Functional Complex Networks Based on Operational Architectonics: Application on EEG-based Brain-computer Interface for Imagined Speech.

A new method for analyzing brain complex dynamics and states is presented. This method constructs functional brain graphs and is comprised of two pylons: (a) Operational architectonics (OA) concept of brain and mind functioning. (b) Network neuroscience. In particular, the algorithm utilizes OA framework for a non-parametric segmentation of EEG signals, which leads to the identification of change points, namely abrupt jumps in EEG amplitude, called Rapid Transition Processes (RTPs). Subsequently, the time coordinates of RTPs are used for the generation of undirected weighted complex networks fulfilling a scale-free topology criterion, from which various network metrics of brain connectivity are estimated. These metrics form feature vectors, which can be used in machine learning algorithms for classification and/or prediction. The method is tested in classification problems on an EEG-based BCI data set, acquired from individuals during imagery pronunciation tasks of various words/vowels. The classification results, based on a Naïve Bayes classifier, show that the overall accuracies were found to be above chance level in all tested cases. This method was also compared with other state-of-the-art computational approaches commonly used for functional network generation, exhibiting competitive performance. The method can be useful to neuroscientists wishing to enhance their repository of brain research algorithms.

Absence of radiographic progression of hip arthritis during infliximab treatment for ankylosing spondylitis.

This study aims to examine the impact of long-term treatment with the anti-TNF antibody infliximab on radiographic progression of hip arthritis in ankylosing spondylitis. Anteroposterior X-rays of the pelvis obtained at baseline from consecutive patients with ankylosing spondylitis and bilateral hip arthritis were compared with X-rays obtained after 6 ± 2.5 years (mean ± SD) of continuous infliximab treatment. Analysis was performed by the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-h) scoring system (min 0, max 4). Hip joint space width was also assessed by the average of measurements at three distinct sites between the acetabulum and femoral head. In 23 patients with active disease (21 men, mean age and disease duration of 45 and 16 years, respectively), the BASRI-h score at baseline was 1 in 7, 2 in 16, 3 in 16, and 4 in 7 hips (including two arthroplasties). Individual BASRI-h scores at baseline (2.50 ± 0.86, mean ± SD) remained unchanged in all patients at end of follow-up. At baseline, the average width of the whole joint space (3.56 ± 0.70 mm, n = 44) was not associated with disease activity measurements but negatively correlated with BAS functional index (Spearman r = -0.5, P = 0.007). After 2-10 years of infliximab treatment, the average width of the whole joint space in these patients (3.59 ± 0.79 mm) was not reduced. These results suggest that radiographic progression of hip arthritis in ankylosing spondylitis may be arrested during infliximab treatment.

Tuberculosis and granuloma formation in patients receiving anti-TNF therapy.

In patients receiving anti-tumor necrosis factor (TNF) therapy, a probable exacerbation of latent tuberculosis (TB) is a major adverse event. The impairment of granuloma differentiation is considered a characteristic feature of TB in these patients. In this report we present three patients with rheumatic disease who developed TB under infliximab treatment. All of them had typical granulomas on the biopsy specimens, indicating that the expected impairment of granuloma formation is not always the case. The notion of granuloma-free TB in patients receiving anti-TNF therapy could shift a clinician's path away from performing a biopsy, thus delaying the establishment of a correct diagnosis.

Psoriasis induced by anti-tumor necrosis factor therapy: a paradoxical adverse reaction.

Administration of anti-tumor necrosis factor (anti-TNF) agents is beneficial in a variety of chronic inflammatory conditions, including psoriasis. We describe 5 patients in whom psoriasiform skin lesions developed 6-9 months after the initiation of anti-TNF therapy for longstanding, seropositive rheumatoid arthritis (etanercept or adalimumab), typical ankylosing spondylitis (infliximab), and Adamantiades-Behçet's disease (infliximab). In all 5 patients, the underlying disease had responded well to anti-TNF therapy. Four patients developed a striking pustular eruption on the palms and/or soles accompanied by plaque-type psoriasis at other skin sites, while 1 patient developed thick erythematous scaly plaques localized to the scalp. In 3 patients there was nail involvement with onycholysis, yellow discoloration, and subungual keratosis. Histologic findings from skin biopsies were consistent with psoriasis. None of these patients had a personal or family history of psoriasis. In all patients, skin lesions subsided either with topical treatment alone, or after discontinuation of the responsible anti-TNF agent. The interpretation of this paradoxical side effect of anti-TNF therapy remains unclear but may relate to altered immunity induced by the inhibition of TNF activity in predisposed individuals.

Hemoglobin normalization results in lower dialysis dose, despite high dialysate flow. Single needle offers inadequate dialysis.

Anemia correction by erythropoietin favorably affects dialysis outcome but may also reduce dialysis efficiency increasing morbidity and mortality. Single needle dialysis (SN) and high dialysate flow (DF) are dialysis variations. We studied the effect of hemoglobin (Hb) normalization on dialysis adequacy under high DF. We also compared double needle (DN) and SN dialysis efficiency. Seventeen stable anuric patients (13 M, 4 F), aged 62 (40-90), on hemodialysis for 48 months (8-204), were studied in two, 6 months apart, periods of low (A) and high Hb (B), during a midweek 4 h dialysis with DN and SN. DF was 500 in A and 800 ml/min in B. Rebound urea samples, 20 min post dialysis, were used for computer calculated double pool urea kinetics. Hb levels were 128 +/- 8 g/L (B) vs. 119 +/- 14 g/L (A), P < 0.03. Despite the use of higher DF less dialysis was delivered in B vs. A, under DN or SN (DN: URR 64.8 +/- 5.8 vs. 69.7 +/- 5.2%, Kt/Vequil. 1.09 +/- 0.19 vs. 1.26 +/- 0.21, nPCR 1.37 +/- 0.29 vs. 1.60 +/- 0.36g/kg/day, changes <0.001, SN: URR 49.7 +/- 7.5% vs. 52.6 +/- 8.8%, Kt/Vequil. 0.74 +/- 0.16 vs. 0.82 +/- 0.23, nPCR 1.05 +/- 0.33 vs. 1.20 +/- 0.31, changes NS). SN was found significantly (P < 0.001) less efficient than DN in A and B. Serum creatinine drop was significantly (P < 0.001) less in both periods with SN vs. DN. Hb (SN in B) correlated inversely to Kt/V (r = -0.5705, P < 0.02) and URR (r = -0.6432, P = 0.005). Hb correction to normality is associated with a decrease in dialysis efficiency. The use of high dialysate flow does not compensate for this loss. SN delivers inadequate dialysis independently of dialysate flow or hemoglobin concentration.

Immunopathogenesis and spectrum of infections in systemic lupus erythematosus.

OBJECTIVE: This study reviews the pertinent immunopathologic mechanisms that contribute to increased susceptibility to infection in patients with systemic lupus erythematosus (SLE) and the spectrum of infections in patients with SLE. It assesses the impact on patient care, morbidity, and mortality. METHODS: The authors performed an extensive search of the literature through MEDLINE, using appropriate keywords and manual search of bibliography cited by retrieved papers. RESULTS: Infection is a leading cause of morbidity and mortality in SLE and may change the natural course of the disease. Patients with SLE display numerous cellular and humoral abnormalities that are expressed in a heterogeneous pattern and contribute in varying degrees to susceptibility to infectious agents. The use of corticosteroid and immunosuppressive drugs is only partially responsible for the high infection rate in lupus patients. Common as well as opportunistic pathogens are frequently encountered among patients with SLE. The susceptibility that SLE patients exhibit to certain bacteria is now better recognized, and a broadening spectrum of pathogens is being reported. The immunization of patients against influenza and pneumococcus and the administration of prophylactic therapy against Pneumocystis carinii infection in certain patients have recently been proposed. CONCLUSION: Disease activity and treatment are responsible for the extensive defects of the immune defense system in lupus patients that increase their susceptibility to an extensive range of infections. Infection imposes a serious burden on lupus patients and on the caring physician.

Leukocyte adhesion deficiency: report of a case and review of the literature.

Leukocyte adhesion deficiency (LAD) is a rare inherited immunodeficiency that is characterized by deficiency of the beta 2 integrin leukocyte adhesion molecules Mac-1, LFA-1, and p150,95. We describe a case of the severe form of LAD in an infant with recurrent infections and with a complete deficiency of beta 2 integrin molecules, and review the clinical aspects of the syndrome.

Change in the epidemiology of Reiter's syndrome (reactive arthritis) in the post-AIDS era? An analysis of cases appearing in the Greek Army.

OBJECTIVE: During the last 5 years we observed a significant decrease in the incidence of newly established cases of Reiter's syndrome (reactive arthritis) in Greek Army personnel. Our study was initiated to validate this observation and to evaluate a possible change in the prevalence of Reiter's syndrome (RS) associated infections. METHODS: The case records of patients with reactive arthritis (ReA) admitted during the periods 1980-83 and 1989-92 at a large Army Hospital were studied retrospectively and the cases of RS were reviewed. In addition, the prevalence of cases with urethritis and dysentery that presented to the hospital in the same periods was studied in retrospect, as these infections are known to participate in the etiopathogenesis of RS. RESULTS: A significant decrease in the overall incidence of the randomly presented RS cases during the second 4 year period was detected (27 versus 4 cases, p < 0.0001, chi 2 test). A similar significant decrease in the number of cases with gonococcal and nongonococcal urethritis was observed while the prevalence of dysentery was not significantly altered during the defined intervals. CONCLUSION: We suggest that the anti-AIDS campaign which began after the years 1984-85 is the principal cause of the observed change of epidemiology of RS cases appearing in the Greek Army.

EGF and EGF-r immunoexpression in Sjögren's syndrome secondary to rheumatoid arthritis. Correlation with EBV expression?

Minor labial salivary gland biopsies from 25 patients with secondary Sjögren's syndrome (SS) suffering from rheumatoid arthritis and from 11 patients complaining of ocular dryness associated with rheumatoid arthritis without proven SS, were studied for the immunohistochemical expression of Epidermal Growth Factor (EGF) and its receptor (EGF-r). Minor labial salivary glands from 11 healthy individuals were used as the control. Furthermore, the results were correlated with data retrieved from a previous study on EBV expression by the in situ hybridization method in the same specimens. In 16/25 cases of secondary SS the epithelial duct cells expressed both EGF and EGF-r, particularly in the areas of lymphoepithelial lesion and tissue destruction. Eleven of these cases expressed a positive EBV hybridization signal. In contrast, only 3/11 patients with ocular dryness and 2/11 cases from the group of healthy individuals showed immunoreactivity for EGF/EGF-r. A positive EBV signal was detected in 3/11 and 1/11 of these cases, respectively. These results indicate that EGF and EGF-r may play a crucial role in the evolution of the disease under the constant influence of EBV, which seems to up-regulate the expression of the EGF/EGF-r system.

A case of Adamantiadis-Behçet's syndrome presenting as myocardial infarction.

We report a case of a 27-year-old man who presented with an acute myocardial infarction. When he was hospitalized one month later to evaluate this recent event, he developed clinical findings consistent with the diagnosis of Adamantiadis-Behçet's syndrome. We believe that the myocardial infarction was due to coronary arteritis, because there were no risk factors for coronary disease present.

Detection of the Epstein Barr viral genome by an in situ hybridization method in salivary gland biopsies from patients with secondary Sjögren's syndrome.

Sections of formalin-fixed paraffin-embedded minor labial salivary glands from 23 patients with Sjögren's syndrome associated with rheumatoid arthritis (secondary Sjögren's syndrome: sSS) and from 11 patients with keratoconjunctivitis sicca (KCS) associated with rheumatoid arthritis but without proven SS were examined by in situ hybridization using the BamH1 V (W) fragment of Epstein Barr viral (EBV) DNA. Minor labial salivary glands from 7 healthy individuals were used as the control. EBV specific DNA sequences were detected in the nuclei of epithelial cells in 16 out of 23 cases with sSS and in 3 out of 11 patients with KCS. None of the 7 salivary gland biopsies from the control group showed a positive hybridization signal. Epithelial cells containing the EBV genome were more frequently detected in areas with tissue destruction and lymphoepithelial lesions. Our results provide evidence for an increased EBV infection load in patients with sSS in comparison with control subjects and suggest that this virus may play a role in the pathogenesis of sSS.