Early prediction of encephalopathic transformation in children with benign epilepsy with centro-temporal spikes

BackgroundMost children with Benign epilepsy with centro-temporal spikes (BECTS) undergo remission during late adolescence and do not require treatment. In a small group of patients, the condition may evolve to encephalopathic syndromes including epileptic encephalopathy with continuous spike-and-wave during sleep (ECSWS), or Landau-Kleffner Syndrome (LKS). Development of prediction models for early identification of at-risk children is of utmost importance.AimTo develop a predictive model of encephalopathic transformation using data-driven approaches, reveal complex interactions to identify potential risk factors.MethodsData were collected from a cohort of 91 patients diagnosed with BECTS treated between the years 2005–2017 at a pediatric neurology institute. Data on the initial presentation was collected based on a novel BECTS ontology and used to discover potential risk factors and to build a predictive model. Statistical and machine learning methods were compared.ResultsA subgroup of 18 children had encephalopathic transformation. The least absolute shrinkage and selection operator (LASSO) regression Model with Elastic Net was able to successfully detect children with ECSWS or LKS. Sensitivity and specificity were 0.83 and 0.44. The most notable risk factors were fronto-temporal and temporo-parietal localization of epileptic foci, semiology of seizure involving dysarthria or somatosensory auras.ConclusionNovel prediction model for early identification of patients with BECTS at risk for ECSWS or LKS. This model can be used as a screening tool and assist physicians to consider special management for children predicted at high-risk. Clinical application of machine learning methods opens new frontiers of personalized patient care and treatment.     

Guillain–Barré syndrome as a parainfectious manifestation of SARS-CoV-2 infection: A case series

The global SARS-CoV-2 pandemic posed an unprecedented challenge to almost all fields of medicine and Neurology is not an exception. Collecting information about its complications and related conditions will help clinicians to become more confident in managing this disease. Guillain-Barre Syndrome (GBS) is mostly described as a post-infectious phenomenon and its occurrence during acute phase of illness is of interest. GBS has recently been reported during the active phase of COVID-19 for the first time. Severity and fast progression of GBS associated with COVID-19 have also been shown in recent studies. Here we report three cases of GBS during the active phase of COVID-19 with severe symptoms and fast progression to quadriplegia and facial diplegia over 2 days, which led to death in one case due to severe autonomic dysfunction. We suggest SARS-CoV-2 might be associated with rather a severe, rapidly progressive and life-threatening phenotype of GBS.     

Delayed sleep–wake phase disorder in young adults: prevalence and correlates from a national survey of Norwegian university students

BackgroundDelayed sleep–wake phase disorder (DSWPD) during adolescence has been linked to impaired health and poor functioning. However there is a dearth of knowledge about DSWPD in young adulthood. We seek to contribute knowledge on the prevalence and correlates of DSWPD in this age group.MethodsData were drawn from a 2018 national survey of students in higher education in Norway (the SHoT-study). All 162,512 fulltime students in Norway were invited to participate and 50,054 students (69.1% women) aged 18–35 years were included (response rate = 30.8%). DSWPD was assessed by self-report, and was operationalized according to the criteria for DSWPD in the most recent edition of the International Classification of Sleep Disorders. Correlates of DSWPD were examined by validated self-report instruments covering a wide range of demographic and health domains.ResultsThe overall prevalence of DSWPD was 3.3%, and significantly higher in male (4.7%) than female (2.7%) students. DSWPD was associated with being single, having financial difficulties, having divorced parents, being overweight/obese, and physical inactivity. Students with DSWPD had more sleep problems during weekdays, and higher levels of somatic and mental health problems. Students with DSWPD also had an elevated risk of self-harm-related thoughts and behaviors as well as suicidality.ConclusionDSWPD remains a significant problem among young adults, and the high symptom load across health domains indicates that suggests a need for existing evidence-based approaches to be scaled for college students who present with DSWPD.     

Optimizing Deep Brain Stimulation Parameters in Obsessive–Compulsive Disorder

ObjectivesDeep brain stimulation (DBS) is an innovative and effective treatment for patients with therapy-refractory obsessive–compulsive disorder (OCD). DBS offers unique opportunities for personalized care, but no guidelines on how to choose effective and safe stimulation parameters in patients with OCD are available. Our group gained relevant practical knowledge on DBS optimization by treating more than 80 OCD patients since 2005, the world’s largest cohort. The article’s objective is to share this experience.Materials and MethodsWe provide guiding principles for optimizing DBS stimulation parameters in OCD and discuss the neurobiological and clinical basis.ResultsAdjustments in stimulation parameters are performed in a fixed order. First, electrode contact activation is determined by the position of the electrodes on postoperative imaging. Second, voltage and pulse width are increased stepwise, enlarging both the chance of symptom reduction and of inducing side effects. Clinical evaluation of adjustments in stimulation parameters needs to take into account: 1) the particular temporal sequence in which the various OCD symptoms and DBS side-effects change; 2) the lack of robust response predictors; 3) the limited sensitivity of the Yale-Brown Obsessive–Compulsive Scale to assess DBS-induced changes in OCD symptoms; and 4) a patient’s fitness for additional cognitive-behavioral therapy (CBT).ConclusionsDecision-making in stimulation parameter optimization needs to be sensitive to the particular time-courses on which various symptoms and side effects change.     

Relative Rigidity of Cell–Substrate Effects on Hepatic and Hepatocellular Carcinoma Cell Migration

Abstract

Polyacrylamide gels with different stiffness and glass were employed as substrates to investigate how substrate stiffness affects the cellular stiffness of adherent hepatocellular carcinoma (HCCLM3) and hepatic (L02) cells. The interaction of how cell-substrate stiffness influences cell migration was also explored. An atom force microscope measured the stiffness of HCCLM3 and L02 cells on different substrates. Further, F-actin assembly was analyzed using immunofluorescence and Western blot. Finally, cell-surface expression of integrin β1 was quantified by flow cytometry. The results show that, while both HCCLM3 and L02 cells adjusted their cell stiffness to comply with the stiffness of the substrate they were adhered to, their tuning capabilities were different. HCCLM3 cell stiffness complied when substrate stiffness was between 1.1 and 33.7 kPa, whereas the analogous stiffness for L02 cells occurred at a higher substrate stiffness, 3.6 kPa up to glass. These ranges correlated with F-actin filament assembly and integrin β1 expression. In a migration assay, HCCLM3 cells migrated faster on a relatively soft substrate, while L02 cells migrated faster on substrates that were relatively rigid. These findings indicate that different tuning capabilities of HCCLM3 and L02 cells may influence cell migration velocity on substrates with different stiffness by regulating cy- toskeleton remodeling and integrin β1 expression.     

Molecular characterization of Echinococcus granulosus in south-eastern Romania: evidence of G1–G3 and G6–G10 complexes in humans

Echinococcus granulosus is the aetiological agent of cystic echinococcosis (CE), which is a public health problem in many eastern European countries, particularly in Romania, where the infection causes a high number of human and animal cases. To shed light on the transmission patterns of the parasite, we performed a genotyping analysis on 60 cyst samples obtained from patients who live in south-eastern Romania and who underwent surgery for liver or lung CE. DNA was extracted from the endocysts or the cyst fluids, and fragments of cytochrome c oxidase subunit 1 and NADH dehydrogenase subunit 1 mitochondrial genes (cox1 and nd1, respectively) were amplified by PCR and sequenced. We found that most of the samples analysed (59/60) belonged to the G1–G3 complex (E. granulosus sensu stricto), which contains the most widespread and infective strains of the parasite. We also identified the first human patient infected by a non-G1–G3 genotype of E. granulosus in this country. As the DNA sequence of this cyst sample showed maximum homology with the G6–G10 complex (Echinococcus canadensis), this is, in all likelihood, a G7 genotype, which is often found in pigs and dogs in most countries of eastern and south-eastern Europe.     

Parent–child attachment,academic performance and the process of high-school dropout: a narrative review

Poor academic performance is a strong predictor of school dropout. Researchers have tried to disentangle variables influencing academic performance. However, studies on preschool and early care variables are seldom examined when explaining the school dropout process. We reviewed the literature on the relationship between caregiver–child attachment and academic performance, including attachment studies from preschool years, seeking out potential contributions to academic performance and the dropout process. The review was organized according to a model of four main mediating hypotheses: the attachment-teaching hypothesis, the social network hypothesis, the attachment-cooperation hypothesis, and the attachment self-regulation hypothesis. The results of the review are summed up in a model. There is some support for all four hypotheses. The review indicates that attachment and early care contribute substantially to dropout and graduation processes. Mediation effects should be given far more attention in future research.