Unraveling the Development of an Algorithm for Recognizing Primary Emotions Through Electroencephalography.

The large range of potential applications, not only for patients but also for healthy people, that could be achieved by affective brain-computer interface (aBCI) makes more latent the necessity of finding a commonly accepted protocol for real-time EEG-based emotion recognition. Based on wavelet package for spectral feature extraction, attending to the nature of the EEG signal, we have specified some of the main parameters needed for the implementation of robust positive and negative emotion classification. Twelve seconds has resulted as the most appropriate sliding window size; from that, a set of 20 target frequency-location variables have been proposed as the most relevant features that carry the emotional information. Lastly, QDA and KNN classifiers and population rating criterion for stimuli labeling have been suggested as the most suitable approaches for EEG-based emotion recognition. The proposed model reached a mean accuracy of 98% (s.d. 1.4) and 98.96% (s.d. 1.28) in a subject-dependent (SD) approach for QDA and KNN classifier, respectively. This new model represents a step forward towards real-time classification. Moreover, new insights regarding subject-independent (SI) approximation have been discussed, although the results were not conclusive.

Anti-IL-6 Receptor Tocilizumab in Refractory Graves' Orbitopathy: National Multicenter Observational Study of 48 Patients.

Graves' orbitopathy (GO) is the most common extrathyroidal manifestation of Graves' disease (GD). Our aim was to assess the efficacy and safety of Tocilizumab (TCZ) in GO refractory to conventional therapy. This was an open-label multicenter study of glucocorticoid-resistant GO treated with TCZ. The main outcomes were the best-corrected visual acuity (BVCA), Clinical Activity Score (CAS) and intraocular pressure (IOP). These outcome variables were assessed at baseline, 1st, 3rd, 6th and 12th month after TCZ therapy onset. The severity of GO was assessed according to the European Group on Graves' Orbitopathy (EUGOGO). We studied 48 (38 women and 10 men) patients (95 eyes); mean age ± standard deviation 51 ± 11.8 years. Before TCZ and besides oral glucocorticoids, they had received IV methylprednisolone (n = 43), or selenium (n = 11). GO disease was moderate (n =29) or severe (n = 19) and dysthyroid optic neuropathy (DON) (n = 7). TCZ was used in monotherapy (n = 45) or combined (n = 3) at a dose of 8 mg/kg IV every four weeks (n = 43) or 162 mg/s.c. every week (n = 5). TCZ yielded a significant improvement in all of the main outcomes at the 1st month that was maintained at one year. Comparing the baseline with data at 1 year all of the variables improved; BCVA (0.78 ± 0.25 vs. 0.9 ± 0.16; p = 0.0001), CAS (4.64 ± 1.5 vs. 1.05 ± 1.27; p = 0.0001) and intraocular pressure (IOP) (19.05 ± 4.1 vs. 16.73 ± 3.4 mmHg; p = 0.007). After a mean follow-up of 16.1 ± 2.1 months, low disease activity (CAS ≤ 3), was achieved in 88 eyes (92.6%) and TCZ was withdrawn in 29 cases due to low disease activity (n = 25) or inefficacy (n = 4). No serious adverse events were observed. In conclusion, TCZ is a useful and safe therapeutic option in refractory GO treatment.

Cortical Asymmetries and Connectivity Patterns in the Valence Dimension of the Emotional Brain.

Understanding the neurophysiology of emotions, the neuronal structures involved in processing emotional information and the circuits by which they act, is key to designing applications in the field of affective neuroscience, to advance both new treatments and applications of brain-computer interactions. However, efforts have focused on developing computational models capable of emotion classification instead of on studying the neural substrates involved in the emotional process. In this context, we have carried out a study of cortical asymmetries and functional cortical connectivity based on the electroencephalographic signal of 24 subjects stimulated with videos of positive and negative emotional content to bring some light to the neurobiology behind emotional processes. Our results show opposite interhemispheric asymmetry patterns throughout the cortex for both emotional categories and specific connectivity patterns regarding each of the studied emotional categories. However, in general, the same key areas, such as the right hemisphere and more anterior cortical regions, presented higher levels of activity during the processing of both valence emotional categories. These results suggest a common neural pathway for processing positive and negative emotions, but with different activation patterns. These preliminary results are encouraging for elucidating the neuronal circuits of the emotional valence dimension.

Lymphatic ascites after retroperitoneal lymphadenectomy in gynecologic cancer.

OBJECTIVES: The incidence, diagnosis, treatment and outcome of lymphatic ascites (LA) are studied on 85 consecutive patients with gynecologic cancer who had undergone pelvic and/or paraaortic lymphadenectomy by means of laparotomy or laparoscopy. METHODS: Patients were distributed in two groups depending in the access: Laparoscopy (study group: 44 patients) and laparotomy (control group: 41 patients). All surgical parameters were collected and patients underwent ultrasound examination on postoperative days 7, 14, and 28. The main outcome measure was the development of symptomatic or asymptomatic LA. DESIGN: Prospective cohort study. RESULTS: LA developed in 3 patients (6.8%) in the study group and 9 in the control group (22%), with statistical difference (p < 0.05). The relative risk to develop lymphatic ascites after surgery performed by laparotomy was 3.2 (95% CI 1.05-11.07). Mean nodes harvested during the surgery was 18.6 (SD 6.6) in the LA group and 20.4 (SD 9.1) in the group with no LA (p = 0.527). CONCLUSIONS: The incidence of LA after retroperitoneal lymphadenectomy in gynecologic cancer patients is lower in the patients treated by laparoscopy.

Endocytosis as a biological response in receptor pharmacology: evaluation by fluorescence microscopy.

The activation of G-protein coupled receptors by agonist compounds results in diverse biological responses in cells, such as the endocytosis process consisting in the translocation of receptors from the plasma membrane to the cytoplasm within internalizing vesicles or endosomes. In order to functionally evaluate endocytosis events resulted from pharmacological responses, we have developed an image analysis method -the Q-Endosomes algorithm- that specifically discriminates the fluorescent signal originated at endosomes from that one observed at the plasma membrane in images obtained from living cells by fluorescence microscopy. Mu opioid (MOP) receptor tagged at the carboxy-terminus with yellow fluorescent protein (YFP) and permanently expressed in HEK293 cells was used as experimental model to validate this methodology. Time-course experiments performed with several agonists resulted in different sigmoid curves depending on the drug used to initiate MOP receptor endocytosis. Thus, endocytosis resulting from the simultaneous activation of co-expressed MOP and serotonin 5-HT2C receptors by morphine plus serotonin was significantly different, in kinetics as well as in maximal response parameters, from the one caused by DAMGO, sufentanyl or methadone. Therefore, this analytical tool permits the pharmacological characterization of receptor endocytosis in living cells with functional and temporal resolution.

Three-dimensional angioultrasonography for the prediction of malignancy in ovarian masses.

OBJECTIVE: To determine the efficacy of the angiographic indexes of 3D power Doppler angiography (3D-PDA) for the diagnosis of malignancy in complex ovarian masses. METHODS: A prospective, observational study of 72 patients with complex adnexal mass. RESULTS: In the morphological study, 3D ultrasound showed sensitivity, specificity, PPV, NPV, PLHR and NLHR of 84.6%, 81.9%, 85.1%, 81.8%, 4.65 and 0.19. No differences in vascular indexes (VI, FI, VFI) between malignant and benign masses were found: VI 5.38 (CI 95% 3.06-7.7) vs. 6.29 (CI 95% 4.41-8.17) (p = 0.53); FI 29.6 (CI 95% 25.17-34.08) vs. 33.8 (CI 95% 30.03-37.3) (p = 0.15); VFI 1.68 (CI 95% 0.94-2.42) vs. 2.37 (CI 95% 1.49-3.25) (p = 0.24). When analysed according to different stages, VI was higher in patients with more advanced stages of disease; 4.34 (95% CI 2.21-6.47) vs. 7.38 (95% CI 4.7-10.06) (p = 0.11). FI was significantly lower in patients with early stages of disease; FI 29.07 (95% CI 21.49-36.68) vs. 36.46 (95% CI 32.31-40.62) (p = 0.04). For VFI, differences were not significant, although there was a strong trend; VFI 1.47 (95% CI 0.67-2.28) vs. 2.86 (95% CI 1.57-4.16) (p = 0.11). 3D-PDA indexes were significantly higher in patients with positive adenopathies. CONCLUSION: 3D-PDA values increase progressively, but not significantly, with the stage of the disease.

Periovulatory follicular volume and vascularization determined by 3D and power Doppler sonography as pregnancy predictors in intrauterine insemination cycles.

PURPOSE: To evaluate the relationship between volume and vascularization of the periovulatory follicle and subfollicular area measured by three-dimensional power Doppler ultrasound (US), and ovulation and pregnancy in patients undergoing intrauterine insemination (IUI). METHODS: We studied 79 consecutive cycles of IUI on hCG administration day. We measured the periovulatory follicle and subfollicular area by means of three-dimensional power Doppler US. The stored volumes were processed with the VOCAL image processing software to calculate the volume of the follicle and the following vascular indices: vascularization index (VI), flow index (FI), and vascularization flow index (VFI). RESULTS: The follicular volume was higher in anovulatory cycles (7.7 ± 3.7 cubic centimeters (CC) versus 4.1 ± 2.0 CC; p < 0.001). There was no difference between the follicular volumes in cycles with or without subsequent pregnancy. The vascular indices of the follicle did not differ significantly between ovulatory and anovulatory cycles, and between cycles that did and did not achieve pregnancy. Periovulatory subfollicular VI and VFI were lower in women who became pregnant (VI: 2.9 ± 2.3% versus 5.6 ± 4.6%; p < 0.05, and VFI: 1.1 ± 0.8 versus 2.2 ± 2.2; p < 0.01). CONCLUSIONS: High values of follicular volume were associated with anovulatory cycles. Subfollicular VI and VFI might be used as markers of follicular quality and pregnancy predictors.

Hysteroscopic dynamic assessment of the endometrium in patients treated with long-term tamoxifen.

STUDY OBJECTIVE: To describe the evolutive endometrial hysteroscopic patterns in patients undergoing long-term tamoxifen treatment. DESIGN: Prospective analysis. Analysis of variance test with post hoc Bonferroni test and homogeneity test of percentages were used for hypothesis contrast between the groups. DESIGN CLASSIFICATION: Canadian task force II-2. SETTING: Four Spanish tertiary care hospitals. PATIENTS: A total of 278 patients with breast cancer diagnosed between 2002 and 2004, which completed 5-years adjuvant therapy with tamoxifen. INTERVENTIONS: Ultrasonography and hysteroscopic explorations were performed before starting the treatment and then at yearly intervals during the 5 years of adjuvant treatment. MEASUREMENTS AND MAIN RESULTS: Hysteroscopic endometrial changes were significant throughout the years of treatment. Tamoxifen-exposed endometria present five different patterns: atrophic, cystic, hypervascularized, endometrial polyp, and suspicious of malignancy. Endometrial carcinoma appeared in four patients (1.5%) that bled during the follow-up. CONCLUSION: Tamoxifen produces five different endometrial patterns that evolve dynamically throughout the 5 years of treatment.

Determinants of organochlorine levels detectable in the amniotic fluid of women from Tenerife Island (Canary Islands, Spain).

Organochlorines (OCs) tend to accumulate in human tissues and can be measured in amniotic fluid (AF). The detection of OCs in AF samples reflects intrauterine exposure of human beings to these persistent organic pollutants. The present study was performed to evaluate the level of contamination of AF by OCs in 100 pregnant women from Tenerife Island (Canary Islands, Spain). Gas chromatography/mass spectrometry (GC/MS) was used to identify and quantify the analytes, including 7 polychlorobiphenyl (PCB) congeners and 18 OC pesticides and metabolites. The majority of the AF samples (67%) showed some detectable OC-residue, hexachlorobenzene (HCB) being the most frequently detected compound (66% of the samples) and at the highest concentration (median 0.023 ng/ml). Lindane was also detected in 28% of the samples. Inverse associations were found between previous lactation and hexachlorocyclohexane isomers (HCH) and cyclodienes in the group of younger women (p = 0.037 and p = 0.027, respectively). Unexpectedly, serum values of HCB (r = -0.414; p = 0.04), gamma-HCH (r = -0.294; p = 0.035), and SigmaOCs (r = -0.350; p = 0.014) were negatively related to age. Even more, women with detectable levels of HCH isomers were younger (33.9 +/- 4.9 years) than women with undetectable levels of them (36.1 +/- 4.9 years; p = 0.035). We conclude that approximately one in two fetuses in the Canary Islands is exposed to OCs in utero, and that, therefore, the exposure of young women from these Islands to some HCH isomers persists nowadays. Because prenatal exposure to these chemicals may be a causative factor in adverse health trends, further studies are required to enhance preventive measures.

Intervillous and uteroplacental circulation in normal early pregnancy and early pregnancy loss assessed by 3-dimensional power Doppler angiography.

OBJECTIVE: To assess intervillous and uteroplacental circulation in early normal pregnancies and miscarriages. STUDY DESIGN: One hundred normal pregnancies and 46 delayed miscarriages were evaluated by 3-dimensional vaginal ultrasound and power Doppler angiography. Volumes of the early placenta and the subplacental area were obtained between 5 and 12.6 weeks' gestation. The placental volume, vascularization index, flow index, and vascularization flow index was calculated. RESULTS: Intraclass correlation coefficients ranged from 0.961 for placental volume to 0.885 for intervillous flow index. Intervillous power Doppler signals were not detected before the sixth week. Placental volume (R(2) = 0.68), intervillous vascularization index (R(2) = 0.30), flow index (R(2) = 0.33) and vascularization flow index (R(2) = 0.35), uteroplacental flow index (R(2) = 0.34), and vascularization flow index (R(2) = 0.17) increase significantly (P < .001) throughout the first trimester of normal pregnancies. Uteroplacental vascularization index was not significantly related to gestational age. Intervillous vasculariztion index, flow index, and vascularization flow index were significantly raised in miscarriages, but there were no significant differences for uteroplacental vascularization index, flow index, or vascularization flow index. CONCLUSION: Intervillous and uteroplacental blood flow increases throughout the first trimester of normal pregnancies. Intervillous circulation is abnormally increased when a miscarriage is diagnosed.

¿Puede la ecografía tridimensional cambiar la exploración ecográfica ginecológica en nuestro medio? / Can 3-dimensional ultrasonography change gynecological ultrasonographic examination in Spain?

Objetivo: Comprobar si la ecografía en 3D vaginal es tan fiable como la convencional y si aporta alguna ventaja al diagnóstico ecográfico ginecológico. Material y métodos: Estudio prospectivo en 46 mujeres a las que se realizó consecutivamente una ecografía vaginal en 2D y en 3D. Se obtuvieron tres volúmenes en 3D (útero y cada uno de los ovarios) y se estudiaron 4 meses más tarde en un ordenador personal. Se compararon ambas técnicas con respecto el diagnóstico y la biometría ecográfica y el tiempo empleado. Resultados: Se comprobó un acuerdo total entre los diagnósticos ecográficos realizados en modo 2D y 3D (31 exploraciones normales, 16 quistes anexiales y 7 miomas uterinos), excepto para la visualización y medida del cuello uterino. El tiempo medio ± desviación estándar por exploración fue de 3,29 ± 1,32 min para el modo 2D y de 2,96 ± 0,58 min para el modo 3D (p = 0,076). La adquisición de los volúmenes en 3D necesita sólo 1 h, lo que permite destinar el ecógrafo a otras exploraciones durante 1 h 32 min (AU)

Objective: To verify whether 3D transvaginal ultrasonography is as accurate as 2D conventional ultrasonography and whether it provides additional advantages in gynecologic diagnosis. Material and methods: We performed a prospective study in 46 women who underwent 2D and 3D transvaginal scans successively. Three 3D volumes (uterus and each ovary) were acquired and evaluated 4 months later on a personal computer. We compared 2D and 3D scans in relation to sonographic diagnosis and biometry and the time spent. Results: There was complete agreement between 2D and 3D techniques for sonographic diagnosis (31 normal exams, 16 adnexal cysts and seven myomas), except for the visualization and measurement of the uterine cervix. The mean time for 2D scans was 3.29 ± 1.32 minutes and was 2.96 ± 0.58 minutes for 3D examination (P=.076). The time required to acquire 3D volumes was only 1 hour, freeing 1 hour and 32 minutes for the performance of new scans. Conclusions: Transvaginal 3D ultrasonography can be more efficient than conventional 2D ultrasonography in gynecologic diagnosis (AU)

Are endometrial parameters by three-dimensional ultrasound and power Doppler angiography related to in vitro fertilization/embryo transfer outcome?

OBJECTIVE: To evaluate whether endometrial parameters by three-dimensional ultrasonography and power Doppler angiography (3D US-PDA) can predict in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcome. DESIGN: Prospective clinical study. SETTING: Assisted reproduction unit in a referral hospital. PATIENT(S): Eighty women who underwent IVF cycles. INTERVENTION(S): Endometrial 3D US-PDA evaluated by VOCAL software (plane C and 9 degrees of rotational steps). MAIN OUTCOME MEASURE(S): Endometrial pattern, endometrial thickness (ET), endometrial volume (EV), and PDA indexes of vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were measured on the day of human chorionic gonadotropin (hCG) administration. These measurements were related to IVF/ICSI and embryo transfer outcome. RESULT(S): In the pregnant group, EV, VI, FI, and FVI but not triple-line pattern and ET were statistically significantly higher. The area under receiver operating characteristic (ROC) curve was statistically significant for EV (0.746), VI (0.724), FI (0.828), and VFI (0.800) when no grade 1 embryos or only one were transferred (43 cycles, 14 pregnancies) but not when two or three grade 1 embryos were transferred. Moreover, these parameters were statistically significant in predicting a normal pregnancy outcome (no early pregnancy loss) but were not related to multiple pregnancies. CONCLUSION(S): In IVF/ICSI cycles, 3D US-PDA is useful for evaluating endometrial receptivity. Endometrial volume and 3D power Doppler indexes are statistically significant in predicting the cycle outcome when one grade 1 or no grade 1 embryos are transferred, which could be helpful data in a single-embryo transfer policy.

Prediction of ovarian response and IVF/ICSI outcome by three-dimensional ultrasonography and power Doppler angiography.

OBJECTIVE: The objective was to evaluate whether three-dimensional ultrasonography (3D-US) and power Doppler angiography (PDA) measurements can predict ovarian response and/or are associated with IVF/ICSI outcome. STUDY DESIGN: A prospective clinical study in 65 women undergoing IVF cycles. Ovarian volume (OV), number of antral follicles > or =2mm (NAF) and PDA indices: vascularisation index (VI), flow index (FI), and vascularisation flow index (VFI) were evaluated by 3D-US and PDA on the day of pituitary suppression control. These measurements, age and BMI were correlated with the number of follicles>10mm on the hCG day and the number of oocytes retrieved. RESULTS: Ovarian volume, NAF, VI, FI and FVI correlate significantly (P<0.01) with the number of follicles and oocytes recovered. Ovarian volume and the number of antral follicles predicted significantly the number of follicles (R=0.67; adjusted R(2)=0.43) and oocytes retrieved (R=0.63; adjusted R(2)=0.37). The oestradiol peak and the number of follicles, oocytes and Grade 1 embryos transferred were higher in the pregnant group. CONCLUSIONS: Three-dimensional ultrasound and PDA make it easier to evaluate all the sonographic parameters implied in ovarian response. Ovarian volume and the number of antral follicles are the only independent predictors of the number of follicles developed and oocytes retrieved.

Assessment of the ovarian volume, number and volume of follicles and ovarian vascularity by three-dimensional ultrasonography and power Doppler angiography on the HCG day to predict the outcome in IVF/ICSI cycles.

OBJECTIVE: The aim of this prospective study was to investigate whether ovarian blood flow is related to embryological parameters and whether it could be a predictor of outcomes of IVF/ICSI. METHODS: Eighty infertile women underwent ovarian stimulation with gonadotrophins after a long protocol with GnRH agonists. The ovarian volume (OV), number of follicles (NF) and follicular volume (FV) of all follicles >10 mm and vascularization index (VI), flow index (FI) and vascularization-flow index (VFI) were obtained by three-dimensional (3D) ultrasonography and power Doppler angiography (PDA) on the day of HCG administration. These parameters were tested for their relation with IVF laboratory parameters. RESULTS: The OV, FV, VI, FI and VFI were significantly greater in the pregnant group. The NF and FV were the only independent predictors of the number of oocytes retrieved, mature and fertilized, and the number of embryos developed and their cumulative embryo score. Nevertheless, the number of grade 1 embryos depends on the NF and the VI. The ovarian FI and the number of transferred grade 1 embryos can predict gestation in 76% of IVF patients. A low FI and non-grade 1 embryo transferred are also associated with an increased pregnancy loss. CONCLUSION: 3D ultrasonography and PDA allow for an easier ovarian assessment in IVF cycles. The predictive value of IVF outcome suggests a high clinical usefulness of this new technique.

Endometrial volume and vascularity measurements by transvaginal three-dimensional ultrasonography and power Doppler angiography in stimulated and tumoral endometria: intraobserver reproducibility.

OBJECTIVES: To assess intraobserver reproducibility of the endometrial volume (EV) and 3D power Doppler indices (vascularization index, VI; flow index, FI; and vascularization flow index, VFI) of the endometrium and subendometrial area using three-dimensional power Doppler angiography (3D-PDA). METHODS: Twenty-five women on the hCG day after controlled ovarian stimulation and 15 patients presenting with uterine bleeding and suspicious endometrial thickening (10 endometrial cancers and 5 endometrial hyperplasias) were scanned. Eighty volume data sets were analyzed using the VOCAL imaging program. EV and VI, FI and VFI of the endometrium and subendometrium (5 mm shell) were manually calculated in the longitudinal and coronal planes with 15 degrees and 9 degrees rotation steps. Intraclass correlation coefficient (ICC) and 95% confidence intervals were used to assess reliability. RESULTS.: EV measurements were highly reproducible (ICC > or = 0.97) without significant differences between planes and rotation steps. Endometrial and subendometrial VI, FI, and VFI presented ICCs above 0.90 with the exception of the subendometrial FI (ICC > or = 0.80). There were no significant differences according to measurement plane and rotation step except for subendometrial VFI. Nevertheless, 3D power Doppler indices calculated in the coronal plane and 9 degrees rotation step obtained the highest ICC. ICCs for 3D-PDA indices from the tumoral endometria were significantly higher than those calculated from the stimulated endometria. CONCLUSIONS: Endometrial volume and endometrial and subendometrial 3D power Doppler indices have an acceptable reproducibility, significantly higher in tumoral endometria. The reliability of measurements does not seem to be significantly influenced by the rotation plane and degrees of rotation. These results support that 3D-PDA and VOCAL are reliable methods to evaluate the physiological and pathological changes of the endometrium.