Alzheimer’s disease: The state of the art in resting-state magnetoencephalography

Publication date: August 2017
Source:Clinical Neurophysiology, Volume 128, Issue 8
Author(s): M.M.A. Engels, W.M. van der Flier, C.J. Stam, A. Hillebrand, Ph. Scheltens, E.C.W. van Straaten
Alzheimer's disease (AD) is accompanied by functional brain changes that can be detected in imaging studies, including electromagnetic activity recorded with magnetoencephalography (MEG). Here, we systematically review the studies that have examined resting-state MEG changes in AD and identify areas that lack scientific or clinical progress. Three levels of MEG analysis will be covered: (i) single-channel signal analysis, (ii) pairwise analyses over time series, which includes the study of interdependencies between two time series and (iii) global network analyses. We discuss the findings in the light of other functional modalities, such as electroencephalography (EEG) and functional magnetic resonance imaging (fMRI). Overall, single-channel MEG results show consistent changes in AD that are in line with EEG studies, but the full potential of the high spatial resolution of MEG and advanced functional connectivity and network analysis has yet to be fully exploited. Adding these features to the current knowledge will potentially aid in uncovering organizational patterns of brain function in AD and thereby aid the understanding of neuronal mechanisms leading to cognitive deficits.



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Benefits of an individualized perioperative plan for children with autism spectrum disorder

Summary

Background

Perioperative care for children with autism spectrum disorder may be challenging. Previous investigators recommend development of an individualized perioperative management plan with caregiver involvement.

Aim

The primary goal was to determine the usefulness of an individualized plan based on the decision to provide preoperative sedation stratified by autism spectrum severity level. Secondary goals were to assess the effectiveness of the plan based on subjective assessment of patient behavior at induction of anesthesia and caregiver satisfaction.

Methods

We developed an individualized plan for each child with autism spectrum disorder scheduled for anesthesia. Children were categorized by autism spectrum disorder severity level. With institutional ethics approval, we conducted a retrospective chart review to document need for preoperative sedation, sedation stratified by autism spectrum disorder severity level, behavior at induction, and caregiver satisfaction.

Results

Between 2012 and 2014, we successfully prepared a plan for 246 (98%) of 251 surgical or diagnostic procedures in 224 patients. Severity level was distributed as 45% Severity Level 1 and Asperger's, 25% Severity Level 2, and 30% Severity Level 3. The majority (90%) of cases were scheduled as day surgery. Preoperative sedation increased with increasing severity level: Severity Level 1 (21%) or Asperger's (31%), Severity Level 2 (44%), and Severity Level 3 (56%). The odds ratio for sedation use was 5.5 [CI: 2.6-11.5, P<.001] with Severity Level 3 vs Severity Level 1 patients. Cooperation at induction of anesthesia was 90% overall with preoperative sedation administered to 94 (38%) of the entire cohort. Cooperation was greatest in Severity Level 1 (98%) and Asperger's patients (93%) and somewhat less (85%) in patients in Severity Levels 2 and 3. The plan was helpful to guide sedation choices as cooperation did not differ between sedated and unsedated children at any severity level (overall χ²=2.87 P=.09).

Satisfaction among caregivers contacted was 98%.

Conclusion

The results suggest that an individualized plan is helpful in the perioperative management of children with autism spectrum disorder and that knowledge of autism spectrum disorder severity level may be helpful in determining the need for preoperative sedation.

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Introduction of color-flow injection test to confirm intravascular location of peripherally placed intravenous catheters

Summary

Background

The incidence of infiltration and extravasation when using peripheral intravenous catheters is high in pediatric patients. Due to the lack of a gold standard test to confirm intravascular location of a peripherally placed intravenous catheter, we introduce a novel method, the color-flow injection test to assess the intravascular location of these catheters. For the color-flow injection test, 1 mL of normal saline was injected within 2 seconds in the distal intravenous catheter and changes in color-flow via ultrasonography were observed at the proximal draining veins. The primary objective of the study was to demonstrate feasibility of the color-flow injection test.

Methods

A prospective study was conducted on children <18 years old undergoing general anesthesia. All peripheral intravenous catheters were subject to the color-flow injection test and standard confirmation tests.

Results

Out of the 100 patients enrolled, 22 patients came to the operating room with preexisting peripheral intravenous catheters. Intraoperatively, 105 attempts were made on 78 patients of which 27 catheters were considered as infiltrated during their placement. A final set of 100 catheters were considered for intraoperative usage after they had passed at least one of the standard confirmatory tests. For the color-flow injection test, the ideal sites for ultrasound evaluation of proximal draining veins were the axillary veins and femoral veins. The color-flow injection test was positive in 93 of the 100 catheters with color-flow changes noticed in the proximal veins during the saline injection. Of the 100 catheters, infiltration around seven catheter sites were observed within 2 hours of intraoperative usage and the color-flow injection test was negative in these seven catheters. The color-flow injection test was also negative in the 27 catheters that had infiltrated during their placement. The color-flow injection test was sensitive at 100% [95% confidence interval (CI)=95-100] and specific at 100% (95% CI=56-100) to indicate intravascular location.

Conclusion

We were able to confirm intravascular location of peripheral intravenous catheters using the color-flow injection test in pediatric patients. The test can lead to early recognition of malfunctioning peripheral intravenous catheters and decrease rate of infiltration-extravasation injuries associated with their use.

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Plant genetics: Branching out for crop improvement

Nature Reviews Genetics 18, 393 (2017). doi:10.1038/nrg.2017.48

Author: Darren J. Burgess

Inflorescence architecture is the arrangement of flowers and their underlying stem branching patterns, and it has important effects on the yield of the fruits or grains from agricultural plants. A new study dissects key genetic underpinnings of tomato inflorescence branching, which not only provides insight

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Associating cellular epigenetic models with human phenotypes

Nature Reviews Genetics 18, 441 (2017). doi:10.1038/nrg.2017.32

Authors: Tuuli Lappalainen & John M. Greally

Epigenetic association studies have been carried out to test the hypothesis that environmental perturbations trigger cellular reprogramming, with downstream effects on cellular function and phenotypes. There have now been numerous studies of the potential molecular mediators of epigenetic changes by epigenome-wide association studies (EWAS). However,

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Plant genetics: Spatial transcriptomics in plants

Nature Reviews Genetics 18, 394 (2017). doi:10.1038/nrg.2017.41

Author: Liesbet Lieben

Spatial transcriptomics combines histological imaging and RNA sequencing to simultaneously quantify and localize gene expression. Giacomello et al. have now optimized this technique for plant tissues, which pose specific challenges compared with mammalian tissues, such as the presence of cell walls, vacuoles, chloroplasts and

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Cancer genomics: Tracking cancer evolution

Nature Reviews Genetics 18, 391 (2017). doi:10.1038/nrg.2017.43

Author: Carolina Perdigoto

Understanding tumour heterogeneity and evolution is essential for the early detection of disease recurrence and the efficient treatment of cancer. Two recent studies published in Nature and in the New England Journal of Medicine prospectively tracked the evolutionary dynamics of early-stage non-small-cell lung

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