Water vapor therapy (Rezum) for lower urinary tract symptoms related to benign prostatic hyperplasia: early results from the first Italian multicentric study.

PURPOSE: Rezum is the latest developed minimally invasive treatment for benign prostatic hyperplasia (BPH). We aimed to carefully assess the functional outcomes of patients treated with Rezum for BPH. METHODS: We prospectively followed 135 consecutive patients treated by Rezum at 5 institutions from June 2019 to August 2020. The International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI SF), the Overactive Bladder Questionnaire-Short Form (OAB-q SF) score, the International Index of Erectile Function (IIEF-5) and questions 9 and 10 to assess ejaculatory dysfunction were recorded. Election criteria were age > 18, no prior prostate interventions, IPSS ≥ 13, post-void residual ≤ 250 mL, prostate volume between 30 and 120 cc. RESULTS: The median operative time was 10.5 (IQR 8.7-15) min. All patients were dismissed few hours after surgery with indwelling urinary catheter that was removed after a median of 7 (IQR 7-10) days. A significantly decrease of IPSS from baseline at first (p = 0.001) and third (p < 0.0001) month after surgery was reported. No difference was reported in terms of ICIQ-UI SF score postoperatively. A mild reduction of the OAB-q SF score was reported at 1 month from surgery (p = 0.06) that turned significant at 3 months postoperatively (p < 0.0001). A slight but statistically significant increase of the IIEF-5 score was reported from baseline at 6 months (p = 0.04). Postoperatively, patients reported a significantly decrease of ejaculatory dysfunction after alpha-blocker interruption. CONCLUSION: Rezum treatment is a feasible minimally invasive option for patients with BPH symptoms and showed optimal early functional outcomes.

Antigen presentation between T cells drives Th17 polarization under conditions of limiting antigen.

T cells form immunological synapses with professional antigen-presenting cells (APCs) resulting in T cell activation and the acquisition of peptide antigen-MHC (pMHC) complexes from the plasma membrane of the APC. They thus become APCs themselves. We investigate the functional outcome of T-T cell antigen presentation by CD4 T cells and find that the antigen-presenting T cells (Tpres) predominantly differentiate into regulatory T cells (Treg), whereas T cells that have been stimulated by Tpres cells predominantly differentiate into Th17 pro-inflammatory cells. Using mice deficient in pMHC uptake by T cells, we show that T-T antigen presentation is important for the development of experimental autoimmune encephalitis and Th17 cell differentiation in vivo. By varying the professional APC:T cell ratio, we can modulate Treg versus Th17 differentiation in vitro and in vivo, suggesting that T-T antigen presentation underlies proinflammatory responses in conditions of antigen scarcity.

Eye-tracking-aided characterization of saccades and antisaccades in SYNE1 ataxia patients: a pilot study.

BACKGROUND: SYNE1 ataxia is an autosomal recessive hereditary condition, the main characteristic features of which are gait and limb ataxia and cerebellar dysarthria. Reports have revealed that the clinical phenotype of SYNE1 ataxia is more complex than the first published cases with pure cerebellar signs indicated. The aim of this study was to characterize eye movement alterations in the first diagnosed Hungarian SYNE1 ataxia patients. RESULTS: Saccades and antisaccades were examined with an eye tracker device in 3 SYNE1 (one patient has two frameshift mutations [c.8515_8516insA, p.Met2839Asnfs*53 and c.11594_11595insG, p.Glu3866*] in a compound heterozygous state, whereas two subjects have a splicing variant [c.23146-2A > G] in a homozygous state), 6 Friedreich ataxia (FA) patients and 12 healthy controls. Besides that, detailed clinical phenotyping and comprehensive neuropsychological assessment were carried out in all patients with ataxia. In addition to the characteristic cerebellar alterations, pyramidal signs and polyneuropathy were observed at least in 2 SYNE1 ataxia patients, for which no other underlying reason was found. The eye tracking assessment revealed hypometric saccades in the longer amplitude (18.4°) saccadic paradigm in all SYNE1 patients, whereas 2 out of 3 SYNE1 subjects performed slow saccades as well. In the antisaccade task, higher incorrect ratios of antisaccades were demonstrated in SYNE1 patients compared to healthy controls, showing inverse correlation with working memory test results. The corresponding data of FA patients was dispersed over a wide range, partially overlapping with control data. CONCLUSIONS: The current study draws attention to the presence of eye movement disorders in patients with SYNE1 ataxia and demonstrates that alterations in the antisaccade paradigm may be related to working memory deficits.

RRAS2 shapes the TCR repertoire by setting the threshold for negative selection.

Signal strength controls the outcome of αß T cell selection in the thymus, resulting in death if the affinity of the rearranged TCR is below the threshold for positive selection, or if the affinity of the TCR is above the threshold for negative selection. Here we show that deletion of the GTPase RRAS2 results in exacerbated negative selection and above-normal expression of positive selection markers. Furthermore, Rras2-/- mice are resistant to autoimmunity both in a model of inflammatory bowel disease (IBD) and in a model of myelin oligodendrocyte glycoprotein (MOG)-induced experimental autoimmune encephalomyelitis (EAE). We show that MOG-specific T cells in Rras2-/- mice have reduced affinity for MOG/I-Ab tetramers, suggesting that enhanced negative selection leads to selection of TCRs with lower affinity for the self-MOG peptide. An analysis of the TCR repertoire shows alterations that mostly affect the TCRα variable (TRAV) locus with specific VJ combinations and CDR3α sequences that are absent in Rras2-/- mice, suggesting their involvement in autoimmunity.

Cognitive features and surgical outcome of patients with long-term epilepsy-associated tumors (LEATs) within the temporal lobe.

OBJECTIVE: The objective of the study was to evaluate cognitive and epilepsy-related features in 166 surgically treated patients with epilepsy with long-term epilepsy-associated tumors (LEATs) located in the temporal lobe. METHOD: Pre- and postsurgical cognitive as well as the one-year seizure outcome of adult patients with histopathologically confirmed LEATs (28 grade-I dysembryoplastic neuroepithelial tumors (DNET), 95 grade-I gangliogliomas (GG), 24 grade-I pilocytic astrocytomas (PA), 9 grade-II pleomorphic xanthoastrocytoma (PXA), 10 grade-II diffuse astrocytoma (DA)) who underwent epilepsy surgery in Bonn/Germany between 1988 and 2012 were evaluated. RESULTS: At baseline, tumor groups differed in regard to age at epilepsy onset and location within the temporal lobe. Postoperative seizure freedom was achieved most frequently (>77.8%) in DNET, GG, and DA, less often in PXA (62.5%) and the least in PA (56.5%). Preoperative memory was impaired in 67.1% of all patients, executive functions in 44.7%, and language in 45.5%. Patients with PA displayed the poorest cognitive performance. Individual significant memory decline that was observed in 27.1% of all patients was predicted by left-sided surgery, a mesial pathology, and extended hippocampal resection. Executive functions depended on antiepileptic drug (AED) load and remained stable (72.0%) or even improved (21.6%) after surgery. Language functions were unchanged in 89.5% of patients. CONCLUSION: Patients with LEATs in the temporal lobe frequently show cognitive impairments. Predictors for pre- and postoperative cognition mostly correspond to what is known for temporal lobe epilepsy and resections in general. However, different tumor types appear to be associated with different cognitive and seizure outcomes with astrocytoma as the least benefitted group.

Application of optimal band-limited control protocols to quantum noise sensing.

Essential to the functionality of qubit-based sensors are control protocols, which shape their response in frequency space. However, in common control routines out-of-band spectral leakage complicates interpretation of the sensor's signal. In this work, we leverage discrete prolate spheroidal sequences (a.k.a. Slepian sequences) to synthesize provably optimal narrowband controls ideally suited to spectral estimation of a qubit's noisy environment. Experiments with trapped ions demonstrate how spectral leakage may be reduced by orders of magnitude over conventional controls when a near resonant driving field is modulated by Slepians, and how the desired narrowband sensitivity may be tuned using concepts from RF engineering. We demonstrate that classical multitaper techniques for spectral analysis can be ported to the quantum domain and combined with Bayesian estimation tools to experimentally reconstruct complex noise spectra. We then deploy these techniques to identify previously immeasurable frequency-resolved amplitude noise in our qubit's microwave synthesis chain.

The Effect of Emotion and Reward Contingencies on Relational Memory in Major Depression: An Eye-Movement Study with Follow-Up.

Background: Episodic memory disturbances were found to constitute a potential trait marker for major depression (MD). The recall of positive or rewarding information in a relational context is specifically impaired. Eye-movement recording constitutes a novel, direct approach to examine implicit memory performance. Here we aimed to assess the effect of emotional context and implicit virtual monetary reward or loss on viewing patterns in association with relational memory in a 6-months follow-up study in MD. Materials and Methods: Twenty-eight patients with MD and 30 healthy participants were trained to associate a face (happy/sad/neutral) with a background scene. After each pair a virtual monetary reward or loss appeared briefly. During testing, scenes were presented as a cue and then overlaid with three previously studied faces. Participants were asked to recall the matching face if present (Match trials), with eye-movements and subsequent forced-choice recognition being recorded. Results: Explicit recognition of the matching face was impaired in the MD group as compared to controls. In correlation with this, viewing of the matching face was significantly reduced in the MD group. We found a significant interaction of group (MD vs HC) with the relational memory condition (Match and Non-match), facial emotion and monetary reward and loss. MD patients attended longer to previously rewarded stimuli, but significantly less to sad faces in the Match condition. The relational memory impairment persisted at follow-up and correlated with symptom severity both at baseline and follow-up. Viewing patterns associated with previous virtual reward were associated with clinical symptoms at follow-up. Conclusion: Our current results provide novel evidence for a specific relational memory impairment in MD as supported by abnormal eye-movement behavior and a deficit in explicit recognition. MD patients showed an attentional bias to rewarded stimuli and decreased viewing of sad faces when relational memory information was present.

Autoestima en estudiantes de medicina de la universidad nacional de Asunción, Paraguay / Self-esteem in medical students of the national university of Asunción, Paraguay

Introducción: Autoestima puede ser definida como el desarrollo de la convicción de que uno es competente para vivir y merece la felicidad, es por tanto capaz de enfrentar la vida con confianza, benevolencia y optimismo lo cual ayuda a alcanzar las metas. Materiales y método: Fue un estudio observacional descriptivo con corte transverso con muestreo no probabilístico de casos consecutivos que se realizó de mayo a junio del 2016 a estudiantes de medicina de la Universidad Nacional de Asunción. Se incluyó a todos los estudiantes que aceptaron participar voluntariamente. Resultados: Se incluyó a 75 sujetos. 60% fue del sexo femenino con edades comprendidas entre 18 y 28 años y una media de 22±2 años. El 48% presenta autoestima elevada, el 18,7% autoestima baja y el 33,3% autoestima baja. Discusión: La prevalencia de autoestima baja en nuestro estudio fue mayor a la encontrada en una población similar donde el 24,5% mostraba puntajes acordes a baja autoestima en contraste con el 33,3% de nuestro estudio. Estos resultados pueden ser explicados por las altas prevalencias de ansiedad, depresión, estresores psicosociales y estrés académico propios de esta población.

Introduction: Self-esteem can be defined as the development of the conviction that one is competent to live and deserves happiness, it is therefore able to face life with confidence, benevolence and optimism which helps to achieve the goals. Methods: It was a descriptive study with transverse cutting non-probability sampling of consecutive cases was conducted from May to June 2016 to medical students at the National University of Asuncion. All students who agreed to participate were included voluntarily. Results: We included 75 subjects. 60% were female with aged between 18 and 28 years and a mean of 22 ± 2 years. 48% have high self-esteem, 18.7% low self-esteem and 33.3% low self-esteem. Discussion: The prevalence of low self-esteem in our study was higher than that found in a similar population where 24.5% had low self-esteem scores chords in contrast to 33.3% of our study. These results can be explained by the high prevalence of anxiety, depression, psychosocial stressors and academic stress of this population.

Reflection of Socioeconomic Changes in Wastewater: Licit and Illicit Drug Use Patterns.

The economic crisis plaguing Greece was expected to impact consumption of pharmaceuticals and illicit drugs - a priori to an unknown extent. We quantified the change of use for various classes of licit and illicit drugs by monitoring Athens' wastewater from 2010 to 2014. A high increase in the use of psychoactive drugs was detected between 2010 and 2014, especially for antipsychotics (35-fold), benzodiazepines (19-fold), and antidepressants (11-fold). This directly reflects the perceived increase of incidences associated with mental illnesses in the population, as a consequence of severe socioeconomic changes. Other therapeutic classes, like antiepileptics, hypertensives, and gastric and ulcer drugs also showed an increase in use (from 2-fold increase for antiepileptics to 13-fold for hypertensives). In contrast, the overall use of antibiotics and NSAIDs decreased. For mefenamic acid, an almost 28-fold decrease was observed. This finding is likely related to the reduction in drug expenditure applied in public health. A 2-fold increase of methamphetamine use was detected, associated with a cheap street drug called ″sisa″ (related to marginal conducts), which is a health concern. MDMA (5-fold) and methadone (7-fold) use showed also an increase, while cocaine and cannabis estimates did not show a clear trend.

Current use of imaging and electromagnetic source localization procedures in epilepsy surgery centers across Europe.

OBJECTIVE: In 2014 the European Union-funded E-PILEPSY project was launched to improve awareness of, and accessibility to, epilepsy surgery across Europe. We aimed to investigate the current use of neuroimaging, electromagnetic source localization, and imaging postprocessing procedures in participating centers. METHODS: A survey on the clinical use of imaging, electromagnetic source localization, and postprocessing methods in epilepsy surgery candidates was distributed among the 25 centers of the consortium. A descriptive analysis was performed, and results were compared to existing guidelines and recommendations. RESULTS: Response rate was 96%. Standard epilepsy magnetic resonance imaging (MRI) protocols are acquired at 3 Tesla by 15 centers and at 1.5 Tesla by 9 centers. Three centers perform 3T MRI only if indicated. Twenty-six different MRI sequences were reported. Six centers follow all guideline-recommended MRI sequences with the proposed slice orientation and slice thickness or voxel size. Additional sequences are used by 22 centers. MRI postprocessing methods are used in 16 centers. Interictal positron emission tomography (PET) is available in 22 centers; all using 18F-fluorodeoxyglucose (FDG). Seventeen centers perform PET postprocessing. Single-photon emission computed tomography (SPECT) is used by 19 centers, of which 15 perform postprocessing. Four centers perform neither PET nor SPECT in children. Seven centers apply magnetoencephalography (MEG) source localization, and nine apply electroencephalography (EEG) source localization. Fourteen combinations of inverse methods and volume conduction models are used. SIGNIFICANCE: We report a large variation in the presurgical diagnostic workup among epilepsy surgery centers across Europe. This diversity underscores the need for high-quality systematic reviews, evidence-based recommendations, and harmonization of available diagnostic presurgical methods.

Assessing the risk associated with the presence of emerging organic contaminants in sludge-amended soil: A country-level analysis.

Greece was used as case study and the environmental risk associated with the existence of 99 emerging organic contaminants (EOCs) in sludge-amended soil was estimated using risk quotient (RQ) approach. Data on the concentration levels of EOCs in sewage sludge was collected after literature review. Chemical analyses were also conducted for 50 pharmaceuticals and illicit drugs in sludge samples from Athens Sewage Treatment Plant. Risk assessment was based on both terrestrial and aquatic acute toxicity data, using both the maximum and the average measured concentrations of the target compounds. EC50/LC50 values were collected through literature review or using the ECOSAR program in cases that experimental values were not available. Triclosan seems to pose an environmental risk on the soil environment, as its RQ values exceeded 1, both in terrestrial and aquatic toxicity data based risk assessment. Calculations based on aquatic toxicity data showed that another eleven compounds had RQs higher than 1, most of them belonging to the classes of synthetic phenolic compounds and siloxanes. Tetradecamethylhexasiloxane presented the highest RQ, while high RQs were also calculated for decamethylcyclopentasiloxane and caffeine. No environmental risk for the terrestrial environment is expected due to the individual action of illicit drugs, perfluorinated compounds and benzotriazoles. The sludge source and the day of sampling affected the estimated threat due to nonylphenolic compounds; however these factors did not affect the estimated risk for siloxanes, caffeine and ofloxacin. Calculation of RQ values for the mixture of EOCs, using either the maximum or the average concentrations, far exceeded 1 (253 and 209, respectively), indicating a presumable threat for the terrestrial environment due to the baseline toxicity of these compounds. Countries that reuse sludge for agricultural purposes should include specific EOCs in national monitoring campaigns and study more thoroughly on their effects to the terrestrial environment.

Occurrence and spatial distribution of 158 pharmaceuticals, drugs of abuse and related metabolites in offshore seawater.

The occurrence and spatial distribution of 158 pharmaceuticals and drugs of abuse were studied in seawater of the Eastern Mediterranean Sea (Saronikos Gulf and Elefsis Bay in central Aegean Sea). This area is affected by various anthropogenic pressures as it receives the treated wastewater of the greatest Athens area and off-shore input fluxes. This study constitutes the largest one in terms of number of analytes in this environmental compartment. It provides the first evidence on the occurrence of several pharmaceuticals in marine environment including amoxicillin, lidocaine, citalopram or tramadol, among others. 22 samples were collected at three different depths in 9 sampling stations in order to assess the presence and the spatial distribution of the target compounds. A multi-residue method based on solid phase extraction and liquid chromatography coupled to tandem mass spectrometry was developed for the determination of the 158 target substances and validated for seawater sample analysis. 38 out of the 158 target compounds were detected, 15 of them with frequencies of detection equal to or higher than 50%. The highest detected values corresponded to amoxicillin, caffeine and salicylic acid, with concentrations in the range of < 5.0-127.8 ng L(-1); 5.2-78.2 ng L(-1) and < 0.4-53.3 ng L(-1), respectively. Inputs from the wastewater treatment plant (WWTP) of Athens revealed to be the main source of pollution in the Inner Saronikos Gulf, whereas, other anthropogenic pressures such as contamination from shipping activity, industrial effluents, dredging and/or inputs from land proved to be also relevant. Τhe concentrations of some compounds varied significantly with depth suggesting that currents play an important role in the dilution of the target compounds.

Multi-residue determination of 10 selected new psychoactive substances in wastewater samples by liquid chromatography-tandem mass spectrometry.

New psychoactive substances (NPSs) have become increasingly popular in recent years. The analysis of these substances in influent wastewater (IWW) can be used to track their use in communities. In addition, an evaluation of the amount of NPSs released to the aquatic environment can be performed through the analysis of effluent wastewater (EWW). This study presents the development, validation and application of an analytical methodology, based on solid phase extraction (SPE) and liquid chromatography-tandem mass spectrometry (LC-MS/MS), for the determination of 10 NPSs in IWW and EWW. Synthetic cannabinoids, cathinones, piperazines and pyrrolidophenones are included among the target analytes. To the authors' knowledge, it is the first time that eight out of these substances (4'-methylpyrrolidinobutyrophenone (MPPP), a-pyrrolidinopentiophenone (a-PVP), 2-[(1S,3R)-3-hydroxycyclohexyl]-5-(2-methyl-2-octanyl) phenol (CP47,497), (1-naphthyl(1-pentyl-1H-indol-3-yl) methanone (JWH-018), (1-butyl-1H-indol-3-yl)(1-naphthyl) methanone (JWH-073), (4-ethyl-1-naphthyl)(1-pentyl-1H-indol-3-yl) methanone (JWH-210), (4-methyl-1-naphthyl) (1-pentyl-1H-indol-3-yl) methanone (JWH-122) and 2-(2-methoxyphenyl)-1-(1-pentyl-1H-indol-3-yl) ethanone (JWH-250)) are investigated in wastewater. The optimized conditions for the analysis of this set of compounds included a SPE clean-up step using a polymeric sorbent and the use of a pentafluorophenyl (PFP) chromatographic column. Despite the broad range of physicochemical properties of the analytes the method allowed acceptable absolute recoveries (40-109%) for all the studied compounds at different levels of concentration. Low method limits of detection (MLODs) were achieved, ranging between 0.3 and 10 ng/L except for BZP and CP47,497 (20 and 23 ng/L, respectively), allowing a reliable and accurate quantification of the analytes. The method was successfully applied to the analysis of IWW and EWW samples from five wastewater treatment plants (WWTPs) located in Santorini Island (a highly touristic resort in Greece). Four out of 10 compounds (a-PVP, CP47,497, JWH-122 and JWH-210) were detected at least in one sample, being the first evidence of their presence in wastewater. CP47,497 was the most ubiquitous and abundant compound, showing concentrations up to 634 ng/L in some cases.

Benzosulfonamides in wastewater: method development, occurrence and removal efficiencies.

Benzosulfonamides (BeSAs) are a family of compounds with a broad application as industrial chemicals: plasticizers, intermediates for pesticides and drugs or used in the production of artificial sweeteners, among others. BeSAs constitute a class of organic compounds of emerging environmental concern. However, analytical methodologies for their determination in the environment are scarce as well as there is a lack of environmental occurrence data for these substances. An analytical methodology based on pseudo-SRM liquid chromatography-tandem mass spectrometry (LC-(ESI-)MS/MS) was developed and optimized for the determination of three BeSAs (benzenesulfonamide (BSA), o-toluenesulfonamide (o-TSA) and p-toluenesulfonamide (p-TSA)) in wastewater. The solid phase extraction protocol was also carefully optimized. The method provided recoveries in the range 83-118% (three different fortification levels). Good precision (<10.2% (intra-day) and <13.6% (inter-day)) and limits of detection achieved (11-89 ng L(-1)) allow a reliable quantification of these compounds in both effluent and influent wastewaters. The presence of BeSAs has been evaluated during seven consecutive days in influent and effluent samples from the wastewater treatment plant of Athens, Greece. o-TSA and p-TSA were detected in 100% of the samples, while BSA was detected in all the influents and in 43% of the effluents. All three compounds were determined in relevant concentrations (up to 1.4 µg L(-1) in the case of p-TSA), constituting the first evidence of the presence of these compounds in Greece, and contributing to the scarce occurrence data. Removal efficiencies of BeSAs during wastewater treatment was also assessed and discussed. In this regard, different behaviors were observed: while BSA and p-TSA were removed in different rates, o-TSA was formed during wastewater treatment. A daily load of 0.48 kg of o-TSA and 0.47 kg of p-TSA was discarded in the receiving Saronikos Gulf.

Is there a risk for the aquatic environment due to the existence of emerging organic contaminants in treated domestic wastewater? Greece as a case-study.

The ecological threat associated with emerging pollutants detected in wastewater was estimated in country level. Treated wastewater was analyzed for pharmaceuticals and illicit drugs; whereas the concentrations of all emerging contaminants determined in Greek Sewage Treatment Plants were recorded through literature review. Toxicity data was collected after literature review or using ECOSAR and risk quotients (RQs) were calculated for treated wastewater and 25 Greek rivers, for 3 different aquatic organisms (fish, daphnia magna, algae). According to the results, monitoring data was available for 207 micropollutants belonging to 8 different classes. RQ>1 was calculated for 30 compounds in secondary treated wastewater. Triclosan presented RQ>1 (in algae) for all studied rivers; decamethylcyclopentasilane (in daphnia magna), caffeine (in algae) and nonylphenol (in fish) presented RQ>1 in rivers with dilution factors (DF) equal or lower to 1910, 913 and 824, respectively. The class of emerging contaminants that present the greatest threat due to single or mixture toxicity was endocrine disrupters. The mixture of microcontaminants seems to pose significant ecological risk, even in rivers with DF equal to 2388. Future national monitoring programs should include specific microcontaminants that seem to possess environment risk to surface water.

The impact of intermediate-term alcohol abstinence on memory retrieval and suppression.

BACKGROUND: The nature of episodic memory deficit in intermediate-term abstinence from alcohol in alcohol dependence (AD) is not yet clarified. Deficits in inhibitory control are commonly reported in substance use disorders. However, much less is known about cognitive control suppressing interference from memory. The Think/No-think (TNT) paradigm is a well established method to investigate inhibition of associative memory retrieval. METHODS: Thirty-six unmedicated patients with AD and 36 healthy controls (HCs) performed the TNT task. Thirty image-word pairs were trained up to a predefined accuracy level. Cued recall was examined in three conditions: Think (T) for items instructed to-be-remembered, No-think (NT) assessing the ability to suppress retrieval and Baseline (B) for general relational memory. Premorbid IQ, clinical variables and impulsivity measures were quantified. RESULTS: AD patients had a significantly increased demand for training. Baseline memory abilities and effect of practice on retrieval were not markedly different between the groups. We found a significant main effect of group (HC vs. AD) × condition (B, T, and NT) and a significant difference in mean NT-B scores for the two groups. DISCUSSION: AD and HC groups did not differ essentially in their baseline memory abilities. Also, the instruction to focus on retrieval improved episodic memory performance in both groups. Crucially, control participants were able to suppress relational words in the NT condition supporting the critical effect of cognitive control processes over inhibition of retrieval. In contrast to this, the ability of AD patients to suppress retrieval was found to be impaired.

Neuropsychological outcome after epilepsy surgery in patients with bilateral Ammon's horn sclerosis.

OBJECT: The purpose of this study was to retrospectively assess the objective and subjective neuropsychological outcome after epilepsy surgery in patients with bilateral Ammon's horn sclerosis (AHS). METHODS: Memory and executive functions were evaluated at baseline and at follow-up in 11 surgically treated patients and compared with 8 pharmacologically treated patients with temporal lobe epilepsy and bilateral AHS. The median follow-up duration was 16 months in the surgically treated patients and 80.5 months in the pharmacologically treated group. Subjective outcome was evaluated by questionnaires and included mood, quality of life, subjective memory, and activities of daily living. RESULTS: At the follow-up assessment, 82% of the surgically treated patients as opposed to 0% of the nonsurgery patients were seizure free. In the surgical group, nonverbal memory performance did not change significantly in any patient after surgery, but there was a floor effect in 55% of the surgical patients. Regarding verbal memory, 9% of the surgical patients improved while 73% declined, despite severe impairments already evident at baseline. In the nonsurgery control group, 13% of the patients declined in nonverbal memory (floor effect in 63%) and 25% declined in verbal memory (floor effect in 25%) at follow-up. None of the controls improved at follow-up. Executive functions remained unchanged on an impaired level in both groups. At follow-up, the patient groups did not differ significantly with respect to mood, quality of life, subjective memory, or activities of daily living. However, in most aspects, surgically treated patients reported a slightly better subjective outcome than pharmacologically treated patients and a significantly improved quality of life. CONCLUSIONS: These results suggest that beyond benefits concerning seizure control, surgically treated patients with bilateral AHS, despite already poor baseline performance, are still at risk for severe postoperative decline in memory. In the light of predominantly minor benefits on a subjective level, the findings put the overall outcome of epilepsy surgery in bilateral AHS patients into perspective.