Differential Sources for 2 Neural Signatures of Target Detection: An Electrocorticography Study.

Electrophysiology and neuroimaging provide conflicting evidence for the neural contributions to target detection. Scalp electroencephalography (EEG) studies localize the P3b event-related potential component mainly to parietal cortex, whereas neuroimaging studies report activations in both frontal and parietal cortices. We addressed this discrepancy by examining the sources that generate the target-detection process using electrocorticography (ECoG). We recorded ECoG activity from cortex in 14 patients undergoing epilepsy monitoring, as they performed an auditory or visual target-detection task. We examined target-related responses in 2 domains: high frequency band (HFB) activity and the P3b. Across tasks, we observed a greater proportion of electrodes that showed target-specific HFB power relative to P3b over frontal cortex, but their proportions over parietal cortex were comparable. Notably, there was minimal overlap in the electrodes that showed target-specific HFB and P3b activity. These results revealed that the target-detection process is characterized by at least 2 different neural markers with distinct cortical distributions. Our findings suggest that separate neural mechanisms are driving the differential patterns of activity observed in scalp EEG and neuroimaging studies, with the P3b reflecting EEG findings and HFB activity reflecting neuroimaging findings, highlighting the notion that target detection is not a unitary phenomenon.

Central nervous system infections in travelers.

International travelers commonly contract infections while abroad, many of which are primary neurological diseases or have potential neurological sequelae. The implications of these neuroinfectious diseases extend beyond the individual, since returning travelers may contribute to the spread of infection in novel areas. In this review, we discuss signs, symptoms, treatments, and prophylaxes for these infections, as well as emerging trends with regard to neuroinfectious diseases of the returning traveler.

Gustatory cortical lesions affect motivation for snack foods.

Most neuropsychological research using food as a reward uses single-bid auctions. We wished to determine whether focal brain lesions would affect the ability and motivation to win snack food items in a computerized auction allowing multiple bids. This allowed us to assess participants' abilities under more complex conditions. We enrolled 154 male penetrating traumatic brain injury (pTBI) veterans, mean age 58, from the Vietnam Head Injury Study registry, and 53 male uninjured veterans, mean age 59. We used voxel-based lesion symptom mapping (VLSM) to identify effects of brain lesions on the ability to win items and on participants' answers to statements regarding their level of motivation and evaluation of how well they performed. Number of items won was not significantly associated with any lesions; however, lesions in gustatory cortex (GC) affected motivation and self-evaluation. Our findings provide further evidence of the primary GC's role in motivation for food and drink.

[Treatment manual for psychotherapy of acute and posttraumatic stress disorders after multiple ICD shocks]. / Behandlungsmanual zur Psychotherapie von akuten und posttraumatischen Belastungsstörungen nach ICD-Mehrfachschocks.

In view of the inceasing number of implanted defibrillators in all industrial nations, the number of people who have suffered so-called multiple shocks (electrical storm, ES) also increases. Common complaints are severe and continuously recurrent massive anxiety, panic attacks, fear of death, helplessness and hopelessness, depression, nervosity and irritability as well as reclusive and uncontrollable avoidance behaviour, intrusions, nightmares, flashbacks, sleeplessness and the inability to show feelings and limitation of future perspectives. Because people with an ICD are often physically (very) ill and after multiple ICD shocks are additionally very insecure, it would seem logical if the inpatient treatment would be carried out in an institution which has close connections and is also spatially close to a cardiology department. The basis of the diagnostics is the clinical anamnesis and a systematic exploration of the trauma situation and the resulting complaints. As an additional diagnostic element psychological test procedures should be implemented to determine the core symptomatic (anxiety, depression, trauma symptoms). Psychological test procedures should be included in the diagnostics so that at the end of treatment it is obvious even to the patient which alterations have occurred. The core element of inpatient treatment is daily intensive psychotherapy and includes deep psychologically well-founded psychotherapy and behavioral therapeutic-oriented anxiety therapy as well as cognitive restructuring and elements of eye movement desensitization and reprocessing (EMDR). A follow-up examination within 4 months of the multiple shocks episode is recommended because symptoms of posttraumatic stress disorder often occur after a long latent time period.

[Rehabilitation of Parkinson's patients with deep brain stimulation. Experiences of the Neurological Rehabilitation Center Godeshöhe]. / Rehabilitation von Parkinson-Patienten mit Tiefenhirnstimulation. Erfahrungen des Neurologischen Rehabilitationszentrums Godeshöhe.

BACKGROUND: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become an important therapeutic option in patients with advanced Parkinson's disease (PD). An increasing number of patients are referred for hospital rehabilitation after initial programming. The role of further DBS and medication adjustments for this rehabilitation therapy is uncertain. METHODS: This study was a retrospective analysis of a hospital rehabilitation program with a systematic algorithm to improve DBS efficacy in PD patients referred within 3 months after electrode implantation. This study analyzed (1) changes of stimulation parameters and medication and (2) changes in the performance of activities of daily living as measured by the Barthel index. RESULTS: After an average of 20.4±10.7 days following surgery 95 PD patients were hospitalized for an average rehabilitation period of 29.0±11.2 days. Technical dysfunctions were found in 3 (3.1%) patients and a bilateral electrode dislocation in 1 (1.1%) patient. Stimulation parameters were adjusted on 7.3±4.0 days, sometimes with several adjustments on the same day. Until discharge the stimulation amplitude was significantly increased from 2.1±0.8 V to 3.0±0.8 V. Moreover, in 70 (73.7%) patients active stimulation contacts were changed. The mean levodopa equivalent dosage decreased from 529±290 mg/die to 300±277 mg/die. The Barthel index increased significantly by 10.3±12.4 points. CONCLUSION: Further DBS and medication adjustments play an important role for hospital rehabilitation of PD patients after initial DBS programming in DBS centers.

Noninvasive testing, early surgery, and seizure freedom in tuberous sclerosis complex.

BACKGROUND: The unambiguous identification of the epileptogenic tubers in individuals with tuberous sclerosis complex (TSC) can be challenging. We assessed whether magnetic source imaging (MSI) and coregistration of (18)fluorodeoxyglucose PET (FDG-PET) with MRI could improve the identification of the epileptogenic regions noninvasively in children with TSC. METHODS: In addition to standard presurgical evaluation, 28 children with intractable epilepsy from TSC referred from 2000 to 2007 had MSI and FDG-PET/MRI coregistration without extraoperative intracranial EEG. RESULTS: Based on the concordance of test results, 18 patients with TSC (64%) underwent surgical resection, with the final resection zone confirmed by intraoperative electrocorticography. Twelve patients are seizure free postoperatively (67%), with an average follow-up of 4.1 years. Younger age at surgery and shorter seizure duration were associated with postoperative seizure freedom. Conversely, older age and longer seizure duration were linked with continued seizures postoperatively or prevented surgery because of nonlateralizing or bilateral independent epileptogenic zones. Complete removal of presurgery MSI dipole clusters correlated with postoperative seizure freedom. CONCLUSIONS: Magnetic source imaging and (18)fluorodeoxyglucose PET/MRI coregistration noninvasively localized the epileptogenic zones in many children with intractable epilepsy from tuberous sclerosis complex (TSC), with 67% seizure free postoperatively. Seizure freedom after surgery correlated with younger age and shorter seizure duration. These findings support the concept that early epilepsy surgery is associated with seizure freedom in children with TSC and intractable epilepsy.

Prevalence of patent foramen ovale (PFO) and MRI-lesions in mild neurological decompression sickness (type B-DCS/AGE).

BACKGROUND: Neurological decompression sickness (DCS/AGE) may cover two variants with either severer and probably central nervous (Type A) or milder and sometimes doubtful neurological symptoms (Type B). The pathophysiology of the Type B-DCS/AGE might be different from the Type A-variant. In Type A-DCS/AGE a higher PFO-prevalence (patent foramen ovale) points towards an embolic origin of the Type A-symptomatology. This is not necessarily expected for the Type B-DCS/AGE if the pathophysiology here is micro-embolic or even non-embolic. METHODS: 18 patients with Type B-DCS/AGE were tested against matched controls for presence and size of a PFO with echocardiography and transcranial ultrasound with echo-contrast. Prevalence and number of Type A-brain lesions were visualized by cranial MRI as possible sequelae from gas-embolic events. RESULTS: PFO-prevalence in both groups, the patients with Type B-DCS/AGE (5/18) as well as the controls (7/18) was similar to published PFO-prevalences in normals without any difference between patients and controls (p = 0.725). Also the number of MRI-lesions (ACFs) was the same for Type B-DCS/AGE cases (15 ACFs in 5 patients) and controls (37 ACFs in 8 divers). CONCLUSION: Indirect findings suggesting embolic brain injuries are found with similar frequency in patients with Type B-DCS/AGE and normal controls, which is in contrast to data about Type A-DCS/AGE. This is compatible with different pathophysiological mechanisms involved in the Type A- and Type B-DCS/AGE.

High gamma power is phase-locked to theta oscillations in human neocortex.

We observed robust coupling between the high- and low-frequency bands of ongoing electrical activity in the human brain. In particular, the phase of the low-frequency theta (4 to 8 hertz) rhythm modulates power in the high gamma (80 to 150 hertz) band of the electrocorticogram, with stronger modulation occurring at higher theta amplitudes. Furthermore, different behavioral tasks evoke distinct patterns of theta/high gamma coupling across the cortex. The results indicate that transient coupling between low- and high-frequency brain rhythms coordinates activity in distributed cortical areas, providing a mechanism for effective communication during cognitive processing in humans.

Automated localization of magnetoencephalographic interictal spikes by adaptive spatial filtering.

OBJECTIVE: Automated adaptive spatial filtering techniques can be applied to magnetoencephalographic (MEG) data collected from people with epilepsy. Source waveforms estimated by these methods have higher signal-to-noise ratio (SNR) than spontaneous MEG data, allowing identification and location of interictal spikes. The software tool SAM(g(2)) provides an adaptive spatial filtering algorithm for MEG data that yields source images of excess kurtosis and provides source time-courses in voxels exhibiting high excess kurtosis. The sensitivity and specificity of SAM(g(2)) in epilepsy is unknown. METHODS: Interictal MEG data from 36 patients with intractable epilepsy were analyzed using SAM(g(2)), and results compared with equivalent current dipole (ECD) fit procedures. RESULTS: When SNR of interictal spikes was high (compared to background) with a clear single focus, in most cases there was good agreement between ECD and SAM(g(2)). With multiple foci, there was typically overlap but imperfect concordance between results of ECD and SAM(g(2)). CONCLUSIONS: SAM(g(2)) may in some cases be equivalent to manual ECD fit for localizing interictal spikes with single locus and good SNR. Further studies are required to validate SAM(g(2)) with multiple foci or poor SNR. SIGNIFICANCE: In some cases, SAM(g(2)) might eventually assist or replace manual ECD analysis of MEG data.

Limitations of Wada memory asymmetry as a predictor of outcomes after temporal lobectomy.

BACKGROUND: The intracarotid amobarbital (Wada) test can be used to evaluate hemispheric memory capacity before anterior temporal lobectomy (ATL). Most patients demonstrate better memory with injection ipsilateral to planned resection (expected asymmetry [EA]), but a substantial minority show better memory with contralateral injection (unexpected asymmetry [UA]). Both degree and direction of Wada memory asymmetry (WMA) have been associated with worse surgical outcome in small series. Reports also suggest that UA is associated with greater decline in verbal memory after left ATL (L-ATL). METHODS: The relationship between WMA and surgical outcome (at 3 months, 1 year, and last follow-up) was examined in a large group of ATL patients (108 L, 119 R) with both EA and UA. Also, memory in a subgroup (96 L, 108 R) was examined, comparing subscores of the Rey Auditory Verbal Learning Test obtained preoperatively, at 3 months, and at 1 year. RESULTS: Thirty-six percent of L-ATL and 8% of R-ATL patients had UA. UA was associated with worse surgical outcome at 1 year for R-ATL patients but was not associated with worse outcome for L-ATL patients. There was no correlation between WMA and persistent postoperative verbal memory change for patients with L- or R-ATL. CONCLUSIONS: Unexpected asymmetry is uncommon in patients with right anterior temporal lobectomy (R-ATL) and may be a risk marker of poor surgical outcome. This relationship may be obscured by language confounds in patients with L-ATL. The results suggest that Wada asymmetry (using mixed stimuli) does not predict postoperative verbal memory; it is unclear whether this finding is generalizable to centers using only nonverbal stimuli.

Resolving abbreviations to their senses in Medline.

MOTIVATION: Biological literature contains many abbreviations with one particular sense in each document. However, most abbreviations do not have a unique sense across the literature. Furthermore, many documents do not contain the long forms of the abbreviations. Resolving an abbreviation in a document consists of retrieving its sense in use. Abbreviation resolution improves accuracy of document retrieval engines and of information extraction systems. RESULTS: We combine an automatic analysis of Medline abstracts and linguistic methods to build a dictionary of abbreviation/sense pairs. The dictionary is used for the resolution of abbreviations occurring with their long forms. Ambiguous global abbreviations are resolved using support vector machines that have been trained on the context of each instance of the abbreviation/sense pairs, previously extracted for the dictionary set-up. The system disambiguates abbreviations with a precision of 98.9% for a recall of 98.2% (98.5% accuracy). This performance is superior in comparison with previously reported research work. AVAILABILITY: The abbreviation resolution module is available at http://www.ebi.ac.uk/Rebholz/software.html.

[Human biomonitoring investigations of organochlorine compounds -- PCB, DDE, HCB, beta- and gamma-HCH, PCDD/PCDF, Dioxin-like PCB's and polybrominated biphenyl ethers]. / Humanbiomonitoring-Untersuchungen von Organohalogenverbindungen -- PCB, DDE; HCB, beta- und gamma-HCH, PCDD/PCDF, koplanaren PCB sowie polybromierten Biphenylethern.

Although PCB and PCB-containing materials are not processed for a long time, PCB is under discussion again and again caused by the pollution of indoor environments. To objectify the discussion, the dates of the PCB-biomonitoring, the organochlorine-compounds (DDE, HCB, beta-/gamma -HCH, PCDD/PCDF) and the polybrominated biphenyl ethers concerning the investigations within the project "Sentinel Health Departments" in Baden-Wurttemberg are represented. Additionally results from children from Kazakhstan (Aral-Sea area) and from teachers which are working in PCB polluted schools as well as from a long term investigated test person are reported. Blood concentrations of the following compounds decreased from 1996/97 to 2002/03: the sum of the concentration of PCB 138,153 and 180 decreased from 0.46 microg/L to 0.20 microg/L, DDE from 0.32 microg/L to 0.17 microg/, HCB from 0.20 microg/L to 0.08 microg/L, beta-HCH below the level of detection, I-TEQ NATO to 4.8 pg/g blood fat, TEQ WHO (without PCB) to 5.5 pg/g blood fat, PCB 126 to 18,8,pg/g blood fat and PCB 169 to 12.8 pg/g blood fat. The influence of breast feeding and the gender on the level of the pollution is conspicious. No local correlations were found in Baden-Wurttemberg, but they were found in comparison with the results of Kazakhstan (Aral-Sea area). The difficulty to produce time series while the analyzing pollutants are more and more decreasing, as well as the change of the calculation base of the summation of parameters like I-TEQ NATO to TEQ WHO are discussed.

[Determination of mold concentrations in homes and schools in Baden-Württemberg]. / Bestimmung der Schimmelpilzkonzentration in Wohnungen und Schulen Baden-Württembergs.

So far there have been rather few reliable and comparable data available on indoor pollution with mould. Following the publication of the Federal Environmental Agency and the Health Agency Baden-Württemberg which supports the assessment of mould pollution of indoor air, it seemed advisable to investigate as to how far these criteria can be used for the assessing the mould pollution in daily practice. The results of investigations of 130 homes and 117 classrooms in Baden-Württemberg. will be represented.

Localization of interictal spikes using SAM(g2) and dipole fit.

SAM(g2) is an automated analysis that transforms the MEG data into a functional image of spike-like activity, giving the source waveforms for those locations. Since the source waveforms estimated by SAM have higher signal-to-noise ratio (SNR) than does the raw MEG data, it is possible to automatically mark the location and timing of each spike for comparisons with dipole fit procedures. Both SAM(g2) and equivalent current dipole (ECD) fits were used to analyze MEG interictal spike recordings in 10 patients with cortical dysplasias and medial temporal lobe epilepsy. The ECD fit locations obtained by manual spike classification and latency marking were compared with those found by automated SAM(g2) procedures. When the SNR of interictal activity was high (compared to the background) with a clear single focus, there was excellent agreement between the ECD cluster location and the SAM(g2) maximum. However, when the SNR of spikes was low, manual single ECD location scatter was larger than SAM(g2) reconstructions. When multiple independent interictal spike loci were present, there was some disagreement between SAM(g2) and ECD scatter in the cases of low SNR spikes. When SAM(g2) indicated multiple coupled spike loci, the residual variance for the dipole fit was high and its scatter unacceptably large--even for multiple dipole models. This study demonstrates that SAM(g2) is equivalent to ECD fit for localizing interictal spikes when there is a single locus and good SNR. Further studies are required to validate cases in which there are multiple spike loci or poor SNR.

[10 years of observation by public health offices in Baden-Württemberg--assessment of human biomonitoring for mercury due to dental amalgam fillings and other sources]. / 10 Jahre Beobachtungsgesundheitsämter in Baden-Württemberg--Beurteilung der Human-Biomonitoring-Untersuchungen bezüglich der Quecksilber-Belastung durch Amalgamfüllungen und andere Quellen.

Since 1992, in Baden-Württemberg, ten-year old children have been surveyed in the project "Sentinel Health Departments" to study their exposure to environmental pollutants and possible health effects. In the four study areas 1200 children have been investigated every year initially, since 1996 every second year. The data for mercury in body fluids are reported here. The decrease in the body burden of mercury as a result of the declining usage of dental amalgam fillings, was been verified. In 1992/93, of all the children who had been surveyed, the 95 percentile for the body burden of mercury was 3.1 microg/l and in 2000/01 1.35 microg/l. Also to be discussed is the reason why mercury-based cosmetic ointments seriously exceed the HBM-II-intervention-value. Because of using these ointments, concentrations of mercury in urine up to 1400 microg/l were found. A study within the project "Sentinel Health Departments" compared the concentrations of mercury in the urine of adults with those in blood and salvia. The results support the opinion that mercury in urine is appropriate for estimating the mercury uptake from dental amalgam fillings. It can be assumed that these results reflect the situation in the entire Federal Republic of Germany. The ten years' experience confirms that the concept of the "Sentinel Health Departments" is excellently suited to obtain data relevant for environmental health of children. Environmental health protection and the essential gathering of data for future health observation in Baden-Württemberg.

[Anxiety: an aspect of the interaction of doctor and patients on the waiting-list and after lung-transplantation]. / Angst: Ein Aspekt der Interaktion von Arzt und Patient auf der Warteliste und nach Lungentransplantation.

Anxiety occurs frequently in patients who are on the waiting-list for a lung-transplantation or have already been transplanted. In this context anxiety is a theme of every interaction of doctor and patient but often remains unrecognized because it hides behind bodily symptoms and mechanisms of defense. Anxiety affects patients' behavior and compliance and may afflict - especially if not recognized - doctors' decisions and thus patients' health and survival. It is therefore necessary to recognize and to openly handle anxiety in the interaction of doctor and patient.

Extranodal head and neck lymphomas in Guatemala: high frequency of Epstein-Barr virus-associated sinonasal lymphomas.

Sinonasal lymphomas of T cell or natural killer cell (T/NK cell) phenotype represent a subset of extranodal head and neck lymphomas. T/NK cell sinonasal lymphomas have been described in diverse geographic settings, including China, Japan, Peru, Northern Europe, and North America. The frequency of these lymphomas is highly dependent on the geographic location in which they occur, their incidence being low in Europe and North America and relatively high in Asian countries and in Peru. Regardless of their geographic location, they are typically associated with the Epstein-Barr virus (EBV). Few studies have addressed the relative frequency of sinonasal lymphoma within the group of extranodal head and neck lymphomas. We investigated the anatomic distribution, immunophenotypical profile, and EBV status of 33 cases of extranodal head and neck lymphoma from patients in Guatemala. The anatomic distribution of these lymphomas is similar to that seen in Asian countries: 17 (52%) in the sinonasal area, five (15%) in the palate, and 11 (33%) in other locations. Fifteen (88%) of the 17 sinonasal lymphomas showed a T or null cell phenotype with a strong association with EBV by in situ hybridization. Most Guatemalan patients with these lymphomas were of Mayan descent. In Guatemala, the relative frequency of sinonasal lymphomas within the group of head and neck lymphomas is significantly higher than that reported for Western countries. In addition, the relative frequency of T/NK versus B cell sinonasal lymphomas is higher than that described in North America and similar to that observed in Asian countries and Peru.

HERV-K: the biologically most active human endogenous retrovirus family.

The human genome contains a wide variety of endogenous retrovirus-like sequences. The human endogenous retrovirus type K (HERV-K) family comprises 30-50 members per haploid genome in humans and is highly conserved in Old World monkeys and apes. Some proviruses are displaying open reading frames (ORF) with coding capacity for viral particles. HERV-K sequences most likely code for the previously described human teratocarcinoma-derived virus (HTDV) and correlated expression of HERV-K Gag has been demonstrated by immunoelectron microscopy studies. Protease, but not yet reverse transcriptase (RT), enzymatic activity was demonstrated for recombinant HERV-K proteins. However, an ultrasensitive RT assay revealed specific polymerase activity associated with the HTDV particles. HERV-K transcription is specifically regulated by viral long terminal repeats and RNA is expressed at low steady-state levels in a variety of human tissues and tumours. In teratocarcinoma cell lines, HERV-K is highly expressed in a complex pattern showing full-length as well as subgenomic envelope (env) and two alternatively spliced small transcripts. The doubly spliced 1.8-kb mRNA codes for cORF protein which resembles Rev of HIV-1 and is located in the nucleolus. In addition, the cORF sequence acts as a leader and is essential for effective expression of glycosylated HERV-K Env protein. Although HERV-K sequences code for all necessary retroviral proteins, infectious particles could not yet be demonstrated. The putative implication of HERV sequences in pathophysiological processes, for example, testicular malignancies, remains to be elucidated.

Esophageal perforation. An unusual presentation of esophageal lymphoma.

A primary histiocytic lymphoma arising in the esophagus and its resultant spontaneous perforation is reported in a 69-year-old female. To our knowledge esophageal perforation occurring as a complication of a primary non-Hodgkin's lymphoma of the esophagus has not been previously reported.