Safety, efficacy and outcome-related factors of perampanel over 12 months in a real-world setting: The FYDATA study.

BACKGROUND: Real-world data of current antiepileptic drugs (AEDs) used to treat focal seizures is of importance to understand the efficacy and safety outside of the clinical trial setting. Here we report real-world data from a large series of patients treated with perampanel for 1year. METHODS: FYDATA was a multicentre, retrospective, 1-year observational study assessing the efficacy and safety of adjuvant perampanel in patients ≥12 years of age with focal epilepsy in a real-world setting. At 12 months, the proportion of patients who were seizure free, median percentage seizure reduction, proportion of responders, retention rate and proportion of patients with adverse events (AEs) were assessed. Analyses were also performed to identify any patient-, medication- and disease-related factors associated with a large clinical response or carry a risk for AEs. RESULTS: A total of 464 patients were included in the study with a retention rate of 60.6% at 1year. The mean number of prior AEDs was 7.8. The median percentage reduction in overall seizures was 33.3% (75% for secondary generalised seizures) after 1year, with 7.2% of patients achieving seizure freedom. Furthermore, patients on non-enzyme-inducing AEDs were more likely to achieve seizure freedom, and logistic regression revealed that patients aged ≥65 years, those with epilepsy due to a vascular aetiology and those who had received fewer prior AEDs showed a better clinical response to perampanel. A total of 62.9% of the patients experienced AEs at 12 months; dizziness, somnolence and irritability were the most frequent AEs. Patients with prior psychiatric comorbidities (hyperactivity and personality disorder) were more likely to experience psychiatric AEs with perampanel, and slower titration schedules were associated with less AEs overall. CONCLUSION: Perampanel, for the treatment of focal epilepsy in a real-world setting in a refractory population, over 1year, demonstrates a similar efficacy and safety profile to that observed in clinical trials. Our results have implications for the optimisation of perampanel use in a clinical setting.

Modelling the spatial tuning of the Hermann grid illusion.

PURPOSE: Does a physiologically plausible model of the retinal ganglion cell (RGC) receptive field (RF) predict the spatial tuning properties of the Hermann Grid Illusion (HGI)? METHODS: The spatial tuning of a single intersection HGI was measured psychophysically in normal observers using a nulling technique at different vertical grid line luminances. We used a model based upon a standard RGC RF, balanced to produce zero response under uniform illumination, to predict the response of the model cell to the equivalent range of stimulus conditions when placed in either the 'street' or the 'intersection' of a single element of a Hermann grid. We determined the equivalent of the nulling luminance required to balance these responses and minimise the HGI. RESULTS: The model and the psychophysical data demonstrated broad spatial tuning with similarly shaped tuning profiles and similar strengths of illusion. The line width at the peak of the model tuning function was around twice the model RGC RF centre size. Modelling the psychophysical functions gave RF centre sizes smaller than expected from human anatomical evidence but similar to that suggested by primate physiological evidence. In the model and psychophysically the strength of the illusion varied with the luminance of the vertical grid line when HGI strength was expressed as a Michelson nulling contrast, but this effect was smaller when HGI strength was expressed as a nulling luminance. CONCLUSIONS: The shape, width, height and position of the spatial tuning function of the HGI can be well modelled by a RGC RF based model. The broad tuning of these functions does not appear to require a broad range of different cell sizes either in the retina or later in the visual pathway.

Time dependence of breakdown in a global fiber-bundle model with continuous damage.

A time-dependent global fiber-bundle model of fracture with continuous damage is formulated in terms of a set of coupled nonlinear differential equations. A first integral of this set is analytically obtained. The time evolution of the system is studied by applying a discrete probabilistic method. Several results are discussed emphasizing their differences with the standard time-dependent model. The results obtained show that with this simple model a variety of experimental observations can be qualitatively reproduced.

Fracture and second-order phase transitions.

Using the global fiber bundle model as a tractable scheme of progressive fracture in heterogeneous materials, we define the branching ratio in avalanches as a suitable order parameter to clarify the order of the phase transition occurring at the collapse of the system. The model is analyzed using a probabilistic approach suited to smooth fluctuations. The branching ratio shows a behavior analogous to the magnetization in known magnetic systems with second-order phase transitions. We obtain a universal critical exponent beta approximately = 0.5 independent of the probability distribution used to assign the strengths of individual fibers.

Gluteus augmentation with fat grafting.

This study presents the authors' experience with gluteus augmentation with autologus fat grafts and liposuction methods, having recorded the evolution of gluteus reshaping with autologus intramuscular fat graft injections for the past 5 years. Preoperative shape is discussed and patient evaluations, operative techniques, postoperative management, and longterm results are emphasized.

Time to failure of hierarchical load-transfer models of fracture.

The time to failure, T, of dynamical models of fracture for a hierarchical load-transfer geometry is studied. Using a probabilistic strategy and juxtaposing hierarchical structures of height n, we devise an exact method to compute T, for structures of height n+1. Bounding T, for large n, we are able to deduce that the time to failure tends to a nonzero value when n tends to infinity. This numerical conclusion is deduced for both power law and exponential breakdown rules.

Modified renormalization strategy for sandpile models.

Following the renormalization-group scheme recently developed by Pietronero et al. [Phys. Rev. Lett. 72, 1690 (1994)] we introduce a simplifying strategy for the renormalization of the relaxation dynamics of sandpile models. In our scheme, five subcells at a generic scale b form the renormalized cell at the next larger scale. Now the fixed point has a unique nonzero dynamical component that allows for a great simplification in the computation of the critical exponent z. The values obtained are in good agreement with both numerical and theoretical results previously reported.

Unified Parkinson's Disease Rating Scale characteristics and structure. The Cooperative Multicentric Group.

Our purpose was to verify some basic aspects of validation of the Unified Parkinson's Disease Rating Scale (UPDRS). One hundred and sixty-seven Parkinson's disease (PD) patients were included. Group A (n = 40) was simultaneously assessed by five raters who applied the UPDRS and other PD rating scales (PDRS). A set of timed tests, the Mini-Mental State Examination (MMSE), and the Hamilton Scale for Depression (HSD) were administered by an independent examiner. Group B (n = 127) was individually assessed through the UPDRS and the other PDRSs by one neurologist in four different hospitals. The UPDRS was administered in 16.95 +/- 7.98 min. The internal consistency was high (Cronbach's alpha = 0.96). Nevertheless, the items related to depression, motivation/initiative, and tremor were scarcely consistent. The Interrater reliability was satisfactory (all the items had k > 0.40). There was a high correlation of the UPDRS with the Hoehn and Yahr staging (rs = 0.71; p < 0.001) and some timed tests (finger tapping; arising from chair), but also with the MMSE and HSD (rs = 0.53; rs = 0.64; p < 0.001). The convergent validity with the other PDRS (Intermediate Scale and Schwab and England Scale) was very high (rs = 0.76-0.96; p < 0.001). The factor analysis identified six factors that explained 59.6% of the variance. The dimension "tremor" showed a remarkable independence. The UPDRS is a multidimensional, reliable, and valid scale, with some inconveniences derived from its internal consistency, discriminant validity, and pragmatic application.

Pieloplastia com molde ureteral interno fixo / Pyeloplasty with fixed internal ureteral splint

Os autores apresentam uma nova maneira de colocaçäo do molde ureteral, sem utilizar a nefrostomia na pieloplastia desmembrada. Um cateter ureteral, com múltiplas perfuraçöes, é deixado desde o bacinete até a bexiga. Um fio de nylon transfixa o cateter na porçäo intrapiélica, penetra através da parênquima renal e é exteriorizado através da pele, onde é amarrado. Isto permite que se tenha um molde ureteral sem nefrostomia e sem exteriorizaçäo do cateter através da pele e, portanto, com menos risco de infecçäo. Säo apresentados os resultados de seis casos operados