Standardized Computer‐based Organized Reporting of EEG: SCORE

The electroencephalography (EEG) signal has a high complexity, and the process of extracting clinically relevant features is achieved by visual analysis of the recordings. The interobserver agreement in EEG interpretation is only moderate. This is partly due to the method of reporting the findings in free‐text format. The purpose of our endeavor was to create a computer‐based system for EEG assessment and reporting, where the physicians would construct the reports by choosing from predefined elements for each relevant EEG feature, as well as the clinical phenomena (for video‐EEG recordings). A working group of EEG experts took part in consensus workshops in Dianalund, Denmark, in 2010 and 2011. The faculty was approved by the Commission on European Affairs of the International League Against Epilepsy (ILAE). The working group produced a consensus proposal that went through a pan‐European review process, organized by the European Chapter of the International Federation of Clinical Neurophysiology. The Standardised Computer‐based Organised Reporting of EEG (SCORE) software was constructed based on the terms and features of the consensus statement and it was tested in the clinical practice. The main elements of SCORE are the following: personal data of the patient, referral data, recording conditions, modulators, background activity, drowsiness and sleep, interictal findings, “episodes” (clinical or subclinical events), physiologic patterns, patterns of uncertain significance, artifacts, polygraphic channels, and diagnostic significance. The following specific aspects of the neonatal EEGs are scored: alertness, temporal organization, and spatial organization. For each EEG finding, relevant features are scored using predefined terms. Definitions are provided for all EEG terms and features. SCORE can potentially improve the quality of EEG assessment and reporting; it will help incorporate the results of computer‐assisted analysis into the report, it will make possible the build‐up of a multinational database, and it will help in training young neurophysiologists.     

Weekly 5-fluorouracil and high-dose folinic acid in combination with epidoxorubicin as first-line therapy in advanced breast cancer: a phase II study

A total of 25 patients with advanced breast cancer were treated weekly with i.v. 5-fluorouracil at 350 mg/m², folinic acid at 500 mg/m², and epidoxorubicin at 35 mg/m² as first-line chemotherapy for a maximum of 18 cycles. In all, 24 patients were evaluable for response. Overall, 1 patient achieved a complete response and 11 patients showed a partial response, for an objective response rate of 50%; the median duration of response was 18.3+ months and median survival amounted to 18.8+ months. Side effects were generally mild, with grade II leukopenia occurring in 10 patients and grade III leukopenia, in 1 patient. Other toxicity included nausea and vomiting (82%), diarrhea (48%), stomatitis (48%), and alopecia (92%), all of which were mainly restricted to WHO grades I and II. Our results suggest that leucovorin modulation of 5-fluorouracil can safely be incorporated into combination chemotherapy with epidoxorubicin on the investigated schedule. The observed response rate appears comparable with the obtained with other first-line regimens.     

The "novelty response" in an electric fish: response properties and habituation

The electromotor behavior evoked by novel sensory stimuli in the electrogenic teleost fish Gnathonemus petersii was examined. Novelty responses (NRs) consisted of a transient accelerations of the rate of electric organ discharges following a change in sensory input. NRs were basically similar in nontreated and in immobilized (treated with curare) fish. NRs could be evoked reliably by brief novel stimuli of all four sensory modalities (acoustic, visual, electrical. electrolocation) used in this study. Stimuli of a duration longer than 5 s caused an on- and off-response. A sudden change in the quality of an ongoing sensory stimulus also evoked novelty responses. NR properties depended on the stimulus modality, stimulus intensity, stimulus duration, and on the prior stimulus history. Habituation of several response parameters of the NR (latency, duration, maximal amplitude, response probability) occurred within a series of repetitive stimuli of a given sensory modality. Each modality appeared to habituate separately. Rate of habituation depended on stimulus intensity and on interstimulus interval. A strong disruptive stimulus of another modality lead to dishabituation. The novelty response evoked by stimuli of low or medium intensities resembled an "orienting response" as described by Sokolov.     

Immunoprofiles of 11 biomarkers using tissue microarrays identify prognostic subgroups in colorectal cancer

BACKGROUND AND AIMS: Genomewide expression profiling has identified a number of genes expressed at higher levels in colorectal cancer (CRC) than in normal tissues. Our objectives in this study were: 1) to test whether genes were also distinct on the protein level; 2) to evaluate these biomarkers in a series of well-characterized CRCs; and 3) to apply hierarchical cluster analysis to the immunohistochemical data. METHODS: Tissue microarrays (TMAs) comprising 351 CRC specimens from 270 patients were constructed to evaluate the genes Adam10, Cyclin D1, Annexin II, NFKB, Casein kinase 2 beta (CK2B), YB-1, P32, Rad51, c-fos, IGFBP4, and Connexin26 (Cx26). In total, 3,797 samples were analyzed. RESULTS: Unsupervised hierarchical clustering discovered subgroups of CRC that differed by tumor stage and survival. Kaplan-Meier analysis showed that reduced Cx26 expression was significantly associated with shorter patient survival and higher tumor grade (G1/G2 vs G3, P = .02), and Adam10 expression with a higher tumor stage (pT1/2 vs pT3/4, P = .04). CONCLUSIONS: Our study highlights the potential of TMAs for a higher-dimensional analysis by evaluating serial sections of the same tissue core (three-dimensional TMA analysis). In addition, it endorses the use of immunohistochemistry supplemented by hierarchical clustering for the identification of tumor subgroups with diagnostic and prognostic signatures.     

A mutation in the zebrafish Na,K-ATPase subunit atp1a1a.1 provides genetic evidence that the sodium potassium pump contributes to left-right asymmetry downstream or in parallel to nodal flow.

While there is a good conceptual framework of dorsoventral and anterioposterior axes formation in most vertebrate groups, understanding of left-right axis initiation is fragmentary. Diverse mechanisms have been implied to contribute to the earliest steps of left-right asymmetry, including small molecule signals, gap junctional communication, membrane potential, and directional flow of extracellular liquid generated by monocilia in the node region. Here we demonstrate that a mutation in the zebrafish Na,K-ATPase subunit atp1a1a causes left-right defects including isomerism of internal organs at the anatomical level. The normally left-sided Nodal signal spaw as well as its inhibitor lefty are expressed bilaterally, while pitx2 may appear random or bilateral. Monocilia movement and fluid circulation in Kupffer's vesicle are normal in atp1a1a(m883) mutant embryos. Therefore, the Na,K-ATPase is required downstream or in parallel to monocilia function during initiation of left-right asymmetry in zebrafish.     

Behavioral genetic analyses of self-reported anxiety at 7 years of age

OBJECTIVE: To conduct behavioral genetic analyses of self-reported childhood anxiety at 7 years of age. METHOD: Three hundred twenty-six same-sex twin pairs (174 monozygotic, 152 dizygotic) completed the Revised Children's Manifest Anxiety Scale at 7 years of age. Behavioral genetic analyses were conducted on the total and subscale scores. RESULTS: Monozygotic within-pair correlations were higher than dizygotic correlations for physiological and social anxiety symptoms, suggesting heritable influences on these aspects. These results were found to be statistically significant with structural equation modeling. CONCLUSION: Certain symptoms of self-reported anxiety in children 7 years of age seem to result, at least in part, from genetic factors. Physiological and social anxiety symptoms, which may be related to behavioral inhibition, appear to be genetically influenced. These results are linked to previous findings in older children and adults.     

Current practices with thrombolytic therapy

This article discusses the current approach of using thrombolytic therapy as treatment for acute myocardial infarction (MI). The etiology of acute MI is reviewed along with recent research findings from definitive clinical trials. The mechanism of action of thrombolysis is described, and the available and investigational thrombolytic agents are compared. Complications of thrombolytic therapy and assessment indicators of reperfusion are presented. Key aspects of the nurse's role in the management of thrombolytic therapy are highlighted.     

The effects of caffeine and aspirin on mood and performance

Caffeine, in addition to being a food constituent, is also a common analgesic adjuvant that is used in combination with aspirin in certain over-the-counter preparations. Caffeine has previously been shown to significantly improve certain aspects of human performance, particularly sustained vigilance, when administered in low and moderate doses (32 to 256 mg). We therefore attempted to determine whether caffeine, in the dose (64 mg) found in some over-the-counter drugs, retains this beneficial property when combined with aspirin. We also measured self-reported mood state, using various standardized questionnaires, since caffeine has been reported to have both beneficial and adverse effects on alertness and anxiety. We observed that caffeine (64 mg), when added to aspirin (800 mg), significantly improves vigilance performance and increases self-reported efficiency when compared with either placebo or aspirin alone. As previously reported, this caffeine dose alone significantly increased vigilance and decreased reaction time. No adverse effects of caffeine were detected on any of the parameters that were assessed. This study therefore demonstrated that the addition of caffeine to aspirin, in a dose commonly employed in over-the-counter drugs, has significant beneficial consequences with respect to mood and performance.