Esthesioneuroblastoma: An Update on the UCLA Experience, 2002–2013

Objectives To profile the clinical presentation and treatment results of esthesioneuroblastomas at the University of California, Los Angeles (UCLA), from 2002 to 2013. Design Retrospective review. Setting Tertiary academic institution. Participants Forty-one patients with esthesioneuroblastomas treated at UCLA. Main Outcome Measures Overall survival (OS) and recurrence-free survival (RFS). Results Thirty-six patients were included with a mean age of 50.1 years and a median duration of follow-up of 33 months. The 5-year RFS and OS were 54% and 82%, respectively. Modified Kadish stage was the only factor identified to affect OS. Multivariate analysis demonstrated that tumor grade was the only factor that had an independent impact on RFS. There was no statistical difference in survival among the surgical approaches chosen. Conclusions The updated data on the UCLA experience reveals that all three surgical approaches chosen provide comparable survival, although longer follow-up will be needed to ascertain if these findings hold true. The endoscopic approach had a statistically significant decrease in length of hospital stay and a trend toward reduced blood loss, intensive care unit admission, and complications. The modified Kadish staging was the only factor identified to predict OS. Multivariate analysis revealed that tumor grade was an independent predictor of recurrence; therefore, its importance should be emphasized in future staging systems.     

Current concepts in combination antibiotic therapy for critically ill patients

Widespread emergence of multidrug resistant (MDR) bacterial pathogens is a problem of global dimension. MDR infections are difficult to treat and frequently associated with high mortality. More than one antibiotic is commonly used to treat such infections, but scientific evidence does not favor use of combination therapy in most cases. However, there are certain subgroups where combination therapy may be beneficial, e.g. sepsis due to carbapenem-resistant Enterobacteriaceae (CRE), bacteremic pneumococcal pneumonia, and patients with multiple organ failure. Well-designed prospective studies are needed to clearly define the role of combination therapy in these subgroups.     

Prenatal growth in humans and postnatal brain maturation into late adolescence

Prenatal life encompasses a critical phase of human brain development, but neurodevelopmental consequences of normative differences in prenatal growth among full-term pregnancies remain largely uncharted. Here, we combine the power of a within-monozygotic twin study design with longitudinal neuroimaging methods that parse dissociable components of structural brain development between ages 3 and 30 y, to show that subtle variations of the in utero environment, as indexed by mild birth weight (BW) variation within monozygotic pairs, are accompanied by statistically significant (i) differences in postnatal intelligence quotient (IQ) and (ii) alterations of brain anatomy that persist at least into late adolescence. Greater BW within the normal range confers a sustained and generalized increase in brain volume, which in the cortical sheet, is specifically driven by altered surface area rather than cortical thickness. Surface area is maximally sensitive to BW variation within cortical regions implicated in the biology of several mental disorders, the risk for which is modified by normative BW variation. We complement this near-experimental test of prenatal environmental influences on human brain development by replicating anatomical findings in dizygotic twins and unrelated singletons. Thus, using over 1,000 brain scans, across three independent samples, we link subtle differences in prenatal growth, within ranges seen among the majority of human pregnancies, to protracted surface area alterations, that preferentially impact later-maturing associative cortices important for higher cognition. By mapping the sensitivity of postnatal human brain development to prenatal influences, our findings underline the potency of in utero life in shaping postnatal outcomes of neuroscientific and public health importance.     

Environmental reduplicative paramnesia in a case of atypical Alzheimer’s disease

A 79-year-old patient with neuropathologically confirmed Alzheimer’s disease (AD) presented with a selective environmental reduplicative paramnesia (RP), the belief that one or more environments exist simultaneously in two or more physical locations. Clinical presentation and neuropathological examination revealed an atypical form of AD. High neurofibrillary tangle densities were observed in the frontal and temporal association cortex, whereas the parietal and entorhinal cortex, as well as the hippocampus, were nearly spared. These findings are compared to those reported in frontal and frontotemporal variants of AD and discussed in the light of current anatomoclinical models for environmental RP.     

Frequency–moment signatures: A method for automated seizure detection from scalp EEG

Objectives

To investigate patient-specific automated epileptic seizure detection from scalp EEG using a new technique: frequency–moment signatures.

Methods

Signatures were calculated from 32 s blocks of data of electrode differences from the right (RH) and left hemisphere (LH). Discrete Fourier transforms of 15 data subsets were calculated per block per hemisphere. The spectral powers at a given frequency from the RH and LH were combined into a single quantity. The signature elements were found by subtracting normalised central moments of the subset distribution from the mean, to measure the consistency of the spectral power at a given frequency over all subsets. The seizure measure was the logarithm of the probability that a signature belonged to a control set of non-seizure signatures.

Results

Following the optimisation of signature parameters using three one-day recordings from each of 12 patients, performance was tested on a separate set of data from the same patients. The method had a sensitivity of 91.0% (total 34 seizures) with 0.020 false positives per hour (total 618 h).

Conclusions

Frequency–moment signatures promise automated seizure detection sensitivities comparable to visual identification and other published methods, with improved false detection rates.

Significance

This technique has the potential to be used more widely in EEG analysis.     

Adaptive reorganization of cortical networks in Alzheimer’s disease

ObjectiveThe impact of neuronal cell loss associated with Alzheimer’s disease (AD) on the network organization of the brain is poorly understood. Here we investigated whether modifications in resting-state functional connectivity (FC) are associated with cognitive function of AD patients.MethodsHigh-density electroencephalograms (EEGs) were obtained from patients with early stages of AD and elderly healthy controls. Cortical oscillations were reconstructed with an adaptive spatial filter. Maps of imaginary coherence (IC) between brain areas were compared between groups and correlated with cognitive performance.ResultsParietal and medial temporal lobes of AD patients showed a disruption of alpha band FC to the rest of the brain. However, an adaptive extension of the language network to the right hemisphere could be observed in AD patients and was correlated with better verbal fluency. A shift of FC from alpha frequencies to theta frequencies could be observed in a memory network and was associated with better verbal memory performance.ConclusionsNot only dysfunctional but also adaptive network reorganization occurs in early AD.SignificanceThe network mechanisms for preserved cognitive functioning may inform novel treatment strategies for AD in the future.