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Ganne C, Hampson JP, Toth E, Hupp NJ, Hampson JS, Mosher JC, Pati S, Lhatoo SD, Lacuey N. Limbic and paralimbic respiratory modulation: from inhibition to enhancement. Epilepsia 2022; 63:1799-1811. [PMID: 35352347 DOI: 10.1111/epi.17244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Increased understanding of the role of cortical structures in respiratory control may help the understanding of seizure-induced respiratory dysfunction that leads to sudden death in epilepsy (SUDEP). The aim of this study was to characterize respiratory responses to electrical stimulation (ES), including inhibition and enhancement of respiration. METHODS We prospectively recruited 19 consecutive patients with intractable epilepsy undergoing stereotactic EEG evaluation from June 2015 to June 2018. Inclusion criteria were patients ≥18 years and in whom ES was indicated for clinical mapping of ictal onset or eloquent cortex as part of the presurgical evaluation. ES was carried out at 50 Hz, 0.2 ms and 1-10 mA current intensity. Common brain regions sampled across all patients were- amygdala (AMY), hippocampus (HG), anterior cingulate gyrus (CING), orbitofrontal cortex (OrbF), temporal neocortex (TNC), temporal pole (TP) and entorhinal cortex (ERC). 755 stimulations were conducted. Quantitative analysis of breathing signal i.e., changes in breathing rate (BR), depth (TV), and minute ventilation (MV) was carried out during ES using the BreathMetrics breathing waveform analysis toolbox. Electrocardiogram, arterial oxygen saturation, end-tidal and transcutaneous carbon dioxide, nasal airflow, and abdominal and thoracic plethysmography were continuously monitored during stimulations. RESULTS Electrical stimulation of TP and CING (at lower current strengths <3mA) increased TV and MV. At 7-10mA, CING decreased TV and MV. On the other hand, decreased TV and MV occurred with stimulation of mesial temporal structures such as AMY and HG. Breathing changes were dependent on stimulation intensity. Lateral temporal, entorhinal, and orbitofrontal cortices did not affect breathing either way. SIGNIFICANCE These findings suggest that breathing responses other than apnea can be induced by ES. Identification of two regions, the temporal pole and anterior cingulate gyrus, for enhancement of breathing may be important in paving the way to future development of strategies for prevention of SUDEP.
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Affiliation(s)
- Chaitanya Ganne
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA.,Department of Neurology, University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Johnson P Hampson
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA.,Department of Neurology, University of Texas Health Science Center (UTHealth), Houston, Texas, USA.,The NINDS Center for SUDEP Research
| | - Emilia Toth
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA.,Department of Neurology, University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Norma J Hupp
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA.,Department of Neurology, University of Texas Health Science Center (UTHealth), Houston, Texas, USA.,The NINDS Center for SUDEP Research
| | - Jaison S Hampson
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA.,Department of Neurology, University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - John C Mosher
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA.,Department of Neurology, University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Sandipan Pati
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA.,Department of Neurology, University of Texas Health Science Center (UTHealth), Houston, Texas, USA
| | - Samden D Lhatoo
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA.,Department of Neurology, University of Texas Health Science Center (UTHealth), Houston, Texas, USA.,The NINDS Center for SUDEP Research
| | - Nuria Lacuey
- Texas Institute of Restorative Neurotechnologies (TIRN), University of Texas Health Science Center (UTHealth), Houston, Texas, USA.,Department of Neurology, University of Texas Health Science Center (UTHealth), Houston, Texas, USA.,The NINDS Center for SUDEP Research
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Goupil-Sormany I, Longtin J, Rouleau I, Fafard J, Gilbert N, Cormiers AD, Toth E. Harmonized Scenario-Based Laboratory Coding System to Guide Real-Time Public Health Actions in Quebec Province, Canada. Int J Infect Dis 2022. [PMCID: PMC8884796 DOI: 10.1016/j.ijid.2021.12.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose Effective public health (PH) response to emerging pathogens requires effective information systems integrating surveillance data from multiple sources. For laboratories, data entry of multiple variables both at pre-analytical steps and again in laboratory information systems (LIS) is time-consuming and difficult to implement in a resource-limited setting and negatively affects the timeliness of the surveillance system. We set up a simple harmonized laboratory query that summarized 22 public-health relevant scenarios and variables, reduced to a two-digit code. Methods & Materials Information data specialists were mobilized to integrate data from the 108 different LIS using the harmonized query, which provided timely access to COVID-19 testing indications, volumes, and positivity rates stratified by age, health region, clinical settings, outbreak context or Health-Care worker status. The information system allowed to develop multiple indicators for a better understanding of the pandemic and the COVID-19 transmission in population subgroups. Results Dashboards were available for public health and infection prevention and control officers in their location. Multiple stakeholders were able to interpret real-time data for more than 40 000 different qPCR tests every day. The data allowed to adjust prescription practice and promote optimal usage and plan contingencies within Quebec's qPCR lab capacities. It also served as the basis to monitor community transmission through test positivity rate in various settings. The coding system also allowed labs to easily implement sample triage, which reduced turnaround time to less than 24h for most samples. Starting May 2021, public health authorities add monitoring of the positive predictive value of rapid antigen test used at the community level to support evidence-based public health decisions about the best possible use of those assays. Conclusion This simple scenario-based coding system allowed timely PH and management of both sampling and processing priorities which proved most useful during surge periods. Quebec Public Health Authorities were better able to target preventive actions and to plan outreach screening activities in subpopulations, neighbourhoods, and communities, while modulating clinical criteria to get access to testing and allowing laboratories to better triage samples.
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Irannejad A, Chaitanya G, Toth E, Pizarro D, Pati S. Direct Cortical Stimulation to Probe the Ictogenicity of the Epileptogenic Nodes in Temporal Lobe Epilepsy. Front Neurol 2022; 12:761412. [PMID: 35095721 PMCID: PMC8793936 DOI: 10.3389/fneur.2021.761412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
Accurate mapping of the seizure onset zone (SOZ) is critical to the success of epilepsy surgery outcomes. Epileptogenicity index (EI) is a statistical method that delineates hyperexcitable brain regions involved in the generation and early propagation of seizures. However, EI can overestimate the SOZ for particular electrographic seizure onset patterns. Therefore, using direct cortical stimulation (DCS) as a probing tool to identify seizure generators, we systematically evaluated the causality of the high EI nodes (>0.3) in replicating the patient's habitual seizures. Specifically, we assessed the diagnostic yield of high EI nodes, i.e., the proportion of high EI nodes that evoked habitual seizures. A retrospective single-center study that included post-stereo encephalography (SEEG) confirmed TLE patients (n = 37) that had all high EI nodes stimulated, intending to induce a seizure. We evaluated the nodal responses (true and false responder rate) to stimulation and correlated with electrographic seizure onset patterns (hypersynchronous-HYP and low amplitude fast activity patterns-LAFA) and clinically defined SOZ. The ictogenicity (i.e., the propensity to induce the patient's habitual seizure) of a high EI node was only 44.5%. The LAFA onset pattern had a significantly higher response rate to DCS (i.e., higher evoked seizures). The concordance of an evoked habitual seizure with a clinically defined SOZ with good outcomes was over 50% (p = 0.0025). These results support targeted mapping of SOZ in LAFA onset patterns by performing DCS in high EI nodes to distinguish seizure generators (true responders) from hyperexcitable nodes that may be involved in early propagation.
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Affiliation(s)
- Auriana Irannejad
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
- Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ganne Chaitanya
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
- Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Emilia Toth
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
- Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Diana Pizarro
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
- Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sandipan Pati
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
- Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, AL, United States
- *Correspondence: Sandipan Pati
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Leenhardt R, Koulaouzidis A, McNamara D, Keuchel M, Sidhu R, McAlindon ME, Saurin JC, Eliakim R, Fernandez-Urien Sainz I, Plevris JN, Rahmi G, Rondonotti E, Rosa B, Spada C, Toth E, Houdeville C, Li C, Robaszkiewicz M, Marteau P, Dray X. A guide for assessing the clinical relevance of findings in small bowel capsule endoscopy: analysis of 8064 answers of international experts to an illustrated script questionnaire. Clin Res Hepatol Gastroenterol 2021; 45:101637. [PMID: 33662785 DOI: 10.1016/j.clinre.2021.101637] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/10/2020] [Accepted: 09/10/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Although recommended, the P-score used for assessing the pertinence / relevance of findings seen in small bowel (SB) capsule endoscopy (CE) is based on a low level of knowledge. The aim of this study was to evaluate the clinical relevance of the most frequent SBCE findings through an illustrated script questionnaire. MATERIALS AND METHODS Sixteen types of SBCE findings were illustrated four times each in three different settings (occult and overt obscure gastrointestinal bleeding and suspected Crohn's disease), and with a variable number (n = 1/n = 2-5/n ≥ 6), thus providing a questionnaire with 192 scenarios and 576 illustrated questions. Fifteen international experts were asked to rate the finding's relevance for each question as very unlikely (-2) / unlikely (-1) / doubtful (0) / likely (+1) / very likely (+2). The median score (≤-0.75, between -0.75 and 0.75, or ≥0.75) obtained for each scenario determined a low (P0), intermediate (P1) or high (P2) relevance, respectively. RESULTS 8064 answers were analyzed. Participation and completion rates were 93% and 100%, respectively. In overt or occult OGIB, resultant P2 findings were 'typical angiectasia', 'deep ulceration', 'stenosis', and'blood', whatever their numbers, and 'superficial ulcerations' when multiple. While in suspected CD, consensus P2 lesions were 'deep ulceration' and 'stenosis' whatever their numbers, and 'aphthoid erosions' and 'superficial ulcerations' when multiple. CONCLUSION This study establishes a guide for the evaluation of relevance of SBCE findings. It represents a step forward for SB-CE interpretation and is intended to be used as a tool for teaching and academic research.
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Affiliation(s)
- R Leenhardt
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France
| | - A Koulaouzidis
- The Royal Infirmary of Edinburgh, Centre For Liver & Digestive Disorders, Edinburgh, United Kingdom
| | - D McNamara
- TAGG Research Centre, Department of Clinical Medicine Tallaght Hospital, Trinity College Dublin, Ireland
| | - M Keuchel
- Bethesda Krankenhaus Bergedorf, Klinik für Innere Medizin, Hamburg, Germany
| | - R Sidhu
- Dept. of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - M E McAlindon
- Dept. of Gastroenterology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - J C Saurin
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Lyon, France
| | - R Eliakim
- Dept. of Gastroenterology, Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - J N Plevris
- The Royal Infirmary of Edinburgh, Centre For Liver & Digestive Disorders, Edinburgh, United Kingdom
| | - G Rahmi
- Université de Paris, Department of Gastroenterology and Digestive Endoscopy, Georges-Pompidou European Hospital, Paris, France
| | - E Rondonotti
- Gastroenterology Unit, Valduce Hospital, Como, Italy
| | - B Rosa
- Universidade do Minho, Hospital Senhora da Oliveira, Departamento de Gastroenterologia, Guimarães, Portugal
| | - C Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy; Digestive Endoscopy Unit, Universita Cattolica del Sacro Cuore, Roma, Italy
| | - E Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - C Houdeville
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France
| | - C Li
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France; Drexel University, College of Arts & Sciences, Philadelphia, USA
| | - M Robaszkiewicz
- La Cavale Blanche University Hospital, Endoscopy Unit, Brest, France
| | - P Marteau
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France
| | - X Dray
- Sorbonne Université, Endoscopy Unit, Hôpital Saint-Antoine, APHP, Paris, France.
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Skjødt MK, Ernst MT, Khalid S, Libanati C, Cooper C, Delmestri A, Rubin KH, Javaid MK, Martinez-Laguna D, Toth E, Prieto-Alhambra D, Abrahamsen B. The treatment gap after major osteoporotic fractures in Denmark 2005-2014: a combined analysis including both prescription-based and hospital-administered anti-osteoporosis medications. Osteoporos Int 2021; 32:1961-1971. [PMID: 33721032 PMCID: PMC8510950 DOI: 10.1007/s00198-021-05890-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/11/2021] [Indexed: 12/11/2022]
Abstract
UNLABELLED This study demonstrates a substantial and persistent anti-osteoporosis treatment gap in men and women ≥50 years old who sustained major osteoporotic fracture(s) between 2005 and 2014 in Denmark. This was not substantially reduced by including hospital-administered anti-osteoporosis treatments. Strengthened post-fracture organization of care and secondary fracture prevention is highly needed. INTRODUCTION The purpose of this study was to evaluate the Danish anti-osteoporosis treatment gap from 2005 to 2014 in patients sustaining a major osteoporotic fracture (MOF), and to assess the impact of including hospital-administered anti-osteoporosis medications (AOM) on the treatment gap among these patients. METHODS In this retrospective, registry-based study, we included men and women aged 50 years or older and living in Denmark, who sustained at least one MOF between 2005 and 2014. We applied a repeated cross-sectional design to generate cohorts of patients sustaining a first MOF, hip, vertebral, humerus, or forearm fracture, respectively, within each calendar year. We evaluated the treatment gap as the proportion of patients within each cohort not receiving treatment with AOM within 1 year of the fracture. Hospital-administered AOM was identified by SKS code. RESULTS The treatment gap among MOF patients decreased from 85% in 2005 to 79% in 2014. The gap was smaller among hip and vertebral fracture patients as compared to humerus and forearm fracture patients, and it was smaller in women than in men. The use of hospital-administered AOM was relatively uncommon, with a maximum of 0.9% of MOF patients initiating hospital-administered AOM (in 2012). We observed substantial variations in this proportion between fracture types and gender. Hospital-administered AOM was most commonly used among vertebral fracture patients. CONCLUSION A significant treatment gap among patients sustaining a major osteoporotic fracture was present throughout our analysis, and including hospital-administered AOM did not significantly improve the treatment gap assessment. Improved secondary fracture prevention is urgently needed.
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Affiliation(s)
- M K Skjødt
- Department of Medicine, Hospital of Holbaek, Smedelundsgade 60, DK-4300, Holbaek, Denmark.
- OPEN, Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark.
| | - M T Ernst
- OPEN, Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- Department of Public Health, Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - S Khalid
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
| | | | - C Cooper
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, England, UK
| | - A Delmestri
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
| | - K H Rubin
- OPEN, Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - M K Javaid
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
| | - D Martinez-Laguna
- GREMPAL Research Group, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), CIBERFES, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - E Toth
- UCB Pharma, Anderlecht, Belgium
| | - D Prieto-Alhambra
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
| | - B Abrahamsen
- Department of Medicine, Hospital of Holbaek, Smedelundsgade 60, DK-4300, Holbaek, Denmark
- OPEN, Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, England, UK
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Chaitanya G, Romeo AK, Ilyas A, Irannejad A, Toth E, Elsayed G, Bentley JN, Riley KO, Pati S. Robot-assisted stereoelectroencephalography exploration of the limbic thalamus in human focal epilepsy: implantation technique and complications in the first 24 patients. Neurosurg Focus 2021; 48:E2. [PMID: 32234983 DOI: 10.3171/2020.1.focus19887] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite numerous imaging studies highlighting the importance of the thalamus in a patient's surgical prognosis, human electrophysiological studies involving the limbic thalamic nuclei are limited. The objective of this study was to evaluate the safety and accuracy of robot-assisted stereotactic electrode placement in the limbic thalamic nuclei of patients with suspected temporal lobe epilepsy (TLE). METHODS After providing informed consent, 24 adults with drug-resistant, suspected TLE undergoing evaluation with stereoelectroencephalography (SEEG) were enrolled in the prospective study. The trajectory of one electrode planned for clinical sampling of the operculoinsular cortex was modified to extend it to the thalamus, thereby preventing the need for additional electrode placement for research. The anterior nucleus of the thalamus (ANT) (n = 13) and the medial group of thalamic nuclei (MED) (n = 11), including the mediodorsal and centromedian nuclei, were targeted. The postimplantation CT scan was coregistered to the preoperative MR image, and Morel's thalamic atlas was used to confirm the accuracy of implantation. RESULTS Ten (77%) of 13 patients in the ANT group and 10 (91%) of 11 patients in the MED group had electrodes accurately placed in the thalamic nuclei. None of the patients had a thalamic hemorrhage. However, trace asymptomatic hemorrhages at the cortical-level entry site were noted in 20.8% of patients, who did not require additional surgical intervention. SEEG data from all the patients were interpretable and analyzable. The trajectories for the ANT implant differed slightly from those of the MED group at the entry point-i.e., the precentral gyrus in the former and the postcentral gyrus in the latter. CONCLUSIONS Using judiciously planned robot-assisted SEEG, the authors demonstrate the safety of electrophysiological sampling from various thalamic nuclei for research recordings, presenting a technique that avoids implanting additional depth electrodes or compromising clinical care. With these results, we propose that if patients are fully informed of the risks involved, there are potential benefits of gaining mechanistic insights to seizure genesis, which may help to develop neuromodulation therapies.
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Affiliation(s)
- Ganne Chaitanya
- 1Department of Neurology.,2Epilepsy and Cognitive Neurophysiology Laboratory, and
| | - Andrew K Romeo
- 3Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Adeel Ilyas
- 2Epilepsy and Cognitive Neurophysiology Laboratory, and.,3Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Auriana Irannejad
- 1Department of Neurology.,2Epilepsy and Cognitive Neurophysiology Laboratory, and
| | - Emilia Toth
- 1Department of Neurology.,2Epilepsy and Cognitive Neurophysiology Laboratory, and
| | - Galal Elsayed
- 3Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - J Nicole Bentley
- 3Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Kristen O Riley
- 3Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Sandipan Pati
- 1Department of Neurology.,2Epilepsy and Cognitive Neurophysiology Laboratory, and
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Toth E, Kumar S, Ganne C, Riley KO, Balasubramanian K, Pati S. Machine learning approach to detect focal-onset seizures in the human anterior nucleus of the thalamus. J Neural Eng 2020; 17. [PMID: 33059336 DOI: 10.1088/1741-2552/abc1b7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/15/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE There is an unmet need to develop seizure detection algorithms from brain regions outside the epileptogenic cortex. The study aimed to demonstrate the feasibility of classifying seizures and interictal states from local field potentials (LFPs) recorded from the human thalamus- a subcortical region remote to the epileptogenic cortex. We tested the hypothesis that spectral and entropy-based features extracted from LFPs recorded from the anterior nucleus of the thalamus (ANT) can distinguish its state of ictal recruitment from other interictal states (including awake, sleep). APPROACH Two supervised machine learning tools (random forest and the random kitchen sink) were used to evaluate the performance of spectral (discrete wavelet transform-DWT), and time-domain (multiscale entropy-MSE) features in classifying seizures from interictal states in patients undergoing stereo EEG evaluation for epilepsy surgery. Under the supervision of IRB, field potentials were recorded from the ANT in consenting adults with drug-resistant temporal lobe epilepsy. Seizures were confirmed in the ANT using line-length and visual inspection. Wilcoxon rank-sum (WRS) method was used to test the differences in spectral patterns between seizure and interictal (awake and sleep) states. MAIN RESULTS 79 seizures (10 patients) and 158 segments (approx. 4 hours) of interictal stereo EEG data were analyzed. The mean seizure detection latencies with line length in the ANT varied between seizure types (range 5-34 seconds). However, the DWT and MSE in the ANT showed significant changes for all seizure types within the first 20 seconds after seizure onset. The random forest (accuracy 93.9 % and false-positive 4.6%) and the random kitchen sink (accuracy 97.3% and false-positive 1.8%) classified seizures and interictal states. SIGNIFICANCE These results suggest that features extracted from the thalamic LFPs can be trained to detect seizures that can be used for monitoring seizure counts and for closed-loop seizure abortive interventions.
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Affiliation(s)
- Emilia Toth
- University of Alabama School of Medicine, Birmingham, Alabama, UNITED STATES
| | - Sachin Kumar
- Centre for Computational Engineering and Networking , Amrita Vishwa Vidyapeetham Amrita School of Engineering, Coimbatore, Tamil Nadu, INDIA
| | - Chaitanya Ganne
- Neurology, University of Alabama at Birmingham, 1720 7th Ave S, Suite 405F, SPARKS building, Birmingham, UNITED STATES
| | - Kristen O Riley
- Neurosurgery, University of Alabama School of Medicine, Birmingham, Alabama, UNITED STATES
| | - Karthi Balasubramanian
- Department of Electronics and Communication Engineering, Amrita Vishwa Vidyapeetham Amrita School of Engineering, Coimbatore, Tamil Nadu, INDIA
| | - Sandipan Pati
- University of Alabama School of Medicine, Birmingham, Alabama, 35294-3412, UNITED STATES
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Skjødt MK, Khalid S, Ernst M, Rubin KH, Martinez-Laguna D, Delmestri A, Javaid MK, Cooper C, Libanati C, Toth E, Abrahamsen B, Prieto-Alhambra D. Secular trends in the initiation of therapy in secondary fracture prevention in Europe: a multi-national cohort study including data from Denmark, Catalonia, and the United Kingdom. Osteoporos Int 2020; 31:1535-1544. [PMID: 32185437 PMCID: PMC7360649 DOI: 10.1007/s00198-020-05358-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/18/2020] [Indexed: 01/06/2023]
Abstract
UNLABELLED This paper demonstrates a large post-fracture anti-osteoporosis treatment gap in the period 2005 to 2015. The gap was stable in Denmark at around 88-90%, increased in Catalonia from 80 to 88%, and started to increase in the UK towards the end of our study. Improved post-fracture care is needed. INTRODUCTION Patients experiencing a fragility fracture are at high risk of subsequent fractures, particularly within the first 2 years after the fracture. Previous studies have demonstrated that only a small proportion of fracture patients initiate therapy with an anti-osteoporotic medication (AOM), despite the proven fracture risk reduction of such therapies. The aim of this paper is to evaluate the changes in this post-fracture treatment gap across three different countries from 2005 to 2015. METHODS This analysis, which is part of a multinational cohort study, included men and women, aged 50 years or older, sustaining a first incident fragility fracture. Using routinely collected patient data from three administrative health databases covering Catalonia, Denmark, and the United Kingdom, we estimated the treatment gap as the proportion of patients not treated with AOM within 1 year of their first incident fracture. RESULTS A total of 648,369 fracture patients were included. Mean age 70.2-78.9 years; 22.2-31.7% were men. In Denmark, the treatment gap was stable at approximately 88-90% throughout the 2005 to 2015 time period. In Catalonia, the treatment gap increased from 80 to 88%. In the UK, an initially decreasing treatment gap-though never smaller than 63%-was replaced by an increasing gap towards the end of our study. The gap was more pronounced in men than in women. CONCLUSION Despite repeated calls for improved secondary fracture prevention, an unacceptably large treatment gap remains, with time trends indicating that the problem may be getting worse in recent years.
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Affiliation(s)
- M K Skjødt
- Department of Medicine, Hospital of Holbaek, Holbaek, Region Zealand, Denmark
- Department of Medicine, Hospital of Slagelse, Slagelse, Region Zealand, Denmark
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - S Khalid
- Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, England
| | - M Ernst
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Public Health, Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - K H Rubin
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - D Martinez-Laguna
- GREMPAL Research Group, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), CIBERFES, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - A Delmestri
- Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, England
| | - M K Javaid
- Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, England
| | - C Cooper
- Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, England
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, England
| | | | - E Toth
- UCB Pharma, Anderlecht, Belgium
| | - B Abrahamsen
- Department of Medicine, Hospital of Holbaek, Holbaek, Region Zealand, Denmark.
- OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
- Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, England.
| | - D Prieto-Alhambra
- Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, England
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9
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Chaitanya G, Toth E, Pizarro D, Irannejad A, Riley K, Pati S. Precision mapping of the epileptogenic network with low- and high-frequency stimulation of anterior nucleus of thalamus. Clin Neurophysiol 2020; 131:2158-2167. [PMID: 32682244 DOI: 10.1016/j.clinph.2020.05.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/18/2020] [Accepted: 05/27/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The goal of thalamic deep brain stimulation in epilepsy is to engage and modulate the epileptogenic network. We demonstrate how the anterior nucleus of thalamus (ANT) stimulation engages the epileptogenic network using electrophysiological measures (gamma response and post-stimulation excitability). METHODS Five patients with suspected temporal lobe epilepsy syndrome, undergoing stereo-electroencephalography (SEEG), were enrolled in the IRB approved study to undergo recording and stimulation of the ANT. We analyzed the extent of gamma-band response (activation or suppression) and post-stimulation change in excitability in various cortical regions during low (10 Hz) and high (50 Hz) frequency stimulations. RESULTS 10 Hz stimulation increased cortical gamma, whereas 50 Hz stimulation suppressed the gamma responses. The maximum response to stimuli was in the hippocampus. High epileptogenicity regions were more susceptible to stimulation. Both 10-and 50 Hz stimulations decreased post-stimulation cortical excitability. The greater the gamma-band activation with 10 Hz stimulation, the greater was the decrease in post-stimulation excitability. CONCLUSIONS We define an EEG marker that delineates stimulation-specific nodal engagement. We proved that nodes that were engaged with the thalamus during stimulation were more likely to show a short term decrease in post-stimulation excitability. SIGNIFICANCE Patient-specific engagement patterns during stimulation can be mapped with SEEG that can be used to optimize stimulation parameters.
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Affiliation(s)
- Ganne Chaitanya
- Department of Neurology, University of Alabama at Birmingham, AL, USA; Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, AL, USA
| | - Emilia Toth
- Department of Neurology, University of Alabama at Birmingham, AL, USA; Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, AL, USA
| | - Diana Pizarro
- Department of Neurology, University of Alabama at Birmingham, AL, USA; Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, AL, USA
| | - Auriana Irannejad
- Department of Neurology, University of Alabama at Birmingham, AL, USA; Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, AL, USA
| | - Kristen Riley
- Department of Neurosurgery, University of Alabama at Birmingham, AL, USA
| | - Sandipan Pati
- Department of Neurology, University of Alabama at Birmingham, AL, USA; Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, AL, USA.
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Chaitanya G, Toth E, Pizarro D, Iasemidis L, Murray TA, Riley K, Pati S. Acute modulation of the limbic network with low and high-frequency stimulation of the human fornix. Epilepsy Behav Rep 2020; 14:100363. [PMID: 32435756 PMCID: PMC7232081 DOI: 10.1016/j.ebr.2020.100363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 12/11/2022] Open
Abstract
Targeted stimulation of white matter has opened newer perspectives in the field of neuromodulation, towards an attempt to improve memory or as a therapy for epilepsy. Stimulation of the fornix, being a part of the Papez circuit, is likely to modulate the limbic network excitability. However, the stimulation-frequency dependent variability in network excitability is unknown. In the case study, which involved stereo electroencephalographic (SEEG) recording of field potentials in a 48-year old left-handed woman with suspected temporal lobe epilepsy, we demonstrated the network effects of acute low (1 and 10 Hz) and high (50 Hz) frequency electrical stimulation of fornix. Mapping the short-latency evoked responses to forniceal stimulation confirmed the SEEG target localization within the Papez circuit. Low and high-frequency stimulation of the fornix produced opposite effects in the post-stimuli excitability, with the latter causing increased excitability in the limbic network that culminated in a clinical seizure. A distinct spectral peak around 8 Hz confirmed that sensing field potentials from the forniceal white matter is feasible. This is the first case study that provided an insight into how the temporal patterning of forniceal stimulation altered the downstream limbic network excitability.
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Affiliation(s)
- Ganne Chaitanya
- Epilepsy and Cognitive Neurophysiology Laboratory, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emilia Toth
- Epilepsy and Cognitive Neurophysiology Laboratory, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Diana Pizarro
- Epilepsy and Cognitive Neurophysiology Laboratory, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Leonidas Iasemidis
- Center for Biomedical Engineering and Rehabilitation Science, Louisiana Tech Institute, Ruston, LA, USA
| | - Teresa A. Murray
- Center for Biomedical Engineering and Rehabilitation Science, Louisiana Tech Institute, Ruston, LA, USA
| | - Kristen Riley
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sandipan Pati
- Epilepsy and Cognitive Neurophysiology Laboratory, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
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Chaitanya G, Toth E, Ilyas A, Pati S. Sensing limbic seizures within the fornical white matter: A technical report. Clin Neurophysiol 2020; 131:1320-1322. [PMID: 32304845 DOI: 10.1016/j.clinph.2020.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Ganne Chaitanya
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emilia Toth
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adeel Ilyas
- Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sandipan Pati
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA; Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, AL, USA.
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12
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Toth E, Chaitanya G, Pati S. Mapping short-latency cortical responses to electrical stimulation of thalamic motor nuclei by increasing sampling rate - A technical report. Clin Neurophysiol 2019; 131:142-144. [PMID: 31765977 DOI: 10.1016/j.clinph.2019.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 10/02/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Emilia Toth
- Department of Neurology, University of Alabama at Birmingham, AL, USA; Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, AL, USA
| | - Ganne Chaitanya
- Department of Neurology, University of Alabama at Birmingham, AL, USA; Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, AL, USA
| | - Sandipan Pati
- Department of Neurology, University of Alabama at Birmingham, AL, USA; Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, AL, USA.
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Jamy R, Kaur M, Pizarro D, Toth E, Pati S. Practice trends and the outcome of neuromodulation therapies in epilepsy: A single-center study. Epilepsia Open 2019; 4:493-497. [PMID: 31440731 PMCID: PMC6698690 DOI: 10.1002/epi4.12345] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/18/2019] [Accepted: 05/29/2019] [Indexed: 11/23/2022] Open
Abstract
Neuromodulation therapies (VNS, RNS, and DBS) can improve seizure control in persons with epilepsy. However, there is a significant service gap in integrating these therapies in clinical care. Our epilepsy center has established an epilepsy neuromodulation clinic to improve access to patients, communication with referring physicians, track outcome and train future providers in programming neuromodulation devices. We report the (a) treatment outcome of the available neuromodulation therapies (ie, reduction in seizure frequency over 6-12 months follow-up); and (b) demonstrate the benefit of the specialized clinic (rapid titration, continuity of care, superior access for patient and vendors). In this single-center, retrospective study, forty-three adults (VNS = 27; RNS = 16) with drug-resistant epilepsy were followed in the clinic during the 19 months study period. About 44-69% of patients reported > 60% decrease in seizure. All patients were scheduled in the clinic within 2-4 weeks, and stimulations were optimized rapidly. About 40% of patients participated in research while 28% were referred for additional diagnostic studies. Nineteen students and fellows were trained in programming neurostimulator. Epilepsy neuromodulation clinic can serve as an optimal solution for patients as well as providers due to rapid access, better continuity of care, higher recruitment for research studies, and training health professionals.
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Affiliation(s)
- Rabia Jamy
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAL
| | - Manmeet Kaur
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAL
| | - Diana Pizarro
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAL
- Epilepsy and Cognitive Neurophysiology LaboratoryUniversity of Alabama at BirminghamBirminghamAL
| | - Emilia Toth
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAL
- Epilepsy and Cognitive Neurophysiology LaboratoryUniversity of Alabama at BirminghamBirminghamAL
| | - Sandipan Pati
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAL
- Epilepsy and Cognitive Neurophysiology LaboratoryUniversity of Alabama at BirminghamBirminghamAL
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Pizarro D, Ilyas A, Chaitanya G, Toth E, Irannejad A, Romeo A, Riley KO, Iasemidis L, Pati S. Spectral organization of focal seizures within the thalamotemporal network. Ann Clin Transl Neurol 2019; 6:1836-1848. [PMID: 31468745 PMCID: PMC6764631 DOI: 10.1002/acn3.50880] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/02/2019] [Accepted: 08/06/2019] [Indexed: 01/08/2023] Open
Abstract
Objective To investigate dynamic changes in neural activity between the anterior nucleus of the thalamus (ANT) and the seizure onset zone (SOZ) in patients with drug‐resistant temporal lobe epilepsy (TLE) based on anatomic location, seizure subtype, and state of vigilance (SOV). Methods Eleven patients undergoing stereoelectroencephalography for seizure localization were recruited prospectively for local field potential (LFP) recording directly from the ANT. The SOZ was identified using line length and epileptogenicity index. Changes in power spectral density (PSD) were compared between the two anatomic sites as seizures (N = 53) transitioned from interictal baseline to the posttermination stage. Results At baseline, the thalamic LFPs were significantly lower and distinct from the SOZ with the presence of higher power in the fast ripple band (P < 0.001). Temporal changes in ictal power of neural activity within ANT mimic those of the SOZ, are increased significantly at seizure onset (P < 0.05), and are distinct for seizures that impaired awareness or that secondarily generalized (P < 0.05). The onset of seizure was preceded by a decrease in the mean power spectral density (PSD) in ANT and SOZ (P < 0.05). Neural activity correlated with different states of vigilance at seizure onset within the ANT but not in the SOZ (P = 0.005). Interpretation The ANT can be recruited at the onset of mesial temporal lobe seizures, and the recruitment pattern differs with seizure subtypes. Furthermore, changes in neural dynamics precede seizure onset and are widespread to involve temporo‐thalamic regions, thereby providing an opportunity to intervene early with closed‐loop DBS.
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Affiliation(s)
- Diana Pizarro
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.,Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, Alabama
| | - Adeel Ilyas
- Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ganne Chaitanya
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.,Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, Alabama
| | - Emilia Toth
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.,Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, Alabama
| | - Auriana Irannejad
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.,Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrew Romeo
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kristen O Riley
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Leonidas Iasemidis
- Center for Biomedical Engineering and Rehabilitation Science, Louisiana Tech University, Ruston, Louisiana
| | - Sandipan Pati
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.,Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Birmingham, Alabama
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Romeo A, Issa Roach AT, Toth E, Chaitanya G, Ilyas A, Riley KO, Pati S. Early ictal recruitment of midline thalamus in mesial temporal lobe epilepsy. Ann Clin Transl Neurol 2019; 6:1552-1558. [PMID: 31402630 PMCID: PMC6689686 DOI: 10.1002/acn3.50835] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/21/2019] [Accepted: 06/12/2019] [Indexed: 11/08/2022] Open
Abstract
The causal role of midline thalamus in the initiation and early organization of mesial temporal lobe seizures is studied. Three patients undergoing stereoelectroencephalography were enrolled for the placement of an additional depth electrode targeting the midline thalamus. The midline thalamus was recruited in all three patients at varying points of seizure initiation (0–13 sec) and propagation (9–60 sec). Stimulation of either thalamus or hippocampus induced similar habitual seizures. Seizure‐induced in the hippocampus rapidly recruited the thalamus. Evoked potentials demonstrated stronger connectivity from the hippocampus to the thalamus than in the opposite direction. The midline thalamus can be within the seizure initiation and symptomatogenic circuits.
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Affiliation(s)
- Andrew Romeo
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | | | - Emilia Toth
- Department of Neurology, University of Alabama at Birmingham, Alabama.,Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Alabama
| | - Ganne Chaitanya
- Department of Neurology, University of Alabama at Birmingham, Alabama.,Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Alabama
| | - Adeel Ilyas
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama.,Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Alabama
| | - Kristen O Riley
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Sandipan Pati
- Department of Neurology, University of Alabama at Birmingham, Alabama.,Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Alabama
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Banefelt J, Åkesson KE, Spångéus A, Ljunggren O, Karlsson L, Ström O, Ortsäter G, Libanati C, Toth E. Risk of imminent fracture following a previous fracture in a Swedish database study. Osteoporos Int 2019; 30:601-609. [PMID: 30680431 PMCID: PMC6422949 DOI: 10.1007/s00198-019-04852-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/10/2019] [Indexed: 01/03/2023]
Abstract
This study examined the imminent risk of a future fracture within 1 and 2 years following a first fracture in women aged 50 years and older and assessed independent factors associated with risk of subsequent fractures. The study highlights the need to intervene rapidly after a fracture to prevent further fractures. INTRODUCTION This study aims to determine the imminent risk of subsequent fractures within 1 and 2 years following a first fracture and to assess independent factors associated with subsequent fractures. METHODS Retrospective, observational cohort study of women aged ≥ 50 years with a fragility fracture was identified from Swedish national registers. Clinical/demographic characteristics at the time of index fracture and cumulative fracture incidences up to 12 and 24 months following index fracture were calculated. Risk factors for subsequent fracture were identified using multivariate regression analysis. RESULTS Two hundred forty-two thousand one hundred eight women (mean [SD] age 74 [12.5] years) were included. The cumulative subsequent fracture incidence at 12 months was 7.1% (95% confidence interval [CI], 6.9-7.2) and at 24 months was 12.0% (95% CI, 11.8-12.1). The rate of subsequent fractures was highest in the first month (~ 15 fractures per 1000 patient-years) and remained steady between 4 and 24 months (~ 5 fractures/1000 patient-years). Higher age was an independent risk factor for imminent subsequent fractures (at 24 months, sub-distribution hazard ratio [HR], 3.07; p < 0.001 for women 80-89 years [reference 50-59 years]). Index vertebral fracture was a strong independent risk factor for subsequent fracture (sub-distribution HR, 2.72 versus hip fracture; p < 0.001 over 12 months; HR, 2.23; p < 0.001 over 24 months). CONCLUSIONS Our findings highlight the need to intervene rapidly after any fragility fracture in postmenopausal women. The occurrence of a fragility fracture provides healthcare systems with a unique opportunity to intervene to reduce the increased risk of subsequent fractures.
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Affiliation(s)
| | - K E Åkesson
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research, Lund University, Malmö, Sweden
- Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | - A Spångéus
- Linköping University, Linköping University Hospital, Linköping, Sweden
| | - O Ljunggren
- Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | | | - O Ström
- Quantify Research, Stockholm, Sweden
- Karolinska Institutet, Stockholm, Sweden
| | | | - C Libanati
- UCB Biopharma Sprl, Allée de la Recherche 60, 1070, Brussels, Belgium
| | - E Toth
- UCB Biopharma Sprl, Allée de la Recherche 60, 1070, Brussels, Belgium.
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Ilyas A, Toth E, Pizarro D, Riley KO, Pati S. Modulation of neural oscillations by vagus nerve stimulation in posttraumatic multifocal epilepsy: case report. J Neurosurg 2018; 131:1079-1085. [PMID: 30497180 DOI: 10.3171/2018.6.jns18735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/12/2018] [Indexed: 11/06/2022]
Abstract
The putative mechanism of vagus nerve stimulation (VNS) for medically refractory epilepsy is desynchronization of hippocampal and thalamocortical circuitry; however, the nature of the dose-response relationship and temporal dynamics is poorly understood. For greater elucidation, a study in a nonepileptic rat model was previously conducted and showed that rapid-cycle (RC) VNS achieved superior desynchrony compared to standard-cycle (SC) VNS. Here, the authors report on the first in-human analysis of the neuromodulatory dose-response effects of VNS in a patient with posttraumatic, independent, bilateral mesial temporal lobe epilepsy refractory to medications and SC-VNS who was referred as a potential candidate for a responsive neurostimulation device. During stereotactic electroencephalography (SEEG) recordings, the VNS device was initially turned off, then changed to SC-VNS and then RC-VNS settings. Spectral analysis revealed a global reduction of power in the theta (4-8 Hz) and alpha (8-15 Hz) bands with both SC- and RC-VNS compared to the stimulation off setting (p < 0.001). Furthermore, in the alpha band, both SC- and RC-VNS were associated with greater global desynchrony compared to the off setting (p < 0.001); and, specifically, in the bilateral epileptogenic hippocampi, RC-VNS further reduced spectral power compared to SC-VNS (p < 0.001). The dose-response and temporal effects suggest that VNS modulates regional and global dynamics differently.
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Affiliation(s)
- Adeel Ilyas
- Departments of1Neurosurgery and
- 3Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Alabama
| | - Emilia Toth
- 2Neurology; and
- 3Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Alabama
| | - Diana Pizarro
- 2Neurology; and
- 3Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Alabama
| | | | - Sandipan Pati
- 2Neurology; and
- 3Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, Alabama
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Pizarro D, Toth E, Irannejad A, Riley KO, Jaisani Z, Muhlhofer W, Martin R, Pati S. Auras localized to the temporal lobe disrupt verbal memory and learning - Causal evidence from direct electrical stimulation of the hippocampus. Epilepsy Behav Case Rep 2018; 10:99-101. [PMID: 30181952 PMCID: PMC6120344 DOI: 10.1016/j.ebcr.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/19/2018] [Accepted: 07/27/2018] [Indexed: 06/08/2023]
Abstract
Auras (focal aware seizure; FAS) are subjective ictal events with retained consciousness. Epileptiform activities can disrupt cognitive tasks, but studies are limited to seizures with impaired awareness. As a proof of concept, we examined the cognitive effects of direct electrical stimulation to the left hippocampus which induced a habitual FAS in a patient with left mesial temporal lobe epilepsy. During the induced habitual FAS, verbal memory performance declined significantly as compared to pre-stimulation testing. Tasks measuring auditory working memory and psychomotor processing speed were not affected by the stimulation. The study confirms that FAS can impair episodic verbal memory and learning.
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Affiliation(s)
- Diana Pizarro
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
- Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, AL, United States of America
| | - Emilia Toth
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
- Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, AL, United States of America
| | - Auriana Irannejad
- Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, AL, United States of America
| | - Kristen O. Riley
- Department of Neurosurgery, University of Alabama at Birmingham, AL, United States of America
| | - Zeenat Jaisani
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
| | - Wolfgang Muhlhofer
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
| | - Roy Martin
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
| | - Sandipan Pati
- Department of Neurology, University of Alabama at Birmingham, AL, United States of America
- Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, AL, United States of America
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Pizarro D, Ilyas A, Toth E, Romeo A, Riley KO, Esteller R, Vlachos I, Pati S. Automated detection of mesial temporal and temporoperisylvian seizures in the anterior thalamic nucleus. Epilepsy Res 2018; 146:17-20. [PMID: 30055392 DOI: 10.1016/j.eplepsyres.2018.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 06/21/2018] [Accepted: 07/22/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Focal seizures can arise from coordinated activity across large-scale epileptic networks and propagate to regions that are not functionally altered but are recruited by epileptiform discharges. In preclinical models of focal epilepsy, the thalamus is recruited by cortical onset seizures, but it remains to be demonstrated in clinical studies. In this pilot study, the authors investigate whether seizures with onset within and outside the mesial temporal structures are detected in the anterior thalamus (ATN). METHODS After written consent, three subjects with suspected temporal lobe epilepsy undergoing stereotactic electrode implantation were recruited prospectively for thalamocortical depth EEG recordings. Three seizure detection metrics (line length-LL, Laplace operator-Lap; Teager energy-TE) were studied within the seizure onset zone and ATN. RESULTS The LL, Lap, and TE metrics detected 40 (95%) seizures each in the ATN before the behavioral manifestation. Rates of detection in the seizure onset zone were 40 (95%), 42 (100%), and 41 (98%), respectively. The mean detection latency in ATN from SOZ ranged from 0.25 to 5.17 s. Seizures were localized to amygdala-hippocampus, temporal pole, anterior insula and superior temporal gyrus. CONCLUSIONS The pilot study demonstrates that seizures in mesial temporal and temporal-plus epilepsies (i.e., temporoperisylvian) can be detected reliably in the ATN. Further studies are needed to validate these findings.
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Affiliation(s)
- Diana Pizarro
- Department of Neurology, University of Alabama at Birmingham, AL, United States; Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, AL, United States
| | - Adeel Ilyas
- Department of Neurosurgery, University of Alabama at Birmingham, AL, United States; Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, AL, United States
| | - Emilia Toth
- Department of Neurology, University of Alabama at Birmingham, AL, United States; Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, AL, United States
| | - Andrew Romeo
- Department of Neurosurgery, University of Alabama at Birmingham, AL, United States
| | - Kristen O Riley
- Department of Neurosurgery, University of Alabama at Birmingham, AL, United States
| | - Rosana Esteller
- Department of Neurology, University of Alabama at Birmingham, AL, United States
| | - Ioannis Vlachos
- Department of Mathematics and Statistics, Louisiana Tech University, Ruston, LA, United States
| | - Sandipan Pati
- Department of Neurology, University of Alabama at Birmingham, AL, United States; Epilepsy and Cognitive Neurophysiology Laboratory, University of Alabama at Birmingham, AL, United States.
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Kirschner AKT, Reischer GH, Jakwerth S, Savio D, Ixenmaier S, Toth E, Sommer R, Mach RL, Linke R, Eiler A, Kolarevic S, Farnleitner AH. Multiparametric monitoring of microbial faecal pollution reveals the dominance of human contamination along the whole Danube River. Water Res 2017; 124:543-555. [PMID: 28806705 PMCID: PMC5718294 DOI: 10.1016/j.watres.2017.07.052] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 05/22/2023]
Abstract
The microbial faecal pollution of rivers has wide-ranging impacts on a variety of human activities that rely on appropriate river water quality. Thus, detailed knowledge of the extent and origin of microbial faecal pollution is crucial for watershed management activities to maintain safe water use. In this study, the microbial faecal pollution levels were monitored by standard faecal indicator bacteria (SFIB) along a 2580 km stretch of the Danube, the world's most international river, as well as the Danube's most important tributaries. To track the origin of faecal pollution, host-associated Bacteroidetes genetic faecal marker qPCR assays for different host groups were applied in concert with SFIB. The spatial resolution analysis was followed by a time resolution analysis of faecal pollution patterns over 1 year at three selected sites. In this way, a comprehensive faecal pollution map of the total length of the Danube was created, combining substantiated information on both the extent and origin of microbial faecal pollution. Within the environmental data matrix for the river, microbial faecal pollution constituted an independent component and did not cluster with any other measured environmental parameters. Generally, midstream samples representatively depicted the microbial pollution levels at the respective river sites. However, at a few, somewhat unexpected sites, high pollution levels occurred in the lateral zones of the river while the midstream zone had good water quality. Human faecal pollution was demonstrated as the primary pollution source along the whole river, while animal faecal pollution was of minor importance. This study demonstrates that the application of host-associated genetic microbial source tracking markers in concert with the traditional concept of microbial faecal pollution monitoring based on SFIB significantly enhances the knowledge of the extent and origin of microbial faecal pollution patterns in large rivers. It constitutes a powerful tool to guide target-oriented water quality management in large river basins.
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Affiliation(s)
- A K T Kirschner
- Medical University of Vienna, Institute for Hygiene and Applied Immunology, Water Hygiene, Kinderspitalgasse 15, A-1090 Vienna, Austria; Interuniversity Cooperation Centre for Water & Health, Austria(1).
| | - G H Reischer
- Interuniversity Cooperation Centre for Water & Health, Austria(1); Technische Universität Wien, Institute for Chemical, Biological and Environmental Engineering, Research Group of Environmental Microbiology and Molecular Diagnostics 166/5/4, Gumpendorferstrasse 1A, A-1060 Vienna, Austria
| | - S Jakwerth
- Medical University of Vienna, Institute for Hygiene and Applied Immunology, Water Hygiene, Kinderspitalgasse 15, A-1090 Vienna, Austria; Interuniversity Cooperation Centre for Water & Health, Austria(1)
| | - D Savio
- Interuniversity Cooperation Centre for Water & Health, Austria(1); Technische Universität Wien, Institute for Chemical, Biological and Environmental Engineering, Research Group of Environmental Microbiology and Molecular Diagnostics 166/5/4, Gumpendorferstrasse 1A, A-1060 Vienna, Austria
| | - S Ixenmaier
- Technische Universität Wien, Institute for Chemical, Biological and Environmental Engineering, Research Group of Environmental Microbiology and Molecular Diagnostics 166/5/4, Gumpendorferstrasse 1A, A-1060 Vienna, Austria
| | - E Toth
- Eötvös Loránd University of Sciences, Department of Microbiology, Pázmány Postny 1/c, H-1117 Budapest, Hungary
| | - R Sommer
- Medical University of Vienna, Institute for Hygiene and Applied Immunology, Water Hygiene, Kinderspitalgasse 15, A-1090 Vienna, Austria; Interuniversity Cooperation Centre for Water & Health, Austria(1)
| | - R L Mach
- Technische Universität Wien, Institute for Chemical, Biological and Environmental Engineering, Research Group of Environmental Microbiology and Molecular Diagnostics 166/5/4, Gumpendorferstrasse 1A, A-1060 Vienna, Austria
| | - R Linke
- Interuniversity Cooperation Centre for Water & Health, Austria(1); Technische Universität Wien, Institute for Chemical, Biological and Environmental Engineering, Research Group of Environmental Microbiology and Molecular Diagnostics 166/5/4, Gumpendorferstrasse 1A, A-1060 Vienna, Austria
| | - A Eiler
- eDNA Solutions Ltd, Björkåsgatan 16, 43131 Mölndal, Sweden; University of Gothenburg, Department of Chemistry and Molecular Biology, Medicinaregatan 9C, 40530 Göteborg, Sweden
| | - S Kolarevic
- University of Belgrade, Chair of Microbiology, Studentski trg 16, SRB-11000 Belgrade, Serbia
| | - A H Farnleitner
- Interuniversity Cooperation Centre for Water & Health, Austria(1); Technische Universität Wien, Institute for Chemical, Biological and Environmental Engineering, Research Group of Environmental Microbiology and Molecular Diagnostics 166/5/4, Gumpendorferstrasse 1A, A-1060 Vienna, Austria; Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, 3500 Krems, Austria.
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Hajnal B, Ujma P, Bodizs R, Toth E, Eross L, Ulbert I, Cash S, Fabo D. P370 The thalamo-cortical generators of sleep spindles as revealed by laminar analysis of neocortex. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.07.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Möricke R, Sunkureddi P, Toth E, Brown J, Machein U, Lheritier K, Junge G, Kivitz A. AB0926 Long-Term Safety and Maintenance of Efficacy of Canakinumab Liquid Formulation in Acute Gouty Arthritis Patients: Results From a 36 Week Extension Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kiss F, Toth E, Peto K, Miko I, Nemeth N. The investigation of interspecies diversity of erythrocyte aggregation properties by two different photometric methods in four animal species. J Anim Physiol Anim Nutr (Berl) 2015; 99:1074-83. [DOI: 10.1111/jpn.12301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 02/03/2015] [Indexed: 11/30/2022]
Affiliation(s)
- F. Kiss
- Department of Operative Techniques and Surgical Research; Institute of Surgery; Faculty of Medicine; University of Debrecen; Debrecen Hungary
| | - E. Toth
- Department of Operative Techniques and Surgical Research; Institute of Surgery; Faculty of Medicine; University of Debrecen; Debrecen Hungary
| | - K. Peto
- Department of Operative Techniques and Surgical Research; Institute of Surgery; Faculty of Medicine; University of Debrecen; Debrecen Hungary
| | - I. Miko
- Department of Operative Techniques and Surgical Research; Institute of Surgery; Faculty of Medicine; University of Debrecen; Debrecen Hungary
| | - N. Nemeth
- Department of Operative Techniques and Surgical Research; Institute of Surgery; Faculty of Medicine; University of Debrecen; Debrecen Hungary
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Entz L, Toth E, Keller CJ, Groppe D, Megevand P, Fabo D, Ulbert I, Eross LG, Mehta A. 193 The Human Neocortex Demonstrates Projectors and Receivers of Influence. Neurosurgery 2014. [DOI: 10.1227/01.neu.0000452467.19162.ae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Sunkureddi P, Toth E, Brown J, Kivitz A, Stancati A, Richard D, Lheritier K, Möricke R. AB0848 Canakinumab Pre-Filled Syringe VS Triamcinolone Acetonide in the Treatment of Acute Gouty Arthritis Attacks: Results from A Post-Hoc Analysis in Difficult-To-Treat Patients. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ferreira MF, Pereira G, Martins AF, Martins CIO, Prata MIM, Petoud S, Toth E, Ferreira PMT, Martins JA, Geraldes CFGC. Ln[DO3A-N-α-(pyrenebutanamido)propionate] complexes: optimized relaxivity and NIR optical properties. Dalton Trans 2014; 43:3162-73. [DOI: 10.1039/c3dt52958d] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Avouac J, Koumakis E, Toth E, Meunier M, Maury E, Cormier C, Kahan A, Allanore Y. FRI0259 Increased risk of osteoporosis and fracture in women with systemic sclerosis: A comparative study to rheumatoid arthritis and healthy controls. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mikhail A, Kaplan M, Macdougall I, Schmidt RJ, Rastogi A, Wang W, Tong S, Mayo M, Oestreicher N, Schiller B, Green JM, Verma R, Leu K, Mortensen RB, Young PR, Schatz P, Wojchowski DM, Shimonaka Y, Sasaki Y, Yorozu K, Sasaki MN, Ikuta K, Kohgo Y, Shimonaka Y, Sasaki Y, Omori YM, Yorozu K, Hiramatsu M, Momoki N, Kakio Y, Shibuto N, Takeuchi H, Fukumoto M, Maruyama K, Matsuo Y, Sasaki Y, Omori Y, Yorozu K, Shimonaka Y, Robinson BM, Larkina M, Goodkin DA, Li Y, Locatelli F, Nolen J, Kleophas W, Pisoni RL, Sibbel S, Brunelli S, Krishnan M, Horie M, Hasegawa E, Minoshima KI, Shimonaka Y, Ambrus C, Kerkovits L, Szegedi J, Benke A, Toth E, Nagy L, Borbas B, Rozinka A, Nemeth J, Varga G, Kulcsar I, Gergely L, Szakony S, Kiss I, Danielson K, Qureshi AR, Heimburger O, Stenvinkel P, Lindholm B, Hylander-Rossner B, Germanis G, Hansson M, Beshara S, Barany P, Dueymes JM, Kolko A, Couchoud C, Combe C, Covic A, Goldsmith D, Zaoui P, Gesualdo L, London G, Dellanna F, Mann J, Turner M, Muenzberg M, MacDonald K, Denhaerynck K, Abraham I, Sanchez MB, Casero RC, Ortiz RV, Carmelo IG, Munoz SC, Gomez ER, Rodriguez CS, Kuji T, Fujikawa T, Kakimoto-Shino M, Shibata K, Toya Y, Umemura S, Topuzovic N, Mihaljevic I, Rupcic V, Sterner G, Clyne N, Mann J, Dellanna F, London G, Combe C, Covic A, Gesualdo L, Goldsmith D, Zaoui P, Turner M, Muenzberg M, MacDonald K, Denhaerynck K, Abraham I, Toblli J, Di Gennaro F, Chmielewski M, Jagodzinski P, Lichodziejewska-Niemierko M, Rutkowski B, Takasawa K, Takaeda C, Ueda H, Higuchi M, Maeda T, Tomosugi N, Moghazy TF, Jakic M, Zibar L, Romei Longhena G, Beck W, Liebchen A, Teatini U, Rottembourg JB, Guerin A, Diaconita M, Dansaert A, Koike K, Fukami K, Shimamatsu K, Kawaguchi A, Okuda S. Anaemia in CKD 5D. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Griva K, Mooppil N, Pala Krishnan DS, McBain H, Newman SP, Tripepi G, Pannier B, Mallamaci F, London G, Zoccali C, Sood M, Manns B, Kappel J, Naimark D, Dart A, Komenda P, Rigatto C, Hiebert B, Tangri N, Perl J, Karaboyas A, Tentori F, Morgenstern H, Sen A, Rayner H, Vanholder R, Combe C, Hasegawa T, Mapes D, Robinson B, Pisoni R, Tentori F, Zepel L, Karaboyas A, Mendelssohn D, Ikizler T, Pisoni R, Fukuhara S, Gillespie B, Bieber B, Robinson B, Wilkie M, Karaboyas A, Rayner H, Fluck R, Morgenstern H, Li Y, Kerr P, Mendelssohn D, Wikstrom B, Tentori F, Pisoni R, Robinson B, Vanita Jassal S, Comment L, Karaboyas A, Bieber B, Morgenstern H, Sen A, De Sequera P, Marshall M, Fukuhara S, Robinson B, Pisoni R, Jin HM, Pan Y, Raimann JG, Etter M, Kooman J, Levin N, Marcelli D, Marelli C, van der Sande F, Thijssen S, Usvyat L, Kotanko P, Lu KC, Yang HY, Su SL, Palmer S, Saglimbene V, Ruospo M, Craig J, Celia E, Gelfman R, Stroumza P, Bednarek A, Dulawa J, Frazao J, Del Castillo D, Ecder T, Hegbrant J, Strippoli GFM, Hecking M, Bieber B, Ethier J, Kautzky-Willer A, Jadoul M, Saito A, Sunder-Plassmann G, Saemann M, Gillespie B, Horl W, Mariani L, Ramirez S, Pisoni R, Robinson B, Port F, Mallamaci F, Tripepi G, Leonardis D, Zoccali C, Fukuma S, Akizawa T, Akiba T, Saito A, Kurokawa K, Fukuhara S, Pannier B, Tripepi G, Mallamaci F, Zoccali C, London G, Stack AG, Casserly LF, Abdalla AA, Murthy BVR, Hegarty A, Cronin CJ, Hannigan A, Shaw C, Pitcher D, Sandford R, Spoto B, Pizzini P, Cutrupi S, D'Arrigo G, Tripepi G, Zoccali C, Mallamaci F, Ghalia K, Gubensek J, Arnol M, Ponikvar R, Buturovic-Ponikvar J, Palmer S, de Berardis G, Craig JC, Pellegrini F, Ruospo M, Tong A, Tonelli M, Hegbrant J, Strippoli GFM, Pizzini P, Torino C, Cutrupi S, Spoto B, D'Arrigo G, Tripepi R, Tripepi G, Zoccali C, Mallamaci F, von Gersdorff G, Usvyat L, Schaller M, Wong M, Thijssen S, Marcelli D, Barth C, Kotanko P, Torino C, D'Arrigo G, Postorino M, Tripepi G, Mallamaci F, Zoccali C, Chanouzas D, Ng KP, Baharani J, Endo M, Nakamura Y, Hara M, Murakami T, Tsukahara H, Watanabe Y, Matsuoka Y, Fujita K, Inoue M, Simizu T, Gotoh H, Goto Y, Delanaye P, Cavalier E, Moranne O, Krzesinski JM, Warling X, Smelten N, Pottel H, Schneider S, Malecki AK, Haller HG, Boenisch O, Kielstein JT, Movilli E, Camerini C, Gaggia P, Zubani R, Feller P, Poiatti P, Pola A, Carli O, Valzorio B, Possenti S, Bregoli L, Foini P, Cancarini G, Palmer S, Ruospo M, Natale P, Gargano L, Saglimbene V, Pellegrini F, Johnson DW, Craig JC, Hegbrant J, Strippoli GFM, Brunelli S, Krishnan M, Van Wyck D, Provenzano R, Goykhman I, Patel C, Nissenson A, De Mauri A, Conte MM, Chiarinotti D, David P, Capurro F, De Leo M, Postorino M, Marino C, Vilasi A, Tripepi G, Zoccali C, Dialysis C, Helps A, Edwards G, Mactier R, Coia J, Abe Y, Ito K, Ogahara S, Sasatomi Y, Saito T, Nakashima H, Jean-Charles C, Morgane V, Leila P, Carole S, Pierre-Louis C, Philippe Z, Jean-Francois T, Couchoud C, Dantony E, Guerrin MH, Villar E, Ecochard R, Nishi S, Goto S, Nakai K, Kono K, Yonekura Y, Ito J, Fujii H, Korkmaz S, Ersoy A, Gulten S, Ercan I, Koca N, Serdengecti K, Suleymanlar G, Altiparmak M, Seyahi N, Jager K, Trabulus S, Erek E, Cobo Jaramillo G, Gallar P, Di Gioia C, Rodriguez I, Ortega O, Herrero JC, Oliet A, Vigil A, Pechter U, Luman M, Ilmoja M, Sinimae E, Auerbach A, Lilienthal K, Kallaste M, Sepp K, Piel L, Seppet E, Muliin M, Telling K, Seppet E, Kolvald K, Veermae K, Ots-Rosenberg M, Ambrus C, Kerkovits L, Szegedi J, Benke A, Toth E, Nagy L, Borbas B, Rozinka A, Nemeth J, Varga G, Kulcsar I, Gergely L, Szakony S, Kiss I, Koo JR, Choi MJ, Yoon MH, Park JY, No EY, Seo JW, Lee YK, Noh JW. Epidemiology - CKD 5D II. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Raimann JG, Gotch F, Keen M, Kotanko P, Levin NW, Pierratos A, Lindsay R, Severova-Andreevska G, Trajceska L, Gelev S, Selim G, Sikole A, Yoon SY, Hwang SD, Cho DK, Cho YH, Moon SJ, Ribitsch W, Schreiner PJ, Uhlmann M, Schilcher G, Stadlbauer V, Horina JH, Rosenkranz AR, Schneditz D, Kiss I, Kerkovits L, Ambrus C, Kulcsar I, Szegedi J, Benke A, Borbas B, Ferenczi S, Hengsperger M, Kazup S, Nagy L, Nemeth J, Rozinka A, Szabo T, Szelestei T, Toth E, Varga G, Wagner G, Zakar G, Gergely L, Tisler A, Kiss Z, Sasaki S, Miyamato M, Nomura A, Koitabashi K, Nishiwaki H, Suzuki T, Uchida D, Kawarazaki H, Shibagaki Y, Kimura K, Libetta C, Martinelli C, Margiotta E, Borettaz I, Canevari M, Esposito P, Sepe V, Dal Canton A, Pateinakis P, Dimitriadis C, Papagianni A, Douma S, Efstratiadis G, Memmos D, Nelson CL, Dunstan PJ, Zwiech R, Hasuike Y, Yanase K, Hamahata S, Nagai T, Yahiro M, Kaibe S, Kida A, Nagasawa Y, Kuragano T, Nakanishi T, Kim JS, Yang JW, Choi SO, Han BG, Chang JH, Kim AJ, Kim HS, Ro H, Jung JY, Lee HH, Chung W, Tanaka H, Kita T, Okamoto K, Mikami M, Sakai R, Libetta C, Canevari M, Martinelli C, Borettaz I, Margiotta E, Lojacono E, Votta B, Rampino T, Gregorini M, Amore A, Coppo R, Dal Canton A, ElSharkawy MMS, Kamel M, Elhamamsy M, Allam S, Ryu JH, Lee S, Hong SC, Kim SJ, Kang DH, Ryu DR, Choi KB, Kiraz T, Yalcin A, Akay M, Sahin G, Musmul A, Chang JH, Ro H, Jung JY, Lee HH, Chung W, Kamijo Y, Horiuchi H, Iida H, Saito K, Furutera R, Ishibashi Y, Sidiropoulou M, Patsialas S, Angelopoulos M, Torreggiani M, Serpieri N, Arazzi M, Esposito V, Calatroni M, La Porta E, Catucci D, Montagna G, Semeraro L, Efficace E, Piazza V, Picardi L, Villa G, Esposito C, Kim JC, Hwang E, Park K, Karakizlis H, Bohl K, Kortus-Goetze B, Dodel R, Hoyer J, Cinar A, Kazancioglu R, Isik AT, Aydemir E, Gorcin B, Radic J, Ljutic D, Radic M, Kovacic V, Sain M, Dodig Curkovic K, Grzegorzewska AE, Niepolski L, Sikora J, Jagodzinski P, Sowinska A, Sirolli V, Rossi C, Di Castelnuovo A, Felaco P, Amoroso L, Zucchelli M, Ciavardelli D, Sacchetta P, Urbani A, Arduini A, Bonomini M, Inoue T, Okano K, Tsuruta Y, Tsuruta Y, Tsuchiya K, Akiba T, Nitta K, Grzegorzewska AE, Pajzderski D, Sowinska A, Jagodzinski P. Pathophysiology and clinical studies in CKD 5D. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hirata M, Tashiro Y, Aizawa K, Endo K, Hirata M, Tashiro Y, Endo K, Aizawa K, Serizawa K, Hirata M, Yogo K, Tashiro Y, Endo K, Cases A, Portoles J, Calls J, Martinez-Castelao A, Munar MA, Segarra A, Samouilidou E, Pantelias K, Petras D, Mpakirtzi T, Pipili C, Chatzivasileiou G, Vasiliou K, Denda E, Grapsa E, Tzanatos H, Shoji S, Inaba M, Tomosugi N, Okuno S, Ichii M, Yamakawa T, Kurihara S, Barsan L, Stanciu A, Stancu S, Capusa C, Bratescu L, Mircescu G, Barsan L, Stanciu A, Stancu S, Capusa C, Mircescu G, Kuo KL, Hung SC, Lee TS, Tarng DC, Nistor I, Covic A, Goldsmith D, Garrido P, Fernandes J, Ribeiro S, Vala H, Parada B, Alves R, Belo L, Costa E, Santos-Silva A, Reis F, Abdulnabi K, Ullah A, Abdulateef A, Howse M, Khalil A, Fouqueray B, Hoffmann M, Addison J, Manamley N, Stamopoulos D, Mpakirtzi N, Afentakis N, Grapsa E, Yu KH, Chou J, Klaus S, Schaddelee M, Kashiwa M, Takada A, Neff T, Galle J, Claes K, Di Giulio S, Guerin A, Herlitz H, Kiss I, Wirnsberger G, Manamley N, Addison J, Fouqueray B, Froissart M, Winearls C, Martinez Castelao A, Cases Amenos A, Torre Carballada A, Torralba Iranzo FJ, Bronsoms Artero JM, Toran Monserrat D, Valles Prats M, Merino JL, Espejo B, Bueno B, Amezquita Y, Paraiso V, Kiss Z, Kerkovits L, Ambrus C, Kulcsar I, Szegedi J, Benke A, Borbas B, Ferenczi S, Hengsperger M, Kazup S, Nagy L, Nemeth J, Rozinka A, Szabo T, Szelestei T, Toth E, Varga G, Wagner G, Zakar G, Gergely L, Kiss I, Exarchou K, Tanahill N, Anthoney A, Khalil A, Ahmed S, Capusa C, Oprican R, Stanciu A, Lipan M, Stancu S, Chirculescu B, Mircescu G, Ferenczi S, Roger S, Malecki R, Farouk M, Dellanna F, Thomas M, Manamley N, Touam M, Chantrel F, Bouiller M, Hurot JM, Raphael T, Testa A, Veillon S, Vendrely B, Masoumi Z, Ahmadpoor P, Ghaderian SMH, Nafar M, Samavat S, Samadian F, Poorrezagholi F, Shahidi M, Riccio E, Visciano B, Capuano I, Memoli A, Mozzillo G, Memoli B, Pisani A. Anaemia in CKD 1-5. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wurm Johansson G, Toth E, Torp J, Ehinger A, Andersson L, Thorlacius H. Acute pancreatitis evoked by small-cell lung carcinoma metastases and detected by endoscopic ultrasound. Endoscopy 2012; 44 Suppl 2 UCTN:E45-6. [PMID: 22396272 DOI: 10.1055/s-0031-1291523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- G Wurm Johansson
- Section of Endoscopy, Department of Clinical Sciences, Malmö, Skåne University Hospital, Lund University, Malmö, Sweden
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Spada C, Hassan C, Galmiche J, Neuhaus H, Dumonceau J, Adler S, Epstein O, Gay G, Pennazio M, Rex D, Benamouzig R, de Franchis R, Delvaux M, Devière J, Eliakim R, Fraser C, Hagenmuller F, Herrerias J, Keuchel M, Macrae F, Munoz-Navas M, Ponchon T, Quintero E, Riccioni M, Rondonotti E, Marmo R, Sung J, Tajiri H, Toth E, Triantafyllou K, Van Gossum A, Costamagna G. Kolonkapselendoskopie: Leitlinie der Europäischen Gesellschaft für Gastrointestinale Endoskopie. Endo heute 2012; 25:145-154. [DOI: 10.1055/s-0032-1312968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- C. Spada
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - C. Hassan
- Department of Gastroenterology and Hepatology, Nantes, University, Nantes, France
| | - J. Galmiche
- Department of Gastroenterology, Evangelisches Krankenhaus, Düsseldorf, Germany
| | - H. Neuhaus
- Service of Gastroenterology and Hepatology, Geneva University Hospitals, Geneva, Switzerland
| | - J. Dumonceau
- Department of Gastroenterology, Bikur Holim Hospital; Jerusalem, Israel
| | - S. Adler
- Department of Gastroenterology, Royal Free and University College Medical School, London, UK
| | - O. Epstein
- Department of Hepato-Gastroenterology, HU Strasbourg, Strasbourg, France
| | - G. Gay
- Division of Gastroenterology 2, San Giovanni Battista University Teaching Hospital, Turin, Italy
| | - M. Pennazio
- Department of Gastroenterology, Indiana University Hospital, Indianapolis, USA
| | - D. Rex
- Department of Gastroenterology, Avienne Hospital, University of Paris, Bobigny, France
| | - R. Benamouzig
- Gastroenterology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - R. de Franchis
- Department of Gastroenterology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - M. Delvaux
- Chaim Sheba Medical Center, Tel-Aviv, Israel
| | - J. Devière
- Department of Gastroenterology, St. Mark's Hospital, London, UK
| | - R. Eliakim
- Department of Medicine I, Altona General Hospital, Hamburg, Germany
| | - C. Fraser
- Gastroenterology Service, Virgen Macarena University Hospital, Seville, Spain
| | - F. Hagenmuller
- Clinic for Internal Medicine, Bethesda Krankenhaus Bergedorf, Hamburg, Germany
| | - J. Herrerias
- Department of Gastroenterology and Clinical Nutrition Service, Royal Melbourne Hospital, Melbourne, Australia
| | - M. Keuchel
- Digestive Endoscopy Unit, Clinica Universitaria de Navarra, Pamplona, Spain
| | - F. Macrae
- Department of Gastroenterology, Hospital Edouard Herriot, Lyon, France
| | - M. Munoz-Navas
- Department of Gastroenterology, Hospital Universitario de Canarias, Tenerife, Spain
| | - T. Ponchon
- Gastroenterology Unit, Ospedale Valdue, Como, Italy
| | - E. Quintero
- Division of Gastroenterology, Curto Hospital, Polla, Italy
| | - M. Riccioni
- Department of Medicine and Therapeutics, Division of Gastroenterology, Prince of Wales Hospital, Shatin, N.T, Hong Kong
| | - E. Rondonotti
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - R. Marmo
- Endoscopy Unit, Skane University Hospital, Lund University, Malmö, Sweden
| | - J. Sung
- Hepatogastroenterology Unit, 2nd department of Internal Medicine-Propaedeutic, Attikon University General Hospital, Athens University, Athens, Greece
| | - H. Tajiri
- Hepatogastroenterology Unit, 2nd department of Internal Medicine-Propaedeutic, Attikon University General Hospital, Athens University, Athens, Greece
| | - E. Toth
- Hepatogastroenterology Unit, 2nd department of Internal Medicine-Propaedeutic, Attikon University General Hospital, Athens University, Athens, Greece
| | - K. Triantafyllou
- Hepatogastroenterology Unit, 2nd department of Internal Medicine-Propaedeutic, Attikon University General Hospital, Athens University, Athens, Greece
| | - A. Van Gossum
- Hepatogastroenterology Unit, 2nd department of Internal Medicine-Propaedeutic, Attikon University General Hospital, Athens University, Athens, Greece
| | - G. Costamagna
- Hepatogastroenterology Unit, 2nd department of Internal Medicine-Propaedeutic, Attikon University General Hospital, Athens University, Athens, Greece
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Spada C, Hassan C, Galmiche JP, Neuhaus H, Dumonceau JM, Adler S, Epstein O, Gay G, Pennazio M, Rex DK, Benamouzig R, de Franchis R, Delvaux M, Devière J, Eliakim R, Fraser C, Hagenmuller F, Herrerias JM, Keuchel M, Macrae F, Munoz-Navas M, Ponchon T, Quintero E, Riccioni ME, Rondonotti E, Marmo R, Sung JJ, Tajiri H, Toth E, Triantafyllou K, Van Gossum A, Costamagna G. Colon capsule endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2012; 44:527-36. [PMID: 22389230 DOI: 10.1055/s-0031-1291717] [Citation(s) in RCA: 178] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PillCam colon capsule endoscopy (CCE) is an innovative noninvasive, and painless ingestible capsule technique that allows exploration of the colon without the need for sedation and gas insufflation. Although it is already available in European and other countries, the clinical indications for CCE as well as the reporting and work-up of detected findings have not yet been standardized. The aim of this evidence-based and consensus-based guideline, commissioned by the European Society of Gastrointestinal Endoscopy (ESGE) is to furnish healthcare providers with a comprehensive framework for potential implementation of this technique in a clinical setting.
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Affiliation(s)
- C Spada
- Digestive Endoscopy Unit, Catholic University, Rome, Italy.
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Johansson GW, Thorlacius H, Toth E. Education and imaging. Gastrointestinal: double pylorus--an uncommon endoscopic finding in the stomach. J Gastroenterol Hepatol 2012; 27:618. [PMID: 22353351 DOI: 10.1111/j.1440-1746.2012.07053.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- G W Johansson
- Department of Clinical Sciences, Skåne University Hospital, Malmö, Lund University, Sweden
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Affiliation(s)
- T Grape
- Department of Surgery, Central Hospital, Kristianstad, Sweden
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Ricon T, Toth E, Leshem M, Braun K, Richter-Levin G. Unpredictable chronic stress in juvenile or adult rats has opposite effects, respectively, promoting and impairing resilience. Stress 2012; 15:11-20. [PMID: 21682654 DOI: 10.3109/10253890.2011.572207] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We evaluated the effects of early maternal deprivation (MD; age 7-14 days) alone or in combination with unpredictable chronic stress (UCS; MDUN; 28-84 days) on anxiety and learning in 90 days old adult rats. We hypothesized that exposure to both stressors (MDUN) would be more detrimental than exposure to one or neither. Unexpectedly, adult rats from the MDUN group did not differ from control animals, whereas adult MD animals exhibited impaired avoidance learning. We next investigated the effect of juvenile-onset (30-90 days) versus adult-onset (60-90 days) stress on avoidance learning in adulthood (90 days). We found that adult-onset chronic stress impaired avoidance learning and memory whereas juvenile-onset stress did not. Thus, the results again indicate that juvenile exposure to UCS induces resilience rather than impairment.
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Affiliation(s)
- T Ricon
- Department of Psychology, he Brain and Behavior Research Center, University of Haifa, Mount Carmel Haifa, Israel.
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Toth E, Nielsen J, Nemeth A, Wurm Johansson G, Syk I, Mangell P, Almqvist P, Thorlacius H. Treatment of a benign colorectal anastomotic stricture with a biodegradable stent. Endoscopy 2011; 43 Suppl 2 UCTN:E252-3. [PMID: 21837599 DOI: 10.1055/s-0030-1256511] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- E Toth
- Endoscopy Unit, Department of Clinical Sciences, Malmö, Skåne University Hospital, Lund University, Malmö, Sweden.
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Affiliation(s)
- G Wurm Johansson
- Department of Clinical Sciences, Endoscopy Unit, Skåne University Hospital, Malmö 205 02, Sweden.
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Affiliation(s)
- E Toth
- Department of Clinical Sciences, Endoscopy Unit, Skåne University Hospital, Malmö, Sweden.
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Abstract
BACKGROUND The incidence of peptic ulcer disease was expected to decrease following the introduction of acid inhibitors and Helicobacter pylori eradication. AIM To analyse possible changes in the incidence of bleeding peptic ulcer, treatment and mortality over time. METHODS Residents of Malmö hospitalized for bleeding gastric or duodenal ulcer disease during 1987-2004 were identified in hospital databases (n = 1610). The material was divided into 6-year periods to identify changes over time. All patients who had been submitted to emergency surgery (n = 137) were reviewed. RESULTS The incidence rate for bleeding gastric or duodenal ulcers decreased by one half in males and by one-third in females and emergency operations decreased significantly (9.2%, 7.5% and 5.7% during the three time periods, respectively (P < 0.05). The post-operative mortality tended to decrease (9.7, 2.4 and 3.7%, respectively) and the 30-day mortality rates in the whole material were 1.2%, 3.6% and 3.4% during the different time periods. CONCLUSION The incidence of bleeding gastric and duodenal ulcer disease has decreased markedly. Operative treatment has been replaced by endoscopic treatment. The bleeding ulcer-related mortality was less than 4% and has not changed over time.
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Affiliation(s)
- J Sadic
- Department of Surgery, Malmö University Hospital, Lund University, Malmö, Sweden
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Toth E, Ralph-Campbell K, Oster R, Connor T, Pick M, Field Team M. Screening indigenous communities for diabetes and its complications: 5 year results from a mobile diabetes outreach service in alberta, canada. Can J Diabetes 2009. [DOI: 10.1016/s1499-2671(09)33248-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Balázs M, Barok M, Lázár V, Rákosy Z, Toth E, Park J, Szöllosi J. Genomic and gene expression characterization of a novel trastuzumab-resistant breast cancer cell line. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)71628-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Rondonotti E, Pennazio M, Toth E, Menchen P, Riccioni ME, De Palma GD, Scotto F, De Looze D, Pachofsky T, Tacheci I, Havelund T, Couto G, Trifan A, Kofokotsios A, Cannizzaro R, Perez-Quadrado E, de Franchis R. Small-bowel neoplasms in patients undergoing video capsule endoscopy: a multicenter European study. Endoscopy 2008; 40:488-95. [PMID: 18464193 DOI: 10.1055/s-2007-995783] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND STUDY AIM Small-bowel tumors account for 1% - 3% of all gastrointestinal neoplasms. Recent studies with video capsule endoscopy (VCE) suggest that the frequency of these tumors may be substantially higher than previously reported. The aim of the study was to evaluate the frequency, clinical presentation, diagnostic/therapeutic work-up, and endoscopic appearance of small-bowel tumors in a large population of patients undergoing VCE. PATIENTS AND METHODS Identification by a questionnaire of patients with VCE findings suggesting small-bowel tumors and histological confirmation of the neoplasm seen in 29 centers of 10 European Countries. RESULTS Of 5129 patients undergoing VCE, 124 (2.4%) had small-bowel tumors (112 primary, 12 metastatic). Among these patients, indications for VCE were: obscure gastrointestinal bleeding (108 patients), abdominal pain (9), search for primary neoplasm (6), diarrhea with malabsorption (1). The main primary small-bowel tumor type was gastrointestinal stromal tumor (GIST) (32%) followed by adenocarcinoma (20%) and carcinoid (15%); 66% of secondary small-bowel tumors were melanomas. Of the tumors, 80.6% were identified solely on the basis of VCE findings. 55 patients underwent VCE as the third procedure after negative bidirectional endoscopy. The lesions were single in 89.5% of cases, and multiple in 10.5%. Retention of the capsule occurred in 9.8% of patients with small-bowel tumors. After VCE, 54/124 patients underwent 57 other examinations before treatment; in these patients enteroscopy, when performed, showed a high diagnostic yield. Treatment was surgery in 95% of cases. CONCLUSIONS Our data suggest that VCE detects small-bowel tumors in a small proportion of patients undergoing this examination, but the early use of this tool can shorten the diagnostic work-up and influence the subsequent management of these patients.
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Affiliation(s)
- E Rondonotti
- Università degli Studi di Milano, IRCCS Fondazione Policlinico, Mangiagalli, Regina Elena Dipartimento di Scienze Mediche, Unità Operativa Gastroenterologia 3, 20122 Milano, Italy
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Toth E, Gersner R, Shabat-Simon M, Zangen A. The effect of subconvulsive electrical stimulation of the nucleus accumbens on depressive behavior. Neurosci Res 2007. [DOI: 10.1016/j.neures.2007.06.1298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Toth E, Kondakor I, Tury F, Gati A, Weisz J, Molnar M. P04.1 EEG-effects of pleasant and unpleasant gustatory, olfactory and provocative and neutral visual stimuli in anorexia nervosa. Clin Neurophysiol 2006. [DOI: 10.1016/j.clinph.2006.06.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- E Toth
- Department of Medicine, Malmö University Hospital, Malmö, Lund University, Sweden.
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