Παρασκευή, 30 Μαρτίου 2018

Inclusion of non‐English‐speaking patients in research: A single institution experience

Pediatric Anesthesia, EarlyView.


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Intraoperative hypoxia secondary to pneumothorax: The role of lung ultrasound

Pediatric Anesthesia, EarlyView.


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Effects of Larval Density on Gene Regulation in Caenorhabditis elegans During Routine L1 Synchronization

Bleaching gravid C. elegans followed by a short period of starvation of the L1 larvae is a routine method performed by worm researchers for generating synchronous populations for experiments. During the process of investigating dietary effects on gene regulation in L1 stage worms by single-worm RNA-Seq, we found that the density of resuspended L1 larvae affects expression of many mRNAs. Specifically, a number of genes related to metabolism and signalling are highly expressed in worms arrested at low density, but are repressed at higher arrest densities. We generated a GFP reporter strain based on one of the most density-dependent genes in our dataset - lips-15 - and confirmed that this reporter was expressed specifically in worms arrested at relatively low density. Finally, we show that conditioned media from high density L1 cultures was able to downregulate lips-15 even in L1 animals arrested at low density, and experiments using daf-22 mutant animals demonstrated that this effect is not mediated by the ascaroside family of signalling pheromones. Together, our data implicate a soluble signalling molecule in density sensing by L1 stage C. elegans, and provide guidance for design of experiments focused on early developmental gene regulation.



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Identification of Proteins Required for Precise Positioning of Apc2 in Dendrites

In Drosophila neurons, uniform minus-end-out polarity in dendrites is maintained in part by kinesin-2-mediated steering of growing microtubules at branch points. Apc links the kinesin motor to growing microtubule plus ends and Apc2 recruits Apc to branch points where it functions. Because Apc2 acts to concentrate other steering proteins to branch points, we wished to understand how Apc2 is targeted. From an initial broad candidate RNAi screen, we found Miro (a mitochondrial transport protein), Ank2, Axin, spastin and Rac1 were required to position Apc2-GFP at dendrite branch points. YFP-Ank2-L8, Axin-GFP and mitochondria also localized to branch points suggesting the screen identified relevant proteins. By performing secondary screens, we found that energy production by mitochondria was key for Apc2-GFP positioning and spastin acted upstream of mitochondria. Ank2 seems to act independently from other players, except its membrane partner, Neuroglian (Nrg). Rac1 likely acts through Arp2/3 to generate branched actin to help recruit Apc2-GFP. Axin can function in a variety of wnt signaling pathways, one of which includes heterotrimeric G proteins and Frizzleds. Knockdown of Gas, Gao, Fz and Fz2, reduced targeting of Apc2 and Axin to branch points. Overall our data suggest that mitochondrial energy production, Nrg/Ank2, branched actin generated by Arp2/3 and Fz/G proteins/Axin function as four modules that control localization of the microtubule regulator Apc2 to its site of action in dendrite branch points.



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Genome-Wide Analysis of Mycoplasma bovirhinis GS01 Reveals Potential Virulence Factors and Phylogenetic Relationships

Mycoplasma bovirhinis is a significant etiology in bovine pneumonia and mastitis, but our knowledge about the genetic and pathogenic mechanisms of M. bovirhinis is very limited. In this study, we sequenced the complete genome of M. bovirhinis strain GS01 isolated from the nasal swab of pneumonic calves in Gansu, China, and we found that its genome forms a 847,985 bp single circular chromosome with a GC content of 27.57% and with 707 protein-coding genes. The putative virulence determinants of M. bovirhinis were then analyzed. Results showed that three genomic islands and 16 putative virulence genes, including one adhesion gene enolase, seven surface lipoproteins, proteins involved in glycerol metabolism, and cation transporters, might be potential virulence factors. Glycerol and pyruvate metabolic pathways were defective. Comparative analysis revealed remarkable genome variations between GS01 and a recently reported HAZ141_2 strain, and extremely low homology with others mycoplasma species. Phylogenetic analysis demonstrated that M. bovirhinis was most genetically close to M. canis, distant from other bovine Mycoplasma species. Genomic dissection may provide useful information on the pathogenic mechanisms and genetics of M. bovirhinis.



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Genome-Wide Association Mapping Uncovers Fw1, a Dominant Gene Conferring Resistance to Fusarium Wilt in Strawberry

Fusarium wilt, a soil-borne disease caused by the fungal pathogen Fusarium oxysporum f. sp. fragariae, threatens strawberry (Fragaria x ananassa) production worldwide. The spread of the pathogen, coupled with disruptive changes in soil fumigation practices, have greatly increased disease pressure and the importance of developing resistant cultivars. While resistant and susceptible cultivars have been reported, a limited number of germplasm accessions have been analyzed, and contradictory conclusions have been reached in earlier studies to elucidate the underlying genetic basis of resistance. Here, we report the discovery of Fw1, a dominant gene conferring resistance to Fusarium wilt in strawberry. The Fw1 locus was uncovered in a genome-wide association study of 565 historically and commercially important strawberry accessions genotyped with 14,408 SNP markers. Fourteen SNPs in linkage disequilibrium with Fw1 physically mapped to a 2.3 Mb segment on chromosome 2 in a diploid F. vesca reference genome. Fw1 and 11 tightly linked GWAS-significant SNPs mapped to linkage group 2C in octoploid segregating populations. The most significant SNP explained 85% of the phenotypic variability and predicted resistance in 97% of the accessions tested-broad-sense heritability was 0.96. Several disease resistance and defense-related gene homologs, including a small cluster of genes encoding nucleotide-binding leucine-rich-repeat proteins, were identified in the 0.7 Mb genomic segment predicted to harbor Fw1. DNA variants and candidate genes identified in the present study should facilitate the development of high-throughput genotyping assays for accurately predicting Fusarium wilt phenotypes and applying marker-assisted selection.



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A Whole Genome Assembly of the Horn Fly, Haematobia irritans, and Prediction of Genes with Roles in Metabolism and Sex Determination

Haematobia irritans, commonly known as the horn fly, is a globally distributed blood-feeding pest of cattle that is responsible for significant economic losses to cattle producers. Chemical insecticides are the primary means for controlling this pest but problems with insecticide resistance have become common in the horn fly. To provide a foundation for identification of genomic loci for insecticide resistance and for discovery of new control technology, we report the sequencing, assembly, and annotation of the horn fly genome. The assembled genome is 1.14 Gb, comprising 76,616 scaffolds with N50 scaffold length of 23 Kb. Using RNA-Seq data, we have predicted 34,413 gene models of which 19,185 have been assigned functional annotations. Comparative genomics analysis with the Dipteran flies Musca domestica L., Drosophila melanogaster, and Lucilia cuprina, show that the horn fly is most closely related to M. domestica, sharing 8,748 orthologous clusters followed by D. melanogaster and L. cuprina, sharing 7,582 and 7,490 orthologous clusters respectively. We also identified a gene locus for the sodium channel protein in which mutations have been previously reported that confers target site resistance to the most common class of pesticides used in fly control. Additionally, we identified 276 genomic loci encoding members of metabolic enzyme gene families such as cytochrome P450s, esterases and glutathione S-transferases, and several genes orthologous to sex determination pathway genes in other Dipteran species.



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Editorial Board

Publication date: April 2018
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms, Volume 1861, Issue 4





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S15-3. Why is theta burst stimulation effective?

As the first patterned protocol of repetitive transcranial magnetic stimulation (rTMS), theta burst stimulation (TBS) gives bursts containing 3 pulses at 50 Hz at 5 Hz in either an uninterrupted continuous train (continuous TBS, cTBS) or short trains with pauses in between (intermittent TBS, iTBS). TBS induces a cortical modulation effect outlasting the stimulation for up to an hour after 20–192 s of stimulation. Since TBS is usually given at a low intensity for a short period of time, coil overheat is rarely seen before the end of stimulation.

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O-1-25. Task-dependent modulation of cerebellar brain inhibition during motor imagery

The aim of study was to investigate cerebellar brain inhibition (CBI) is affected by imaginary muscle contraction (Contract-I) and relaxation (Relax-I) using paired pulse paradigm with transcranial magnetic stimulation (TMS) in healthy human. Participants performed tonic actual contraction and relaxation of right first dorsal interosseous (FDI) muscle with visual feedback using electromyography. The motor evoked potential (MEP) in right FDI induced by TMS over the left primary motor cortex with or without conditioning TMS over the right cerebellum was measured during no-imagery (No-I), Contract-I (1st experiment, n = 9) and Relax-I (2nd experiment, n = 20).

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O-2-28. Vulnerability of each branch of median nerve in carpal tunnel syndrome

It is widely believed that sensory conduction study (SCS) is more sensitive than motor conduction study (MCS) in carpal tunnel syndrome (CTS). However, the sensitivity depends not only on the vulnerability of each branch of the median nerve, but on measurement errors and cut-off values. In this study, we aimed to clarify the true vulnerability of each branch in CTS. Subjects consisted of 144 CTS patients and 66 controls. The impairment of a branch was defined as the prolongation of onset latency.

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O-2-17. Influence of different types of orthoses on muscle synergy control during gait in stroke patients with hemiparesis

The purpose of this study was to verify the influence of lower limb orthoses on muscle synergy control during gait in stroke patients with hemiparesis. In four subjects with acute stroke, surface EMG signals from eight muscles of the paretic lower limb were measured during gait in two conditions (ankle foot orthosis; AFO or knee ankle foot orthosis; KAFO). The number of modules, muscle weightings and activation timing profile of each module were analyzed using non-negative matrix factorization. In two subjects (Fugl Meyer Assessment; FMA > 20) who walked with mild assistance, three modules were identified during gait with KAFO, whereas two modules were identified with AFO.

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O-2-24. Multimodal evoked potential study following posterior quadrantectomy in children with intractable epilepsy

To identify surgical effects on brainstem and cortical function objectively, we compared auditory brainstem response (ABR), somatosensory evoked potential (SEP) and flash visual evoked potential (fVEP) before and after posterior quadrantectomy (PQ) in 11 young children with intractable epilepsy associated with posterior quadrant cortical dysplasia. Mean age of seizure onset and the surgery was 1.4 months and 7.7 months old, respectively. Seven patients showed spasm and 2 had tonic seizures preoperatively.

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O-1-35. The verification for stimulation characteristics of Cortical Stimulator

Bipolar stimulation (BS) used in intraoperative mapping is said to have less influence of leakage current. Its characteristics were actually verified while comparing with monopolar stimulation (MS).

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O-1-24. Cortical silent period during force control task

We investigated whether transcranial magnetic stimulation (TMS)-induced cortical silent period (cSP), which reflects activation of the GABAergic inhibitory neural circuit in the primary motor cortex (M1), was modulated with dependency on actual output force and corticospinal excitability. Eleven healthy participants were asked to control the force of abduction of the right index finger to 10–100% of the maximum voluntary contraction. TMS was delivered to the left M1 during the task. The results showed that actual output force level, background electromyography activity (bEMG) and area of motor evoked potential (aMEP) in the right first dorsal interosseous muscle gradually increased with increasing target force level while cSP gradually decreased with increasing target force level.

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S19-4. Establishment of evidence-based physical therapy

Motor imagery and imitation have been widely used by physical therapist as part of rehabilitation program. However, there have been few evidences for the effect of these approaches on the physical therapy in terms of the neuroscience. Understanding of their neural mechanisms leads to establishment of evidence-based physical therapy (EBPT). Recently, we demonstrated some of the neural mechanism of motor imagery and imitation using MEG.

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Expression of C19MC miRNAs in HCC associates with stem-cell features and the cancer-testis genes signature

Intratumor heterogeneity of hepatocellular carcinoma (HCC) and, among HCC cell subsets, the cancer stem cell population (hCSC), is responsible for therapeutic resistance and disease relapse.

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Diagnostic Ability of Blue Laser Imaging Combined with Magnifying Endoscopy for Early Esophageal Cancer

Blue laser imaging (BLI) is a new image-enhanced endoscopy technique that utilizes a laser light source developed for narrow-band light observation.

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Knowledge and practice regarding the German and the EASL-EASD-EASO NAFLD-guidelines among members of the German Obesity Society



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Expression of C19MC miRNAs in HCC associates with stem-cell features and the cancer-testis genes signature

Intratumor heterogeneity of hepatocellular carcinoma (HCC) and, among HCC cell subsets, the cancer stem cell population (hCSC), is responsible for therapeutic resistance and disease relapse.

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Diagnostic Ability of Blue Laser Imaging Combined with Magnifying Endoscopy for Early Esophageal Cancer

Blue laser imaging (BLI) is a new image-enhanced endoscopy technique that utilizes a laser light source developed for narrow-band light observation.

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Knowledge and practice regarding the German and the EASL-EASD-EASO NAFLD-guidelines among members of the German Obesity Society



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Prior knowledge of category size impacts visual search

Psychophysiology, EarlyView.


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Laparoscopic sigmoidectomy in a case of sigmoid colon cancer with situs inversus totalis

Asian Journal of Endoscopic Surgery, EarlyView.


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Survival benefit of lymph node dissection in surgery for colon cancer in elderly patients: A multicenter propensity score‐matched study in Japan

Asian Journal of Endoscopic Surgery, EarlyView.


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Alcohol hangover impacts learning and reward processing within the medial‐frontal cortex

Psychophysiology, EarlyView.


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Post-deployment Mental Health Screening: A Systematic Review of Current Evidence and Future Directions

Abstract

Population-based post-deployment screening programs within the Departments of Defense and Veterans Affairs have been implemented to assess for mental health conditions and traumatic brain injury. The purpose of this paper is to systematically review the literature on post-deployment screening within this context and evaluate evidence compared to commonly accepted screening implementation criteria. Findings reflected highly variable psychometric properties of the various screens, variable treatment referral rates following screening, low to moderate treatment initiation rates following screening, and no information on treatment completion or long-term outcomes following screening. In sum, the evidence supporting population based post-deployment screening is inconclusive. Implications are discussed.



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Editorial Board

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Publication date: May 2018
Source:Journal of Human Evolution, Volume 118





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In Memoriam

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Publication date: Available online 29 March 2018
Source:International Journal of Psychophysiology





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The relationship between the menstrual cycle and cortisol secretion: Daily and stress-invoked cortisol patterns

Publication date: Available online 29 March 2018
Source:International Journal of Psychophysiology
Author(s): Eva Montero-López, Ana Santos-Ruiz, M. Carmen García-Ríos, Manuel Rodríguez-Blázquez, Heather L. Rogers, María Isabel Peralta-Ramírez
The menstrual cycle involves significant changes in hormone levels, causing physical and psychological changes in women that are further influenced by stress. The aim of this study was to understand the relationship between menstrual cycle phase and salivary cortisol patterns during the day as well as the salivary cortisol response to the Virtual Reality Version of the Trier Social Stress Test (TSST-VR).Forty two women not taking oral contraceptives (24 in follicular phase and 18 in luteal phase) participated in the study. Five samples of salivary cortisol collected during the day and another five samples of cortisol during the TSST-VR were analyzed. Psychological stress measures and psychopathological symptomatology were also evaluated. A 2 × 4 mixed ANCOVA showed an interaction between the two groups on the TSST-RV invoked cortisol response to the [F(3,42) = 3.681; p = 0.023) where women in luteal phase showed higher cortisol post exposure levels (5.96 ± 3.76 nmol/L) than women in follicular phase (4.31 ± 2.23 nmol/L). No other significant differences were found.Our findings provide evidence that menstrual cycle phase tended to influence cortisol response to laboratory-induced mental stress, with more reactivity observed in the luteal phase.



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Use of Nasotracheal Intubation during General Anesthesia in Two Ponies with Tracheal Collapse.

Related Articles

Use of Nasotracheal Intubation during General Anesthesia in Two Ponies with Tracheal Collapse.

Front Vet Sci. 2018;5:42

Authors: Ida KK, Sauvage A, Gougnard A, Grauwels M, Serteyn D, Sandersen C

Abstract
Ponies with tracheal collapse may have an increased anesthetic risk due to airway obstruction during induction and recovery. To our knowledge, there are no anesthetic descriptions of these patients, despite a reported 5.6% incidence and 77% mortality rate. Two Shetland ponies with tracheal collapse, a 12-year-old male (pony 1) and a 27-year-old female (pony 2), were referred for right eye enucleation due to a perforating corneal ulcer and severe recurrent uveitis, respectively. Pony 1 was stressed, had lung stridor and hyperthermia, and developed inspiratory dyspnea with handling. Radiography confirmed collapse of the entire trachea as well as inflammation of the lower airways. Corticosteroids and bronchodilators were administered by nebulization for 1 week before surgery. Pony 2 had a grade III/VI mitral murmur and a clinical history of esophageal obstructions and tracheal collapse requiring tracheostomy. Both ponies were premedicated with acepromazine and xylazine; anesthesia was induced with midazolam and ketamine. Nasotracheal intubation was performed in left lateral recumbency with extension of the neck and head and was guided by capnography. The nasotracheal tube consisted of two endotracheal tubes attached end-to-end to create a tube of adequate length and diameter. Pony 2 was orotracheally intubated during surgery and later reintubated with a nasotracheal tube. Anesthesia was maintained with isoflurane using volume-controlled ventilation. Analgesia was provided by a retrobulbar blockade with mepivacaine and lidocaine. Cardiovascular support consisted of lactated Ringer's solution and dobutamine. After surgery, the ponies were administered xylazine and supplemented with oxygen through the nasotracheal tube. Recovery was assisted by manual support of the head and tail. Successful extubation was achieved following butorphanol administration after approximately 1 h in standing position. Both ponies were discharged from the clinic a few days after surgery.

PMID: 29594157 [PubMed]



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The opioid epidemic and pregnancy: implications for anesthetic care

Purpose of review This review summarizes evolving knowledge regarding adverse maternal, fetal, and neonatal effects of opioid exposure during pregnancy, and current treatment options for opioid use disorder (OUD). Maternal and fetal implications of maternal opioid maintenance with methadone and buprenorphine are described. Finally, acute and chronic pain management strategies in opioid-tolerant parturients are reviewed. Recent findings Opioid use among parturients has risen dramatically, with opioid use during pregnancy as high as 20%. Of women with chronic pain, most continue to take opioids during pregnancy. Medication-assisted therapy with methadone or buprenorphine is currently the standard for treatment of opiate use disorder. Buprenorphine has unique pharmacologic properties that account for its preference over methadone. It has also been shown to produce more favorable neonatal outcomes compared with methadone. Increased clearance and volume of distribution associated with pregnancy require adjustment of dosing regimens of both medications. Multimodal adjuncts can be important alternatives for treatment of pain in opioid-tolerant parturients. Summary The dramatic rise in OUD in pregnancy has had staggering socioeconomic consequences, carrying with it profound maternal and fetal health problems. Medication-assisted treatment utilizing either methadone, or more commonly buprenorphine, is considered the standard of care for OUD during pregnancy. Peripartum pain management for opioid-tolerant patients is challenging and requires consideration for regional anesthesia along with multimodal pharmacotherapy. Correspondence to Michael G. Richardson, Division of Obstetric Anesthesiology, Department of Anesthesiology, 4202 VUH, Vanderbilt University Medical Center, Nashville, TN 37232-7580, USA. Tel: +1 615 322 8476; e-mail: Michael.g.richardson@vanderbilt.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Drug error in paediatric anaesthesia: current status and where to go now

Purpose of review Medication errors in paediatric anaesthesia and the perioperative setting continue to occur despite widespread recognition of the problem and published advice for reduction of this predicament at international, national, local and individual levels. Current literature was reviewed to ascertain drug error rates and to appraise causes and proposed solutions to reduce these errors. Recent findings The medication error incidence remains high. There is documentation of reduction through identification of causes with consequent education and application of safety analytics and quality improvement programs in anaesthesia departments. Children remain at higher risk than adults because of additional complexities such as drug dose calculations, increased susceptibility to some adverse effects and changes associated with growth and maturation. Major improvements are best made through institutional system changes rather than a commitment to do better on the part of each practitioner. Summary Medication errors in paediatric anaesthesia represent an important risk to children and most are avoidable. There is now an understanding of the genesis of adverse drug events and this understanding should facilitate the implementation of known effective countermeasures. An institution-wide commitment and strategy are the basis for a worthwhile and sustained improvement in medication safety. Correspondence to Professor Brian J. Anderson, PhD, FANZCA, FCICM, Department of Anaesthesiology, University of Auckland, Faculty of Medical and Health Sciences, Auckland 1023, New Zealand. Tel: +64 9 3074903; fax: +64 9 3078986; e-mail: briana@adhb.govt.nz Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Hand distance modulates the electrophysiological correlates of target selection during a tactile search task

Psychophysiology, EarlyView.


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B-15. Waveform analysis of sympathetic skin response

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Minoru Toyokura
The author analyzed waveform of sympathetic skin response (SSR). Waveforms were classified as either the P-type, in which the positive component was larger than the negative one, or the N-type, in which the negative component was larger the positive one. P-type-SSR had shorter latency and larger amplitude than N-type-SSR. Among 50 subjects 14 and 9 ones had only the P-type and N-type during 20 electrical stimulations, respectively. The remaining 27 subjects had both types. Habituation was associated with waveform changes from P to N types. Palm-SSR had the largeer amplitude and more common appearance of P-type waveform than sole-SSR. When the stimulation was increased, the SSR size became larger. Strong responses likely produced large P-type-SSR. The waveform and size of SSR seemed to be rather consistent in individuals even if the stimulation modality was changed. SSRs from two palm sites had significantly shorter latencies and larger amplitudes than the SSRs evoked from proximal sites of the forearm (paradoxical shortening of the latency). The SSR waveform pattern was not affected by the pathological condition related to diabetes. These findings above can be explained by a model of the equivalent current dipole caused by the Na+ concentration gradient in terms of SSR generation.



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Contents

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5





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B-3. Electroencephalography and seizures learned from ictal recording

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Masaki Iwasaki, Naoki Ikegaya, Yuiko Kimura, Yuu Kaneko
Experience on ictal video electroencephalography (EEG) recording enriches knowledge on EEG and seizures. Following five fundamentals are important for correct interpretation of EEG during focal epileptic seizures.Epileptic seizures never happen without EEG changes.Epileptic seizure propagates.EEG changes are not necessarily visible.EEG changes occur as a remote effect.EEG seizure explains clinical symptoms.Focal epileptic seizure starts with several patterns such as low voltage fast activity or repetitive spikes, followed by ictal rhythm that evolves spatially from focal to diffuse area, and temporally from low amplitude fast to high amplitude slow waves. The seizure propagation can occur very rapidly. For the sensitivity of EEG depends on the distance from source to electrode, EEG seizure may only appear after seizure activity involves adequately large area of cortex. The seizure activity limited to the deep area such as mesial temporal region will not appear in scalp EEG. Slow rhythmic activity can be induced in the remote cortex as an inhibitory effect of focal seizure, so that diffuse delta rhythm at the beginning of seizure may not localize the seizure onset zone. Epileptogenic zone is estimated by correlating supposed EEG seizure localization and clinical symptoms.



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Shimazono-Lecture-1. What I have done using TMS techniques

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Yoshikazu Ugawa
CMCT, CTX-BST CT, BST-Cv CT, CCCT, CECT: Using brainstem and conus medullaris stimulation in combination with the motor cortical and spinal nerve stimulation, we estimated conduction delays at several segments in CSTs.Cerebellar inhibition of the motor cortex (CBI): Purkinje cell activation by TMS induced a transient motor cortical inhibition. Mechanisms underlying ataxia was studied with this method.Shor interval intracortical inhibition (SICI): We showed the dependency of SICI on the motor cortical TMS pulse directions, which gave us a hint about the mechanisms of SICI. Neuroplasticity induction by QPS: We have introduced quadripulse stimulation (QPS) for steady plasticity induction in human brain. Using this method, we have shown the normal and abnormal motor or sensory cortical plasticity, drug influence on the plasticity, and also mechanisms for speech production, motor sequence learning or other human performances.Treatments by rTMS and combination with other methods: We have shown some clinical beneficial effects in patients with Parkinson's disease by rTMS over supplementary motor cortex or other areas.Spike time dependent spinal cord plasticity: We induced spike timing dependent plasticity at the CST- spinal motor neuron synapses with combination of brainstem stimulation and peripheral nerve stimulation.



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B-10. Electrodiagnostic studies in entrapment neuropathy

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Mitsuhiko Kodama
Electrodiagnosis of entrapment neuropathy at the upper limb is important to determine the treatment procedure. The median sensory nerve conduction studies and median nerve motor nerve distal latency have conventionally been performed for the diagnosis of carpal tunnel syndrome (CTS), but their sensitivities are not always sufficient. As a result of our research in 104 hands with CTS symptoms, both the ring finger test and second lumbrical–interossei comparison test had especially high sensitivity (92%), and this result supports the practice parameters recommended by the Japanese Society of Neurological Therapeutics. Exact localization of the lesion by electrodiagnosis in patients with ulnar neuropathy at the elbow (UNE) is often difficult because other disorders may mimic its symptoms (e.g., cervical lesion, brachial plexopathy, and Guyon's canal syndrome). In one of our studies, sensitivity of the ulnar nerve motor nerve conduction velocity across the elbow lacked accuracy (54%). Meanwhile, the short-segment incremental study had the highest sensitivity (82%), maintaining high specificity (95%). In extreme UNEs, the combination of sensory nerve conduction studies evoked from the dorsal ulnar cutaneous branch and the medial antebrachial cutaneous nerve may be helpful in the exclusion of other disorders.



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Editorial Board

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5





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Clinical utility of EEG in diagnosing and monitoring epilepsy in adults

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): W.O. Tatum, G. Rubboli, P.W. Kaplan, S.M. Mirsatari, K. Radhakrishnan, D. Gloss, L.O. Caboclo, F.W. Drislane, M. Koutroumanidis, D.L. Schomer, D. Kastelijn-Nolst Trenite, Mark Cook, S. Beniczky
Electroencephalography (EEG) remains an essential diagnostic tool for people with epilepsy (PWE). The International Federation of Clinical Neurophysiology produces new guidelines as an educational service for clinicians to address gaps in knowledge in clinical neurophysiology. The current guideline was prepared in response to gaps present in epilepsy-related neurophysiological assessment and is not intended to replace sound clinical judgement in the care of PWE. Furthermore, addressing specific pathophysiological conditions of the brain that produce epilepsy is of primary importance though is beyond the scope of this guideline. Instead, our goal is to summarize the scientific evidence for the utility of EEG when diagnosing and monitoring PWE.



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B-9. Quantitative evaluation of motor function and its clinical application

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Shinji Kakei
A classic hypothesis for motor control assumes that the predictive controller (PC) and the feedback controller (FBC) work in parallel. Nevertheless, dissociation of outputs from the two controllers has never been possible, preventing evaluation of motor functions in movement disorders. Here we demonstrate a new method to separate outputs from PC and FBC. Subjects performed a tracking movement to pursue a slowly moving target, while we recorded movement with a manipulandum or a Kinect v2 sensor. We identified three components of tracking movement that were separable with FFT and identified in terms of their function. The primary, a lower frequency component (<0.5 Hz) continuously reproduced the target motion in a predictive manner. The second, an intermediate frequency component (0.5–3.0 Hz) represented intermittent corrections of position errors in a feedback manner. These results confirmed that the two components were generated from separate controllers. Furthermore, we identified the third, an even higher frequency component (>3.0 Hz), which showed characteristic increases in patients with Parkinson's disease or stroke. Each of the three components provides unique parameters to quantify motor function of patients with movement disorders. Our new method provides a new framework to characterize movement disorders.



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A-19. Visual evoked potentials: Basic technology and clinical applications

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Yoshinobu Goto
Visual information is processed simultaneously via multiple parallel channels and each channel constitutes a set of sequential processes. The visual evoked potentials (VEPs) are the evoked electrophysiological potential that can be extracted, using signal averaging, from the electroencephalographic activity recorded at the scalp. VEPs can provide important diagnostic information regarding the functional integrity of the visual pathways and the visual cortex. Commonly used visual stimuli are flashing lights or pattern reversal (checkerboards or gratings) on the TV monitor or video screen. Pattern reversal is the preferred technique for most clinical purposes. The results of pattern reversal stimuli are less variable in the waveform and the timing than the results elicited by other stimuli. The pattern onset/offset technique can be useful in the detection of malingering and in patients with nystagmus, and the flash VEP is particularly useful when optical factors or poor cooperation make the use of pattern stimulation inappropriate. In addition, pattern reversal VEP to full-field stimulation is best suited to evaluate anterior visual pathways while hemi-field VEP is most effective in the assessment of chiasmal and post-chiasmal functions. This article presents the basic technology and current standard for flash and pattern reversal VEP recording methods based on the major parallel pathways of the visual system from the retina to the primary visual cortex via lateral geniculate nucleus that receive visual input.



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B-7. Electrodiagnostic criteria for ALD: Current state and perspectives

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Satoshi Kuwabara
The diagnosis of amyotrophic lateral sclerosis (ALS) requires (1) evidence for extensive upper and lower motor neuron dysfunction, (2) progressive course, and (3) exclusion of other causes of motor neuronal loss. So far, a number of diagnostic criteria for ALS have been proposed, such as El Escorial (1990), revised El Escorial (1998), Awaji (2008), and updated Awaji (2015). According to the frequent revision/proposal criteria, electrodiagnostic criteria for ALS are somewhat confusing. In these criteria, the body motor system are divided into 4 regions; cranial, cervical, thoracic, and lumbosacral, and evidence for upper and lower motor neuron signs in the two or more regions are required for the diagnosis of "probable" ALS. This lecture reviews a history, current status, and perspectives for ALS electrogiagnosis. The diagnostic sensitivity latest version, the updated Awaji criteria is reported to be 73% in a recent systematic review.



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B-13. Educational lecture B-13. Fun of needle electromyography

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Kazuto Akaboshi
I think that many physicians feel "needle electromyography is interesting?" But it is interesting if you can understand and boring if you can not. For that, it is important to know the meaning of electromyogram waveform. Since any of these waveforms is a potential originating from the muscle fibers, it is natural that the appearances are similar, and experts can not judge only by that "shape". They judge based on the rhythm of the waveform and muscular strength. It is important to know the characteristics of the waveform, for example, whether the waveform originates from one muscle fiber, whether it is firing as a motor unit, or a potential arising from multiple muscle fibers not related to motor units. It is also important to know whether the potential is generated by voluntary muscle contraction, irrelevant to muscle contraction or induced by needle sticking. For example, there are fibrillation potentials, positive sharp waves, and myotonic discharges as potentials to be generated from one muscle fiber, and the motion unit potential and the fasciculation potential are potentials generated from the motion unit. In this presentation, we will briefly describe other potentials and clinical points.



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B-17. Future and problems of neurorehabilitation – The concept of smart rehabilitation

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Meigen Riu
To develop and apply revolutionary neurorehabilitation (NR) technologies, findings from neuroscientific studies and clinical evidence must be collected, intellectual property must be managed, and NR technologies must be commercialized, approved by the Pharmaceutical and Medical Device Act, and put into commercial operation. The development of NR devices, such as the brain-machine interface (BMI) NR device by the Medical Engineering Coordination Team at Keio University, is supported by multiple grants from the Japan Agency for Medical Research and Development (AMED) focused on different phases and continuing on a clear path toward application. Taking EEG-BMI NR system developed to improve severe upper extremity paresis after stroke as an example, we will explain how the above-mentioned process has been achieved.In the near future, we plan to systemize in the cloud revolutionary NR device groups under development as well as existing superior NR devices, and to continue integrating these into a "smart NR office" that can seamlessly provide systematic, cutting-edge NR based on determined indications. We therefore aim to optimize, streamline, and advance NR treatments and dramatically expand the range of therapeutic potential, bringing about a revolution in NR.



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SP-2. What dose TMS stimulate?

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Ying-Zu Huang
Transcranial magnetic stimulation (TMS) is a technique to stimulate the nervous system non-invasively through the intact scalp and skin. The TMS machine delivers a short pulse of electric current into a TMS coil to generate a quick changing magnetic field surrounding the coil as an example of Ampere's law. TMS stimulates the neuronal circuits with the eddy current induced by the changing magnetic field, not the magnetic field its self, based on Faraday's law. To generate enough power for stimulating human's brain, a TMS machine is generally built to generate a current of around 8000 A for a 2.5–4 Tesla output, although it may vary between machine types and manufacturers. TMS is capable of stimulating human's cortex to induce recordable responses, e.g. motor evoked potentials (MEPs). However, how TMS actives the circuits and what TMS stimulates is in fact more complicated than most people think. The current knowledge of what TMS stimulates is mainly learned from the stimulation over the motor cortex generating MEPs. In this session, the mechanism of TMS will be explained, the effects of TMS over the motor cortex will be introduced and the underlying mechanisms of how TMS induces such responses and effects will be discussed.



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Shourei Prize 2. Utility of TMS for neuroscience of speech

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Takenobu Murakami
Transcranial magnetic stimulation (TMS) has widely been accepted as a useful method of non-invasive brain stimulation in neuroscience. Compared with neuroimaging and intraoperative mapping, the number of speech experiments using TMS has, however, still been small. Here, an introduction to recent TMS studies that explored speech perception and imitation is presented. Single-pulse TMS of the primary motor cortex (M1) showed a speech specific and topographically specific increase of excitability in the M1 lip area during speech perception. This may be explainable by the motor theory of speech perception and reflect the function of mirror neurons. The updated speech model is constituted of dual speech processing streams; dorsal and ventral streams. A paired-coil stimulation demonstrates an increase in the effective connectivity from brain regions in the dorsal stream to the M1 lip area. Application of repetitive TMS (rTMS) to parts of the dorsal stream can modulate performance of phonological recognition, whereas semantic perception is altered by rTMS over the ventral pathway. Speech imitation combined with facilitatory rTMS over the left posterior inferior frontal gyrus can enhance accuracy of imitation performance. In summary, TMS is an innovative tool to understand the brain network of speech processing on perception and imitation.



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B-2. Clinical application of patterned DC stimulation

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Tatsuya Mima
In addition to conventional surgical and pharmacological methods, electromagnetic interventions to the human brain have been developed for testing and treating neuropsychiatric disorders. Considering that the central principle of brain coding is based on neural firings and cell membrane potentials, that is electrical phenomena, electromagnetic intervention to the brain can be useful and effective for modulating brain functions.Among various electromagnetic methods, the most advanced one is the transcranial magnetic stimulation (TMS) which was put into practical use in 1985. The transcranial direct current stimulation (tDCS) whose usefulness has been reconfirmed since the late 1990s is spreading as a simple and inexpensive brain function intervention method. With regard to the safety of tDCS, it is not strong enough to cause neural firing itself, so there is the advantage that epilepsy and other health risks are extremely low.Instead of applying tDCS at a constant current, a patterned current stimulation performed by a variable current – one example of which is AC stimulation (tACS) – can be useful for efficiently modifying brain function with low energy by entrainment. This is because oscillation is important as a general organization principle of brain function (Grant-in-Aid for Scientific Research on Innovative Areas "Oscillology"). Regarding the oscillation phenomenon, it is known that entrainment occurs between oscillations of similar frequencies and synchronization of phase difference is likely to occur even in communication with a small amount of energy. It has been shown that it is possible to synchronize EEG activity to tACS in alpha rhythm.Currently, we are studying whether it is possible to reconstruct gait function in Parkinson patients by patterned current stimulation synchronized with walking rhythm. In this educational lecture, we describe the importance of the oscillation in the brain function and the clinical application of the patterned current stimulation.



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B-4. Neurophysiology of sleep in humans

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Makoto Uchiyama
Studies on EEG slowing in the progression of sleep since the discovery of electroencephalogram (EEG) in the 1920s, and identification of rapid eye movement (REM) sleep in the 1950s lead to the current principle that human sleep consists of REM and non-REM (NREM) sleep cycles. In this lecture, I will review sleep-wake homeostasis. Quantitative analysis of sleep EEG has revealed that delta EEG activity is enhanced according to the length of prior wakefulness, and achieved the recovery of the brain. This provides understanding on those clinical facts that disturbed sleep accelerates physical or mental disorders. I will also review a recent topic that deep NREM sleep with delta EEG activity is an active brain process, in which memory and skills acquired during wakefulness are consolidated and made to be ready for use. In addition, such delta EEG activity during sleep is more strongly induced in those cortical areas where intensive task is loaded during wakefulness. Finally, I will consider how the above processes are controlled by the network between the thalamus and the cortex, with special reference to its relation to conventional sleep EEG patterns such as K-complex, spindle or sleep delta waves.



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B-11. Application of EEG-based brain computer interface to movement and sensory disorders

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Tetsuo Ota
ObjectiveTo examine the effect of the EEG-based brain computer interface (BCI) training for patients with stroke, writer's cramp and neuropathic pain. Method: Using the EEG recorded with Ag/AgCl electrodes placed at C3 and C4, as designated according to the International 10/20 system, we gave real time visual feedback to the patients with PC monitor which is placed in front of them. Participants were required to imagine the affected wrist extending in stroke and neuropathic pain patients. Patients with writer's cramp were requested to relax their wrist flexor while extending their wrist. If these tasks were able to have an effect to the affected sensory motor cortex, we can see the change of patient's sensory motor rhythm, for example what is called event-related desynchronization (ERD). While practicing this biofeedback system, patients made an effort to control their affected side EEG activity representing the ERD in stroke and neuropathic pain patients, and diminishing the event-related synchronization (ERS) in writer's cramp patients. Results: After several months BCI training, some patients with stroke and neuropathic pain were able to change their EEG activity easily to have the ERD and after the 6 months training one writer's cramp patient was able to diminish the ERS resulted in good performance. Moreover we could also confirm this change in stroke patients representing the sensory motor cortex activity by recording the functional MRI. Implications/Impact on Rehabilitation: The results suggest that this type of EEG-based brain computer interface training is useful method to improve some kinds of movement and sensory disorders.



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B-14. Pathophysiological diagnosis of status epilepticus with complementary use of the periictal MRI (arterial spin labeling perfusion and diffusion-weighted images) and EEG

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Takato Morioka
In the diagnosis of nonconvulsive status epilepticus (NCSE), capture of ongoing ictal EEG findings is the gold standard; however, this is practically difficult without continuous EEG monitoring facilities. MRI, including diffusion-weighted imaging (DWI) and perfusion MRI with arterial spin labeling (ASL), have been applied mainly in emergency situations. Recent reports have described that ictal MRI findings, including ictal hyperperfusion on ASL and cortical hyperintensity of cytotoxic edema on DWI, can be obtained from epileptically activated cortex. We demonstrate the diagnostic value of ictal MRI findings in 15 patients diagnosed as having NCSE (eight had complex partial status epilepticus (SE) and seven subtle SE) who underwent an initial MRI and subsequent routine EEG. In all 10 patients with an epileptogenic lesion, there was a tight topographical relationship between the lesion and the localization of ictal MRI findings. In the other five patients, ictal MRI findings were useful in the diagnosis of NCSE of non-lesional elderly epilepsy, or de novo NCSE of frontal origin as situation-related NCSE. The present study clearly demonstrates that the initial use of ASL and DWI has the ability to diagnose partial NCSE and also allows documentation of the pathophysiological mechanism in each patient.



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B-16. Artificial neural connection using a computer interface

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Yukio Nishimura
Functional loss of limb control in individuals with spinal cord injury or stroke can be caused by transection of descending pathways those connects cortical to spinal network, although neural circuits locate above and below the impaired site remains their function. I will show an artificial neuronal connection (ANC) that bridges supra-spinal system and spinal network beyond the lesion site restore lost function. The ANC was produced by a computer interface that can detect the neural activity and converted in real-time to activity-contingent electrical stimuli delivered to nervous system. A promising application is to bridge impaired biological connections, a paradigm that was demonstrated for cortically controlled electrical stimulation of paralyzed forearm muscles. ANC have clinical potential for restoring walking ability in patients with spinal cord injury. A clinical application of the ANC is the volitional walking in could be restored by muscle-controlled non-invasive magnetic stimulation to lumbar spinal cord. Patients with severe SCI could regain voluntarily-controlled walking which are initiate, stop walking and change the step cycles through ANC. These paradigms have numerous potential applications, depending on the input signals, the computed transform and the output targets.



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B-18. Where ‘ERP’ is and where it is going?

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Publication date: May 2018
Source:Clinical Neurophysiology, Volume 129, Issue 5
Author(s): Hirooki Yabe
Sutton (1965) classified Event-Related Potentials (ERPs) into exogenous and endogenous components. Exogenous ERPs would reflect automatic processing and endogenous ones would reflect controlled processing (Picton and Hillyard, 1988). Only mismatch negativity (MMN), an automatic but endogenous ERP found by Näätänen et al. (1978), does not match this classification. MMN is automatically elicited by occasional deviation in a sequence of homogenous sounds. MMN is considered to be generated by the comparison process between deviated sound and neural trace of preceding sounds encoded in sensory memory. Plenty of studies have given evidence for "memory trace theory". MMN provides a promising tool for clinical populations, because MMN elicitation does not require any tasks and MMN to duration deviation (i.e., duration-MMN) is exceptionally sensitive to clinical populations such as schizophrenia. Michie et al. (2000) reported that only duration-MMN was reliably reduced in patients with schizophrenia. Todd et al. (2007) also reported that a definite reduction in early schizophrenia was evident in duration-MMN but not frequency deviants. Impairment of MMN is one of the most robust findings in schizophrenia. MMN to duration is a candidate of the trait marker. Importantly, MNN reduction predict conversion to psychosis among the subjects clinically at risk-mental state (ARMS).



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