The neglected role of the right hemisphere in spatial representation of words for reading

Background: Previous studies have indicated that focal brain damage can result in different types of “neglect dyslexia” (reading errors specific to the side of printed material contralateral to the side of brain damage).Aims: To identify the sites of lesions (or dysfunctional brain tissue) responsible for distinct types of neglect dyslexia, to inform a functional neuroanatomical model of brain regions involved in early stages of reading.Methods & Procedures: A battery of tests of hemispatial neglect and reading designed to distinguish neglect dyslexia in different reference frames (viewer-centred, stimulus-centred, and object-centred) was administered to 95 patients within 48 hours of onset of nondominant hemisphere stroke. Magnetic resonance diffusion and perfusion imaging was obtained on the same day as testing. Associations between each type of neglect dyslexia and areas of hypoperfusion and/or infarct were evaluated using chi-squared tests.Outcomes & Results: Viewer-centred neglect dyslexia was associated with hypoperfusion and/or infarct in right angular and supramarginal gyri and visual association cortex (“dorsal stream”). Stimulus-centred neglect dyslexia was associated with hypoperfusion and/or infarct of right superior temporal cortex (“ventral stream”). Object-centred neglect dyslexia was observed only with hypoperfusion and/or infarct of non-dominant superior temporal cortex in left-handed individuals.Conclusions: The identified associations provide evidence that different regions of cortex are critical for spatial attention to, or processing of, representations of words with distinct coordinate frames in the reading task.     

The Crucial Role of Posterior Frontal Regions in Modality Specific Components of the Spelling Process

Although it is commonly assumed that posterior temporo-parietal regions are the regions of the brain essential for accessing orthographic representations for written output, patients with lesions in these areas also have reading and/or naming impairments at least early after stroke onset. This observation raises the possibility that these regions are important for components of spelling that are not specific to written output. The goal of the present study was to identify any regions of the brain that, when damaged, result in selective impairment in accessing orthographic representations for written output. We studied 54 consecutive right-handed patients with acute, left hemisphere ischemic stroke, who were able to perform the motor aspects of writing with the right hand and had at least a 10th grade education, on a battery of lexical tasks designed to identify impaired and spared cognitive processes underlying spelling and with advanced magnetic resonance imaging. Only five patients had pure agraphia, and had evidence of impaired access to lexical-orthographic representations for output; and all five had infarct or ischemia in Brodmann’s area 44 and 45. Analysis of performance across tasks of three of these patients, whose performance has not been previously reported, provides evidence for additional impairment in converting graphemes to letter shapes or letter-specific motor programs. These three patients, unlike previously reported patients with lexical-orthographic impairment and compromised function in Brodmann’s area 44 and 45, also had infarcts in Brodmann’s area 6. On the basis of these cases, and those in the literature, we propose a network of brain regions involved in writing words, each with a separate function. This proposal emphasizes the role of left posterior frontal regions in modality-specific output processes.     

Methicillin-resistant Staphylococcus aureus (MRSA) in an Austrian urological department: 10 years experience covering 95.161 patients

Purpose

So far, few data is available on Methicillin-resistant Staphylococcus aureus (MRSA) infections in urology. To obtain a better insight into MRSA infections, we studied prevalence, colonization and infection site and clinical implications of MRSA in a urological department over a 10-year period.

Methods

A retrospective study of all patients diagnosed with MRSA for the first time over a 10-year period was set-up.

Results

Between 2000 and 2009, a total of 95.161 in- and outpatients were seen at our department. The prevalence of patients with newly diagnosed MRSA was low, that is, <0.1 % per year (mean 0.07%, 0.02–0.1 %). In total, 62 MRSA cases were identified over a 10-year period. MRSA incidence was 10 times higher in inpatients (0.2 %) than in outpatients (0.02 %). Asymptomatic MRSA colonization was present in 25/62 patients (40.3 %), the remaining 59.7 % (37/62) showed clinical symptoms: MRSA positive swabs from open wounds were seen in 10/62 patients (16.1 %). Urinary tract infections were seen in 26/10 patients (41.9 %), while life-threatening MRSA sepsis occurred in one patient only over a decade.

Conclusions

In summary, we observed very low rates of MRSA colonization and infection. Still, complications like delayed wound healing, development of abscess and even sepsis may occur.     

Detection of triclocarban and two co-contaminating chlorocarbanilides in US aquatic environments using isotope dilution liquid chromatography tandem mass spectrometry

The antimicrobial compound triclocarban (TCC; 3,4,4'-trichlorocarbanilide; CAS# 101-20-2) is a high-production-volume chemical, recently suggested to cause widespread contamination of US water resources. To test this hypothesis, we developed an isotope dilution liquid chromatography electrospray ionization tandem mass spectrometry method for ultratrace analysis of TCC (0.9 ng/L detection limit) and analyzed low-volume water samples (200 mL) along with primary sludge samples from across the United States. All river water samples (100%) collected downstream of wastewater treatment plants had detectable levels of TCC, as compared to 56% of those taken upstream. Concentrations of TCC (mean+/-standard deviation) downstream of sewage treatment plants (84+/-110 ng/L) were significantly higher (P<0.05; Wilcoxon rank sum test) than those of samples taken upstream (12+/-15 ng/L). Compared to surface water, mean TCC concentrations found in dried, primary sludge obtained from municipal sewage treatment plants in five states were six orders of magnitude greater (19,300+/-7100 microg/kg). Several river samples contained a co-contaminant, identified based on its chromatographic retention time, molecular base ion, and MS/MS fragmentation behavior as 4,4'-dichlorocarbanilide (DCC; CAS# 1219-99-4). In addition to TCC and DCC, municipal sludge contained a second co-contaminant, 3,3',4,4'-tetrachlorocarbanilide (TetraCC; CAS# 4300-43-0). Both newly detected compounds were present as impurities (0.2%(w/w) each) in technical grade TCC (99%). Application of the new method for chlorocarbanilide analysis yielded TCC occurrence data for 13 US states, confirmed the role of sewage treatment plants as environmental inputs of TCC, and identified DCC and TetraCC as previously unrecognized pollutants released into the environment alongside TCC.     

Photoaffinity Analog of the Semisynthetic Echinocandin LY303366: Identification of Echinocandin Targets in Candida albicans

The echinocandins are a family of cyclic lipopeptides with potent antifungal activity. These compounds inhibit the synthesis of β-1,3-glucan in fungi. The new semisynthetic echinocandin LY303366 was derivatized to produce a photoactivatable cross-linking echinocandin analog with antifungal activity. This analog was radioiodinated and used as a probe in microsomal membrane preparations of Candida albicans which contain glucan synthase activity. The photoaffinity probe identified two major proteins of 40 and 18 kDa in both membrane preparations. Labeling of these proteins was specific in that it required irradiation with UV light and was effectively competed against with unlabeled echinocandin analogs. In addition, the abilities of echinocandin analogs to compete with the photoaffinity probe correlated to their relative antifungal potencies and glucan synthase inhibition. The 40-kDa protein was isolated, and partial sequences were obtained from internal peptide fragments of the protein. Analysis of the sequences of these internal peptides of the 40-kDa protein revealed that it was a new protein not previously described as being involved in glucan synthesis or the mode of action of echinocandins.     

Evaluation of Patient Expectations and Treatment Satisfaction after 1-Year Tadalafil Therapy for Erectile Dysfunction: The DETECT Study

IntroductionErectile dysfunction (ED) is a self-reported condition and satisfaction with sexual performance is individual, subjective, and multi-factorial. Treatment success depends on several outcomes. Tadalafil is a long-acting, selective inhibitor of phosphodiesterase 5 that has been shown to be effective at treating men with ED.AimTo investigate patient's ED treatment expectations at baseline; patient satisfaction with tadalafil treatment after 12 months; factors associated with satisfaction; and effect of early tadalafil treatment satisfaction on tadalafil continuation at 12 months.MethodsThe Determinants of Continued Use of Tadalafil study is a 12-month, prospective, pan-European, noninterventional, observational study, which enrolled 1,900 patients with ED wishing to initiate or change their treatment to tadalafil. Assessments were made on predefined treatment outcomes in a routine clinical setting.Main Outcome MeasuresInternational Index of Erectile Function-erectile function domain scores (at baseline, 1, 6, and 12 month visit), ED Inventory of Treatment Satisfaction (EDITS) scores (after 1, 6, and 12 months), and patient expectation questionnaire (at baseline visit) were analyzed for these patients.ResultsData were available from 1,567 patients (82%) after 12 months, with similar baseline characteristics as the initial cohort. Treatment expectations identified as important included: erection hardness and ability to maintain erection through intercourse completion (>92% of patients); confidence, partner satisfaction, and naturalness (>84% of patients); rapid effect and long duration of treatment (>75% of patients). Continued tadalafil use from 1,319 (84%) patients at 12 months were reported. Total EDITS scores for those continuing treatment was 85.9 (95% CI: 85.1–86.7). Increased satisfaction was associated with higher effectiveness, number of sexual attempts, partner support, good relationships, and good drug tolerance. Treatment satisfaction at 1 month was best predictive of treatment continuation at 12 months.ConclusionsEighty-four percent of patients reported continued use of tadalafil after 12 months. High satisfaction after first month of treatment was the best predictor of treatment continuation. Perimenis P, Roumeguere T, Heidler H, Roos E, Belger M, and Schmitt H. Evaluation of patient expectations and treatment satisfaction after one year tadalafil therapy for erectile dysfunction: The DETECT study.