Determination of Doxazosin Mesylate in Tablets by RP-HPLC

A simple, precise and rapid RP-HPLC method was developed for the determination of doxazosin mesylate in pharmaceutical formulations. The method was carried out on a Chromolith RP-C₁₈ column using a mixture of potassium phosphate buffer and methanol (40:60 v/v) and detection was done at 251 nm. The linearity range was 1-5 μg/ml. The retention time of the drug was 3.8 min. The LOD and LOQ were found to be 0.1 μg/ml and 0.5 μg/ml, respectively.

Causal density and integrated information as measures of conscious level

An outstanding challenge in neuroscience is to develop theoretically grounded and practically applicable quantitative measures that are sensitive to conscious level. Such measures should be high for vivid alert conscious wakefulness, and low for unconscious states such as dreamless sleep, coma and general anaesthesia. Here, we describe recent progress in the development of measures of dynamical complexity, in particular causal density and integrated information. These and similar measures capture in different ways the extent to which a system's dynamics are simultaneously differentiated and integrated. Because conscious scenes are distinguished by the same dynamical features, these measures are therefore good candidates for reflecting conscious level. After reviewing the theoretical background, we present new simulation results demonstrating similarities and differences between the measures, and we discuss remaining challenges in the practical application of the measures to empirically obtained data.

Behaviour of Granger causality under filtering: theoretical invariance and practical application

Granger causality (G-causality) is increasingly employed as a method for identifying directed functional connectivity in neural time series data. However, little attention has been paid to the influence of common preprocessing methods such as filtering on G-causality inference. Filtering is often used to remove artifacts from data and/or to isolate frequency bands of interest. Here, we show [following Geweke (1982)] that G-causality for a stationary vector autoregressive (VAR) process is fully invariant under the application of an arbitrary invertible filter; therefore filtering cannot and does not isolate frequency-specific G-causal inferences. We describe and illustrate a simple alternative: integration of frequency domain (spectral) G-causality over the appropriate frequencies ("band limited G-causality"). We then show, using an analytically solvable minimal model, that in practice G-causality inferences often do change after filtering, as a consequence of large increases in empirical model order induced by filtering. Finally, we demonstrate a valid application of filtering in removing a nonstationary ("line noise") component from data. In summary, when applied carefully, filtering can be a useful preprocessing step for removing artifacts and for furnishing or improving stationarity; however filtering is inappropriate for isolating causal influences within specific frequency bands.

Role of Biopsy from Gastric Corpus in Diagnosis of Helicobacter pylori Infection in Patients on Acid Suppression Therapy

There are reports of migration of Helicobacter pylori from the gastric antrum to the proximal stomach following acid suppression therapy. The diagnosis of H pylori infection is usually based on rapid urease test and histology of gastric antral biopsies. 50 consecutive patients of peptic ulcer, 22 on proton pump inhibitors and 28 on histamine-2 receptor antagonists for at least 4 weeks were subjected to biopsies from the gastric corpus in addition to the antrum at the time of upper gastrointestinal endoscopy. H pylori infection was detected in 42 (84%) patients. The diagnosis was established from both antral and corpus biopsies in 34 (68%) and only antrum in 4 (8%). In 4 patients, 3 on proton pump inhibitors and one on H-2 receptor antagonists, H pylori was isolated only from the corpus. The rapid urease test was positive at a mean time of 67.6 minutes from the antrum as compared to 234.6 minutes from the corpus. Testing for H pylori from the antrum alone and not the corpus would have resulted in a false negative result in 8% patients. Biopsy from the gastric antrum should always be combined with biopsy from gastric corpus for the diagnosis of H pylori infection in patients with dyspepsia on acid suppression therapy.

Dopamine-signaled reward predictions generated by competitive excitation and inhibition in a spiking neural network model

Dopaminergic neurons in the mammalian substantia nigra display characteristic phasic responses to stimuli which reliably predict the receipt of primary rewards. These responses have been suggested to encode reward prediction-errors similar to those used in reinforcement learning. Here, we propose a model of dopaminergic activity in which prediction-error signals are generated by the joint action of short-latency excitation and long-latency inhibition, in a network undergoing dopaminergic neuromodulation of both spike-timing dependent synaptic plasticity and neuronal excitability. In contrast to previous models, sensitivity to recent events is maintained by the selective modification of specific striatal synapses, efferent to cortical neurons exhibiting stimulus-specific, temporally extended activity patterns. Our model shows, in the presence of significant background activity, (i) a shift in dopaminergic response from reward to reward-predicting stimuli, (ii) preservation of a response to unexpected rewards, and (iii) a precisely timed below-baseline dip in activity observed when expected rewards are omitted.

Practical measures of integrated information for time-series data

A recent measure of 'integrated information', Φ(DM), quantifies the extent to which a system generates more information than the sum of its parts as it transitions between states, possibly reflecting levels of consciousness generated by neural systems. However, Φ(DM) is defined only for discrete Markov systems, which are unusual in biology; as a result, Φ(DM) can rarely be measured in practice. Here, we describe two new measures, Φ(E) and Φ(AR), that overcome these limitations and are easy to apply to time-series data. We use simulations to demonstrate the in-practice applicability of our measures, and to explore their properties. Our results provide new opportunities for examining information integration in real and model systems and carry implications for relations between integrated information, consciousness, and other neurocognitive processes. However, our findings pose challenges for theories that ascribe physical meaning to the measured quantities.

Detecting conscious awareness from involuntary autonomic responses

Can conscious awareness be ascertained from physiological responses alone? We evaluate a novel learning-based procedure permitting detection of conscious awareness without reliance on language comprehension or behavioural responses. The method exploits a situation whereby only consciously detected violations of an expectation alter skin conductance responses (SCRs). Thirty participants listened to sequences of piano notes that, without their being told, predicted a pleasant fanfare or an aversive noise according to an abstract rule. Stimuli were presented without distraction (attended), or while distracted by a visual task to remove awareness of the rule (unattended). A test phase included occasional violations of the rule. Only participants attending the sounds reported awareness of violations and only they showed significantly greater SCR for noise occurring in violation, vs. accordance, with the rule. Our results establish theoretically significant dissociations between conscious and unconscious processing and furnish new opportunities for clinical assessment of residual consciousness in patient populations.

Neural theories need to account for, not discount, introspection and behavior

Abstract A satisfying neuroscience of consciousness must account for phenomenological properties in terms of neural properties. While pursuing this project may challenge our intuitions about what we are conscious of, evidence from behavior and introspection should not be discounted. All three lines of evidence need to be integrated in order to naturalize phenomenal experience.

Measuring any conscious content versus measuring the relevant conscious content: comment on Sandberg et al

Sandberg et al. show that the Perceptual Awareness Scale (PAS) scale is sensitive compared to confidence ratings and wagering in detecting accurate perception. They go on to argue that the PAS scale is hence a sensitive measure of conscious perception compared to confidence ratings, a claim disputed here. The fact that some visual content is conscious does not entail that the visual content relevant to making a discrimination is conscious. For example, if one saw a square but was only aware of seeing a flash of something, then one has not consciously seen a square. When PAS and confidence ratings come in conflict, we suggest that it is confidence ratings that more reliably indicate the conscious status of contents allowing discrimination.

Multivariate Granger causality and generalized variance

Granger causality analysis is a popular method for inference on directed interactions in complex systems of many variables. A shortcoming of the standard framework for Granger causality is that it only allows for examination of interactions between single (univariate) variables within a system, perhaps conditioned on other variables. However, interactions do not necessarily take place between single variables but may occur among groups or "ensembles" of variables. In this study we establish a principled framework for Granger causality in the context of causal interactions among two or more multivariate sets of variables. Building on Geweke's seminal 1982 work, we offer additional justifications for one particular form of multivariate Granger causality based on the generalized variances of residual errors. Taken together, our results support a comprehensive and theoretically consistent extension of Granger causality to the multivariate case. Treated individually, they highlight several specific advantages of the generalized variance measure, which we illustrate using applications in neuroscience as an example. We further show how the measure can be used to define "partial" Granger causality in the multivariate context and we also motivate reformulations of "causal density" and "Granger autonomy." Our results are directly applicable to experimental data and promise to reveal new types of functional relations in complex systems, neural and otherwise.

Measuring autonomy and emergence via Granger causality

Concepts of emergence and autonomy are central to artificial life and related cognitive and behavioral sciences. However, quantitative and easy-to-apply measures of these phenomena are mostly lacking. Here, I describe quantitative and practicable measures for both autonomy and emergence, based on the framework of multivariate autoregression and specifically Granger causality. G-autonomy measures the extent to which the knowing the past of a variable helps predict its future, as compared to predictions based on past states of external (environmental) variables. G-emergence measures the extent to which a process is both dependent upon and autonomous from its underlying causal factors. These measures are validated by application to agent-based models of predation (for autonomy) and flocking (for emergence). In the former, evolutionary adaptation enhances autonomy; the latter model illustrates not only emergence but also downward causation. I end with a discussion of relations among autonomy, emergence, and consciousness.

Granger causality and transfer entropy are equivalent for Gaussian variables

Granger causality is a statistical notion of causal influence based on prediction via vector autoregression. Developed originally in the field of econometrics, it has since found application in a broader arena, particularly in neuroscience. More recently transfer entropy, an information-theoretic measure of time-directed information transfer between jointly dependent processes, has gained traction in a similarly wide field. While it has been recognized that the two concepts must be related, the exact relationship has until now not been formally described. Here we show that for Gaussian variables, Granger causality and transfer entropy are entirely equivalent, thus bridging autoregressive and information-theoretic approaches to data-driven causal inference.

A MATLAB toolbox for Granger causal connectivity analysis

Assessing directed functional connectivity from time series data is a key challenge in neuroscience. One approach to this problem leverages a combination of Granger causality analysis and network theory. This article describes a freely available MATLAB toolbox--'Granger causal connectivity analysis' (GCCA)--which provides a core set of methods for performing this analysis on a variety of neuroscience data types including neuroelectric, neuromagnetic, functional MRI, and other neural signals. The toolbox includes core functions for Granger causality analysis of multivariate steady-state and event-related data, functions to preprocess data, assess statistical significance and validate results, and to compute and display network-level indices of causal connectivity including 'causal density' and 'causal flow'. The toolbox is deliberately small, enabling its easy assimilation into the repertoire of researchers. It is however readily extensible given proficiency with the MATLAB language.

Epidemiological and clinical profile of irritable bowel syndrome in India: report of the Indian Society of Gastroenterology Task Force

AIMS

To study the profile of irritable bowel syndrome (IBS), and the frequency of such symptoms among the general population, in India.

METHODS

In this prospective, multi-center study, data were obtained from 2785 patients with chronic lower gastrointestinal symptoms (complainants) with no alarm feature and negative investigations for organic causes visiting physicians at 30 centers, and from 4500 community subjects (non-complainants), using separate questionnaires.

RESULTS

Most complainants were middle-aged (mean age 39.4 years) and male (1891; 68%). The common symptoms were: abdominal pain or discomfort (1958; 70%), abdominal fullness (1951; 70%); subjective feeling of constipation (1404 of 2656; 53%), or diarrhea (1252 of 2656, 47%), incomplete evacuation (2134; 77%), mucus with stools (1506; 54%), straining at stools (1271; 46%), epigastric pain (1364; 49%) and milk intolerance (906; 32%). Median stool frequency was similar in patients who felt they had constipation or those who felt they had diarrhea. Information to subtype symptoms using standard criteria was available in 1301 patients; of these, 507 (39%) had constipation-predominant IBS ( 3 <or= stools/week), 50 (4%) had diarrhea-predominant IBS (>3 stools/day) and 744 (57%) had indeterminate symptoms. Among non-complainants, most subjects reported daily defecation frequency of one (2520 [56%]) or two (1535 [34%]). Among non-complainants, 567 (12.6%) reported abdominal pain, 503 (11%) irregular bowel, 1030 (23%) incomplete evacuation, 167 (4%) mucus and 846 (18%) straining at stools; a combination of abdominal pain or discomfort relieved by defecation, and incomplete evacuation was present in 189/4500 (4.2%) community subjects.

CONCLUSIONS

Most patients with IBS in India are middle-aged men, and have a sense of incomplete evacuation and mucus with stools. Abdominal pain or discomfort is frequent but not universal. Importantly, stool frequency was similar irrespective of whether the patients felt having constipation or diarrhea. Most (90%) non-complainant subjects had 1 or 2 stools per day; symptoms complex suggestive of IBS was present in 4.2% of community subjects.

Measuring consciousness: relating behavioural and neurophysiological approaches

The resurgent science of consciousness has been accompanied by a recent emphasis on the problem of measurement. Having dependable measures of consciousness is essential both for mapping experimental evidence to theory and for designing perspicuous experiments. Here, we review a series of behavioural and brain-based measures, assessing their ability to track graded consciousness and clarifying how they relate to each other by showing what theories are presupposed by each. We identify possible and actual conflicts among measures that can stimulate new experiments, and we conclude that measures must prove themselves by iteratively building knowledge in the context of theoretical frameworks. Advances in measuring consciousness have implications for basic cognitive neuroscience, for comparative studies of consciousness and for clinical applications.

Embodied models of delayed neural responses: spatiotemporal categorization and predictive motor control in brain based devices

In order to respond appropriately to environmental stimuli, organisms must integrate over time spatiotemporal signals that reflect object motion and self-movement. One possible mechanism to achieve this spatiotemporal transformation is to delay or lag neural responses. This paper reviews our recent modeling work testing the sufficiency of delayed responses in the nervous system in two different behavioral tasks: (1) Categorizing spatiotemporal tactile cues with thalamic "lag" cells and downstream coincidence detectors, and (2) Predictive motor control was achieved by the cerebellum through a delayed eligibility trace rule at cerebellar synapses. Since the timing of these neural signals must closely match real-world dynamics, we tested these ideas using the brain based device (BBD) approach in which a simulated nervous system is embodied in a robotic device. In both tasks, biologically inspired neural simulations with delayed neural responses were critical for successful behavior by the device.

Introduction. Modelling natural action selection

Action selection is the task of resolving conflicts between competing behavioural alternatives. This theme issue is dedicated to advancing our understanding of the behavioural patterns and neural substrates supporting action selection in animals, including humans. The scope of problems investigated includes: (i) whether biological action selection is optimal (and, if so, what is optimized), (ii) the neural substrates for action selection in the vertebrate brain, (iii) the role of perceptual selection in decision-making, and (iv) the interaction of group and individual action selection. A second aim of this issue is to advance methodological practice with respect to modelling natural action section. A wide variety of computational modelling techniques are therefore employed ranging from formal mathematical approaches through to computational neuroscience, connectionism and agent-based modelling. The research described has broad implications for both natural and artificial sciences. One example, highlighted here, is its application to medical science where models of the neural substrates for action selection are contributing to the understanding of brain disorders such as Parkinson's disease, schizophrenia and attention deficit/hyperactivity disorder.

The ecology of action selection: insights from artificial life

The problem of action selection has two components: what is selected and how is it selected? To understand what is selected, it is necessary to distinguish between behavioural and mechanistic levels of description. Animals do not choose between behaviours per se; rather, behaviour reflects interactions among brains, bodies and environments. To understand what guides selection, it is useful to take a normative perspective that evaluates behaviour in terms of a fitness metric. This perspective, rooted in behavioural ecology, can be especially useful for understanding apparently irrational choice behaviour. This paper describes a series of models that use artificial life (AL) techniques to address the above issues. We show that successful action selection can arise from the joint activity of parallel, loosely coupled sensorimotor processes. We define a class of AL models that help to bridge the ecological approaches of normative modelling and agent- or individual-based modelling (IBM). Finally, we show how an instance of apparently suboptimal decision making, the matching law, can be accounted for by adaptation to competitive foraging environments.

Causal networks in simulated neural systems

Neurons engage in causal interactions with one another and with the surrounding body and environment. Neural systems can therefore be analyzed in terms of causal networks, without assumptions about information processing, neural coding, and the like. Here, we review a series of studies analyzing causal networks in simulated neural systems using a combination of Granger causality analysis and graph theory. Analysis of a simple target-fixation model shows that causal networks provide intuitive representations of neural dynamics during behavior which can be validated by lesion experiments. Extension of the approach to a neurorobotic model of the hippocampus and surrounding areas identifies shifting causal pathways during learning of a spatial navigation task. Analysis of causal interactions at the population level in the model shows that behavioral learning is accompanied by selection of specific causal pathways-"causal cores"-from among large and variable repertoires of neuronal interactions. Finally, we argue that a causal network perspective may be useful for characterizing the complex neural dynamics underlying consciousness.

Protein-c deficiency presenting with subacute intestinal obstruction due to mesenteric vein thrombosis

We describe a patient with protein C deficiency who presented with subacute intestinal obstruction due to ischaemic small bowel stricture. The patient also had left sided ileofemoral thrombosis. Venous thrombosis at unusual sites especially if associated with deep vein thrombosis of lower limb warrants a thorough screen for underlying thrombophilia. This, however, is a rare cause for ischaemic small bowel stricture.

Post-decision wagering measures metacognitive content, not sensory consciousness

A recent report by Persaud et al. [Persaud, N., McLeod, P. & Cowey, A. (2007). Post-decision wagering objectively measures awareness. Nature Neuroscience 10, 257-261] addresses a fundamental issue in consciousness science: the experimental measurement of conscious content. The authors propose a novel technique, 'post-decision wagering', in which subjects place bets on the correctness of decisions or discriminations. In this note, I critique the authors' claim that their method "measures awareness directly".

Distinguishing causal interactions in neural populations

We describe a theoretical network analysis that can distinguish statistically causal interactions in population neural activity leading to a specific output. We introduce the concept of a causal core to refer to the set of neuronal interactions that are causally significant for the output, as assessed by Granger causality. Because our approach requires extensive knowledge of neuronal connectivity and dynamics, an illustrative example is provided by analysis of Darwin X, a brain-based device that allows precise recording of the activity of neuronal units during behavior. In Darwin X, a simulated neuronal model of the hippocampus and surrounding cortical areas supports learning of a spatial navigation task in a real environment. Analysis of Darwin X reveals that large repertoires of neuronal interactions contain comparatively small causal cores and that these causal cores become smaller during learning, a finding that may reflect the selection of specific causal pathways from diverse neuronal repertoires.

Single-trial discrimination of truthful from deceptive responses during a game of financial risk using alpha-band MEG signals

We studied whether magnetoencephalography (MEG) could detect deceptive responses on a single-subject, trial-by-trial basis. To elicit spontaneous, ecologically valid deception, we developed a paradigm in which subjects in a simulated customs setting were presented with a series of pictures of items which might be in their baggage, and for each item, they decided whether to "declare" (tell the truth) or "smuggle" (lie). Telling the truth involved a small but certain monetary penalty, whereas lying involved both greater monetary risk and greater potential reward. Most subjects showed decreased signal power in the 8-12 Hz (alpha) range during deceptive responses as compared to truthful responses. In a cross-validation analysis, we were able to use alpha power to classify truthful and deceptive responses on a trial-by-trial basis, with significantly greater predictive accuracy than that achieved using simultaneously recorded skin conductance signals. Average predictive accuracy for spontaneous deception was greater than 78%, and for some subjects, predictive accuracy exceeded 90%. Our results raise the possibility that alpha power modulation during deception may reflect risk management and/or cognitive control.

Risk Factors of Hepatotoxicity During Anti-tuberculosis Treatment

BACKGROUND

Antituberculosis treatment (ATT) induced hepato-toxicity is common, but risk factors predicting its development are poorly understood. The present study evaluates the clinical risk factors predicting the development of hepatotoxicity in Indian patients with tuberculosis on antituberculosis treatment.

METHODS

Three groups of patients were studied at three service hospitals over a 3 year period from 2000-2002. Patients given ATT were followed up with monthly LFTs. Consecutive patients who developed Liver dysfunction (rise in SGPT > 5 times upper limit of normal) were studied, along with matched controls who did not. Markers for hepatitis B were also noted in these patients once in 6 months. A third group of patients who did not receive ATT but were HBsAg positive, were also similarly followed up. The possible association of age and sex of the patient, alcoholism, unrecognized chronic liver disease, hepatitis B virus carrier status and nutritional status with ATT-induced hepatitis was assessed. Statistical analysis was carried out by Chi square test/Fisher's exact test using WHO provided software Epi Info 6. Sixty-nine patients with ATT-induced hepatotoxicity were prospectively studied. In addition 128 patients on anti-tuberculosis drugs without hepatotoxicity and 39 HBsAg carriers not on ATT were followed up for 1 year.

RESULTS

Age, Sex, history of alcohol intake and BMI were not found to be related to development of hepatotoxicity. Presence of HBV infection or an underlying silent chronic liver disease were found to significantly increase the risk of development of ATT-induced hepatotoxicity. Continuation of ATT after development of jaundice was associated with a high fatality rate. It was possible to re-introduce isoniazid in 96% and rifampicin in 88% of patients with ATT induced hepatotoxicity.

CONCLUSION

ATT-induced hepatitis is common and is potentially fatal. It is likely to occur in those with underlying silent chronic liver disease, HBV infection and have been given ATT without a definite evidence of tuberculosis. Discontinuation of ATT leads to rapid recovery in most cases and drugs can safely be introduced after recovery in a majority of cases.

ETS family of genes in leukemia and Down syndrome

The human ETS2 and ERG genes are members of the ETS gene family, with sequence homology to the viral ets gene of the avian erythroblastosis retrovirus, E26. These genes are located on chromosome 21 and molecular genetic analysis of Down syndrome (DS) patients with partial trisomy 21 suggested that ETS2 may be a gene within the minimal DS genetic region. We have, in fact, been able to confirm the presence of the ETS2 gene dosage in triplicate occurring in occult human 21 chromosome abnormalities. It is known that ERG and ETS2 gene translocations occur in certain specific leukemias associated with defined chromosome rearrangements [e.g., t(8;21)]. Moreover, it is known that DS individuals are at greater risk for leukemic disease than their normal familial cohorts, implying that trisomy of that region of human chromosome 21 may play a role in the development of this type of neoplasia. The human ETS genes, first identified in our laboratory, are highly conserved, being found from lower organisms, like Drosophila and sea urchin, to humans. In mammals, the ETS genes are structurally distinct, located on separate chromosomes; they are transcriptionally active and differentially regulated. The ETS2 protein is phosphorylated and turns over with a half-life of approximately 20 min. After activation with the tumor promoter, TPA, the level of ETS2 elevates 5- to 20-fold. The properties of the ETS2 protein, such as nuclear localization, phosphorylation, rapid turnover, and response to protein kinase C, indicate that this protein belongs to a group of oncogene proteins thought to have regulatory functions in the nucleus. In the mouse thymus ets-1 and ets-2 are 8-10-fold higher, respectively, in the CD4+ subset than in other subsets examined, suggesting a role in T-cell development for these genes. Cells transfected with the cellular ets-2 gene, expressing higher levels of ets-2 products, showed a stimulated proliferation response, abolished their serum requirement and formed colonies in soft agar that could induce tumors in nude mice. Collectively, these data suggest that this family of genes might play a role in controlling specific steps of the signaling transduction pathway. Thus, the ETS genes, as other genes with homology to viral oncogenes, might be instrumental in regulating cellular growth and differentiation, as well as organismal development.

Identifying hallmarks of consciousness in non-mammalian species

Most early studies of consciousness have focused on human subjects. This is understandable, given that humans are capable of reporting accurately the events they experience through language or by way of other kinds of voluntary response. As researchers turn their attention to other animals, "accurate report" methodologies become increasingly difficult to apply. Alternative strategies for amassing evidence for consciousness in non-human species include searching for evolutionary homologies in anatomical substrates and measurement of physiological correlates of conscious states. In addition, creative means must be developed for eliciting behaviors consistent with consciousness. In this paper, we explore whether necessary conditions for consciousness can be established for species as disparate as birds and cephalopods. We conclude that a strong case can be made for avian species and that the case for cephalopods remains open. Nonetheless, a consistent effort should yield new means for interpreting animal behavior.

Neural Darwinism and consciousness

Neural Darwinism (ND) is a large scale selectionist theory of brain development and function that has been hypothesized to relate to consciousness. According to ND, consciousness is entailed by reentrant interactions among neuronal populations in the thalamocortical system (the 'dynamic core'). These interactions, which permit high-order discriminations among possible core states, confer selective advantages on organisms possessing them by linking current perceptual events to a past history of value-dependent learning. Here, we assess the consistency of ND with 16 widely recognized properties of consciousness, both physiological (for example, consciousness is associated with widespread, relatively fast, low amplitude interactions in the thalamocortical system), and phenomenal (for example, consciousness involves the existence of a private flow of events available only to the experiencing subject). While no theory accounts fully for all of these properties at present, we find that ND and its recent extensions fare well.

Causal connectivity of evolved neural networks during behavior

To show how causal interactions in neural dynamics are modulated by behavior, it is valuable to analyze these interactions without perturbing or lesioning the neural mechanism. This paper proposes a method, based on a graph-theoretic extension of vector autoregressive modeling and 'Granger causality,' for characterizing causal interactions generated within intact neural mechanisms. This method, called 'causal connectivity analysis' is illustrated via model neural networks optimized for controlling target fixation in a simulated head-eye system, in which the structure of the environment can be experimentally varied. Causal connectivity analysis of this model yields novel insights into neural mechanisms underlying sensorimotor coordination. In contrast to networks supporting comparatively simple behavior, networks supporting rich adaptive behavior show a higher density of causal interactions, as well as a stronger causal flow from sensory inputs to motor outputs. They also show different arrangements of 'causal sources' and 'causal sinks': nodes that differentially affect, or are affected by, the remainder of the network. Finally, analysis of causal connectivity can predict the functional consequences of network lesions. These results suggest that causal connectivity analysis may have useful applications in the analysis of neural dynamics.

Criteria for consciousness in humans and other mammals

The standard behavioral index for human consciousness is the ability to report events with accuracy. While this method is routinely used for scientific and medical applications in humans, it is not easy to generalize to other species. Brain evidence may lend itself more easily to comparative testing. Human consciousness involves widespread, relatively fast low-amplitude interactions in the thalamocortical core of the brain, driven by current tasks and conditions. These features have also been found in other mammals, which suggests that consciousness is a major biological adaptation in mammals. We suggest more than a dozen additional properties of human consciousness that may be used to test comparative predictions. Such homologies are necessarily more remote in non-mammals, which do not share the thalamocortical complex. However, as we learn more we may be able to make "deeper" predictions that apply to some birds, reptiles, large-brained invertebrates, and perhaps other species.

Spatial Navigation and Causal Analysis in a Brain-Based Device Modeling Cortical–Hippocampal Interactions

We describe Darwin X, a physical device that interacts with a real environment, whose behavior is guided by a simulated nervous system incorporating aspects of the detailed anatomy and physiology of the hippocampus and its surrounding regions. This brain-based device integrates cues from its environment and solves a spatial memory task. The responses of simulated neuronal units in the hippocampal areas during its exploratory behavior are comparable to place cells in the rodent hippocampus and emerged by associating sensory cues during exploration. To identify different functional hippocampal pathways and their influence on behavior, we employed a time series analysis that distinguishes causal interactions within and between simulated hippocampal and neocortical regions while the device is engaged in a spatial memory task. Our analysis identified different functional pathways within the neural simulation and prompts novel predictions about the influence of the perforant path, the trisynaptic loop and hippocampal-cortical interactions on place cell activity and behavior during navigation. Moreover, this causal time series analysis may be useful in analyzing networks in general.

Should one vaccinate patients with chronic liver disease for hepatitis A virus in India?

BACKGROUND

Hepatitis A virus (HAV) vaccination is recommended worldwide for patients with chronic liver disease to prevent decompensation due to superinfection with HAV. India being endemic for HAV, the prevalence of pre-existing antibodies against HAV due to subclinical exposure to the virus in childhood among patients with chronic liver disease may be high and, therefore, vaccination may not be needed. However, little data are available on the prevalence of HAV antibody among patients with chronic liver disease in India.

METHODS

All patients with chronic liver disease seen at Gastroenterology Center, Army Hospital R and R, New Delhi during the year 2002 and diagnosed to have either chronic liver disease were tested for the presence of IgG anti-HAV antibody in their sera (using a commercial ELISA kit). All patients with acute exacerbation or rapid deterioration of a preexisting chronic liver disease were separately studied for presence of IgM anti-HAV. In addition, a matched number of patients who attended the center due to diseases other than liver disease were also studied as controls.

RESULTS

One hundred and eighty seven patients of chronic liver disease and 89 controls were studied. Mean age of these two groups was 38.6 and 42.1 years and 153 (81.8%) and 78 (87.6%) of them were males respectively. Etiology of chronic liver disease was HBV infection in 91(48.7%), HCV infection in 62 (33.2%), autoimmune chronic hepatitis in 3 (1.6%), PBC in seven (3.7%) and cryptogenic 24 (12.8%). Of these 179 (95.7%) patients tested positive for IgG anti-HAV. A total of 37 hospitalisations in 29 patients were noted during the study period due to acute exacerbation of pre-existing chronic liver disease. None of these were positive for IgM anti-HAV, while 28 were positive for IgG anti-HAV. Among the controls, 87 controls (94.6%) were positive IgG anti-HAV. The prevalence of anti-HAV positivity was similar among patients with various etiologies.

CONCLUSION

Vaccination against HAV is not routinely required among patients with chronic liver disease in India as there is a very high prevalence of pre-existing antibodies in these patients. HAV superinfection as a cause of acute exacerbation of chronic liver disease was not seen in this.

Visual Binding Through Reentrant Connectivity and Dynamic Synchronization in a Brain-based Device

Effective visual object recognition requires mechanisms to bind object features (e.g. color, shape and motion) while distinguishing distinct objects. Synchronously active neuronal circuits among reentrantly connected cortical areas may provide a basis for visual binding. To assess the potential of this mechanism, we have constructed a mobile brain-based device, Darwin VIII, which is guided by simulated analogues of cortical and sub-cortical areas required for visual processing, decision-making, reward and motor responses. These simulated areas are reentrantly connected and each area contains neuronal units representing both the mean activity level and the relative timing of the activity of groups of neurons. Darwin VIII learns to discriminate among multiple objects with shared visual features and associates 'target' objects with innately preferred auditory cues. We observed the co-activation of globally distributed neuronal circuits that corresponded to distinct objects in Darwin VIII's visual field. These circuits, which are constrained by a reentrant neuroanatomy and modulated by behavior and synaptic plasticity, are necessary for successful discrimination. By situating Darwin VIII in a rich real-world environment involving continual changes in the size and location of visual stimuli due to self-generated movement, and by recording its behavioral and neuronal responses in detail, we were able to show that reentrant connectivity and dynamic synchronization provide an effective mechanism for binding the features of visual objects.

The power of human brain magnetoencephalographic signals can be modulated up or down by changes in an attentive visual task

This paper presents evidence indicating that the signals generated by neural responses to visual input can be either enhanced by increasing or suppressed by decreasing the area of the stimuli to which attention is directed. We used magnetoencephalography (MEG) to measure the frequency-tagged steady-state visual evoked responses of 11 subjects presented with two superimposed images flickering at different frequencies. Each image consisted of seven parallel bars of equal length; in any image, all bars were either red or green and either horizontal or vertical. At randomly chosen times during the experiments, any one of the three middle bars in either image transiently increased or decreased in width. Subjects were asked to attend to one image and ignore the other and to respond to changes in bar width in the attended image with a key press. In one condition, subject responses were required for changes in any of the three central bars of the attended image. We found that visual steady-state evoked responses to the attended image were enhanced relative to those evoked by the unattended image in this condition. In a second condition, subject responses were required for changes only in the middle bar. In this condition, the responses to the attended image were suppressed relative to those of the unattended image. These results may reflect relative differences in the synchronization and desynchronization of responding neuronal populations.

Reversible segmental portal hypertension--an unusual presentation of abdominal tuberculosis in a renal transplant recipient

Infections are the commonest cause of morbidity and mortality in renal transplant recipients. In India, tuberculosis is a one such common infection in these patients and presents with protean manifestations. We report here a case of pyrexia of unknown origin (PUO) and segmental portal hypertension in a renal transplant recipient. Search for the cause of portal hypertension revealed abdominal tubercular lymphadenitis. Treatment with anti-tubercular therapy caused regression of segmental portal hypertension.

ACCURACY OF SERUM - ASCITES ALBUMIN GRADIENT IN THE AETIOLOGICAL DIAGNOSIS OF ASCITES

50 adults with ascites admitted to our hospital were studied. Simultaneous samples of ascitic fluid and blood were collected and subjected to analysis including ascitic fluid total protein and serum ascites albumin gradient The cut off value of serum-ascites albumin gradient for differentiating between high and low gradient was taken as 1.1 gm % and of ascitic fluid protein for differentiating exudate and transudate as 2.5 gm%. The sensitivity, specificity, positive predictive value and negative predictive value of high gradient and transudative ascites in diagnosing portal hypertension were 943%, 60%, 84.6%, 81.8% and 62.9%, 133%, 91.7% and 50% respectively. High gradient ascites is a sensitive test in the diagnosis of portal hypertension as a cause of ascites. The exudate-transudate approach has severe limitations in the differential diagnosis of ascites.

Recurrent diarrhea in children living in areas with high levels of nitrate in drinking water

Given that there was documented evidence of an association between diarrhea and high nitrate ingestion, the authors examined drinking water nitrate concentration and its possible correlation(s) with methemoglobin levels, cytochrome b5 reductase activity, and recurrent diarrhea. In addition, the authors studied histopathological changes in the intestines of rabbits in an animal model. Five village areas were studied, and nitrate concentrations (expressed in mg of nitrate per liter of water) of 26, 45, 95, 220, and 459 existed in the respective villages. The study included 88 randomly selected children who were 8 yr of age or younger; they represented 10% of the total population of each of the areas. Detailed histories of recurrent diarrhea were noted, and medical examinations were conducted. Cytochrome b5 reductase activity and methemoglobin levels were estimated biochemically. Collected data were analyzed statistically with Microsoft Excel software. In addition, the authors exposed rabbits to various levels of nitrate, and histopathological changes of the stomach and intestine (small and large) were evaluated. There was a strong relationship between nitrate concentration and recurrent diarrhea; 80% of the recurrent diarrhea cases were explained by nitrate concentration alone. In the rabbit intestines, lymphocytic infiltration and hyperplasia characterized the submucosa as nitrate concentrations increased.

Hepatopulmonary syndrome: prevalence and clinical profile

BACKGROUND

The hepatopulmonary syndrome (HPS) is defined as a triad of liver dysfunction, intrapulmonary vascular dilatations (IPVD) and arterial hypoxemia. There is paucity of Indian studies regarding the prevalence of IPVD and arterial hypoxemia particularly amongst patients with non-cirrhotic portal fibrosis (NCPF) and extrahepatic portal vein obstruction (EHPVO), where liver dysfunction is not a feature.

METHODS

All patients with portal hypertension and esophageal varices seen at a tertiary care hospital during 1995-98 were studied. Ultrasonography of abdomen, contrast-enhanced echocardiography (CEE), arterial blood gas analysis and assessment of alveolar-arterial oxygen gradient were done.

RESULTS

Of 138 patients with portal hypertension seen during the study period, 88 fulfilled the inclusion and exclusion criteria. These included 63 with cirrhosis, 15 with NCPF and 10 with EHPVO. CEE showed IPVD in 17 (27%) patients with cirrhosis, of which 11 (17.5%) fulfilled the criteria for HPS. IPVD were also noted in 4 (26.6%) cases of NCPF and 3 (30%) of EHPVO, though only 2 (13.3%) and 1 (10%) respectively had elevated alveolar-arterial gradient and liver dysfunction in addition. Age and sex distribution and duration of symptoms were not different in patients with HPS. Patients with HPS had higher incidence of dyspnea, platypnea, clubbing and spider nevi.

CONCLUSIONS

Hepatopulmonary syndrome is present in 17.5% of cirrhotics, 13.3% of patients with NCPF and 10% with EHPVO. Patients with HPS had significantly higher incidence of dyspnea, platypnea, clubbing and spider nevi.

GRANULOCYTE MACROPHAGE COLONY STIMULATING FACTOR IMPROVES IMMUNOGENECITY OF HEPATITIS B VACCINE IN HEMODIALYSIS PATIENTS

Only 20-50% of hemodialysis patients, develop protective antibodies following double dose Hepatitis B vaccination. Early reports suggest augmented response with concomitant use of Granulocyte macrophage colony stimulating factor (GMCSF). This study was done to assess the response rate to hepatitis B vaccine in hemodialysis patients with use of GMCSF. Seventeen patients were included in study, all received 40 mcg of hepatitis B vaccine at 0,1 and 2 months. Ten of these received 150 mcg of GMCSF with each dose of vaccine while 7 were taken as controls. Only one patient from control group (14.3%) while 5/10 (50%) patients from GMCSF group, developed protective antibodies, i.e. anti HBS titres > 10miu/ml (p < 0.05). Present study shows the beneficial effect of GMCSF when used as adjuvant with hepatitis B vaccine, in hemodialysis patients.

Recurrent acute respiratory tract infections in areas with high nitrate concentrations in drinking water

A review of the literature indicated an association among high nitrate ingestion, methemoglobinemia, and pathologic changes in bronchi and lung parenchyma. The present study examined a possible correlation among drinking water nitrate concentration, methemoglobin levels, cytochrome b(5) reductase activity, and acute respiratory tract infection with a history of recurrence (RRTI). Our study was conducted in five village units in the state of Rajasthan, India, with nitrate concentrations of 26, 45, 95, 222, and 459 mg NO(3) ion/L. We randomly selected 88 children. The children were up to 8 years of age, age matched, and represented 10% of the total population of these areas. We obtained detailed RRTI histories and conducted medical examinations. Methemoglobin levels and cytochrome b(5) reductase activity were estimated biochemically. The data collected were statistically analyzed using spreadsheet software on a personal computer. We observed strong interdependence between methemoglobin levels and RRTI in children up to 8 years of age. Methemoglobin levels alone explained 80% of the variation in the RRTI cases. This study indicates that methemoglobinemia, secondary to high nitrate ingestion in drinking water, causes RRTI. Increased production of methemoglobin and free radicals of nitric oxide and oxygen due to nitrate metabolism in the body lead to alveolar damage and mismatching of ventilation and perfusion, which may be the reason for high mortality in children due to RRTI.

Recurrent acute respiratory tract infections in areas with high nitrate concentrations in drinking water

A review of the literature indicated an association among high nitrate ingestion, methemoglobinemia, and pathologic changes in bronchi and lung parenchyma. The present study examined a possible correlation among drinking water nitrate concentration, methemoglobin levels, cytochrome b(5) reductase activity, and acute respiratory tract infection with a history of recurrence (RRTI). Our study was conducted in five village units in the state of Rajasthan, India, with nitrate concentrations of 26, 45, 95, 222, and 459 mg NO(3) ion/L. We randomly selected 88 children. The children were up to 8 years of age, age matched, and represented 10% of the total population of these areas. We obtained detailed RRTI histories and conducted medical examinations. Methemoglobin levels and cytochrome b(5) reductase activity were estimated biochemically. The data collected were statistically analyzed using spreadsheet software on a personal computer. We observed strong interdependence between methemoglobin levels and RRTI in children up to 8 years of age. Methemoglobin levels alone explained 80% of the variation in the RRTI cases. This study indicates that methemoglobinemia, secondary to high nitrate ingestion in drinking water, causes RRTI. Increased production of methemoglobin and free radicals of nitric oxide and oxygen due to nitrate metabolism in the body lead to alveolar damage and mismatching of ventilation and perfusion, which may be the reason for high mortality in children due to RRTI.

Methaemoglobinaemia in areas with high nitrate concentration in drinking water

BACKGROUND

An epidemiological investigation was undertaken in all age groups to assess the prevalence of methaemoglobinaemia in areas with high nitrate concentration in drinking water.

METHODS

Five areas were selected with an average nitrate concentration (as nitrate) of 26, 45, 95, 222 and 459 mg nitrate ions/litre in drinking water. These areas were visited and the house schedule (containing name, age, sex and weight of the family members) prepared in accordance with the statistically designed protocol. In all, 178 persons, matched for age and weight, were selected and arranged in five age groups. They constituted 10% of the total population of each of these areas. A detailed history of the selected population was taken, medical examination conducted and blood samples taken to ascertain the level of methaemoglobin. The collected data were subjected to statistical analysis to ascertain a relationship between nitrate concentration and methaemoglobinaemia.

RESULTS

High nitrate concentrations cause severe methaemoglobinaemia (7%-27% of Hb) in all age groups, especially in the age group of less than 1 year and above 18 years. The lower levels of methaemoglobin in the age group of 1-18 years is probably due to better reserve of cytochrome b5 reductase activity and its adaptation to increasing nitrate concentration in water to compensate for methaemoglobinaemia in this age group.

CONCLUSION

We conclude that high nitrate ingestion causes methaemoglobinaemia in all age groups. Cytochrome b5 reductase activity and its adaptation with increasing water nitrate ingestion plays a role in compensating for the methaemoglobinaemia.

Epidemiological evaluation of recurrent stomatitis, nitrates in drinking water, and cytochrome b5 reductase activity

OBJECTIVE

Our aim was to examine a possible correlation between drinking water nitrate concentration, recurrent stomatitis, and cytochrome b5 reductase activity. Dietary nitrate can form nitrite in vivo. This can cause methemoglobinemia in the red blood cells. Cytochrome b5 reductase is an enzyme in the red blood cells that reduces methemoglobin back to hemoglobin.

METHODS

Five areas were selected in the State of Rajasthan, India, having drinking water nitrate concentration (as nitrate) of 26, 45, 95, 222, and 459 mg of NO3/L. House schedules were prepared in these areas in accordance with a statistically designed protocol. We selected 193 age- and weight-matched persons, representing 10% of the total population in each of these areas. Detailed history was taken for recurrent stomatitis, medical examination was conducted, and blood samples were taken to ascertain cytochrome b5 reductase activity in the selected population. Collected data were statistically analyzed to ascertain a relationship between nitrate concentration, cytochrome b5 reductase activity, and percent stomatitis, using Microsoft Excel software.

RESULTS

This study suggests that there is a significant interdependence between drinking water nitrate concentration, cytochrome b5 reductase activity, and recurrent stomatitis.

CONCLUSION

Increased cytochrome b5 reductase activity primarily induced by the presence of high nitrate concentration in drinking water could be the cause for recurrent stomatitis.

Biomechanical analysis of flat and oblique tibial tubercle osteotomy for recurrent patellar instability

Both flat (Elmslie-Trillat) and oblique (Fulkerson) osteotomy techniques are successful in treating patellar instability episodes by moving the tibial tubercle medially. The oblique osteotomy also results in anterior displacement that decreases patellofemoral forces. Recent reports have described proximal tibial fractures occurring during early weightbearing after oblique osteotomy. We performed oblique and flat osteotomies on 13 pairs of fresh-frozen cadaveric knees. The knees were then tested to failure on a materials testing system by exerting a load through the quadriceps tendon at a rate of 1000 N/sec to simulate a stumble injury. The failure mechanism for flat osteotomies was more likely to be tubercle "shingle" fracture, while oblique osteotomies more frequently failed through a tibial fracture or fixation failure in the posterior tibial cortex. Mean load to failure was significantly higher in the flat osteotomy specimens (1639 N versus 1166 N), as was total energy to failure (224 N.m versus 127 N.m). There was no significant difference in stiffness (87 N/cm versus 74 N/cm). We recommend the flat osteotomy for patients with isolated recurrent patellar instability and the oblique osteotomy in patients who have concomitant patellofemoral pain or articular degenerative changes. When an oblique osteotomy is used, we recommend postoperative brace protection and restricted weightbearing until the osteotomy heals.

Adaptation of cytochrome-b5 reductase activity and methaemoglobinaemia in areas with a high nitrate concentration in drinking-water

An epidemiological investigation was undertaken in India to assess the prevalence of methaemoglobinaemia in areas with high nitrate concentration in drinking-water and the possible association with an adaptation of cytochrome-b5 reductase. Five areas were selected, with average nitrate ion concentrations in drinking-water of 26, 45, 95, 222 and 459 mg/l. These areas were visited and house schedules were prepared in accordance with a statistically designed protocol. A sample of 10% of the total population was selected in each of the areas, matched for age and weight, giving a total of 178 persons in five age groups. For each subject, a detailed history was documented, a medical examination was conducted and blood samples were taken to determine methaemoglobin level and cytochrome-b5 reductase activity. Collected data were subjected to statistical analysis to test for a possible relationship between nitrate concentration, cytochrome-b5 reductase activity and methaemoglobinaemia. High nitrate concentrations caused methaemoglobinaemia in infants and adults. The reserve of cytochrome-b5 reductase activity (i.e. the enzyme activity not currently being used, but which is available when needed; for example, under conditions of increased nitrate ingestion) and its adaptation with increasing water nitrate concentration to reduce methaemoglobin were more pronounced in children and adolescents.