Motor Evoked Potential-A Pilot Study Looking at Reliability and Clinical Correlations in Multiple Sclerosis

PURPOSE

Multiple sclerosis (MS) is a clinically heterogeneous disease. Biomarkers that can assess pathological processes that are unseen with conventional imaging remain an unmet need in MS disease management. Motor evoked potentials (MEPs) could be such a biomarker. To determine and follow longitudinal MEP reliability and correlations with clinical measures in MS patients.

METHODS

This is a single-center study in alemtuzumab-treated MS patients to evaluate temporal reliability of MEPs, identify MEP minimum detectible differences, and explore correlations with existing clinical scales. Ten MS patients recently treated with alemtuzumab were evaluated every 6 months over 3 years. Clinical evaluations consisted of expanded disability status scale, timed 25-foot walk, 6-minute walk, and nine-hole peg test. MEPs were measured twice, 2 weeks apart, every 6 months.

RESULTS

Eight patients completed all 3 years of study. The intraclass correlation coefficient for MEP parameters ranged from 0.76 to 0.98. TA latency and amplitude with facilitation significantly and strongly correlated with all clinical measures, whereas the MEP duration modestly correlated. Biceps latency with facilitation significantly and moderately correlated with 9-hole peg test. Longitudinal correlations demonstrated good predictive values for either clinical deterioration or improvement.

CONCLUSIONS

MEPs have excellent intrapatient and intrarater reliability, and TA MEPs significantly and strongly correlated with expanded disability status scale, 6-minute walk, and timed 25-foot walk, whereas biceps MEPs significantly and moderately correlated with nine-hole peg test. Further studies using larger cohorts of MS patients are indicated.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, Identifier: NCT02623946.

Level of processing's effect on episodic retrieval following traumatic brain injury in the elderly: An event-related potential study

Individuals who have sustained a traumatic brain injury (TBI) can suffer from episodic memory impairments. Until now, the neural correlates underlying episodic retrieval in individuals with TBI remained scarce, particularly in older adults. We aimed to fill this gap by recording event-related potentials during an old/new episodic recognition task in 26 older adults, 13 healthy and 13 with TBI. The task manipulated the level of processing in encoding with the use of semantic organizational strategies (deep guided, deep self-guided, and shallow encoding). For all encoding conditions, behavioral data analyses on the discrimination rate indicated that older adults with TBI were globally impaired compared with healthy older adults. The electrophysiological results indicated that the left-parietal effect was larger in the deep guided condition than in the shallow condition. In addition, the results show that the mid-frontal and left-parietal positive old/new effects were absent in both groups. The main findings are the observation, in the control group only, of an early frontal old/new effect (P200; 150-300 ms) and of a late frontal old/new effect on the left hemisphere, only in the Spontaneous condition. Together, results suggest an impairment of the allocation of attentional resources and working memory necessary for retrieving and monitoring items in the elderly with TBI.

The Rare Knowledge Mining Methodological Framework for the Development of Practice Guidelines and Knowledge Translation Tools for Rare Diseases

Rare diseases bring on a heavy health, social and economic burden that impacts patients' lives and puts pressure on the healthcare system. Furthermore, they are often associated with limited published studies to inform multidisciplinary clinical practice thus limiting evidence-based practice. Moreover, the development of knowledge translation products including clinical care guidelines are often very challenging based on the current available methodological frameworks relying mostly on critical appraisal of the published research evidence where randomized clinical trial design is considered as the gold standard. To overcome this barrier, we proposed the Rare Knowledge Mining Methological Framework (RKMMF). The RKMMF is one possible answer to improve the development of knowledge translation products for rare diseases. This framework includes other sources of evidence including registry information and qualitative studies and the involvement of expert patients. This article documents the RKMMF structure and its application is exemplified through knowledge translation products developed for a neuromuscular population.

Earthquakes and extreme rainfall induce long term permeability enhancement of volcanic island hydrogeological systems

Earthquakes affect near-surface permeability, however temporal permeability evolution quantification is challenging due to the scarcity of observations data. Using thirteen years of groundwater level observations, we highlight clear permeability variations induced by earthquakes in an aquifer and overlaying aquitard. Dynamic stresses, above a threshold value PGV > 0.5 cm s⁻¹, were mostly responsible for these variations. We develop a new model using earth tides responses of water levels between earthquakes. We demonstrate a clear permeability increase of the hydrogeological system, with the permeability of the aquifer increasing 20-fold and that of the aquitard 300-fold over 12 years, induced by fracture creation or fracture unclogging. In addition, we demonstrate unprecedented observations of increase in permeability due to the effect of extreme tropical deluges of rainfall and hurricanes. The water pressure increase induced by the exceptional rainfall events thus act as piston strokes strong enough to unclog congested fractures by colloids, particles or precipitates. Lastly, an analysis of regional permeabilities also highlights a permeability increase over geological timeframes (× 40 per million years), corroborating the trend observed over the last decade. This demonstrates that permeability of aquifers of andesitic volcanic islands, such as the Lesser Antilles, significantly evolve with time due to seismic activity and extreme rainfall.

Evaluation of the Assurance GDS® for Salmonella Method in Foods and Environmental Surfaces: Multilaboratory Collaborative Study

A multilaboratory collaborative study was conducted to compare the detection of Salmonella by the Assurance GDS® for Salmonella method and the Reference culture methods. Six foods, representing a variety of low microbial and high microbial load foods were analyzed. Seventeen laboratories in the United States and Canada participated in this study. No statistical differences (P < 0.05) were observed between the Assurance GDS for Salmonella and the Reference culture methods for any inoculation level of any food type or naturally contaminated food, except for pasta, for which the Assurance GDS method had a higher number of confirmed test portions for Salmonella compared to the Reference method.

Effects of ractopamine administration and castration method on muscle fiber characteristics and sensory quality of the longissimus muscle in two Piétrain pig genotypes

Single and combined effects of ractopamine supplementation (RAC, 7.5 vs. 0 ppm), castration method (surgical castration: SC vs. immuno-castration: IM) and genotype (genotype A: GA vs. GB containing 25% or 50% Piétrain) were determined on longissimus muscle (LM) fiber traits and quality of pork (n=512). RAC increased fiber IIX cross-sectional area (P=0.009) and decreased glycolytic potential (P=0.02) and pork tenderness (P<0.001). Fiber traits indicated that LM of IM pigs was more oxidative (P<0.05) and meat had slightly higher (P=0.04) off-flavor score and WBSF than SC. LM from GB pigs was paler (P<0.05) and had greater (P<0.05) glycolytic potential, IIX fiber cross sectional area and pork off-flavor than GA. RAC supplementation, castration method and genotype or their combination affected some fiber traits and some quality parameters but differences reported were small indicating these treatments or their combination could be used without major prejudice to meat quality.

Effects of low-voltage electrical stimulation and aging on lamb meat quality

Pouliot, E., Gariépy, C., Thériault, M., Avezard, C., Fortin, J., Simmons, N. J. and Castonguay, F. W. 2012. Effects of low-voltage electrical stimulation and aging on lamb meat quality. Can. J. Anim. Sci. 92: 59–66. The aim of this study was to evaluate the effect of electrical stimulation (ES) and aging time on meat quality of heavy lamb as produced in Quebec. Seventy-six Suffolk-sired crossbred male lambs were slaughtered at a target weight of 50±2 kg. Half of them were electrically stimulated (ES vs. control) at 5–10 min postmortem (21 V; 0.25 A; 60 s). Postmortem pH decline and temperature were monitored. After carcass cutting, longissimus dorsi sections were assigned to aging periods of 1, 3 or 8 d. Temperature decline was the same for both treatments (P=0.749). However, ES carcasses always had a lower pH value than controls during the first 24 h (P<0.001) while the ultimate pH was equivalent (P=0.803). Tenderness, as assessed by either Warner-Bratzler shear force (39 carcasses) or sensory evaluation (35 carcasses) was enhanced by both ES (P<0.001) and aging (P<0.001). At each aging time, tenderness was greater for ES meat. In addition, only 3 d of aging were necessary for ES meat to achieve the tenderness level attained by the controls after 8 d. Sarcomeres were longer (P<0.001) in ES meat than in controls while myofibrillar fragmentation index was not affected by ES treatment (P=0.743). Electrical stimulation also had small effects on color parameters (a*, b* and L*; P<0.01) and flavor (P=0.04). These results provide the first evidence that tenderness of the meat from heavy lambs produced and processed in Quebec could be enhanced by ES, mostly through cold shortening reduction.

British HIV Association and Children's HIV Association position statement on infant feeding in the UK 2011

To prevent the transmission of HIV infection during the postpartum period, the British HIV Association and Children's HIV Association (BHIVA/CHIVA) continue to recommend the complete avoidance of breast feeding for infants born to HIV-infected mothers, regardless of maternal disease status, viral load or treatment.

Growth performance, carcass traits and meat quality of heavy lambs reared in a warm or cold environment during winter

The goal of this study was to evaluate the impact of winter rearing environment on the growth performance and meat quality of heavy lambs. Half of sixty-four Dorset lambs (32 males and 32 females) were raised in each of two different environments: warm and cold with average temperature of 10.9 ± 0.7 °C and -2.0 ± 5.2 °C, respectively. The lambs were slaughtered at live weights of 41-45 kg for females and 46-50 kg for males. Cold environment had no adverse effect on either growth performance or carcass quality. The rate of longissimus dorsi muscle deposition (P = 0.049) and its depth at slaughter (P = 0.027) were rather greater in lambs reared in the cold environment and a higher proportion of oxido-glycolytic fibres (P = 0.047) was also observed in this muscle. Rearing environment had only a minor effect on the organoleptic qualities, with the cold environment promoting juiciness of the meat (P = 0.043). Therefore, cold environment rearing such as used in this study represents an economic advantage for lamb producers by reducing the costs associated with the construction of insulated barns, while maintaining growth performance, as well as carcass and meat quality. Key words: Lamb, rearing environment, temperature, growth, carcass, meat quality

Continuous non-invasive blood pressure monitoring using concentrically interlocking control loops

A new method and apparatus for non-disruptive blood pressure (BP) recording in the finger based on the vascular unloading technique is introduced. The instrument, in contrast to intermittent set point readjustments of the conventional vascular unloading technique, delivers BP without interruptions, thus refining the Penáz' principle. The method is based on concentrically interlocking control loops for correct long-term tracing of finger BP, including automatic set point adaptation, light control and separate inlet and outlet valves for electro-pneumatic control. Examples of long-term BP recordings at rest and during autonomic function tests illustrate the potential of the new instrument.

Non-invasive beat-to-beat cardiac output monitoring by an improved method of transthoracic bioimpedance measurement

The report describes a method of impedance cardiography using an improved estimate of thoracic volume. The formulas and their implementation in hardware and software are explained and new shortband electrodes are described which generate a good homogeneous thoracic field. Examples of stroke volume and cardiac output curves underline the capabilities of the monitoring system "Task Force Monitor". In several experiments, results are compared to thermodilution as well as to BioZ measurements: the new method excels in comparison with thermodilution and is comparable to the BioZ device. Compared to traditional electrodes, the new shortband electrodes are shown to provide better reproducibility.

Preferential bromide and pesticide movement to tile drains under different cropping practices

Subsurface drainage systems are useful tools to study chemical leaching in soils. Our objective was to compare the breakthrough behavior of bromide, atrazine (2-chloro-4-ethylamino-6-isopropylamino-s-triazine) and metolachlor [2-chloro-N-(2-ethyl-6-methylphenyl)-N-(2-methoxy-1-methylethyl) acetamid] to tile drains under two fall tillage practices (conventional tillage [CT] with a moldboard plow, and reduced tillage [RT] with a chisel plow) in field plots cultivated with corn (Zea mays L.). Leachate volume were greater in RT than in CT, with no statistical differences. Soil analysis showed that bromide migrated deeper in the soil profile than both herbicides, with little tillage effect. All chemicals were detected in drainage water at the same time and followed an event-driven behavior. Tillage had no effect on atrazine and metolachlor found in drainage water, while bromide concentration peaks were higher in RT than in CT in 1999. Concentration peaks were recorded earlier for atrazine and metolachlor than for bromide. Plots of cumulative relative chemical mass (cumulative mass divided by total mass measured in drainage) as a function of cumulative drainage were mostly linear for bromide, while they were S-shaped for both herbicides. Drainage that corresponded to 50% of relative cumulative mass ranged from 40 to 55% for bromide and from 5 to 28% for both herbicides. Rapid chemical movement to tile drains suggested that preferential flow was important in both CT and RT, and that these tillage practices had little influence on this phenomena.

Hyperbaric oxygen for children with cerebral palsy: a randomised multicentre trial. HBO-CP Research Group

BACKGROUND

The use of hyperbaric oxygen for children with cerebral palsy has spread worldwide, despite little scientific evidence of efficacy. We did a randomised trial to assess the efficacy and side-effects of this form of therapy in children with cerebral palsy.

METHODS

111 children with cerebral palsy aged 3-12 years were randomly assigned hyperbaric oxygen (n=57) or slightly pressurised room air (n=54). All children received 40 treatments over 2 months. Hyperbaric oxygen treatment was 1 h in 100% oxygen at 1.75 atmospheres absolute (ATA); children on slightly pressurised air received air at 1.3 ATA (the lowest pressure at which pressure can be felt, thereby ensuring the maintenance of masking). The main outcome measure was gross motor function. Secondary outcomes included performance in activities of daily living, attention, working memory, and speech.

FINDINGS

For all outcomes, both groups improved over the course of the study, but without any difference between the two treatments. The score on the global gross motor function measure increased by 3.0% in the children on slightly pressurised air and 2.9% in those on hyperbaric oxygen. The mean difference between treatments was -0.40 (95% CI -1.69 to 0.90, p=0.544). Other changes were seen in speech, attention, memory, and functional skills. Ear problems occurred in 27 children treated by hyperbaric oxygen and in 15 treated with hyperbaric air (p=0.004).

INTERPRETATION

In this study, hyperbaric oxygen did not improve the condition of children with cerebral palsy compared with slightly pressurised air. The improvement seen in both groups for all dimensions tested deserves further consideration.

Universal fluctuations in correlated systems

The probability density function (PDF) of a global measure in a large class of highly correlated systems has been suggested to be of the same functional form. Here, we identify the analytical form of the PDF of one such measure, the order parameter in the low temperature phase of the 2D XY model. We demonstrate that this function describes the fluctuations of global quantities in other correlated equilibrium and nonequilibrium systems. These include a coupled rotor model, Ising and percolation models, models of forest fires, sandpiles, avalanches, and granular media in a self-organized critical state. We discuss the relationship with both Gaussian and extremal statistics.

Forecasting patient services: a 21st century vision of an academic health centre

This article provides an overview of the development and implementation of the McGill University Health Centre model for forecasting patient services in the year 2004, and advice on how to apply the model. Critical success factors and case examples are highlighted. The insights provided will be of value to hospitals and other institutions that recognize the necessity of engaging in long-range planning and forecasting.

beta-2 Adrenergic receptor variants affect resting blood pressure and agonist-induced vasodilation in young adult Caucasians

Recent evidence suggests that the prodownregulatory Gly16 allele of the beta-2 adrenergic receptor (beta-2 AR) is associated with essential hypertension in African Caribbeans. To further investigate the effect of the glycine (Gly)16 and arginine (Arg)16 beta-2 AR variants on hemodynamics, we investigated the agonist-mediated in vivo vasodilation in normotensive Austrian Caucasians and analyzed the results with respect to the Gly16/Arg16 polymorphism. Fifty-seven normotensive men, 20 to 32 years of age with body mass index of 18.7 to 29.9 kg/m2, were genotyped for the Arg16/Gly16 beta-2 AR alleles. All 15 Gly16/Gly16 subjects, all 12 Arg16/Arg/16 subjects, and 27 of 30 heterozygous subjects underwent hemodynamic measurements while supine after an overnight fast. The observers were unaware of the subjects' genotypes. The subjects received a graded infusion of the selective beta-2 AR agonist salbutamol (0.07, 0.14, and 0.21 microgram/kg per minute, respectively), each dose over 8 minutes. Stroke volume and blood pressure were determined continuously by means of impedance cardiography and oscillometry, respectively. The last 4 minutes of each infusion were evaluated statistically. Basal mean blood pressure was higher in the Gly16/Gly16 subjects compared with Arg16/Arg16 subjects (mean+/-SD: 81.6+/-6.14 versus 75.2+/-4.93 mm Hg, P<0.01). Homozygous Gly16 subjects showed a significantly decreased vasodilation during the first dose of salbutamol infusion compared with Arg16/Arg16 subjects (Deltatotal peripheral resistance index -17.9+/-14.4 versus -30. 6+/-8.3%, P<0.01) despite increased sympathetic counterregulation in the Arg16/Arg16 group (Deltaheart rate +16.9+/-7.0% versus +8.6+/-7. 0%, P<0.01; Deltacardiac index +39.5+/-18.5% versus 21.4+/-18.8%, P<0.05). Our results provide additional evidence that the Gly16/Arg16 alleles of the beta-2 AR are intimately related to blood pressure regulation and deserve further studies in the pathogenesis of essential hypertension.