study.

Localization of the messenger RNAs encoding three gamma-aminobutyric acid (GABA) transporters, termed GAT-1, GAT-2, and GAT-3, has been carried out in rat brain using radiolabeled oligonucleotide probes and in situ hybridization histochemistry. Hybridization signals for GAT-1 mRNA were observed over many regions of the rat brain, including the retina, olfactory bulb, neocortex, ventral pallidum, hippocampus, and cerebellum. At the microscopic level, this signal appeared to be restricted to neuronal profiles, and the overall distribution of GAT-1 mRNA closely paralleled that seen in other studies with antibodies to GABA. Areas containing hybridization signals for GAT-3 mRNA included the retina, olfactory bulb, subfornical organ, hypothalamus, midline thalamus, and brainstem. In some regions, the hybridization signal for GAT-3 seemed to be preferentially distributed over glial cells, although hybridization signals were also observed over neurons, particularly in the retina and olfactory bulb. Notably, hybridization signal for GAT-3 mRNA was absent from the neocortex and cerebellar cortex, and was very weak in the hippocampus. In contrast to the parenchymal localization obtained for GAT-1 and GAT-3 mRNAs, hybridization signals for GAT-2 mRNA were found only over the leptomeninges (pia and arachnoid). The differential distribution of the three GABA transporters described here suggests that while each plays a role in GABA uptake, they do so via distinct cellular populations.

Cloning and expression of a betaine/GABA transporter from human brain.

A cDNA clone encoding a human gamma-aminobutyric acid (GABA) transporter has been isolated from a brain cDNA library, and its functional properties have been examined in mammalian cells. The nucleotide sequence predicts a transporter with 614 amino acids and 12 putative transmembrane domains. The highest degree of amino acid identity is with a betaine/GABA transporter originally cloned from the dog termed BGT-1 (91%) and a related transporter from mouse brain (87%). These identities are similar to those for species homologues of other neurotransmitter transporters and suggest that the new clone represents the human homologue of BGT-1. The transporter displays high affinity for GABA (IC50 of 30 microM) and is also sensitive to phloretin, L-2,4-diaminobutyric acid, and hypotaurine (IC50 values of approximately 150-400 microM). The osmolyte betaine is approximately 25-fold weaker than GABA, displaying an IC50 of approximately 1 mM. The relative potencies of these inhibitors at human BGT-1 differ from those of mouse and dog BGT-1. Northern blot analysis reveals that BGT-1 mRNA is widely distributed throughout the human brain. The cloning of the human homologue of BGT-1 will further our understanding of the roles of GABA and betaine in neural function.

Molecular cloning of an orphan transporter. A new member of the neurotransmitter transporter family.

A complementary DNA clone predicted to encode a novel transporter was isolated from rat brain and the localization of its mRNA was examined. The cDNA, designated rB21a, predicts a protein with 12 putative transmembrane domains that exhibits significant sequence homology with neurotransmitter transporters. Expression studies have not yet identified the endogenous substrate for this transporter, but the presence of rB21a mRNA within the leptomeninges of the brain suggests the transporter may regulate CSF levels of its substrate. The cloning of rB21a provides the means to determine its physiological functions and the potential to design novel, transporter-based therapeutic agents for neurological and psychiatric disorders.

Re-evaluation of GABA transport in neuronal and glial cell cultures: correlation of pharmacology and mRNA localization.

Molecular cloning has revealed the existence of four distinct transporters for the inhibitory neurotransmitter gamma-aminobutyric acid (GABA), termed GAT-1, GAT-2, GAT-3, and BGT-1. To determine which of the cloned transporters are in neurons and which are in glia, we have undertaken a combined pharmacological and molecular biological study using cell cultures derived from rat brain. In neuronal cultures approximately 70% of GABA transport is sensitive to the GAT-1-selective ligand NNC-711 and drug potencies at this site correlate well with their potencies at GAT-1; GAT-1 mRNA is abundant in these cultures as determined by northern blot analysis. Drug potencies at the NNC-711-resistant component correlate well with their potencies at GAT-2 and GAT-3, whose pharmacological profiles are similar to one another. Northern blots reveal the presence of mRNA for GAT-3 in neuronal cultures, whereas GAT-2 and BGT-1 mRNAs are not detected. Type 1 astrocyte cultures exhibit very low levels of GABA transport activity, which has very low potency for GABA but high potency for taurine. Such cultures have mRNA for a taurine transporter and BGT-1, but not for GAT-1, GAT-2, and GAT-3. In cultures containing O-2A progenitor cells and Type 2 astrocytes, approximately 75% of GABA uptake is sensitive to NNC-711 and drug potencies at this site correlate well with their potencies at GAT-1; GAT-1 mRNA is abundant. Drug potencies at the NNC-711-resistant component correlate well with their potencies at GAT-2 and GAT-3; mRNAs for both of these transporters are present (though GAT-2 mRNA is the more abundant), as is BGT-1 mRNA. In summary, these data demonstrate heterogeneity of both neuronal and glial GABA transport.

Tiagabine, SK&F 89976-A, CI-966, and NNC-711 are selective for the cloned GABA transporter GAT-1.

gamma-Aminobutyric acid (GABA) is the major inhibitory neurotransmitter in the mammalian brain. The synaptic action of GABA is terminated by rapid uptake into presynaptic terminals and surrounding glial cells. Molecular cloning has revealed the existence of four distinct GABA transporters termed GAT-1, GAT-2, GAT-3, and BGT-1. Pharmacological inhibition of transport provides a mechanism for increasing GABA-ergic transmission, which may be useful in the treatment of various neuropsychiatric disorders. Recently, a number of lipophilic GABA transport inhibitors have been designed and synthesized, which are capable of crossing the blood brain barrier, and which display anticonvulsive activity. We have now determined the potency of four of these compounds, SK&F 89976-A (N-(4,4-diphenyl-3-butenyl)-3-piperidinecarboxylic acid), tiagabine ((R)-1-[4,4-bis(3-methyl-2-thienyl)-3-butenyl]-3- piperidencarboxylic acid), CI-966 ([1-[2-[bis 4-(trifluoromethyl)phenyl]methoxy]ethyl]-1,2,5,6-tetrahydro-3- pyridinecarboxylic acid), and NNC-711 (1-(2-(((diphenylmethylene)amino)oxy)ethyl)-1,2,4,6-tetrahydro-3- pyridinecarboxylic acid hydrochloride), at each of the four cloned GABA transporters, and find them to be highly selective for GAT-1. These data suggest that the anticonvulsant activity of these compounds is mediated via inhibition of uptake by GAT-1.

Design, synthesis and evaluation of substituted triarylnipecotic acid derivatives as GABA uptake inhibitors: identification of a ligand with moderate affinity and selectivity for the cloned human GABA transporter GAT-3.

gamma-Aminobutyric acid (GABA) is the major inhibitory neurotransmitter in the mammalian central nervous system. Molecular biology has revealed the presence of four high-affinity GABA transporters in the brain, GAT-1, GAT-2, GAT-3, and BGT-1, the latter transporting both GABA and the osmolyte Betaine. We have shown that known GABA uptake inhibitors such as SK&F 89976-A, CI-966, and Tiagabine exhibit high affinity and selectivity for GAT-1. In the present paper we describe the design and synthesis of a novel series of triarylnipecotic acid derivatives for evaluation as GABA uptake inhibitors. The design lead for this series of compounds was the nonselective GABA uptake inhibitor EGYT-3886, [(-)-2-phenyl-2-[(dimethylamino)ethoxy]-(1R)- 1,7,7-trimethylbicyclo[2.2.1]heptane]. From this series of compounds (S)-1-[2-[tris(4-methoxyphenyl)methoxy]ethyl]-3-piperidinecarboxylic+ ++ (S)-1-[2-[tris(4-methoxyphenyl)methoxy]ethyl]-3-piperidinecarboxylic+ ++ acid, 4(S) was identified as a novel ligand with selectivity for GAT-3. 4(S) displayed an IC50 of 5 microM at GAT-3, 21 microM at GAT-2, > 200 microM at GAT-1, and 140 microM at BGT-1. This compound will be an important tool for evaluating the role of GAT-3 in neural function.

The effects of a 0.3% triclosan-containing dentifrice on the microbial composition of supragingival plaque.

144 subjects completed a 6-month, double-blind study which examined the effects of a 0.3% triclosan/2% copolymer/0.243% sodium fluoride dentifrice on the microflora of supragingival dental plaque. The subjects were randomly assigned to use, in an oral hygiene program, either the triclosan/copolymer/fluoride test dentifrice or a control dentifrice. The latter had the same formulation as the test dentifrice except it did not contain triclosan. Supragingival plaque was collected from the buccal and lingual surfaces of 4 teeth at baseline, 3 months, and 6 months, and microbiologically examined by darkfield microscopy, gram stain morphology, immunofluorescence, and selective and non-selective media. Antimicrobial susceptibilities were determined by agar dilution and whole plaque susceptibility methodologies on plaque samples from 136 subjects at each of the above sample periods and at 6-week intervals for an additional 6 months post-therapy. Both dentifrices resulted in highly statistically significant reductions in the total cultivable flora obtained at both the 3 and 6-month samples relative to baseline as well as at 6 months relative to the 3-month sample. The relative decrease in total anaerobic counts and in strict anaerobes, while not statistically significant, was more pronounced at both the 3- and 6-month sample periods in subjects receiving the triclosan dentifrice than for the controls. Neither dentifrice resulted in detrimental shifts in the microbial composition of the normal flora nor led to the emergence of periodontal or opportunistic pathogens.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of a new experimental prebrushing dental rinse on plaque removal.

A randomized, double-blind, placebo-controlled study evaluated the effectiveness of a new and improved prebrushing dental rinse, Advanced Formula Plax, in reducing supragingival plaque. Following a 4-week pretest phase, the oral soft tissue, stain, gingivitis, and pre- and postbrushing plaque scores were evaluated for 153 subjects at baseline, 6, 12, 18, and 26 weeks. Patients were randomly assigned to receive either the active prebrushing dental rinse or a matching placebo that lacked the key ingredients responsible for the surfactant action of the active rinse. Compared with placebo, use of the active prebrushing rinse was associated with a significant reduction from baseline in postbrushing plaque scores at 12, 18, and 26 weeks on smooth surfaces, and with a significant reduction in postbrushing plaque scores on all surfaces at weeks 18 and 26. No significant difference was noted between the two treatment groups in gingivitis scores and stain indices. No product-related adverse experiences were noted. The results indicate that use of the new and improved prebrushing dental rinse represents a beneficial adjunct to toothbrushing and improved oral hygiene.

Cloning of the human homologue of the GABA transporter GAT-3 and identification of a novel inhibitor with selectivity for this site.

Molecular cloning has revealed the presence of four high-affinity GABA transporters in the brain. The existence of three of these sites, GAT-2, GAT-3, and BGT-1, was unknown prior to their cloning and almost nothing is known of the role they play in regulating GABAergic transmission. In large measure our paucity of knowledge is attributable to the lack of specific inhibitors for these sites. In the present communication we describe the cloning and expression of the human homologue of GAT-3, and the identification of an inhibitor, (S)-SNAP-5114, with selectivity for this site. (S)-SNAP-5114 displays an IC50 of 5 microM at GAT-3, 21 microM at GAT-2, and > or = 100 microM at GAT-1 and BGT-1. Due to its lipophilicity, (S)-SNAP-5114 is also expected to cross the blood-brain-barrier and therefore, should be an important tool for evaluating the role of GAT-3 in neural function.