Strength and stability of EEG functional connectivity predict treatment response in infants with epileptic spasms

Publication date: Available online 4 August 2018

Source: Clinical Neurophysiology

Author(s): Daniel W. Shrey, Olivia Kim McManus, Rajsekar Rajaraman, Hernando Ombao, Shaun A. Hussain, Beth A. Lopour

Abstract

Objective

Epileptic spasms (ES) are associated with pathological neuronal networks, which may underlie characteristic EEG patterns such as hypsarrhythmia. Here we evaluate EEG functional connectivity as a quantitative marker of treatment response, in comparison to classic visual EEG features.

Methods

We retrospectively identified 21 ES patients and 21 healthy controls. EEG data recorded before treatment and after ≥10 days of treatment underwent blinded visual assessment, and functional connectivity was measured using cross-correlation techniques. Short-term treatment response and long-term outcome data were collected.

Results

Subjects with ES had stronger, more stable functional networks than controls. After treatment initiation, all responders (defined by cessation of spasms) exhibited decreases in functional connectivity strength, while an increase in connectivity strength occurred only in non-responders. There were six subjects with unusually strong pre-treatment functional connectivity, and all were responders. Visually assessed EEG features were not predictive of treatment response.

Conclusions

Changes in network connectivity and stability correlate to treatment response for ES, and high pre-treatment connectivity may predict favorable short-term treatment response. Quantitative measures outperform visual analysis of the EEG.

Significance

Functional networks may have value as objective markers of treatment response in ES, with potential to facilitate rapid identification of personalized, effective treatments.

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A correlation study of continuously monitored gamma dose rate and meteorological conditions

Publication date: December 2018

Source: Journal of Environmental Radioactivity, Volume 192

Author(s): Yan-Jun Huang, Zhi-Hong Shang-Guan, Feng Zhao, Ming-Gui Lin, Xiang-Dong Sha, Dun-Ye Luo, Qian Chen, Kai Peng

Abstract

In this paper, the correlations between the continuously monitored gamma dose rate (GDR) and meteorological parameters, including precipitation, air temperature, relative humidity, air pressure, wind direction, and wind speed, were analyzed by using one year of the hourly dataset from a monitoring system with ten stations. The correlation coefficients are varied by the range of each meteorological parameter. Precipitation would enhance the GDR up to 84%, which is highly related to precipitation intensity and ground type. Strong and positive correlation between the GDR and light precipitation was identified, while the correlation was reduced with increasing of precipitation. Air temperature could cause a fluctuation of the average GDR within the range 1.8–5.3 nGy h⁻¹, and different correlation characteristics were indicated for low and high air temperature. The GDR was positively correlated with relative humidity, though relative humidity is inversely correlated with air temperature. Correlations between the GDR and air pressure were mainly negative. Diurnal variations between the GDR and the air temperature, relative humidity, and air pressure were also analyzed. The wind played an important role also in the fluctuation of the GDR with the GDR difference up to 2.00 nGy h⁻¹ averaged from the sixteen wind-directions. Lower GDR can be found in the direction of prevailing wind because of the dilution effect of the radon progenies in the surface air. In this paper, some exploratory interpretation of physical influence mechanisms of meteorological parameters on the GDR was also presented, which suggests further work should be carried out to explore the variation and correlation principle.

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Evaluating the progressive cardiovascular health benefits of short-term high-intensity interval training

Abstract

Purpose

High-intensity training is recognised as a time-efficient way of improving aerobic fitness. However, there is a lack of consensus regarding the temporal nature of adaptation response and which peripheral and cardiac changes occur using the same exercise stimulus and protocol. Therefore, this study aimed to evaluate the progression of vascular and cardiac changes over a 6-week training period.

Methods

Twelve healthy males (age 21 ± 2 years; 42.5 ± 8.3 ml min⁻¹ kg⁻¹) participated in a high-intensity training programme consisting of 1-min sprints, interspersed with 2 min active recovery, 3 days/week for 6 weeks on a cycle ergometer. Cardiac, vascular, blood lipids and VO_2max measurements were taken at 0, 3 and 6 weeks and compared against a participant-matched control group (age 21 ± 2 years; 37.7 ± 8.3 ml min⁻¹ kg⁻¹).

Results

There was a significant improvement in VO_2max (42.5 ± 8.3–47.4 ± 8.5 ml min⁻¹ kg⁻¹; p = 0.009) in the training group and a significant decrease in systolic blood pressure (8%) from 0 to 6 weeks (p = 0.025). There was a small yet significant decrease in ejection fraction and increased end-systolic volume in both groups over time (p = 0.01) with no significant interaction effect (p > 0.05). A between-group difference in peak velocity of early diastolic mitral annular motion was also observed (p = 0.01). No improvements were seen in blood lipid profiles, central arterial stiffness and cardiometabolic risk score.

Conclusions

Six weeks of high-intensity training increases aerobic fitness and is enough to stimulate initial reductions in peripheral pressure, but not sufficient to elicit structural and functional cardiac changes, reduce arterial stiffness or lower CV risk.

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Analgesic effects of methadone and magnesium following posterior spinal fusion for idiopathic scoliosis in adolescents: a randomized controlled trial

Abstract

Purpose

To provide optimal conditions for neurophysiological monitoring and rapid awakening, remifentanil is commonly used during pediatric spinal surgery. However, remifentanil may induce hyperalgesia and increase postoperative opioid requirements. We evaluated the potential of methadone or magnesium to prevent remifentanil-induced hyperalgesia.

Methods

Using a prospective, randomized, blinded design, adolescents presenting for posterior spinal fusion to treat idiopathic scoliosis were assigned to receive desflurane with remifentanil alone (REMI), remifentanil + methadone (MET) (0.1 mg/kg IV over 15 min), or remifentanil + magnesium (MAG) (50 mg/kg bolus over 30 min followed by 10 mg/kg/h). Primary outcomes were opioid requirements and postoperative pain scores. Secondary outcomes included intraoperative anesthetic requirements, neurophysiological monitoring conditions, and emergence times.

Results

Data analysis included 60 patients. Total opioid requirement (hydromorphone) in the REMI group (received perioperatively and on the inpatient ward) was 0.34 ± 0.11 mg/kg compared to 0.26 ± 0.10 mg/kg in the MET group (95% confidence interval (CI) of difference: − 0.14, − 0.01; p = 0.035). The difference in opioid requirements between the REMI and MET group was related to intraoperative dosing (0.04 ± 0.02 mg/kg vs. 0.02 ± 0.01 mg/kg; 95% CI of difference: − 0.01, − 0.02; p = 0.003). No difference was noted in pain scores, and no differences were noted when comparing the REMI and MAG groups.

Conclusion

With the dosing regimens in the current study, the only benefit noted with methadone was a decrease in perioperative opioid requirements. However, given the potential for hyperalgesia with the intraoperative use of remifentanil, adjunctive use of methadone appears warranted.

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Neonatal Abstinence Syndrome (NAS) in Southwestern Border States: Examining Trends, Population Correlates, and Implications for Policy

Abstract

Introduction Neonatal abstinence syndrome (NAS) is withdrawal syndrome in newborns following birth and is primarily caused by maternal drug use during pregnancy. This study examines trends, population correlates, and policy implications of NAS in two Southwest border states. Materials and Methods A cross-sectional analysis of Hospital Inpatient Discharge Data (HIDD) was utilized to examine the incidence of NAS in the Southwest border states of Arizona (AZ) and New Mexico (NM). All inpatient hospital births in AZ and NM from January 1, 2008 through December 31, 2013 with ICD9-CM codes for NAS (779.5), cocaine (760.72), or narcotics (760.75) were extracted. Results During 2008–2013 there were 1472 NAS cases in AZ and 888 in NM. The overall NAS rate during this period was 2.83 per 1000 births (95% CI 2.68–2.97) in AZ and 5.31 (95% CI 4.96–5.66) in NM. NAS rates increased 157% in AZ and 174% in NM. NAS newborns were more likely to have low birth weight, have respiratory distress, more likely to have feeding difficulties, and more likely to be on state Medicaid insurance. AZ border region (border with Mexico) had NAS rates significantly higher than the state rate (4.06 per 1000 births [95% CI 3.68–4.44] vs. 2.83 [95% CI 2.68–2.97], respectively). In NM, the border region rate (2.09 per 1000 births [95% CI 1.48–2.69]) was significantly lower than the state rate (5.31 [95% CI 4.96–5.66]). Conclusions Despite a dramatic increase in the incidence of NAS in the U.S. and, in particular, the Southwest border states of AZ and NM, there is still scant research on the overall incidence of NAS, its assessment in the southwest border, and associated long-term outcomes. The Healthy Border (HB) 2020 binational initiative of the U.S.-Mexico Border Health Commission is an initiative that addresses several public health priorities that not only include chronic and degenerative diseases, infectious diseases, injury prevention, maternal and child health but also mental health and addiction. The growing opioid epidemic and rise in NAS cases in the Southwest border, as partially shown in this study, provides another opportunity to track health illnesses and outcomes in the Southwest border, especially because there are targeted resources through High Intensity Drug Trafficking Areas (HIDTA) funding.

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The Acute Metabolic and Vascular Impact of Interrupting Prolonged Sitting: A Systematic Review and Meta-Analysis

Abstract

Objective

The aim was to conduct a systematic review and meta-analysis analyzing the impact of up to 24 h of prolonged sitting on postprandial glucose, insulin and triglyceride responses, blood pressure and vascular function, in comparison to sitting interrupted with light- to moderate-intensity physical activity.

Methods

To be included, studies had to examine the impact of prolonged sitting lasting < 24 h in apparently healthy males or females of any age. Studies were identified from searches of the MEDLINE, CINAHL and SportDISCUS databases on July 6, 2016. Study quality was assessed using the Downs and Black Checklist; publication bias was assessed via funnel plot.

Results

Forty-four studies met the inclusion criteria for the systematic review; of these, 20 were included in the meta-analysis, which compared prolonged sitting to the effects of interrupting sitting with regular activity breaks on postprandial glucose, insulin and triglycerides. When compared to prolonged sitting, regular activity breaks lowered postprandial glucose (d = − 0.36, 95% confidence interval [CI] − 0.50 to − 0.21) and insulin (d = − 0.37, 95% CI − 0.53 to − 0.20), but not triglyceride responses (d = 0.06, 95% CI − 0.15 to 0.26). Subgroup analyses indicated reductions in postprandial triglyceride responses only occurred 12–16 h after the intervention. The magnitude of the reductions in glucose, insulin or triglyceride response was not modified by the intensity of the activity breaks, the macronutrient composition of the test meal, or the age or body mass index of participants.

Conclusion

Prolonged sitting results in moderate elevations in postprandial glucose and insulin responses when compared to sitting interrupted with activity breaks.

PROSPERO ID

CRD42015020907.

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SpyCatcher: Use of a Novel Cholangioscopic Snare for Capture and Retrieval of a Proximally Migrated Biliary Stent

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