HIV Knowledge and Perceived Risk Among Black Men and Women Who Are Incarcerated in Kentucky

In the United States, Black men and women who are incarcerated bear a disproportionate and inequitable burden of HIV infection. While HIV knowledge does not consistently predict HIV risk behaviors, HIV knowledge can inform one's perceptions of their risk for HIV. We examined gender differences in HIV knowledge and perceived risk of contracting HIV (N = 424) among Black men and women who were incarcerated and nearing community reentry from seven prisons in Kentucky. Our results demonstrated that women reported greater levels of HIV knowledge and perceived greater risk for contracting HIV than their male counterparts. Implications for HIV prevention interventions are discussed.

A highly virulent variant of HIV-1 circulating in the Netherlands

We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log₁₀ increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.

Diepoxybutane-induced apoptosis is mediated through the ERK1/2 pathway

Diepoxybutane (DEB) is the most potent active metabolite of butadiene, a regulated air pollutant. We previously reported the occurrence of DEB-induced, p53-dependent, mitochondrial-mediated apoptosis in human lymphoblasts. The present study investigated the role of the extracellular signal-regulated protein kinases 1 and 2 (ERK1/2) pathway in DEB-induced apoptotic signaling in exposed human lymphoblasts. Activated ERK1/2 and mitogen-activated protein (MAP) kinase/ERK1/2 kinase (MEK) levels were significantly upregulated in DEB-exposed human lymphoblasts. The MEK inhibitor PD98059 and ERK1/2 siRNA significantly inhibited apoptosis, ERK1/2 activation, as well as p53 and phospho-p53 (serine-15) levels in human lymphoblasts undergoing DEB-induced apoptosis. Collectively, these results demonstrate that DEB induces apoptotic signaling through the MEK-ERK1/2-p53 pathway in human lymphoblasts. This is the first report implicating the activation of the ERK1/2 pathway and its subsequent role in mediating DEB-induced apoptotic signaling in human lymphoblasts. These findings contribute towards the understanding of DEB toxicity, as well as the signaling pathways mediating DEB-induced apoptosis in human lymphoblasts.

Frequency and topography in monkey electroencephalogram during action observation: possible neural correlates of the mirror neuron system

The observation of actions executed by others results in desynchronization of electroencephalogram (EEG) in the alpha and beta frequency bands recorded from the central regions in humans. On the other hand, mirror neurons, which are thought to be responsible for this effect, have been studied only in macaque monkeys, using single-cell recordings. Here, as a first step in a research programme aimed at understanding the parallels between human and monkey mirror neuron systems (MNS), we recorded EEG from the scalp of two monkeys during action observation. The monkeys were trained to fixate on the face of a human agent and subsequently to fixate on a target upon which the agent performed a grasping action. We found that action observation produced desynchronization in the 19-25 Hz band that was strongest over anterior and central electrodes. These results are in line with human data showing that specific frequency bands within the power spectrum of the ongoing EEG may be modulated by observation of actions and therefore might be a specific marker of MNS activity.

A randomised controlled trial of ALA vs. Photofrin photodynamic therapy for high-grade dysplasia arising in Barrett's oesophagus

Photofrin photodynamic therapy (PDT) is a licenced treatment for Barrett's oesophagus (BE) with high-grade dysplasia (HGD) but causes strictures and photosensitivity and complete reversal of dysplasia (CR-HGD) by 50 % at 5 years. 5-Aminolaevulinic acid (ALA) is an alternative treatment with non-randomised data suggesting 85 % CR-HGD and a low risk of side effects. We aimed to compare efficacy and side effect profile between the drugs. A single-centre randomised controlled trial was conducted. Presence of HGD was confirmed on three occasions by two specialist GI pathologists. Stratification was by length of BE and extent of dysplasia. Standard protocols for ALA and Photofrin-PDT were followed. Endoscopic follow-up with 2-cm four-quadrant biopsy was at 6 weeks, 4 months, and then annually. All adverse event data were collected. Sixty four patients were randomised, 34 ALA and 30 Photofrin-PDT. Median follow-up is 24 months. On intention-to-treat analysis, CR-HGD was 16/34 (47 %) with ALA-PDT and 12/30 (40 %) with Photofrin-PDT. The overall cancer incidence was 14 % (9/64). On sub-group log-rank analysis, for BE ≤ 6 cm, CR-HGD was significantly higher with ALA-PDT than Photofrin-PDT (χ(2) =5.39, p=0.02). Strictures and skin photosensitivity were significantly more common after treatment with Photofrin-PDT than ALA-PDT (33 vs. 9 % and 43 vs. 6 %, respectively, p<0.05). The rate of buried glands with either drug was significantly higher post-PDT (48 % of patients) than pre-PDT (20 %). ALA-PDT has a better risk profile than Photofrin-PDT. In patients with BE length ≤ 6 cm, preliminary results show ALA-PDT is associated with significantly higher CR-HGD. In longer segments of BE, neither PDT drug is sufficiently efficacious to warrant routine use.

Factors associated with a difficult induction of general anaesthesia

BACKGROUND

Many children experiencing a procedure under general anaesthetic (GA), including those having surgery for cochlear implantation, display behaviours indicative of distress during induction of anaesthesia. It would be useful to ascertain which factors in the pre-operative period are related to the presence of distress at induction in order to target appropriate psychological preparation.

METHODS

The families of 84 children aged 4-7 years undergoing a procedure under GA (including insertion of a cochlear implant) completed three questionnaires assessing temperament, behavioural difficulties, and pre-operative worries. Demographic variables were also recorded. The outcome measure was the amount of behavioural distress at induction.

RESULTS

Statistically significant relationships with the outcome measure of distress at induction were obtained for three factors; an emotional or sociable temperament, and the number of previous procedures. Further, children receiving inhalation inductions displayed greater distress than those receiving intravenous inductions.

CONCLUSION

Undergoing cochlear implantation under GA is a major life event for many recipients. Psychologically preparing children for this has been found to be efficacious, but is not currently available to all children. It is suggested that preparation can be targeted at children, as identified in this study, who have elevated emotionality or sociability scores or who have previous experience of procedures under general anaesthesia. This is of particular current relevance as children are increasingly likely to require re-implantation as they grow older and as unilaterally implanted children are now being offered a sequential bilateral implant, both necessitating further surgery.

Radiofrequency ablation is effective for the treatment of high-grade dysplasia in Barrett's esophagus after failed photodynamic therapy

Endoscopic radiofrequency ablation (RFA) is an effective treatment for high-grade dysplasia in Barrett's esophagus in ablation-naïve patients, but no studies have evaluated its use in patients in whom ablative therapy has previously failed. We describe 14 patients with residual high-grade dysplasia following aminolevulinic acid or Photofrin (porfimer sodium) photodynamic therapy (PDT). An overall complete reversal of dysplasia was achieved in 86 % with a combination of RFA and rescue endoscopic mucosal resection. The median total follow-up is 19 months. The rate of strictures was 7 % (1/14) and there was a low rate of buried glands (0.5 % follow-up biopsies). These data suggest RFA is both safe and effective for eradication of high-grade dysplasia in patients in whom PDT has failed.

Image cytometry accurately detects DNA ploidy abnormalities and predicts late relapse to high-grade dysplasia and adenocarcinoma in Barrett's oesophagus following photodynamic therapy

Background and aims:

DNA ploidy abnormalities (aneuploidy/tetraploidy) measured by flow cytometry (FC) are strong predictors of future cancer development in untreated Barrett's oesophagus, independent of histology grade. Image cytometric DNA analysis (ICDA) is an optical technique allowing visualisation of abnormal nuclei that may be undertaken on archival tissue. Our aim was to determine the accuracy of ICDA vs FC, and evaluate DNA ploidy as a prognostic biomarker after histologically successful treatment with photodynamic therapy (PDT).

Methods:

Nuclei were extracted from 40 μm sections of paraffin-embedded biopsies and processed for ICDA at UCL and FC at UW using standardised protocols. Subsequently, DNA ploidy was evaluated by ICDA on a cohort of 30 patients clear of dysplasia 1 year after aminolaevulinic acid PDT for high-grade dysplasia (HGD). The results were correlated with long-term outcome.

Results:

In the comparative study, 93% (41 out of 44) of cases were classified identically. Errors occurred in the near-diploid region by ICDA and the tetraploid region by FC. In the cohort study, there were 13 cases of late relapse (7 cancer, 6 HGD) and 17 patients who remained free of dysplasia after a mean follow-up of 44 months. Aneuploidy post-PDT was highly predictive for recurrent HGD or cancer with a hazard ratio of 8.2 (1.8–37.8) (log-rank P=0.001).

Conclusions:

ICDA is accurate for the detection of DNA ploidy abnormalities when compared with FC. After histologically successful PDT, patients with residual aneuploidy are significantly more likely to develop HGD or cancer than those who become diploid. DNA ploidy by ICDA is a valuable prognostic biomarker after ablative therapy.

Variations in behavior and condition of a Southern Ocean top predator in relation to in situ oceanographic conditions

Responses by marine top predators to environmental variability have previously been almost impossible to observe directly. By using animal-mounted instruments simultaneously recording movements, diving behavior, and in situ oceanographic properties, we studied the behavioral and physiological responses of southern elephant seals to spatial environmental variability throughout their circumpolar range. Improved body condition of seals in the Atlantic sector was associated with Circumpolar Deep Water upwelling regions within the Antarctic Circumpolar Current, whereas High-Salinity Shelf Waters or temperature/salinity gradients under winter pack ice were important in the Indian and Pacific sectors. Energetic consequences of these variations could help explain recently observed population trends, showing the usefulness of this approach in examining the sensitivity of top predators to global and regional-scale climate variability.

Pegfilgrastim can be effectively administered the same day as chemotherapy to prevent neutropenia-related complications

19571

Background: Pegfilgrastim has been proven to reduce neutropenia-related complications of chemotherapy. However, the administration of pegfilgrastim 24 hours after chemotherapy treatment often poses an inconvenience for the patients and care givers. Methods: A retrospective chart review of the patients who received pegfilgrastim the same day as chemotherapy was done at a rural oncology practice, where some patients travel more than 100 miles each way for treatment. Incidence of febrile neutropenia (FN), defined as ANC = 500 and temperature =101° F; hospitalization for FN; dose-delay; dose-reduction (= 15% reduction in the planned dose); ANC recovery (ANC=1,500 on the day of next treatment), Grade III/IV neutropenia one week after chemotherapy and empiric use of prophylactic antibiotics was recorded. Results: Between 11/05 and 11/06, 243 doses of pegfilgrastim were given the same day as chemotherapy to 48 patients. M/F=14/34; Age(median): 61.2 yrs (range: 27–88 yrs).The diagnoses were NSCLC=13 (Stage II, III, IV: 2, 2 and 9, respectively); Breast Ca=11 (stage II, III, IV: 4, 6 and 1, respectively); Diffuse large B-cell lymphoma (DLBCL)= 6 (stage III, IV: 4, 2); Follicular lymphoma=3 (stage IV: 3); SCLC=3 (stage IV: 3); Ovarian Ca=2 (stage III, IV: 1, 1); and others=10. Twenty five different chemotherapy regimens were administered (Q3 wk. regimens: 19, Q2 wk. regimens: 4 and others=2). No patient had FN or hospitalization for FN. ANC recovery was sub- optimal twice (ANC of 880 and 1,010 on the day of next treatment). Dose was delayed only once due to neutropenia (ANC=880), patient with ANC of 1,010 received treatment as scheduled. Three patients needed dose-reduction of more than 15% (all had DLBCL). Grade III/IV neutropenia after one week of treatment (CBC was available after 235 treatments) was observed in 52 (0.2%) patients, 23 patients had had AC and 25 patients had had CHOP. Empiric prophylactic antibiotics were not given to any patient. Conclusions: Pegfilgrastim can be effectively given the same day as chemotherapy to ameliorate neutropenia-related complications. Same-day administration of pegfilgrastim could improve the quality of life of patients and may reduce the health care costs. Large prospective trials should be done to address this issue.

No significant financial relationships to disclose.

Initial force and postural adaptations when pushing and pulling on floor surfaces with good and reduced resistance to slipping

The objective of the present study was to determine whether differences in the frictional properties of a floor surface may affect the kinematics and kinetics of pushing and pulling. Eight male participants were required to push and pull a four-wheeled trolley over two level surfaces, on which were mounted floor coverings with good (safety floor) and reduced (standard floor) frictional properties. A psychophysical approach was used to determine the initial maximum acceptable horizontal force required to move the trolley over a short distance (3 m). Three-dimensional (3D) hand and ground reaction forces and 3D postures were measured during initial force exertions. The results showed that psychophysically derived measures of initial horizontal force and horizontal components of hand forces did not differ significantly between floor surfaces. Despite the ability to exert similar forces, the measured maximum coefficient of friction varied according to floor surface. These changes reflected significant alterations in vertical and horizontal components of ground reaction and vertical hand forces, suggesting that participants had maximized the frictional properties available to them. Postures also changed as a consequence of floor surface, with significant changes occurring in knee flexion and trunk extension. This study has shown that handlers involved in the pushing and pulling of trolleys are capable of adjusting posture and the direction of hand and foot forces in order to compensate for reduced levels of floor friction. This has particular relevance when assessing the musculoskeletal loads imposed on the handler and the likely mechanisms of injury resulting from variations in floor conditions when workers undertake pushing and pulling tasks in the workplace.

The use of a whole body index with bone scintigraphy to monitor the response to therapy in Paget's disease

Bone scintigraphy has long been used to assess Paget's disease and investigate the response to therapy. Objective visual assessment is, however, difficult. The aim of this study was to derive, from a bone scintigram, an index which objectively measured the extent and severity of Paget's disease in the entire skeleton. This whole body index would provide a single numerical value which could be used to monitor the response to therapy in both monostotic and polyostotic disease. Comparison with other methods of assessing the condition, such as biochemical markers and pain scores, would also be possible. The whole body index was developed and used to retrospectively analyse 80 bone scintigrams on 40 patients. The majority of patients (36) received treatment with a bisphosphonate between the two scintigrams. Whole body index was compared with serum alkaline phosphatase measured at the same time; a significant correlation was found (before treatment P=0.001, after treatment P<0.001). The change in whole body index and alkaline phosphatase following treatment with various bisphosphonates was also investigated and a significant correlation found (P<0.001). Whilst performing the analysis it was also noted that the increase in uptake of the radiopharmaceutical was significantly greater in the cortical long bones than in the trabecular axial skeleton. This study suggests that a whole body index may be a suitable tool for assessing the response to treatment in Paget's disease.

Spike-based strategies for rapid processing

Most experimental and theoretical studies of brain function assume that neurons transmit information as a rate code, but recent studies on the speed of visual processing impose temporal constraints that appear incompatible with such a coding scheme. Other coding schemes that use the pattern of spikes across a population a neurons may be much more efficient. For example, since strongly activated neurons tend to fire first, one can use the order of firing as a code. We argue that Rank Order Coding is not only very efficient, but also easy to implement in biological hardware: neurons can be made sensitive to the order of activation of their inputs by including a feed-forward shunting inhibition mechanism that progressively desensitizes the neuronal population during a wave of afferent activity. In such a case, maximum activation will only be produced when the afferent inputs are activated in the order of their synaptic weights.

Changes in concentration of five PCDD/F congeners after cooking beef from treated cattle

A large piece of meat taken from a single animal, which had been dosed with five selected PCDD/Fs, was prepared and cooked by a selection of different methods; burgers (fried, grilled, barbecued), roasts (cooked using conventional and microwave ovens) and stews (open pan and pressure cooked). For some of the cooking methods, concentration changes, on a whole product basis, were observed between raw and cooked product. However, in all cases these could be explained simply through changes arising from loss of water and elimination of PCDD/Fs with released fat. The total amounts of PCDD/Fs present in the system (including in released fat) remained unchanged. Dietary intake of PCDD/Fs could therefore be reduced by the removal of visible fat from meat before cooking and by discarding any fat released from foods during the cooking process.

Concentration changes for 5 PCDD/F congeners after administration in beef cattle

Ten cattle were treated with daily doses of five PCDD/F congeners, over a 4 week period. Four control animals were not treated. They were subsequently slaughtered as three groups, at 5, 18 and 31 weeks after the first dose. All congeners showed an increase in concentration within animal tissues when sampled at 5 weeks post-dosing. Concentrations had reduced after 18 weeks and there was a further small reduction after 31 weeks. Halflives for each congener were calculated at 13-21 weeks (93-148 days). Concentrations of congeners were different in the various tissues analysed. At 5 weeks after dosing commenced, concentrations in sub-cutaneous fat and in perirenal fat were close to 40 ng/kg (a predicted level based on 50% absorption of the dosed compounds). Concentrations on a fat basis in muscle tissue and liver were, however, about 5 and 10 times higher, respectively. The concentrations found in muscle tissue and liver samples taken at 18 and 31 weeks were approximately twice that found in fat deposits, thus the differences were still apparent, but at a reduced level. It is possible that the distribution phase was incomplete and that PCDD/Fs remained predominantly in association with circulating blood lipids rather than in equilibrium with depot fat. It follows that if livestock were recently exposed to PCDD/Fs (for example, through the consumption of contaminated feed), the analysis of depot fats would not necessarily provide a reliable indicator of the concentrations of PCDD/Fs in edible tissues.

A limit to the speed of processing in ultra-rapid visual categorization of novel natural scenes

The processing required to decide whether a briefly flashed natural scene contains an animal can be achieved in 150 msec (Thorpe, Fize, & Marlot, 1996). Here we report that extensive training with a subset of photographs over a 3-week period failed to increase the speed of the processing underlying such Rapid Visual Categorizations: Completely novel scenes could be categorized just as fast as highly familiar ones. Such data imply that the visual system processes new stimuli at a speed and with a number of stages that cannot be compressed. This rapid processing mode was seen with a wide range of visual complex images, challenging the idea that short reaction times can only be seen with simple visual stimuli and implying that highly automatic feed-forward mechanisms underlie a far greater proportion of the sophisticated image analysis needed for everyday vision than is generally assumed.

Brain areas involved in rapid categorization of natural images: an event-related fMRI study

Event-related fMRI was used to investigate brain activation during a visual go/no-go categorization task based on colored photographs of natural scenes, similar to a previous ERP study by Thorpe et al. (1996, Nature 381: 520-522). Subjects had to press a key when an animal was present in the display. Stimuli were flashed for 33 ms using an intertrial interval of 5 s and a design that carefully balanced targets and distractors in a pseudo-random sequence. Activation produced by targets and distractors was compared with two different techniques, one based on correlations with the stimulation pattern, the other using simple t score statistics to compare selected scans. The contralateral primary motor cortex and the ipsilateral cerebellum were both more active following target trials than following distractors, thus confirming the sensitivity of the method. Differential activity was also seen in the posterior cingulate cortex, the fusiform, and the parahippocampic gyri. Activity in such structures could underlie the differential evoked-potentials reported previously in the same task. Surprisingly, in these visual structures, the signal was stronger following distractor trials than target ones. This result could be due to more prolonged processing on distractor trials. Alternatively, it could be that target detection induces strong activation of a small proportion of neurons, which, because of competitive inhibitory mechanisms, could result in a decrease in activity for the population as a whole. We suggest that this kind of mechanism could also account for the decreases in signal observed in perceptual priming experiments.

Responsibility attitudes and interpretations are characteristic of obsessive compulsive disorder

The cognitive-behavioural theory of Obsessive Compulsive Disorder (OCD) proposes that a key factor influencing obsessional behaviour is the way in which the intrusive cognitions are interpreted. The present paper reports an investigation of links between clinical symptoms (of anxiety, depression and obsessionality) and responsibility beliefs. These beliefs include not only measures of general responsibility attitudes (assumptions) but also more specific responsibility appraisals consequent on intrusive cognitions. The characteristics of two new questionnaires specifically designed to measure these beliefs were assessed in patients suffering from Obsessive Compulsive Disorder, in patients suffering from other anxiety disorders and in non-clinical controls. The scales measuring negative beliefs about responsibility were found to have good reliability and internal consistency. Comparisons between criterion groups indicate considerable specificity for both assumptions and appraisals with respect to OCD. There was also good evidence of specificity in the association between responsibility cognitions and obsessional symptoms across groups, and that this association was not a consequence of links with anxiety or depressive symptoms. Although the two measures were correlated, they each made unique contributions to the prediction of obsessional symptoms. Overall, the results are consistent with the hypothesis that responsibility beliefs are important in the experience of obsessional problems.

The use of a blood conservation pressure transducer system in critically ill patients

We tried to determine if a blood conservation pressure transducer system reduced blood transfusions, increased haemoglobin concentration or reduced line infections in critically ill patients. One hundred patients were randomly allocated to conventional or blood conserving systems attached to systemic and pulmonary arterial catheters. Intravascular lines were cultured after removal. There were no significant differences in transfusions or haemoglobin concentration. Blood conservation: median units transfused, 2 (range 0-19); mean haemoglobin at 7 days, 11.2 g.dl-1 (SD, 1.0). Conventional: median units, 2 (range 0-34); mean haemoglobin at 7 days, 11.1 g.dl-1 (SD 1.0). Thirty-seven of 99 arterial lines were colonised in the controls compared with 29 of 96 in the blood conservation group. Patients who required haemofiltration in both groups had significantly increased transfusion requirements. Haemofiltration: median 6 units (range 0-34) vs. non-haemofiltered: median 1 (range 0-14; p < 0.001). There were no significant differences in transfusions, haemoglobin concentration or line colonisation with the blood conservation system. There is considerable potential for blood conservation during haemofiltration.

Onapristone, a progesterone receptor antagonist, as first-line therapy in primary breast cancer

The progesterone receptor antagonist, Onapristone, is an effective endocrine agent in experimental breast cancer models. This study aimed to investigate this agent as first-line endocrine therapy in patients with breast cancer. However, owing to the recognition in this and other clinical studies that some patients on Onapristone developed liver function test abnormalities, the development of this drug and recruitment to the study stopped in 1995. 19 patients either with locally advanced breast cancer (n = 12) or who were elderly, unfit patients with primary breast cancer (n = 7) received Onapristone 100 mg/day. Seventeen of the 19 tumours expressed oestrogen receptors (ER) whilst 12 of the 18 tumours tested expressed progesterone receptors (PgR). Tumour remission was categorised by International Union Against Cancer criteria. One patient was withdrawn after 4.5 months while her disease was static. Of the remaining 18 patients, 10 (56%) showed a partial response and 2 (11%) durable static disease (> or = 6 months), giving an overall tumour remission rate of 67%. The median duration of remission was 70 weeks. Transient liver function test abnormalities developed in a number of patients, mainly during the first 6 weeks of treatment. In conclusion Onapristone can induce tumour responses in human breast cancer.

Time trends in human dietary exposure to PCDDs, PCDFs and PCBs in the UK

Total Diet Study samples collected in 1982 and 1992 were analysed. Estimated dietary intakes of PCDDs, PCDFs and PCBs by UK consumers were found to have fallen substantially during this period and are now considerably below the Tolerable Daily Intake (TDI). Composite samples of human milk were also analysed for PCDDs, PCDFs and PCBs. Estimated combined dietary intakes of PCDDs, PCDFs and PCBs by breast fed infants in 1993-94 via breast milk fell from 170 pg TEQ/kg bodyweight/day at 2 months to 39 pg TEQ/kg bodyweight/day at 10 months.

Face processing using one spike per neurone

The speed with which neurones in the monkey temporal lobe can respond selectively to the presence of a face implies that processing may be possible using only one spike per neurone, a finding that is problematic for conventional rate coding models that need at least two spikes to estimate interspike interval. One way of avoiding this problem uses the fact that integrate-and-fire neurones will tend to fire at different times, with the most strongly activated neurones firing first (Thorpe, 1990, Parallel Processing in Neural Systems). Under such conditions, processing can be performed by using the order in which cells in a particular layer fire as a code. To test this idea, we have explored a range of architectures using SpikeNET (Thorpe and Gautrais, 1997, Neural Information Processing Systems, 9), a simulator designed for modelling large populations of integrate-and-fire neurones. One such network used a simple four-layer feed-forward architecture to detect and localise the presence of human faces in natural images. Performance of the model was tested with a large range of grey-scale images of faces and other objects and was found to be remarkably good by comparison with more classic image processing techniques. The most remarkable feature of these results is that they were obtained using a purely feed-forward neural network in which none of the neurones fired more than one spike (thus ruling out conventional rate coding mechanisms). It thus appears that the combination of asynchronous spike propagation and rank order coding may provide an important key to understanding how the nervous system can achieve such a huge amount of processing in so little time.

Rate coding versus temporal order coding: a theoretical approach

The belief that neurones transmit information in the form of a firing rate code is almost universal. However, we argue that at least in some situations, the efficiency of a coding strategy based on rate coding is surprisingly poor. A simple mathematical analysis reveals that, due to the stochastic nature of spike generation, even transmitting the simplest signals reliably would require either: (1) excessively long observation periods incompatible with the speed of sensory processing or (2) excessively large numbers of redundant neurones, incompatible with the anatomical constraints imposed by sensory pathways. We argue that such problems may be avoided by using alternative temporal codes which rely on the asynchrony of firing across a population of afferent neurones.

The effects of spatial frequency on binocular fusion: from elementary to complex images

Factors limiting binocular fusion were studied using 2-dimensional difference of Gaussian (2D-DOG) stimuli. The proportion of fused stimuli and observer's response time were determined for stimuli that varied in spatial frequency composition between 0.22 and 4.8 cycles per degree. At small disparities, mean fusion response times were short and relatively stable but increased rapidly once the disparity reached a certain critical value. This 2-phase function implies the existence of 2 separate fusional mechanisms: a rapid neurally based fusional process, which operates at small disparities, and a second mechanism involving reflexive vergence movements operating at disparities 2 to 3 times larger. Both mechanisms are highly influenced by spatial frequency, being 4 to 5 times more effective at low spatial frequencies. Additional experiments demonstrated that with compound stimuli, the fusion limit is not determined by the highest spatial frequency components (as had been reported previously) but, rather, can take advantage of the additional fusional range associated with low spatial frequencies. Such cooperation may be obvious only in the case of 2-dimensional stimuli.

Radiotherapy enhances laser palliation of malignant dysphagia: a randomised study

BACKGROUND/AIMS

A major drawback of laser endoscopy in the palliation of malignant dysphagia is the need for repeated treatments. This study was designed to test whether external beam radiotherapy would reduce the necessity for repeated laser therapy.

PATIENTS/METHODS

Sixty seven patients with inoperable oesophageal or gastric cardia cancers and satisfactory swallowing after initial laser recanalisation were randomised to palliative external beam radiotherapy (30 Gy in 10 fractions) or no radiotherapy. All patients underwent a 'check' endoscopy five weeks after initial recanalisation and were subsequently reendoscoped only for recurrent dysphagia, which occurred in 59 patients.

RESULTS

Dysphagia was relieved equally well in both groups and the improvement was maintained with further endoscopic treatment. The initial dysphagia controlled interval and the duration between procedures required to maintain lifelong palliation (treatment interval) increased from five to nine weeks (median) in the radiotherapy group (p < 0.01 both parameters). Radiotherapy was well tolerated in all but three patients. One perforation occurred and two fistulae opened after dilatation in patients who received radiotherapy.

CONCLUSION

Additional radiotherapy reduces the necessity for therapeutic endoscopy for a patient's remaining life. It has an important role in relatively well patients who are likely to survive long enough to benefit.

Preliminary evaluation of the toxicity and efficacy of novel 2,4-diamino-5-benzylpyrimidine-sulphone derivatives using rat and human tissues in vitro

Four novel combined dapsone and trimethoprim analogues, K-120, K-150, K-138 and DRS-506, have been compared with dapsone in their methaemoglobin forming abilities as well as their anti-inflammatory properties using rat and human tissues in vitro. All four compounds formed consistently less methaemoglobin compared with dapsone in both the rat and human microsomes. Using human microsomes from five livers, K-120 was significantly less toxic than the other analogues in three of the five livers (P < 0.01). DRS-506 and K-138 both inhibited the human neutrophil respiratory burst to a significantly greater degree compared with dapsone at 0.5 mM (P < 0.01), while K-120 and K-150 showed no significant effect at 0.5 mM. At 1 mM, DRS-506, K-120 and K-138 were more potent than dapsone (P < 0.01), although K-150 appeared to increase the neutrophil activation. All four analogues caused a significant reduction in neutrophil adhesion to human umbilical vein cells at 0.1 mM. In view of its efficacy and low toxicity, K-120 shows considerable promise for future clinical evaluation.

Neural processing of stereopsis as a function of viewing distance in primate visual cortical area V1

1. The influence of viewing distance on disparity selectivity was investigated in area V1 of behaving monkeys. While the animals performed a fixation task, cortical cells were recorded extracellularly in the foveal representation of the visual field. Disparity selectivity was assessed by using static random dot stereograms (RDSs) through red/green filters flashed over the central fixation target. To determine the influence of the viewing distance, a color video monitor was positioned at fixed distances of 20, 40, or 80 cm. The same RDSs with the same angular size of dots were used at the three distances. 2. Disparity sensitivity was tested on 139 cells, of which 78 were analyzed at two or more distances and the rest (61) at a single distance. When disparity selectivity was analyzed at a given distance, about half the cells were found to be selective at 40 or 80 cm, but only a third at 20 cm. Near cells were > or = 1.5 times more common than far cells at all three distances. The latency distribution of the responses of disparity-selective (DS) cells was similar at all three distances, with a mean distribution centered around 60 ms. 3. Changing the viewing distance drastically affected the neural activity of the V1 neurons. The visual responsiveness of 60 of 78 cells (77%) was significantly changed. Disparity selectivity could be present at a given distance and absent at other(s), with often a loss of visual response. This emergence of disparity coding was the strongest effect (28 of 78 or 36%) and occurred more frequently from short to long distances. Among the cells that remained disparity insensitive at all recorded distances (31 of 78 or 40%), about half also showed modulations of the amplitude of the visual response. For cells that remained DS at all recorded distances (13 of 78 or 17%), changing the viewing distance also affected the sharpness (or magnitude) of disparity coding in terms of level of visual responsiveness and those changes were often combined with variations in tuning width. In only two cells did the peak of selectivity type change. Finally, the activity of four DS cells was not affected at all by the viewing distance. 4. Another effect concerned the level of ongoing activity (OA), defined as being the neural activity in darkness preceding the flash of the visual stimulus while the monkey was fixating the small bright target. Changing the viewing distance resulted in significant changes in OA level for more than half of the cells (41 of 78 or 53%). The most common effect was an increase in OA level at the shorter distance. The modulations of both visual responsiveness and OA could occur simultaneously, although they often had opposite signs. Indeed, the two effects were statistically independent of each other, i.e., modulations of visual responses were not related to the level of excitability of the neurons. 5. Control experiments were performed that showed that the effects of changing the viewing distance were not due to the retinal patterns in that the modulations of visual responsiveness were independent of the dot density. Seventeen cells were also tested for a possible effect of vergence by the use of prisms. When there was an effect of distance, it could be closely or partially reproduced by using prisms. These controls, together with the effects observed on OA, strongly suggest that the modulations of neural activity of the V1 neurons by the viewing distance are extraretinal in origin, probably proprioceptive. 6. The modulation of visual responsiveness by the viewing distance in the primary visual cortex indicates that integration of information from both retinal and extraretinal sources can occur early in the visual processing pathway for cortical representation of three-dimensional space. A functional scheme of three-dimensional cortical circuitry is discussed that shows cortical areas where disparity selectivity and modulations of visual activity by the angle of gaze have been described so far.

Rapid Categorisation of Natural Images with Extrafoveal Presentations

Last year, we showed that most of the visual processing for categorising centrally presented images could be done in 150 ms. The human subjects were given a go — no go categorisation task in which they had to release a button when they could identify an animal. All the pictures were natural scenes taken from a vast CD-ROM data bank allowing access to several thousands of stimuli so that each image was only seen once. Targets (animals) included fish, birds, mammals, reptiles, insects in their natural environment; distractors included landscapes, trees, flowers, fruits. They were presented for a very short duration (20 ms) in order to avoid eye movement. In the present study we wanted to evaluate how the performance was affected with extrafoveal stimulations. We used the same task, but the visual stimuli could be presented at random, either centrally where subjects had to maintain fixation or laterally (left or right hemifield). Behavioural data and concomitant evoked potentials were recorded. The subject's performance was extremely good with a mean score of 90% correct and a mean reaction time of 500 ms. Comparison of performance between central and lateral stimulations showed that most subjects could process lateral and central stimuli with the same speed (reaction time distributions were not statistically different), and that, although extrafoveal presentations induced a drop in the percentage of correct responses (mean decrease 5%), it was not significant in all subjects. Moreover, when compared with last year's study the increase of the number of spatial locations where the visual stimulus could appear did not induce a significant behavioural cost, in terms of speed or accuracy of the response. We also looked at a possible hemispheric specialisation with no clear results. The results obtained here show that even with shared spatial attention and extrafoveal vision, the human visual system is remarkably efficient in an identification task.

Speed of processing in the human visual system

How long does it take for the human visual system to process a complex natural image? Subjectively, recognition of familiar objects and scenes appears to be virtually instantaneous, but measuring this processing time experimentally has proved difficult. Behavioural measures such as reaction times can be used, but these include not only visual processing but also the time required for response execution. However, event-related potentials (ERPs) can sometimes reveal signs of neural processing well before the motor output. Here we use a go/no-go categorization task in which subjects have to decide whether a previously unseen photograph, flashed on for just 20 ms, contains an animal. ERP analysis revealed a frontal negativity specific to no-go trials that develops roughly 150 ms after stimulus onset. We conclude that the visual processing needed to perform this highly demanding task can be achieved in under 150 ms.

Dynamics of orientation coding in area V1 of the awake primate

To investigate the importance of feedback loops in visual information processing, we have analyzed the dynamic aspects of neuronal responses to oriented gratings in cortical area V1 of the awake primate. If recurrent feedback is important in generating orientation selectivity, the initial part of the neuronal response should be relatively poorly selective, and full orientation selectivity should only appear after a delay. Thus, by examining the dynamics of the neuronal responses it should be possible to assess the importance of feedback processes in the development of orientation selectivity. The results were base on a sample of 259 cells recorded in two monkeys, of which 89% were visually responsive. Of these, approximately two-thirds were orientation selective. Response latency varied considerably between neurons, ranging from a minimum of 41 ms to over 150 ms, although most had latencies of 50-70 ms. Orientation tuning (defined as the bandwidth at half-height) ranged from 16 deg to over 90 deg, with a mean value of around 55 deg. By examining the selectivity of these different neurons by 10-ms time slices, starting at the onset of the neuronal response, we found that the orientation selectivity of virtually every neuron was fully developed at the very start of the neuronal response. Indeed, many neurons showed a marked tendency to respond at somewhat longer latencies to stimuli that were nonoptimally oriented, with the result that orientation selectivity was highest at the very start of the neuronal response. Furthermore, there was no evidence that the neurons with the shortest onset latencies were less selective. Such evidence is inconsistent with the hypothesis that recurrent intracortical feedback plays an important role in the generation of orientation selectivity. Instead, we suggest that orientation selectivity is primarily generated using feedforward mechanisms, including feedforward inhibition. Such a strategy has the advantage of allowing orientation to be computed rapidly, and avoids the initially poorly selective neuronal responses that characterize processing involving recurrent loops.

Radiation enhancement of laser palliation for advanced rectal and rectosigmoid cancer: a pilot study

Laser palliation for advanced rectal or rectosigmoid cancer requires repeat treatments every four to six weeks. Thirteen patients (seven men, six women) age range 65-91 (median 81) received additional external beam radiotherapy in an attempt to reduce the frequency of laser treatments required. After successful laser recanalisation, patients were treated with a dose of 30-55 Gy in 10-20 fractions. Bowel symptoms were well controlled for prolonged periods in 11 patients (85%) and further laser procedures were only required every 19 weeks median (range 6-53 weeks). The laser energy required after radiotherapy was only 800 J/month (median). Survival was 14 months (median, range 2.5-20 months) for the seven patients who have died. Seven patients received laser treatment only for three months or more (median 14 weeks, range 13-39). In this group control of symptoms required procedures every four weeks (median) before radiotherapy and 20 weeks (median) afterwards. The laser energy required before radiotherapy was 15,000 J/month and 2000 J/month afterwards (Wilcoxon rank sum test, p < 0.01 for both). Radiotherapy was well tolerated in all but one patient. Three patients developed strictures after radiotherapy but all were dealt with endoscopically. There were no complications solely due to endoscopic procedures. Additional radiotherapy enhances laser palliation for inoperable rectal or rectosigmoid cancer.

Radiation enhancement of laser palliation for malignant dysphagia: a pilot study

Laser therapy offers rapid relief of dysphagia for patients with cancers of the oesophagus and gastric cardia but repeat treatments are required approximately every five weeks to maintain good swallowing. To try to prolong the treatment interval, 22 elderly patients were given additional external beam radiotherapy. Nine had squamous cell carcinoma and 13 adenocarcinoma: five had documented metastases. Six received 40 Gy and 16,30 Gy in 10-20 fractions. A 'check' endoscopy was performed three weeks after external beam radiotherapy. Dysphagia was graded from 0-4 (0 = normal; 4 = dysphagia for liquids). The median dysphagia grade improved from 3 to 1 after laser treatment. This improvement was maintained in the 30 Gy group but there was a noticeable deterioration in three of those who had received the higher radiation dose. A lifelong dysphagia grade of 2 or better was enjoyed by 14 of 16 patients in the 30 Gy group but only two of six in the 40 Gy group. The dysphagia controlled interval was 9 weeks (median) after check endoscopy and subsequent endoscopic procedures were required every 13 weeks to maintain good swallowing. There were no endoscopy related complications. Combined treatment is a promising approach for reducing the frequency of endoscopic treatments. The 30 Gy dose seems more appropriate and may prolong survival. A randomised study to test these conclusions is in progress.

Cuffed esophageal prosthesis: a useful device in desperate situations in esophageal malignancy

Sixteen patients (three groups) underwent endoscopic intubation with cuffed Wilson-Cook esophageal endoprostheses. Group 1 comprised 10 patients with spontaneous esophago-respiratory fistulas due to malignancy. Six primaries were esophageal, three bronchial and one ovarian. One patient could not tolerate a cuffed tube. All other fistulas closed with intubation but two tubes displaced later. Seven patients managed a soft diet after intubation, but two liquids only. Median survival was 4 weeks (range, 0 to 9 weeks). Group 2 comprised three patients with large endoscopic instrumental tears. Two had definite perforations with extensive surgical emphysema. All had satisfactory contrast swallows the day after intubation and were started on semi-solid diets; median survival was 10 weeks (one still alive). Group 3 included three patients with life-threatening arterial bleeding from cancers of the gastric cardia. No further bleeding occurred in any of the three after intubation and two survived for extended periods (15 and 26 weeks). Cuffed tubes are invaluable in these desperate situations and are worth considering for symptomatic relief even when prognosis is short.

Modulation of neural stereoscopic processing in primate area V1 by the viewing distance

Accurate binocular depth perception requires information about both stereopsis (relative depth) and distance (absolute depth). It is unclear how these two types of information are integrated in the visual system. In alert, behaving monkeys the responsiveness of a large majority of neurons in the primary visual cortex (area V1) was modulated by the viewing distance. This phenomenon affected particularly disparity-related activity and background activity and was not dependent on the pattern of retinal stimulation. Therefore, extraretinal factors, probably related to ocular vergence or accommodation, or both, can affect processing early in the visual pathway. Such modulations could be useful for (i) judging true distance and (ii) scaling retinal disparity to give information about three-dimensional shape.

Cellular analogs of visual cortical epigenesis. I. Plasticity of orientation selectivity

A differential pairing procedure was applied in vivo to individual neurons in the primary visual cortex of anesthetized paralyzed cats, in order to produce changes in their relative orientation preference. While we recorded from a single cell, its visual response to a light bar was driven iontophoretically to a "high" level when stimulating with an initially nonpreferred orientation (S+), and alternately reduced to a "low" level when stimulating with the preferred orientation (S). This associative procedure was devised to test the possible role of neuronal coactivity in controlling the plasticity of orientation selectivity. Among 87 cells tested, 35 (40%) showed significant long-lasting changes, either in the relative orientation preference for the two "paired" stimuli S+ and S-, in the global orientation tuning profile, or in both. Measurements of relative orientation preference demonstrated significant effects in 27 cells (31%), all in favor of the positively reinforced orientation (S+). Modifications of orientation selectivity (studied over the entire orientation spectrum in 45 of the conditioned cells) usually consisted (21 out of 25 modified cells) of a competitive reorganization of the orientation tuning curve: the preferred orientation shifted toward S+, and a loss of relative visual responsiveness was observed for orientations close to the negatively reinforced orientation (S-). The largest changes were found in deprived kittens at the peak of the critical period, although the probability of inducing a significant change studied during the first year of postnatal life was independent of age. These functional modifications demonstrated at the cellular level are analogous to those induced by a global manipulation of the visual environment, when only a restricted spectrum of orientations is experienced during the critical period. Our results support the hypothesis that covariance levels between pre- and postsynaptic activity determine the sign and the amplitude of the modification of efficacy of cortical synapses.

Recanalization of tube overgrowth: a useful new indication for laser in palliation of malignant dysphagia

Overgrowth of an esophageal prosthesis by cancer is a late complication of insertion which presents a difficult management problem. We have treated 14 such patients; 9 had Celestin tubes and 5 Atkinson tubes in situ for a median of 7 months. The median patient age was 75 years; 3 had squamous cell carcinomas and 11 adenocarcinomas; 12 were at the lowest thoracic esophagus or cardia, and 2 were anastomotic. Eleven tubes were overgrown at the top, two at the bottom only, and one at both ends. Dysphagia was graded from 0 to 4 (0 = normal; 4 = dysphagia for liquids). All patients but one improved with treatment. The median pre-treatment grade was 4 (range, 2 to 4) and post-treatment was 2 (0 to 3). This improvement was significant (p less than 0.01) Wilcoxon-signal rank). Most patients required only one or two endoscopies. The median survival was 9 weeks from first laser session (range, 3 to 36 weeks). We feel these results justify laser treatment in most patients in whom cancer overgrowth causes blockage of an esophageal prosthesis.

A cellular analogue of visual cortical plasticity

Neuronal activity plays an important role in the development of the visual pathway. The modulation of synaptic transmission by temporal correlation between pre- and postsynaptic activity is one mechanism which could underly visual cortical plasticity. We report here that functional changes in single neurons of area 17, analogous to those known to take place during epigenesis of visual cortex, can be induced experimentally during the time of recording. This was done by a differential pairing procedure, during which iontophoresis was used to artificially increase the visual response for a given stimulus, and to decrease (or block) the response for a second stimulus which differed in ocularity or orientation. Long-term modifications in ocular dominance and orientation selectivity were produced in 33% and 43% of recorded cells respectively. Neuronal selectivity was nearly always displaced towards the stimulus paired with the reinforced visual response. The largest changes were obtained at the peak of the critical period in normally reared and visually deprived kittens, but changes were also observed in adults. Our findings support the role of temporal correlation between pre- and postsynaptic activity in the induction of long-lasting modifications of synaptic transmission during development, and in associative learning.