Contrast enhancement method in aero thermal radiation images based on cyclic multi-scale illumination self-similarity and gradient perception regularization.

In aerospace, the effects of thermal radiation severely affect the imaging quality of infrared (IR) detectors, which blur the scene information. Existing methods can effectively remove the intensity bias caused by the thermal radiation effect, but they have limitations in the ability of enhancing contrast and correcting local dense intensity or global dense intensity. To address the limitations, we propose a contrast enhancement method based on cyclic multi-scale illumination self-similarity and gradient perception regularization solver (CMIS-GPR). First, we conceive to correct for intensity bias by amplifying gradient. Specifically, we propose a gradient perception regularization (GPR) solver to correct intensity bias by directly decomposing degraded image into a pair of high contrast images, which do not contain intensity bias and exhibit inverted intensity directions. However, we find that the GPR fails for dense intensity area due to small gradient of the scene. Second, to cope with the cases of dense intensity, we regard the dense intensity bias as the sum of multiple slight intensity bias. Then, we construct a cyclic multi-scale illumination self-similarity (CMIS) model by using multi-scale Gaussian filters and structural similarity prior to removing the dense intensity layer by layer. The result acts as coarse correction for GPR, which does not need to be overly concerned with whether the result has intensity residuals or not. Finally, the coarse corrected result is input to the GPR module to further correct residual intensity bias by enhancing contrast. Extensive experiments in real and simulated data have demonstrated the superiority of the proposed method.

Impact of Lycium barbarum polysaccharide on the expression of glucagon-like peptide 1 in vitro and in vivo.

Several studies showed the efficacy of Lycium barbarum polysaccharide (LBP) in diabetic animals and patients with type 2 diabetes mellitus (T2DM). However, the mechanism of LBP in alleviating T2DM based on glucagon-like peptide 1 (GLP1) has not been suitably elucidated. GLP1 is an important peptide that plays a role in blood glucose homeostasis. Inhibition of sodium/glucose cotransporter 1 (SGLT1) can result in a net increase in GLP1 release. We found that LBP could reduce SGLT1 expression. Thus, the effects of LBP on the first- and second-phase secretion of GLP1 were systematically assessed in vitro using STC1 cells and in vivo using diabetic KKAy mice. LBP could induce the first-phase secretion of GLP1 by stimulating calcium ion influx in vitro and by inhibiting alpha-glucosidase activity in vivo. Regulation of Gcg gene expression by modulating the Wnt/ß-catenin and cAMP/Epac pathways, as well as inhibition of alpha-glucosidase activity, was responsible for the second-phase secretion of GLP1. LBP could stimulate GLP1 secretion; however, dipeptidyl peptidase 4 (DPP4) activated by LBP might offset the second-phase secretion of GLP1. Thus, we suggest considering the simultaneous use of LBP and a DPP4 inhibitor to stimulate slow, continuous GLP1 secretion. Further studies are warranted for in-depth mechanistic information.

Continuous theta-burst stimulation modulates resting-state EEG microstates in healthy subjects.

Continuous theta-burst stimulation (cTBS) induces long-lasting inhibitory effects on cortical excitability. Although cTBS has been reported to modulate neural oscillations and functional connectivity, it is still unclear how cTBS affects brain dynamics that could be captured by the resting-sate EEG microstate sequences. This study aims to investigate how cTBS over the left motor cortex affects brain dynamics. We applied 40 s-long cTBS over the left motor cortex of 28 healthy participants. Before and in multi-sessions up to 90 min after cTBS, their performance in a Nine-Hole Peg Test (NHPT), that measures the hand dexterity, and resting state EEG were recorded. Resting-sate EEG data were clustered into four microstates (namely A, B, C, and D) using k-means clustering algorithms. cTBS-induced changes in NHPT performance, microstate dynamics and functional connectivity networks were comprehensively assessed. As compared with baseline, the completion time of NHPT became shorter immediately after cTBS, suggesting cTBS-induced motor function improvement. After cTBS, the topography of microstate B revealed a greater change compared with other three topographies. Importantly, cTBS-induced decrease in completion time of NHPT correlated with cTBS-induced decrease of the mean occurrence of microstate B. Functional connectivity analysis further revealed that cTBS led to an increase of the node efficiency at C4 electrode in microstate B. These results indicated the specific modulation of cTBS over the motor cortex on the dynamics of microstate B. This work provided the evidence of the association between B and motor function, and it also implies the modulation of cTBS over the motor network. Supplementary Information: The online version contains supplementary material available at 10.1007/s11571-021-09726-6.

Diagnosis of Ureaplasma parvum meningitis by mNGS in an extremely low birth weight infant with multi-system lesions.

Ureaplasma parvum encephalitis is a rare disease with high mortality in the neonates. While the manifestations are atypical and identification of U. parvum is difficult, diagnosis would always be delayed. Metagenomic next-generation sequencing (mNGS) is a pre-hypothesis free technique which could theoretically detect all the microbes in a sample. Herein we report a case of U. parvum meningitis identified by mNGS in an extremely low birth weight neonate complicated with multi-system lesions. The patient was treated with erythromycin and ciprofloxacin, symptoms were relieved in the following days and the patient was transferred to treat complications after three weeks' therapy.

Vigilance Estimating in SSVEP-Based BCI Using Multimodal Signals.

Brain-computer interface (BCI) is a communication system that allows a direct connection between the human brain and external devices. With the application of BCI, it is important to estimate vigilance for BCI users. In order to investigate the vigilance changes of the subjects during BCI tasks and develop a multimodal method to estimate the vigilance level, a high-speed 4-target BCI system for cursor control was built based on steady-state visual evoked potential (SSVEP). 18 participants were recruited and underwent a 90-min continuous cursor-control BCI task, when electroencephalogram (EEG), electrooculogram (EOG), electrocardiography (ECG), and electrodermal activity (EDA) were recorded simultaneously. Then, we extracted features from the multimodal signals and applied regression models to estimate vigilance. Experimental results showed that the differential entropy (DE) feature could effectively reflect the change of vigilance. The vigilance estimation method, which integrates DE and EOG features into the support vector regression (SVR) model, achieved a better performance than the compared methods. These results demonstrate the feasibility of our methods for estimating vigilance levels in BCI.

Detection of aerobe-anaerobe mixed infection by metagenomic next-generation sequencing in an adult suffering from descending necrotizing mediastinitis.

BACKGROUND: Descending necrotizing mediastinitis (DNM) is one of the most virulent forms of mediastinitis. The main causes of high mortality in DNM are believed to stem from difficulty and delay in the diagnosis. Fast and accurate identification of pathogens is important for the treatment of these patients. Metagenomics next-generation sequencing (mNGS) is a powerful tool to identify all kinds of pathogens, especially for rare and complex infections. CASE PRESENTATION: A 64-year-old male patient was admitted to the intensive care unit (ICU) with unconsciousness, dyspnea, and swelling in the mandible and neck. Computed tomography (CT) scan results combined with clinical laboratory examination indicated DNM. Vancomycin and imipenem were used, and vacuum sealing drainage was applied for debridement and drainage of the infected area. The positive mNGS results of drainage fluid confirmed the presence of mixed infection caused by Streptococcus anginosus, Prevotella oris, and several other anaerobes. The antibiotics were adjusted to piperacillin/tazobactam and tinidazole according to the mNGS results and antimicrobial susceptibility testing of cultured pathogens. After 11 days of antibiotic therapy, the infection symptoms of the neck and mediastinum improved, and the patient was transferred out of the ICU on the 26th day after negative result of drainage fluid culture. CONCLUSION: This case suggested that mNGS is a promising technology for precise and fast pathogens identification with high sensitivity, which may guide the diagnosis of infectious diseases in the future trend.

Target Detection Using Ternary Classification During a Rapid Serial Visual Presentation Task Using Magnetoencephalography Data.

Background: The rapid serial visual presentation (RSVP) paradigm is a high-speed paradigm of brain-computer interface (BCI) applications. The target stimuli evoke event-related potential (ERP) activity of odd-ball effect, which can be used to detect the onsets of targets. Thus, the neural control can be produced by identifying the target stimulus. However, the ERPs in single trials vary in latency and length, which makes it difficult to accurately discriminate the targets against their neighbors, the near-non-targets. Thus, it reduces the efficiency of the BCI paradigm. Methods: To overcome the difficulty of ERP detection against their neighbors, we proposed a simple but novel ternary classification method to train the classifiers. The new method not only distinguished the target against all other samples but also further separated the target, near-non-target, and other, far-non-target samples. To verify the efficiency of the new method, we performed the RSVP experiment. The natural scene pictures with or without pedestrians were used; the ones with pedestrians were used as targets. Magnetoencephalography (MEG) data of 10 subjects were acquired during presentation. The SVM and CNN in EEGNet architecture classifiers were used to detect the onsets of target. Results: We obtained fairly high target detection scores using SVM and EEGNet classifiers based on MEG data. The proposed ternary classification method showed that the near-non-target samples can be discriminated from others, and the separation significantly increased the ERP detection scores in the EEGNet classifier. Moreover, the visualization of the new method suggested the different underling of SVM and EEGNet classifiers in ERP detection of the RSVP experiment. Conclusion: In the RSVP experiment, the near-non-target samples contain separable ERP activity. The ERP detection scores can be increased using classifiers of the EEGNet model, by separating the non-target into near- and far-targets based on their delay against targets.

Temporal Dynamics on Decoding Target Stimuli in Rapid Serial Visual Presentation using Magnetoencephalography.

Rapid serial visual presentation (RSVP) is a high efficient paradigm in brain-computer interface (BCI). Target detection accuracy is the first consideration of RSVP-BCI. But the influence of different frequency bands and time ranges on decoding accuracy are still an open questions. Moreover, the underlying neural dynamic of the rapid target detecting process is still unclear. Methods: This work focused the temporal dynamic of the responses triggered by target stimuli in a static RSVP paradigm using paired structural Magnetic Resonance Imaging (MRI) and magnetoencephalography (MEG) signals with different frequency bands. Multivariate pattern analysis (MVPA) was applied on the MEG signal with different frequency bands and time points after stimuli onset. Cortical neuronal activation estimation technology was also applied to present the temporal-spatial dynamic on cortex surface. Results: The MVPA results showed that the low frequency signals (0.1 - 7 Hz) yield highest decoding accuracy, and the decoding power reached its peak at 0.4 second after target stimuli onset. The cortical neuronal activation method identified the target stimuli triggered regions, like bilateral parahippocampal cortex, precentral gyrus and insula cortex, and the averaged time series were presented.

A Transfer Learning Framework for RSVP-based Brain Computer Interface.

Rapid Serial Visual Presentation (RSVP)-based Brain-Computer Interface (BCI) is an efficient information detection technology by detecting event-related brain responses evoked by target visual stimuli. However, a time-consuming calibration procedure is needed before a new user can use this system. Thus, it is important to reduce calibration efforts for BCI applications. In this paper, we collect an RSVP-based electroencephalogram (EEG) dataset, which includes 11 subjects. The experimental task is image retrieval. Also, we propose a multi-source transfer learning framework by utilizing data from other subjects to reduce the data requirement on the new subject for training the model. A source-selection strategy is firstly adopted to avoid negative transfer. And then, we propose a transfer learning network based on domain adversarial training. The convolutional neural network (CNN)-based network is designed to extract common features of EEG data from different subjects, while the discriminator tries to distinguish features from different subjects. In addition, a classifier is added for learning semantic information. Also, conditional information and gradient penalty are added to enable stable training of the adversarial network and improve performance. The experimental results demonstrate that our proposed method outperforms a series of state-of-the-art and baseline approaches.

Changes of resting-state EEG microstates induced by low-frequency repetitive transcranial magnetic stimulation.

Repetitive Transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation technique that can influence cortical excitability. Low-frequency rTMS (stimulation frequency ≤1Hz) induces long-lasting inhibitory effects on cortical excitability. At the same time, EEG microstates have been studied and have been thought to corresponding to functional relevant brain-states. In order to investigate dynamic changes in EEG microstates after low-frequency rTMS, 20 healthy subjects received 1-Hz rTMS over the right motor area, and electroencephalography (EEG) in resting condition with eyes open was recorded before rTMS (Pre) and at 0 min, 20 min, 40 min, and 60 min after rTMS (Post0, Post20, Post40, and Post60). Resting state EEG data of all five sessions were computed using a clustering algorithm. Four EEG microstates were found and labeled with the letters A, B, C and D. No significant difference in duration was found among five sessions for four microstates. For microstates A, and B, there is an increase in the mean duration immediately after rTMS. And for microstate C, the mean duration at Post0 and Post60 was significantly higher than that before rTMS. For microstate D, there is an increase in the mean duration at 60min after rTMS. These results showed that we reproduced the same four microstate maps best representing the resting state EEG as found by others and that low-frequency rTMS produced long-lasting alterations in the mean duration of EEG microstates. It implies that low-frequency rTMS increases the stability of EEG microstates.

Integrated Metabolomics and Proteomics Analysis Reveals Plasma Lipid Metabolic Disturbance in Patients With Parkinson's Disease.

Parkinson's disease (PD) is a common neurodegenerative disease in the elderly with a pathogenesis that remains unclear. We aimed to explore its pathogenesis through plasma integrated metabolomics and proteomics analysis. The clinical data of consecutively recruited PD patients and healthy controls were assessed. Fasting plasma samples were obtained and analyzed using metabolomics and proteomics methods. After that, differentially expressed metabolites and proteins were identified for further bioinformatics analysis. No significant difference was found in the clinical data between these two groups. Eighty-three metabolites were differentially expressed in PD patients identified by metabolomics analysis. These metabolites were predominately lipid and lipid-like molecules (63%), among which 25% were sphingolipids. The sphingolipid metabolism pathway was enriched and tended to be activated in the following KEGG pathway analysis. According to the proteomics analysis, forty proteins were identified to be differentially expressed, seven of which were apolipoproteins. Furthermore, five of the six top ranking Gene Ontology terms from cellular components and eleven of the other fourteen Gene Ontology terms from biological processes were directly associated with lipid metabolism. In KEGG pathway analysis, the five enriched pathways were also significantly related with lipid metabolism (p < 0.05). Overall, Parkinson's disease is associated with plasma lipid metabolic disturbance, including an activated sphingolipid metabolism and decreased apolipoproteins.

The Lasting Effects of Low-Frequency Repetitive Transcranial Magnetic Stimulation on Resting State EEG in Healthy Subjects.

Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation technique that can influence cortical excitability. Low-frequency rTMS (stimulation frequency ≤1Hz) can induce inhibitory effects on cortical excitability. In order to investigate dynamic changes in neuronal activity after low-frequency rTMS, 20 healthy subjects received 1-Hz rTMS over the right motor area, and electroencephalography (EEG) in resting condition with eyes open was recorded before rTMS and at 0 min, 20 min, 40 min, and 60 min after rTMS. Power values, functional connectivity based on a weighted phase lag index (wPLI), and network characteristics were assessed and compared to study the aftereffects of rTMS. Our results show that low-frequency rTMS produced a delayed long-lasting increase in alpha-band power values in frontoparietal brain areas and an immediate long-lasting increase in theta-band power values in the ipsilateral frontal and contralateral centroparietal areas. In the alpha band, functional connectivity decreased immediately after rTMS but significantly increased at 20 min after rTMS. Moreover, an analysis of undirected graphs revealed that the number of connections significantly changed in the anterior and posterior regions in the alpha band. In addition, there were significant decreases in clustering coefficients of the channels near the site of stimulation in the alpha and theta bands after rTMS. In conclusion, low-frequency rTMS produces widespread and long-lasting alterations in neural oscillation and functional connectivity. This work implies that low-frequency rTMS can induce inhibitory effects on motor cortical excitability ipsilateral to the stimulation site.

Reorganization of rich-clubs in functional brain networks during propofol-induced unconsciousness and natural sleep.

BACKGROUND: General anesthesia (GA) provides an invaluable experimental tool to understand the essential neural mechanisms underlying consciousness. Previous neuroimaging studies have shown the functional integration and segregation of brain functional networks during anesthetic-induced alteration of consciousness. However, the organization pattern of hubs in functional brain networks remains unclear. Moreover, comparisons with the well-characterized physiological unconsciousness can help us understand the neural mechanisms of anesthetic-induced unconsciousness. METHODS: Resting-state functional magnetic resonance imaging was performed during wakefulness, mild propofol-induced sedation (m-PIS), and deep PIS (d-PIS) with clinical unconsciousness on 8 healthy volunteers and wakefulness and natural sleep on 9 age- and sex-matched healthy volunteers. Large-scale functional brain networks of each volunteer were constructed based on 160 regions of interest. Then, rich-club organizations in brain functional networks and nodal properties (nodal strength and efficiency) were assessed and analyzed among the different states and groups. RESULTS: Rich-clubs in the functional brain networks were reorganized during alteration of consciousness induced by propofol. Firstly, rich-club nodes were switched from the posterior cingulate cortex (PCC), angular gyrus, and anterior and middle insula to the inferior parietal lobule (IPL), inferior parietal sulcus (IPS), and cerebellum. When sedation was deepened to unconsciousness, the rich-club nodes were switched to the occipital and angular gyrus. These results suggest that the rich-club nodes were switched among the high-order cognitive function networks (default mode network [DMN] and fronto-parietal network [FPN]), sensory networks (occipital network [ON]), and cerebellum network (CN) from consciousness (wakefulness) to propofol-induced unconsciousness. At the same time, compared with wakefulness, local connections were switched to rich-club connections during propofol-induced unconsciousness, suggesting a strengthening of the overall information commutation of networks. Nodal efficiency of the anterior and middle insula and ventral frontal cortex was significantly decreased. Additionally, from wakefulness to natural sleep, a similar pattern of rich-club reorganization with propofol-induced unconsciousness was observed: rich-club nodes were switched from the DMN (including precuneus and PCC) to the sensorimotor network (SMN, including part of the frontal and temporal gyrus). Compared with natural sleep, nodal efficiency of the insula, frontal gyrus, PCC, and cerebellum significantly decreased during propofol-induced unconsciousness. CONCLUSIONS: Our study demonstrated that the rich-club reorganization in functional brain networks is characterized by switching of rich-club nodes between the high-order cognitive and sensory and motor networks during propofol-induced alteration of consciousness and natural sleep. These findings will help understand the common neurological mechanism of pharmacological and physiological unconsciousness.

In Vitro Antimicrobial Activity of Various Cefoperazone/Sulbactam Products.

: This study aims to assess the in vitro activity of different samples of cefoperazone/sulbactam (CFP/SUL) against multidrug-resistant organisms (MDROs). Clinical isolates of extended-spectrum ß-lactamase (ESBL)-Escherichia coli, ESBL-Klebsiella pneumoniae, carbapenem-resistant Acinetobacter baumannii (CR-AB), and carbapenem-resistant Pseudomonas aeruginosa (CR-PA) were collected. The minimum inhibitory concentration (MIC) and time-killing methods were used to assess and compare the in vitro activities of different samples of cefoperazone/sulbactam (CFP/SUL) against these MDROs. For ESBL-E. coli, ESBL-K. pneumoniae, and CR-PA, product C had smaller variations than product A and B (p < 0.05). For CR-AB, product B had the largest variation compared to the other two products (p < 0.05). In the time-killing studies, significant differences among the products when used at 16/16 µg/mL were noted for ESBL-E. coli, ESBL-K. pneumoniae, and CR-AB isolates. In conclusion, this study demonstrated the significantly different activity of different products of CFP/SUL against MDROs.

Bronchial blocker versus double-lumen endobronchial tube in minimally invasive cardiac surgery.

BACKGROUND: To compare the therapeutic value of a bronchial blocker (BB) with a double-lumen tube (DLT) in minimally invasive cardiac surgery (MICS). METHODS: Sixty patients who underwent MICS were randomized to use either a DLT (Group D, n = 30) or a BB (Group B, n = 29; one failed was omitted). The following data were collected: time of intubation and tube localization; incidence of tube displacement; postoperative sore throat and hoarseness; time of cardiopulmonary bypass; maintenance time for SpO2 < 90% (PaCO2 < 60 mmHg); mean arterial pressure and heart rate; SpO2, PaO2, PaCO2, EtCO2, mean airway pressure, and airway peak pressure; surgeons' satisfaction with anesthesia; and short-term complications. RESULTS: The times of intubation and tube localization were significantly longer in Group B than in Group D (P < 0.05). Patients in Group B exhibited significantly lower incidence of tube displacement, postoperative sore throat, and hoarseness when compared with patients in Group D (P < 0.05). Mean arterial pressure and heart rate were significantly lower in Group B than in Group D after tracheal intubation (P < 0.05). The mean airway pressure and airway peak pressure were significantly lower in Group B than in Group D after one-lung ventilation (P < 0.05). SpO2 and PaO2 in Group B were significantly higher than in group D after cardiopulmonary bypass (P < 0.05). No short-term postoperative complications were observed in patients of Groups B and D during 3 month follow-up. CONCLUSION: BB can be a potential alternative to the conventional DLT for lung isolation in MICS. TRIAL REGISTRATION: ChiCTR1900024250, July 2, 2019.

Disparity level identification using the voxel-wise Gabor model of fMRI data.

Perceiving disparities is the intuitive basis for our understanding of the physical world. Although many electrophysiology studies have revealed the disparity-tuning characteristics of the neurons in the visual areas of the macaque brain, neuron population responses to disparity processing have seldom been investigated. Many disparity studies using functional magnetic resonance imaging (fMRI) have revealed the disparity-selective visual areas in the human brain. However, it is unclear how to characterize neuron population disparity-tuning responses using fMRI technique. In the present study, we constructed three voxel-wise encoding Gabor models to predict the voxel responses to novel disparity levels and used a decoding method to identify the new disparity levels from population responses in the cortex. Among the three encoding models, the fine-coarse model (FCM) that used fine/coarse disparities to fit the voxel responses to disparities outperformed the single model and uncrossed-crossed model. Moreover, the FCM demonstrated high accuracy in predicting voxel responses in V3A complex and high accuracy in identifying novel disparities from responses in V3A complex. Our results suggest that the FCM can better characterize the voxel responses to disparities than the other two models and V3A complex is a critical visual area for representing disparity information.

Colistin-sparing regimens against Klebsiella pneumoniae carbapenemase-producing K. pneumoniae isolates: Combination of tigecycline or doxycycline and gentamicin or amikacin.

BACKGROUND/PURPOSE: In vitro studies of the combination of an aminoglycoside with tigecycline or doxycycline against Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae isolates are rarely published. The goal of this study was to evaluate the antibacterial activity of the combination regimens. METHODS: Thirteen genetically different KPC-producing K. pneumoniae isolates were randomly selected. Drug concentrations of amikacin, gentamicin, tigecycline, and doxycycline were adjusted to 1-, 1/2-, and 1/4-fold of respective minimum inhibitory concentrations (MICs). Each drug alone or the combinations of amikacin or gentamicin with tigecycline or doxycycline were tested by combination studies. RESULTS: Treatment with the 1× MIC concentration in combinations of amikacin or gentamicin and tigecycline or doxycycline for 24 hours resulted in bactericidal activity of 84-100% in the isolates. Treatment with 1/2× MIC combinations resulted in synergism of 69-100% in the isolates. Notably, doxycycline plus gentamicin or amikacin was synergistic for all tested isolates. However, bactericidal or synergistic effect was barely evident following 1/4× MIC combinations. There was no antagonism in any of the combination regimens. CONCLUSION: Enhanced activity was noted following treatment with doxycycline combined with gentamicin or amikacin against KPC-producing K. pneumoniae isolates, warranting further in vitro and animal investigations before clinical application.

The lasting effects of 1Hz repetitive transcranial magnetic stimulation on resting state EEG in healthy subjects.

Repetitive Transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation technique that able to influence cortical excitability. Low-frequency rTMS (stimulation frequency ≤1Hz) induces long-lasting inhibitory effects on cortical excitability. In order to study the effects of 1Hz rTMS of the motor cortex on neuronal activity, 20 healthy subjects were recruited to receive rTMS, and electroencephalography (EEG) in resting condition with eye open were recorded before rTMS, at 0min, 20min, 40min, 60min after rTMS. In multiple frequency bands, power values on each channel were calculated, and functional connectivity between two channels was assessed using phase synchronization. We found an increase in power of theta-band oscillations in the frontal and the central brain areas immediately after rTMS. And alpha resting power in the central-parietal brain area did not change immediately after rTMS, but increased at 20min after rTMS. Moreover, there is a widespread increase in functional connectivity after rTMS in the theta band, whereas widespread decreases in the functional connectivity were found in the alpha band after rTMS. At the same time, there was no significant recovery on power and functional connectivity at 60min after rTMS. These results provide an evidence for a transient reorganization of neuronal activity after 1Hz rTMS over the motor cortex. In addition, low-frequency rTMS produces widespread long-lasting alterations in cortical functional connectivity.

Simultaneous three Enterobacteriaceae with different bla NDM-1-encoding plasmids in a patient transferred from mainland China to Taiwan.

New-Delhi metallo-ß-lactamase1 (NDM-1) Enterobacteriaceae are increasing worldwide. Herein, we describe a single patient who carried three unusual NDM-1 carbapenem-resistant Enterobacteriaceae - Enterobacter cloacae (E. cloacae) yielded from a urine specimen and Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli) from stool specimens. For E. cloacae, its bla NDM-1-encoding plasmid was pKP04NDM with a size of ~54 kb replicons with an IncN backbone. For K. pneumoniae, its bla NDM-1-encoding plasmid was pNDM-BTR with a size of ~59.6 kb and belonged to IncN. For E. coli, its main bla NDM-1-encoding plasmid was pIMP-HK1500, and the NDM-1 gene was obtained from a part of pNDM-BTR (8439 bp). These three clinical strains are reported for the first time and are assumed to be imported from mainland China to Taiwan. The three different plasmids were never reported in K. pneumoniae, E. coli, and Citrobacter spp before. Owing to their associated multidrug resistance, appropriate measures of periodic, targeted surveillance, and development of new antimicrobial agents are urgently needed.