Focused ultrasounds: What is their future in epileptology? A critical review

High intensity focused ultrasounds (HIFU) are being increasingly advocated as a useful tool in the management of focal drug-resistant epilepsy. Our aim was to review current literature on the topic and perform an inventory of open trials assessing HIFU effectiveness and safety in epilepsy management. To do so, a review was conducted and yielded one prospective clinical trials, two case reports and one safety study were retrieved, indicating that HIFU is still in its infancy when it comes to focal drug-resistant epilepsy therapy. Efforts should be made to develop this technology using multicentric prospective data with larger cohorts and prolonged follow-up.

Search for Gamma-Ray Spectral Lines from Dark Matter Annihilation up to 100 TeV toward the Galactic Center with MAGIC

Linelike features in TeV γ rays constitute a "smoking gun" for TeV-scale particle dark matter and new physics. Probing the Galactic Center region with ground-based Cherenkov telescopes enables the search for TeV spectral features in immediate association with a dense dark matter reservoir at a sensitivity out of reach for satellite γ-ray detectors, and direct detection and collider experiments. We report on 223 hours of observations of the Galactic Center region with the MAGIC stereoscopic telescope system reaching γ-ray energies up to 100 TeV. We improved the sensitivity to spectral lines at high energies using large-zenith-angle observations and a novel background modeling method within a maximum-likelihood analysis in the energy domain. No linelike spectral feature is found in our analysis. Therefore, we constrain the cross section for dark matter annihilation into two photons to ⟨σv⟩≲5×10^{-28}  cm^{3} s^{-1} at 1 TeV and ⟨σv⟩≲1×10^{-25}  cm^{3} s^{-1} at 100 TeV, achieving the best limits to date for a dark matter mass above 20 TeV and a cuspy dark matter profile at the Galactic Center. Finally, we use the derived limits for both cuspy and cored dark matter profiles to constrain supersymmetric wino models.

Comparative effectiveness of antiretroviral drug classes for the treatment of HIV infection in patients with high viral loads: a multicentre retrospective cohort study

OBJECTIVES

We aimed to compare the effectiveness of antiretroviral therapy (ART) classes for achieving HIV RNA suppression to < 50 HIV-1 RNA copies/mL within 6 months of initiation with high viral loads (VLs). Secondary objectives were to compare viral suppression (VS) at 12 weeks and 12 months, partial HIV RNA suppression to < 200 copies/mL, time to VS, time to rebound, and change in CD4 cell count.

METHODS

This was a multicentre, retrospective, observational study. Adult patients were included if they initiated ART between January 2005 and December 2016 with a VL ≥ 100 000 copies/mL.

RESULTS

There were 220 patients included in the study. The median VL was 252 919 [interquartile range (IQR) 149 472-500 000] copies/mL. Nonnucleoside reverse transcriptase inhibitor (NNRTI) recipients were more likely to achieve VS by 6 months compared to those initiating ART containing protease inhibitors (PIs) [75.4% vs. 44.1%, respectively; odds ratio (OR) 3.34; 95% confidence interval (CI) 1.62-6.90] or integrase strand transfer inhibitors (INSTIs) (75.4% vs. 55.8%, respectively; OR 2.40; 95% CI 1.03-5.58). VS at 12 weeks was more frequent with INSTI-containing regimens than with PIs (28.9% vs. 9.0%, respectively; OR 4.10; 95% CI 1.69-9.92). VS at 12 months did not significantly differ between treatment regimens. Median time to complete VS for INSTI, PI and NNRTI recipients was 22.3 (95% CI 13.4-33), 30.1 (95% CI 25-36) and 19.9 (95% CI 16-22.3) weeks, respectively. There were no significant differences in time to viral rebound or change in CD4 cell counts.

CONCLUSIONS

Patients with high VLs initiated on NNRTIs were more likely to achieve VS by 6 months on ART compared to INSTI and PI recipients.

Large-area electrode design for vertical electrical impedance scanning of concrete bridge decks

Vertical electrical impedance (VEI) testing is a method that was developed specifically for quantifying the level of protection against chloride ingress in concrete bridge decks. A significant operational difficulty associated with VEI testing has been establishing the required rebar tap as a ground reference. As described in this work, the use of a large-area electrode (LAE) can potentially remove the need for a rebar tap and therefore significantly simplify and accelerate the VEI testing process. The specific objective of the research was to develop both theoretical and practical guidance for the design of an LAE for VEI testing. To investigate several variables that can affect the accuracy of VEI measurements obtained using an LAE connection, including various combinations of deck cover and water resistivity values, electrode separation distance, counter electrode (CE) effective area, and area ratio between the LAE and the CE, an analytical model (AM) and a finite-element model (FEM) were developed and validated with laboratory and field experiments. From the results of the AM and FEM simulations and the results of the laboratory and field experiments, LAE design considerations were developed for each of these variables that should allow proper implementation of a VEI measurement system using an LAE connection.

Perceptions and experiences of environmental health risks among new mothers: a qualitative study in Ontario, Canada

There is a growing awareness and concern in contemporary societies about potential health impacts of environmental contaminants on children. Mothers are traditionally more involved than other family members in managing family health and household decisions and thus targeted by public health campaigns to minimise risks. However little is known about how new mothers perceive and experience environmental health risks to their children. In 2010, we undertook a parallel case study using qualitative, in-depth interviews with new mothers and focus groups with public health key informants in two Public Health Units in Ontario Province, Canada. We found that the concern about environmental hazards among participants ranged from having no concerns to actively incorporating prevention into daily life. Overall, there was a common perception among participants that many risks, particularly in the indoor environment, were controllable and therefore of little concern. But environmental risks that originate outside the home were viewed as less controllable and more threatening. In response to such threats, mothers invoked coping strategies such as relying on the capacity of children's bodies to adapt. Regardless of the strategies adopted, actions (or inactions) were contingent upon active information seeking. We also found an optimistic bias in which new mothers reported that other children were at greater risk despite similar environmental circumstances. The findings suggest that risk communication experts must attend to the social and environmental contexts of risk and coping when designing strategies around risk reducing behaviours.

Molecular characterization of neuroendocrine lung-tumors induced in hamsters by treatment with nitrosamines and hyperoxia

Treatment of hamsters with nitrosamines and hyperoxia (60% O2) induces neuroendocrine lung tumors. Analysis of 8 different tumors from 7 different hamsters demonstrated 2- to 3.5-fold increases in the expression of c-myc in 4 of 8 tumors, c-fos in 3 tumors, c-jun in 1 tumor, c-raf in 1 tumor, and Ki-ras in 2 tumors. No overexpression of the c-src and Ha-ras gene transcripts were detected. Expression levels of N-myc, p53 and the retinoblastoma gene transcript were too low to be quantitated accurately. In some cases, slightly elevated levels of protooncogene transcripts (less than 2-fold) were detected in normal-appearing tissue isolated from the same tumor bearing hamsters. Hyperoxia alone had little effect on the expression of c-myc or c-fos RNA transcripts compared to untreated hamsters. Reverse transcription of the RNAs and amplification of the cDNA copies by the polymerase chain reaction, followed by selective oligonucleotide hybridization with normal and mutant probes, did not reveal any mutations in the 12th, 13th, or 61st codons of the seven tumors which produced Ki-ras cDNA. An additional 8 tumors were also screened for Ki-ras mutations following amplification of genomic DNA and demonstrated an absence of point mutations at the Ki-ras gene locus. These results indicate that the hamster neuroendocrine lung tumors exhibit slight increases in c-myc and c-fos RNA expression but lack mutations at the Ki-ras gene locus.

Positive supercoiling of mitotic DNA drives decatenation by topoisomerase II in eukaryotes

DNA topoisomerase II completely removes DNA intertwining, or catenation, between sister chromatids before they are segregated during cell division. How this occurs throughout the genome is poorly understood. We demonstrate that in yeast, centromeric plasmids undergo a dramatic change in their topology as the cells pass through mitosis. This change is characterized by positive supercoiling of the DNA and requires mitotic spindles and the condensin factor Smc2. When mitotic positive supercoiling occurs on decatenated DNA, it is rapidly relaxed by topoisomerase II. However, when positive supercoiling takes place in catenated plasmid, topoisomerase II activity is directed toward decatenation of the molecules before relaxation. Thus, a topological change on DNA drives topoisomerase II to decatenate molecules during mitosis, potentially driving the full decatenation of the genome.

Physical linkages between sister chromatids and their removal during yeast chromosome segregation

The fidelity of chromosome inheritance is of paramount importance to all living organisms. In eukaryotic cells, the strategy to ensure physical segregation of chromosomes to daughter cells relies on two basic steps ordered in time: an initial linkage, or cohesion, of sister chromatids and its timely and complete dissolution during anaphase. The current view is that these two basic steps are accomplished around the regulation of a protein complex called cohesin that serves as "clamp brackets" distributed at intervals throughout the genome. However, many of the DNA metabolic activities during interphase also produce physical linking of chromatids. For example, during replication, intertwines between sister chromatids are formed. Here, we review our understanding of the processes that generate physical linkages between chromatids and discuss potential mechanisms that are involved in the removal of such obstacles to the complete physical separation of chromatids at anaphase.

Does having a chronic physical condition affect the likelihood of treatment seeking for a mental health problem and does this vary by ethnicity?

OBJECTIVE

The comorbidity of mental disorders with chronic physical conditions is known to have important clinical consequences, but it is not known whether mental-physical comorbidity influences mental health treatment seeking. This study investigates whether the presence of a chronic physical condition influences the likelihood of seeking treatment for a mental health problem, and whether that varies among ethnic subgroups in New Zealand.

METHODS

Analyses were based on a subsample (n = 7,435) of The New Zealand Mental Health Survey, a nationally representative household survey of adults (response rate 73.3%). Ethnic subgroups (Maori and Pacific peoples) were oversampled. DSM-IV mental disorders were measured face-to-face with the Composite International Diagnostic Interview (CIDI 3.0). Ascertainment of chronic physical conditions was via self-report.

RESULTS

In the general population, having a chronic medical condition increased the likelihood of seeking mental health treatment from a general practitioner (OR: 1.58), as did having a chronic pain condition (OR: 2.03). Comorbid chronic medical conditions increased the likelihood of seeking mental health treatment most strongly among Pacific peoples (ORs: 2.86-4.23), despite their being less likely (relative to other ethnic groups) to seek mental health treatment in the absence of physical condition comorbidity.

CONCLUSION

In this first investigation of this topic, this study finds that chronic physical condition comorbidity increases the likelihood of seeking treatment for mental health problems. This provides reassurance to clinicians and health service planners that the difficult clinical problem of mental-physical comorbidity is not further compounded by the comorbidity itself constituting a barrier to mental health treatment seeking.

Linear and nonlinear characteristics of heart rate time series in obesity and during weight-reduction surgery

Obesity is associated with abnormal cardiac regulation by the autonomic nervous system (ANS), this being reversed by weight loss. Bariatric (weight-reduction) surgery can induce substantial long-term weight reductions. This study compares the acute influence on ANS control of two different types of bariatric surgery involving laparascopic and open procedures. To distinguish between the cardiac influences of surgery and obesity, we perform the same analysis for laparascopic surgery in non-obese patients. Eight morbidly obese and five non-obese patients underwent surgery. Obese patients received either laparoscopic procedures (group A: n = 5, BMI = 44.3 +/- 2.7 kg m(2)) or open procedures (group B: n = 3, BMI = 55.2 +/- 4.5 kg m(2)) and non-obese patients received a laparoscopic procedure (group C: n = 5, BMI = 30.8 +/- 5.8 kg m(-2)). Holter ECG was recorded and heart rate variability (HRV) was quantified together with measures of complexity (sample entropy) and structure (Hurst coefficient, scaling coefficient) of the heart rate data. Multifractal characteristics of heart rate data, not previously reported for obese patients, are also quantified and interpreted. Mixed model ANOVA was used to assess the magnitudes of each quantified variable, with surgical group and perioperative time as main factors. HRV measures were influenced only during anaesthesia (LFn increase: p = 0.009; HFn decrease: p = 0.033) and did not discriminate between patient groups. Multifractality was the only characteristic of heart rate data that discriminated between patient groups, being significantly (p < 0.001) greater in non-obese (group C) compared with obese patients (groups A and B, who had similar multifractal properties). Multifractality was also enhanced during anaesthesia (p = 0.028) but did not differ for other stages. We conclude that obesity per se rather than response to surgery is the cause of reduced multifractality. Reduced multifractality in obesity might reflect a diminished 'scaling' or 'collective response' across the multiple autonomic modulators of heart rate. The multifractal method appears to be a more sensitive measure of integrated cardiac autonomic function than linear methods for these patients.

Imatinib sensitivity as a consequence of a CSF1R-Y571D mutation and CSF1/CSF1R signaling abnormalities in the cell line GDM1

Imatinib is usually a highly effective treatment for myeloproliferative neoplasms (MPNs) associated with ABL, PDGFRA or PDGFRB gene fusions; however, occasional imatinib-responsive patients have been reported without abnormalities of these genes. To identify novel imatinib-sensitive lesions, we screened 11 BCR-ABL-negative cell lines and identified GDM1, derived from a patient with an atypical MPN (aMPN), as being responsive to imatinib. Screening of genes encoding known imatinib targets revealed an exon 12 mutation in the colony-stimulating factor 1 receptor (CSF1R; c-FMS) with a predicted Y571D amino-acid substitution. CSF1R in GDM1 was constitutively phosphorylated, but rapidly dephosphorylated on exposure to imatinib. Y571D did not transform FDCP1 cells to growth factor independence, but resulted in a significantly increased colony growth compared with controls, constitutive CSF1R phosphorylation and elevated CSF1R signaling. We found that GDM1 expresses CSF1, and CSF1 neutralization partially inhibited proliferation, suggesting the importance of both autocrine and intrinsic mechanisms of CSF1R activation. An extensive screen of CSF1R in aMPNs and acute myeloid leukemia identified three additional novel missense variants. None of these variants were active in transformation assays and are therefore likely to be previously unreported rare polymorphisms or non-pathogenic passenger mutations.

A randomized comparison of two instruments for measuring self-reported antiretroviral adherence

A randomised trial compared two instruments for assessing self-reported adherence to antiretroviral medications: (1) a day-by-day recall instrument that elicited the number of missed doses in each of the prior three days (3-day instrument; n=64) and (2) a general recall instrument that elicited an estimate of proportion of pills taken during the prior seven days (7-day instrument; n=70). Adherence was measured at study visits over 12 months among participants in a clinical trial assessing treatment strategies for individuals with virologic failure and multidrug-resistant HIV. Participants had a median (interquartile range) of 133 (41-264) CD4 cells/ml(3) and a median of 10 major HIV resistance mutations at baseline. Mean adherence levels were 90-98% throughout the study. There was a greater trend in the likelihood of 100% adherence when measured by the 3-day versus the 7-day instrument (odds ratio (OR)=1.45; p=0.06). The likelihood of consistent 100% adherence measured by either instrument decreased over time (p<0.001). Participants reporting 100% adherence at more than half of study visits had better virologic and immunologic outcomes at month-12 compared to those reporting 100% adherence at half or fewer visits (HIV RNA decline of 0.96 versus 0.51 log, respectively, p=0.02; and CD4 cell increase of 51.0 versus 17.8 cells, p=0.04). This study demonstrated the utility of the general 7-day recall adherence self-report instrument as well as the 3-day day-by-day recall adherence self-report instrument for measuring antiretroviral adherence. Self-reported adherence was significantly associated with virologic and immunologic outcomes in this population with advanced drug-resistant HIV disease.

Cervical length for prediction of preterm birth in women with multiple prior induced abortions

OBJECTIVE

To determine whether transvaginal sonographic cervical length predicts preterm birth in women with multiple prior induced abortions.

METHODS

This was a retrospective cohort study using the Thomas Jefferson University Prematurity Database. Patients with a singleton pregnancy and a history of more than one induced abortion were identified. Exclusion criteria were cerclage and indicated preterm birth. Subjects were followed with transvaginal ultrasound measurement of the cervix between 14 and 24 weeks' gestation and grouped into those with and those without a short cervix; a cervical length of < 25 mm was considered short. The primary outcome was spontaneous preterm birth at < 35 weeks.

RESULTS

Fifteen of the 65 (23%) women with more than one induced abortion included in the study had a short cervix. The demographics and risk factors were similar between those with and those without a short cervix. The overall incidence of preterm birth was 21.5% (14/65); in women with a short cervix the incidence was 47% (7/15) and in women without a short cervix it was 14% (7/50). The sensitivity, specificity and positive and negative predictive values of a short cervix in the prediction of preterm birth were 50%, 84%, 47% and 86%, respectively. The relative risk of a short cervix for spontaneous preterm birth was 3.3 (95% CI, 1.4-7.4).

CONCLUSION

A cervical length of < 25 mm on transvaginal ultrasound is predictive of preterm birth in women with more than one prior induced abortion. Women with multiple prior induced abortions and a short cervix have a 3.3-fold greater chance of spontaneous preterm birth compared with those with a cervical length of > or = 25mm.

The degradation of the herbicide bromoxynil and its impact on bacterial diversity in a top soil

AIMS

To study how repeated applications of an herbicide bromoxynil to a soil, mimicking the regime used in the field, affected the degradation of the compound and whether such affects were reflected by changes in the indigenous bacterial community present.

METHODS AND RESULTS

Bromoxynil degradation was monitored in soil microcosms using HPLC. Its impact on the bacterial community was determined using denaturing gradient gel electrophoresis (DGGE) and quantitative PCR of five bacterial taxa (Pseudomonads, Actinobacteria, alpha-Proteobacteria, Acidobacteria and nitrifying bacteria). Three applications of 10 mg kg(-1) of bromoxynil at 28-day intervals resulted in rapid degradation, the time for removal of 50% of the compound decreasing from 6.4 days on the first application to 4.9 days by the third. Bacterial population profiles showed significant similarity throughout the experiment. With the addition of 50 mg kg(-1) bromoxynil to soil, the degradation was preceded by a lag phase and the time for 50% of the compound to be degraded increased from 7 days to 28 days by the third application. The bacterial population showed significant differences 7 days after the final application of bromoxynil that correlated with an inhibition of degradation during the same period.

CONCLUSIONS

These analyses highlighted that the addition of bromoxynil gave rise to significant shifts in the community diversity and its structure as measured by four abundant taxa, when compared with the control microcosm. These changes persisted even after bromoxynil had been degraded.

SIGNIFICANCE AND IMPACT OF THE STUDY

Here we show that bromoxynil can exert an inhibitory effect on the bacterial population that results in decreased rates of degradation and increased persistence of the compound. In addition, we demonstrate that molecular approaches can identify statistically significant changes in microbial communities that occur in conjunction with changes in the rate of degradation of the compound in the soil.

The application of the herbicide bromoxynil to a model soil-derived bacterial community: impact on degradation and community structure

AIMS

Bromoxynil degradation by soil micro-organisms has been shown to be co-oxidative in character. In this study, we investigate both the impact of the application of increasing bromoxynil concentrations on soil-derived bacterial communities and how these changes are reflected in the degradation of the compound. Our aim was to test the hypothesis that the addition of bromoxynil to a soil-derived bacterial community, and the availability of a readily utilizable carbon source would have an impact on bromoxynil degradation, and that would be reflected in the bacteria present in the soil community.

METHODS AND RESULTS

Degradation of bromoxynil was observed in soil-derived communities containing 15 mg l(-1), but not 50 mg l(-1) of the compound, unless glucose was added. This suggests that the addition of carbon stimulates co-oxidative bromoxynil degradation by the members of the bacterial community. Measurable changes in the bacterial community indicated that the addition of bromoxynil led to deterministic selection on the bacterial population, i.e. the communities observed arise through the selection of specific micro-organisms that are best adapted to the conditions in the soil. The addition of bromoxynil was also shown to have a negative impact on the presence of alpha and gamma-proteobacteria in the soil community.

CONCLUSION

Bromoxynil degradation is significantly inhibited in bacterial soil communities in the absence of readily accessible carbon. The application of bromoxynil appears to exert deterministic selection on the bacterial community.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study highlights the effects of increasing bromoxynil concentrations on a model bacterial population derived from soil. Soil communities show qualitative and quantitative differences to bromoxynil application depending on the availability of organic carbon. These findings might have implications for the persistence of bromoxynil in agricultural soils.

The impact of acrylonitrile and bioaugmentation on the biodegradation activity and bacterial community structure of a topsoil

The analysis of the bacterial community within the soil using DGGE showed acrylonitrile (ACN) could lead to the selection of significantly similar communities. Moreover, Rhodococcus sp. AJ270 was successfully established in the soil community. High GC G+-bacteria also responded positively to ACN addition. Bioaugmentation or carbon addition had no impact on the rate or degree of ACN degradation. ACN could be readily degraded by the soil bacteria, however, the community structure was significantly affected by its addition as well as by the addition of carbon or Rhodococcus sp. AJ270. The bioaugmentation of the soil with this strain was successful, in that the organism became established within the community. ACN addition to a soil produces statistically significant changes in the bacterial community.

The Impact of Bioaugmentation on Metal Cyanide Degradation and Soil Bacteria Community Structure

Metal cyanides are significant contaminants of many soils found at the site of former industrial activity. In this study we isolated bacteria capable of degrading ferric ferrocyanide and K2Ni(CN)4. One of these bacteria a Rhodococcus spp. was subsequently used to bioaugment a minimal medium broth, spiked with K2Ni(CN)4, containing 1 g of either an uncontaminated topsoil or a former coke works site soil. Degradation of the K2Ni(CN)4 was observed in both soils, however, bioaugmentation did not significantly impact the rate or degree of K2Ni(CN)4 removal. Statistical analysis of denaturing gradient gel electrophoresis profiles showed that the topsoil bacterial community had a higher biodiversity, and its structure was not significantly affected by either K2Ni(CN)4 or bioaugmentation. In contrast, profiles from the coke works site indicated significant changes in the bacterial community in response to these additions. Moreover, in both soils although bioaugmentation did not affect rates of biodegradation the Rhodococcus spp. did become established in the communities in broths containing both top and coke works soil. We conclude that bacterial communities from contaminated soils with low biodiversity are much more readily perturbed through interventions such as contamination events or bioaugmentation treatments and discuss the implications of these findings for bioremediation studies.

Pneumococcal vaccination during pregnancy for preventing infant infection

BACKGROUND

Each year at least one million children worldwide die of pneumococcal infections. The development of bacterial resistance to antimicrobials adds to the difficulty of treatment of diseases and emphasizes the need for a preventive approach. Newborn vaccination schedules could substantially reduce the impact of pneumococcal disease in immunized children, but does not have an effect on the morbidity and mortality of infants less than three months of age. Pneumococcal vaccination during pregnancy may be a way of preventing pneumococcal disease during the first months of life before the pneumococcal vaccine administered to the infant starts to produce protection.

OBJECTIVES

To assess the effect of pneumococcal vaccination during pregnancy for preventing infant infection.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group Trials Register (June 2004), CENTRAL (The Cochrane Library, Issue 2, 2004), MEDLINE (January 1966 to June 2004), EMBASE (January 1985 to June 2004), and reference lists of articles.

SELECTION CRITERIA

Randomized controlled trials in pregnant women comparing pneumococcal vaccine with placebo or doing nothing or with another vaccine to prevent infant infections.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed methodological quality and extracted data using a data collection form. Study authors were contacted for additional information.

MAIN RESULTS

Three trials (280 participants) were included. There was no evidence that pneumococcal vaccination during pregnancy reduces the risk of neonatal infection (one trial, 149 pregnancies, relative risk (RR) 0.51; 95% confidence interval (CI) 0.18 to 1.41). Although the data suggest an effect in reducing pneumococcal colonisation in infants by 16 months of age (one trial, 56 pregnancies, RR 0.33; 95% CI 0.11 to 0.98), there was no evidence of this effect in infants at two months of age (RR 0.28; 95% CI 0.02 to 5.11) or by seven months of age (RR 0.32; 95% CI 0.08 to 1.29).

AUTHORS' CONCLUSIONS

There is insufficient evidence to support whether pneumococcal vaccination during pregnancy could reduce infant infections.