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Xue J, Wang H, LI H, Song H, LI Y, Shi X, Zhao H, Wei F, Xiao H, Wu B, Jia Y, Xiao F, Wu H. SAT0646-HPR PATTERN AND INFLUENTIAL FACTORS IN PROMOTING TREAT-TO-TARGET (T2T) FOR FOLLOW-UP OF ANKYLOSING SPONDYLITIS (AS) PATIENTS WITH A RHEUMATOLOGIST-PATIENT INTERACTIVE SMART SYSTEM OF DISEASE MANAGEMENT (SSDM): A COHORT STUDY FROM CHINA. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Ankylosing Spondylitis Disease Activity Score (ASDAS) is adopted to evaluate the degree of disease activity and the inflammatory response in AS patients. ASDAS score <= 1.3 represents inactive disease status and achievement of T2T. SSDM is a mobile application for disease management.Objectives:To evaluate the patterns of T2T and related influential factors among AS patients after applying SSDM in the real world.Methods:AS Patients were trained to master SSDM by healthcare professionals (HCPs) and to conduct ASDAS self-assessments. Patients were also required for repeating self-assessments after leaving the hospital. After entry by patients, data can be synchronized to the SSDM terminal of authorized rheumatologists. Based on these data, the patients can apply for consultation to their physicians and rheumatologists can provide medical advices to their patients.Results:From Jan 2015 to Jan 2020, 17,870 AS patients enrolled in SSDM with the mean age of 34.62±10.98 years old and the median disease duration of 3.58 years. Among them, 1,127 AS patients from 150 hospitals were followed up for more than 6 months through SSDM. The results at baseline and in final follow up were summarized in Table 1.Table 1.The T2T results at baseline and in final follow up.Baseline\Final follow-upn%x <= 1.3%1.3 < x <= 2.1%2.1 < x <= 3.5%3.5 < x%x <= 1.331527.95%20665.40%7423.49%268.25%92.86%1.3 < x <= 2.134030.17%13840.59%11433.53%7522.06%133.82%2.1 < x <= 3.536332.21%9526.17%10629.20%13336.64%297.99%3.5 < x1099.67%2422.02%2522.94%4238.53%1816.51%Total1,127100%46341.08%31928.31%27624.49%696.12%The rate of T2T achievers were 27.95% (315/1,127) at baseline, and improved significantly to 41.08% (463/1,127) after 6 months follow up, p<0.01. Among T2T achievers at baseline, 65.40% (206/315) maintained T2T, 34.60% (109/315) relapsed. Of patients who didn’t achieve T2T at baseline, only 31.65% (257/812) achieved T2T after 6 months follow up.The impact of the online interaction between patients and physicians and the frequency of self-assessment for ASDAS on T2T has been analyzed. Compared with 544 patients who didn’t interact online with their physicians and self-assessed less than 3times, 104 patients with online interaction and monthly assessments achieved significant higher improvement rate of T2T (9.19% vs 23.08%, p<0.01). The more frequent of the self-assessments being performed by patients, the higher improvement of T2T rate will be. The improvement of T2T rate(y) was positively correlated with times of self-assessment for ASDAS(x) independently. The regression equation as “y = 0.0304x + 0.0521”, r = 0.9107, p<0.01 (Figure 1).Figure 1.Conclusion:Significant improvement was observed under applying SSDM through empowering AS patients. After proactive disease management via SSDM for more than 6 months, patients with ASDAS<=1.3 score at baseline had a significantly higher retention rate of inactive disease activity. The patients who performed more frequent self-assessments had lower probability of relapse and higher rate of T2T. Online interaction between patients and physicians contributed to promote the improvement rate of T2T. SSDM is a valuable tool for long term follow-up through empowering patients.Acknowledgments:SSDM was developed by Shanghai Gothic Internet Technology Co., Ltd.Disclosure of Interests:None declared
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Zhao Y, Mu R, LI X, Sun H, MI C, Wang G, Xu S, Xu M, Chen H, Huang Q, Lei L, Haili S, Chen X, Xiao F. SAT0647-HPR DEVELOP A MACHINE LEARNING MODEL AND ALGORITHM BASED ON SMART SYSTEM OF DISEASE MANAGEMENT (SSDM) BIG DATA FOR RA FLARE PREDICTION. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Flare, relapse from status of treat-to-target (T2T, DAS28<=3.2), is hard predicted. We try to make it predictable by applying machine learning to a database from smart system of disease management (SSDM). SSDM is an interactive mobile disease management APPs.Objectives:To develop and validate machine learning algorithms for flare prediction in RA.Methods:Patients were trained using SSDM and input their data, including demographic, comorbidities (COMBs), lab test, medications and monthly self-assessments, including DAS28, HAQ, SF-36, Hospital Anxiety and Depression Scale (HADS). The data was uploaded to cloud and synchronized to the mobile of authorized rheumatologists. The COMBs were by ICD-9, and medications were listed as cDMARDs, Bio (BioDMARDs), NSAIDs, Steroid, FS (food supplements), MC (medicine for COMBs), TCM (Traditional Chinese Medicine), and combinations.Results:From Jan of 2015 to Jan of 2020, 8811 RA patients, 85% female and 15% male, used to reach T2T. 4556 were flare-free and 4255 suffering at least one flare. The average 160 attributes were extracted from each flare-free patient at time of reaching T2T, and each flare patients at time of 3 months before the flare. Patients were randomly assigned as model setup (training) group (70%) and validation (testing) group30%.For training, data were processed using Python with statistical analyses in R. In R, random forests were implemented. Logistic regression via glm in base R. The random forest comprises a set of decision trees. “Splits” in the decision trees reflect binary (i.e., yes/no) respect to attributors. Bootstrapping was used to assess, quantify, and adjust for model optimism. Model performance was evaluated using AUC, precision and recall metrics. Brier scores for accuracy of probabilistic predictions ranged from 0 to 1 (0 is perfect discrimination).The testing showed model performance for prediction windows are 0.78 for AUC (95% CI), 0.71 for Recall (sensitivity), 0.195 for Brier score, and 0.68 for precision (true positive 893, false positive 417, false negative 367, true negative 966).Based on weighing in the random forest, the top 10 pro-flare attributes were CRP, swollen joint count (SJC), tender joint count (TJC), HAQ, DAS28, morning stiffness, gout, MCTD, OA, duration; while top 10 anti-flare attributes were cDMARDs+Bio, cDMARDs+steroid+NSAIDs, stable on HAQ, on morning stiffness, on SJC, medicine on COMBs, cDMARDs+TCM, stable on TJC, on ESR, income at 100-200k (Fig.1). The top weighing COMBs for pro-flaring were gout (0.81), MRD (0.75), OA (0.56), AS (0.48). The monotherapies with either Bio or NSAIDs, or steroid, or TCM was pro-flare; while with cDMARDs was anti-flare (-0.21).Figure 1.Conclusion:The attempt to develop a machine learning algorithm for RA flare prediction is successful. The discrimination was acceptable. The attributes of both pro-flare and anti-flare are identified, which may inspire the proactive intervention.Acknowledgments:SSDM was developed by Shanghai Gothic Internet Technology Co., Ltd.Disclosure of Interests:None declared
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Xiao F, Zhao L, Han F. 0761 Independent Components Analysis And Graph Theoretical Analysis In Patients With Narcolepsy. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
To evaluate resting state functional connectivity and topological properties of brain network in narcolepsy compared with healthy controls.
Methods
Resting state fMRI was performed in 26 adult narcolepsy patients and 30 matched healthy controls. MRI data was first analyzed by group independent component analysis, then a graph theoretical method was applied to evaluate topological properties within whole brain. Small-world network parameters and nodal topological properties were measured. Altered topological properties in brain areas between groups were selected as ROI-seeds, then functional connectivity among these ROI-seeds were compared between groups. Partial correlation analysis was performed to evaluate the relationship between sleepiness severity and functional connectivity or topological properties in the narcolepsy.
Results
21 independent components out of 48 components were obtained. Compared with healthy controls, narcolepsy exhibited a significant decreased functional connectivity within the executive and salience network, while increased functional connectivity in bilateral frontal lobe within executive network can be detected in narcolepsy. There were no differences in small-world network properties between narcolepsy and healthy controls. The altered brain areas in nodal topological properties were mainly located in inferior frontal cortex, basal ganglia, anterior cingulate, sensory cortex, supplementary motor cortex and visual cortex between groups. In the partial correlation analysis, nodal topological properties in putamen, anterior cingulate and sensory cortex as well as functional connectivity between these brain regions were correlated with the severity of sleepiness (sleep latency, REM sleep latency and ESS) among narcolepsy.
Conclusion
Altered connectivity within executive network and salience network were found in narcolepsy. Functional connection changes between left frontal cortex and left caudate nucleus may be one of the parameters describing the severity of narcolepsy. Nodal topological properties alterations in left putamen and left posterior cingulate, changes in functional connectivity between left supplementary motor area and right occipital as well as changes in functional connectivity between left anterior cingulate gyrus and bilateral postcentral gyrus can be considered to be a specific indicator for evaluating the severity of narcolepsy.
Support
National Natural Science Foundation of China (81700088)National Program on Key Basic Research Project of China (973 Program, 2015CB856405)
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Ding Q, Li J, Xiao F, Zhang C, Dong X, Han F. 0009 Anti-Streptococcal Antibodies in Chinese Patients with Type -1 Narcolepsy. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Narcolepsy type 1 (NT1) is considered to be an autoimmune disease, and streptococcal infection may be an environmental trigger. However, previous studies from Asian narcolepsy patients did not reveal elevated anti-streptolysin O [ASO]. The aim is to investigate whether large sample Chinese patients with NT1 have an increase in antistreptococcal antibody titers.
Methods
A total of 214 narcolepsy patients and 360 healthy controls were recruited. All patients were DQB1*0602 positive with clear-cut cataplexy or had low CSF hypocretin-1. Participants were tested for ASO and anti DNAse B [ADB]. These patients were divided into five groups according to disease duration, including 29 patients less than 3 months; 25 from 3 months to 1 year; 40 from 1 to 3 years; 61 from 3 to 10 years and 59 patients over 10 years. Comparison was also made between children and adults with age matched controls, respectively.
Results
There were no significant differences between patients and healthy controls in regard to both ASO ≥ 200 IU (19.2% vs. 16.9%, p = 0.50) and ADB≥480IU (9.8% vs. 10.3%, p = 0.86). For children narcolepsy patients, ASO positive rates(19.8% vs. 18%, p = 0.68) and ADB positive rates(10.4% vs. 12%, p = 0.72) had no differences compared to age matched controls. And no difference was observed in adult narcolepsy patients either, with ASO positive rates (18.5% vs. 13.8%, p = 0.39) and ADB positive rates (9.3% vs. 5.3%, p = 0.42) compared to age matched controls, respectively. ASO (ADB) positive rates had no significant differences among different disease duration groups(p= 0.55, 0.9).
Conclusion
It is indicated that positive rates of ASO and ADB were not significantly different between Chinese patients with NT1 and healthy controls, including recent onset cases and children.
Support
The study was supported by the National Natural Science Foundation of China (No. 81420108002 and NO. 81570083)
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Audi H, Viero Y, Alwhaibi N, Chen Z, Iazykov M, Heynderickx A, Xiao F, Guérin D, Krzeminski C, Grace IM, Lambert CJ, Siri O, Vuillaume D, Lenfant S, Klein H. Electrical molecular switch addressed by chemical stimuli. NANOSCALE 2020; 12:10127-10139. [PMID: 32352127 DOI: 10.1039/d0nr02461a] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We demonstrate that the conductance switching of benzo-bis(imidazole) molecules upon protonation depends on the lateral functional groups. The protonated H-substituted molecule shows a higher conductance than the neutral one (Gpro > Gneu), while the opposite (Gneu > Gpro) is observed for a molecule laterally functionalized by amino-phenyl groups. These results are demonstrated at various scale lengths: self-assembled monolayers, tiny nanodot-molecule junctions and single molecules. From ab initio theoretical calculations, we conclude that for the H-substituted molecule, the result Gpro > Gneu is correctly explained by a reduction of the LUMO-HOMO gap, while for the amino-phenyl functionnalized molecule, the result Gneu > Gpro is consistent with a shift of the HOMO, which reduces the density of states at the Fermi energy.
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Long L, Galovic M, Chen Y, Postma T, Vos SB, Xiao F, Wu W, Song Y, Huang S, Koepp M, Xiao B. Shared hippocampal abnormalities in sporadic temporal lobe epilepsy patients and their siblings. Epilepsia 2020; 61:735-746. [PMID: 32196657 DOI: 10.1111/epi.16477] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To examine the shared familial contribution to hippocampal and extrahippocampal morphological abnormalities in patients with sporadic temporal lobe epilepsy (TLE) and their unaffected siblings. METHODS We collected clinical, electrophysiological, and T1-weighted magnetic resonance imaging (MRI) data of 18 sporadic patients with TLE without lesions other than hippocampal sclerosis (12 right, 6 left), their 18 unaffected full siblings, and 18 matched healthy volunteers. We compared between-group differences in cortical thickness and volumes of five subcortical areas (hippocampus, amygdala, thalamus, putamen, and pallidum). We determined the subregional extent of hippocampal abnormalities using surface shape analysis. All our imaging results were corrected for multiple comparisons using random field theory. RESULTS We detected smaller hippocampal volumes in patients (right TLE: median right hippocampus 1.92 mL, interquartile range [IQR] 1.39-2.62, P < .001; left TLE: left hippocampus 2.05 mL, IQR 1.99-2.33, P = .01) and their unaffected siblings (right hippocampus 2.65 mL, IQR 2.32-2.80, P < .001; left hippocampus 2.39 mL, IQR 2.18-2.53, P < .001) compared to healthy controls (right hippocampus 2.94 mL, IQR 2.77-3.24; left hippocampus 2.71 mL, IQR 2.37-2.89). Surface shape analysis showed that patients with TLE had bilateral subregional atrophy in both hippocampi (right > left). Similar but less-pronounced subregional atrophy was detected in the right hippocampus of unaffected siblings. Patients with TLE had reduced cortical thickness in bilateral premotor/prefrontal cortices and the right precentral gyrus. Siblings did not show abnormalities in cortical or subcortical areas other than the hippocampus. SIGNIFICANCE Our results demonstrate a shared vulnerability of the hippocampus in both patients with TLE and their unaffected siblings, pointing to a contribution of familial factors to hippocampal atrophy. This neuroimaging trait could represent an endophenotype of TLE, which might precede the onset of epilepsy in some individuals.
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Zhou B, An D, Xiao F, Niu R, Li W, Li W, Tong X, Kemp GJ, Zhou D, Gong Q, Lei D. Machine learning for detecting mesial temporal lobe epilepsy by structural and functional neuroimaging. Front Med 2020; 14:630-641. [PMID: 31912429 DOI: 10.1007/s11684-019-0718-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/07/2019] [Indexed: 02/04/2023]
Abstract
Mesial temporal lobe epilepsy (mTLE), the most common type of focal epilepsy, is associated with functional and structural brain alterations. Machine learning (ML) techniques have been successfully used in discriminating mTLE from healthy controls. However, either functional or structural neuroimaging data are mostly used separately as input, and the opportunity to combine both has not been exploited yet. We conducted a multimodal ML study based on functional and structural neuroimaging measures. We enrolled 37 patients with left mTLE, 37 patients with right mTLE, and 74 healthy controls and trained a support vector ML model to distinguish them by using each measure and the combinations of the measures. For each single measure, we obtained a mean accuracy of 74% and 69% for discriminating left mTLE and right mTLE from controls, respectively, and 64% when all patients were combined. We achieved an accuracy of 78% by integrating functional data and 79% by integrating structural data for left mTLE, and the highest accuracy of 84% was obtained when all functional and structural measures were combined. These findings suggest that combining multimodal measures within a single model is a promising direction for improving the classification of individual patients with mTLE.
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Ruan Q, Xiao F, Gong K, Zhang W, Zhang M, Ruan J, Zhang X, Chen Q, Yu Z. Prevalence of Cognitive Frailty Phenotypes and Associated Factors in a Community-Dwelling Elderly Population. J Nutr Health Aging 2020; 24:172-180. [PMID: 32003407 DOI: 10.1007/s12603-019-1286-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Cognitive frailty was notable target for the prevention of adverse health outcomes in future. The goal of this study was to use a population-based survey to investigate cognitive frailty phenotypes and potentially sociodemographic factors in elderly Chinese individuals. DESIGN Cross-sectional study. SETTING General community. PARTICIPANTS A total of 5328 elderly adults (aged 60 years or older, mean age 71.36 years) enrolled in the Shanghai study of health promotion for elderly individuals with frailty. MEASUREMENTS The 5-item FRAIL scale and the 3-item Rapid Cognitive Screen tools were used to assess physical frailty and cognitive impairment, including dementia or mild cognitive impairment (MCI). Physical frailty was diagnosed by limitations in 3 or more of the FRAIL scale domains and pre-physical frailty by 1-2 limitations. Subjective cognitive decline (SCD) and pre-MCI SCD, was diagnosed with two self-report measures based on memory and other cognitive domains in elderly adults. RESULTS Of the participating individuals, 97.17% (n= 5177, female 53.4%) were eligible. Notably, 9.67%, 41.61% and 35.20% of participants were MCI, SCD and pre-MCI SCD; 35.86% and 4.41% exhibited physical pre-frailty and frailty; and 19.86% and 6.30% exhibited reversible and potential reversible cognitive frailty. Logistic regression analyses indicated that physical frailty phenotypes were significantly associated with MCI with SCD, and pre-MCI with SCD. Older single females with a high education level were more likely to exhibit the reversible cognitive frailty; and younger elderly individuals with a middle education level were at lower risk for potentially reversible cognitive frailty. CONCLUSIONS The prevalence of pre-physical and reversible cognitive frailty was high in elderly individuals and age was the most significant risk factor for all types of frailty phenotypes. To promote the rapid screening protocol of cognitive frailty in community-dwelling elderly is important to find high-risk population, implement effective intervention, and decrease adverse prognosis.
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Catalan L, Xiao F, Griffith JF. Reporting of Osteoporotic Vertebral Fracture Detected Opportunistically on Thoraco-abdominal Computed Tomography. HONG KONG JOURNAL OF RADIOLOGY 2019. [DOI: 10.12809/hkjr1916919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Xiao F, Koepp MJ, Zhou D. Pharmaco-fMRI: A Tool to Predict the Response to Antiepileptic Drugs in Epilepsy. Front Neurol 2019; 10:1203. [PMID: 31798524 PMCID: PMC6863979 DOI: 10.3389/fneur.2019.01203] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 10/28/2019] [Indexed: 02/05/2023] Open
Abstract
Pharmacological treatment with antiepileptic medications (AEDs) in epilepsy is associated with a variety of neurocognitive side effects. However, the mechanisms underlying these side effects, and why certain brain anatomies are more affected still remain poorly understood. Advanced functional magnetic resonance imaging (fMRI) methods, such as pharmaco-fMRI, can investigate medication-related effects on brain activities using task and resting state fMRI and showing reproducible activation and deactivation patterns. This methodological approach has been used successfully to complement neuropsychological studies of AEDs. Here we review pharmaco-fMRI studies in people with epilepsy targeting the most-widely prescribed AEDs. Pharmco-fMRI has advanced our understanding of the impact of AEDs on specific brain networks and thus may provide potential biomarkers to move beyond the current “trial and error” approach when commencing anti-epileptic medication.
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Lancaster T, Huddart BM, Williams RC, Xiao F, Franke KJA, Baker PJ, Pratt FL, Blundell SJ, Schlueter JA, Mills MB, Maahs AC, Preuss KE. Probing magnetic order and disorder in the one-dimensional molecular spin chains CuF 2(pyz) and [Ln(hfac) 3(boaDTDA)] n (Ln = Sm, La) using implanted muons. JOURNAL OF PHYSICS. CONDENSED MATTER : AN INSTITUTE OF PHYSICS JOURNAL 2019; 31:394002. [PMID: 31239417 DOI: 10.1088/1361-648x/ab2cb6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We present the results of muon-spin relaxation ([Formula: see text]SR) measurements on antiferromagnetic and ferromagnetic spin chains. In antiferromagnetic CuF2(pyz) we identify a transition to long range magnetic order taking place at [Formula: see text] K, allowing us to estimate a ratio with the intrachain exchange of [Formula: see text] and the ratio of interchain to intrachain exchange coupling as [Formula: see text]. The ferromagnetic chain [Sm(hfac)3(boaDTDA)] n undergoes an ordering transition at [Formula: see text] K, seen via a broad freezing of dynamic fluctuations on the muon (microsecond) timescale and implying [Formula: see text]. The ordered radical moment continues to fluctuate on this timescale down to 0.3 K, while the Sm moments remain disordered. In contrast, the radical spins in [La(hfac)3(boaDTDA)] n remain magnetically disordered down to T = 0.1 K suggesting [Formula: see text].
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Caciagli L, Wandschneider B, Xiao F, Vollmar C, Centeno M, Vos SB, Trimmel K, Sidhu MK, Thompson PJ, Winston GP, Duncan JS, Koepp MJ. Abnormal hippocampal structure and function in juvenile myoclonic epilepsy and unaffected siblings. Brain 2019; 142:2670-2687. [PMID: 31365054 PMCID: PMC6776114 DOI: 10.1093/brain/awz215] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 04/09/2019] [Accepted: 05/27/2019] [Indexed: 02/05/2023] Open
Abstract
Juvenile myoclonic epilepsy is the most common genetic generalized epilepsy syndrome, characterized by a complex polygenetic aetiology. Structural and functional MRI studies demonstrated mesial or lateral frontal cortical derangements and impaired fronto-cortico-subcortical connectivity in patients and their unaffected siblings. The presence of hippocampal abnormalities and associated memory deficits is controversial, and functional MRI studies in juvenile myoclonic epilepsy have not tested hippocampal activation. In this observational study, we implemented multi-modal MRI and neuropsychological data to investigate hippocampal structure and function in 37 patients with juvenile myoclonic epilepsy, 16 unaffected siblings and 20 healthy controls, comparable for age, gender, handedness and hemispheric dominance as assessed with language laterality indices. Automated hippocampal volumetry was complemented by validated qualitative and quantitative morphological criteria to detect hippocampal malrotation, assumed to represent a neurodevelopmental marker. Neuropsychological measures of verbal and visuo-spatial learning and an event-related verbal and visual memory functional MRI paradigm addressed mesiotemporal function. We detected a reduction of mean left hippocampal volume in patients and their siblings compared with controls (P < 0.01). Unilateral or bilateral hippocampal malrotation was identified in 51% of patients and 50% of siblings, against 15% of controls (P < 0.05). For bilateral hippocampi, quantitative markers of verticalization had significantly larger values in patients and siblings compared with controls (P < 0.05). In the patient subgroup, there was no relationship between structural measures and age at disease onset or degree of seizure control. No overt impairment of verbal and visual memory was identified with neuropsychological tests. Functional mapping highlighted atypical patterns of hippocampal activation, pointing to abnormal recruitment during verbal encoding in patients and their siblings [P < 0.05, familywise error (FWE)-corrected]. Subgroup analyses indicated distinct profiles of hypoactivation along the hippocampal long axis in juvenile myoclonic epilepsy patients with and without malrotation; patients with malrotation also exhibited reduced frontal recruitment for verbal memory, and more pronounced left posterior hippocampal involvement for visual memory. Linear models across the entire study cohort indicated significant associations between morphological markers of hippocampal positioning and hippocampal activation for verbal items (all P < 0.05, FWE-corrected). We demonstrate abnormalities of hippocampal volume, shape and positioning in patients with juvenile myoclonic epilepsy and their siblings, which are associated with reorganization of function and imply an underlying neurodevelopmental mechanism with expression during the prenatal stage. Co-segregation of abnormal hippocampal morphology in patients and their siblings is suggestive of a genetic imaging phenotype, independent of disease activity, and can be construed as a novel endophenotype of juvenile myoclonic epilepsy.
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Zhang SY, Li XH, Xiao F. [Clinical features and prognosis of infective endocarditis patients with acute kidney injury]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:737-741. [PMID: 31420632 DOI: 10.19723/j.issn.1671-167x.2019.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the clinical features and treatment of infective endocarditis (IE) patients with acute kidney injury (AKI), and to compare the adverse complications and outcome with IE patients without AKI. METHODS Clinical data of 100 IE cases in Peking University First Hospital from January 2002 to June 2018 were retrospectively reviewed. The patients were divided into AKI group (n=21) and non-AKI group (n=79) based on the AKI network (AKIN) definition. The clinical data and prognosis were compared between the two groups. RESULTS The incidence of AKI was 21%. The average age was (43.7±15.7) years, and the ratio of male to female was 3 ∶1. There was no significant difference in age and gender between the two groups. Compared with non-AKI group, the AKI group had more rash and lower limbs edema (P=0.017 and P=0.001), higher urine blood and protein positive rate (both P<0.001). Lower hemoglobin and serum albumin level (both P<0.001), worse clinical cardiac function (NYHA III-IV, P=0.033) were found in AKI group compared with non-AKI group. There was no significant difference in microbiologic positive rate and pathogenic bacteria sorts between the two groups. Nine patients refused surgery, and the other 91 cases underwent cardiac surgery with cardiopulmonary bypass under general anesthesia, including 19 cases of AKI group and 72 cases of non-AKI group. The ventilation time and intensive care unit (ICU) stay time were longer in AKI group than in non-AKI group (P=0.028 and P=0.003). AKI group needed more red blood cell transfusion (P=0.010). Using the last serum creatinine before surgery as basic level, there was more new-onset AKI cases in AKI group than in non-AKI group. During the median follow-up time 42 months, there was no significant difference in perioperative and follow-up mortality between the two groups (P=0.463 and P=0.581). CONCLUSION More perioperation complications occurred in IE patients with AKI, but no significant difference in in-hospital and follow-up mortality between the AKI and non-AKI groups was observed.
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Asadi-Pooya AA, Xiao F, Zhou D. Real-time effects of centrotemporal spikes on cognition in rolandic epilepsy: An EEG-fMRI study. Neurology 2019; 87:551-2. [PMID: 27481460 DOI: 10.1212/wnl.0000000000002967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Guo Y, Zhang H, Liu Q, Wei F, Tang J, Li P, Han X, Zou X, Xu G, Xu Z, Zong W, Ran Q, Xiao F, Mu Z, Mao X, Ran N, Cheng R, Li M, Li C, Luo Y, Meng C, Zhang X, Xu H, Li J, Tang P, Xiang J, Shen C, Niu H, Li H, Shen J, Ni C, Zhang J, Wang H, Ma L, Bieber T, Yao Z. Phenotypic analysis of atopic dermatitis in children aged 1-12 months: elaboration of novel diagnostic criteria for infants in China and estimation of prevalence. J Eur Acad Dermatol Venereol 2019; 33:1569-1576. [PMID: 30989708 DOI: 10.1111/jdv.15618] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/01/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is the most common skin disorder in infancy. However, the diagnosis and definite significance of infantile AD remains a debated issue. OBJECTIVE To analyse the phenotypes of AD in infancy, to establish diagnostic criteria and to estimate the prevalence of this condition in China. METHODS This is a multicentric study, in which 12 locations were chosen from different metropolitan areas of China. Following careful and complete history-taking and skin examination, the definite diagnosis of AD was made and the severity based on the SCORAD index was determined by local experienced dermatologists. Based on the detailed phenotyping, the major and representative clinical features of infantile AD were selected to establish the diagnostic criteria and evaluate their diagnostic efficacy. RESULTS A total of 5967 infants were included in this study. The overall point prevalence of AD was 30.48%. The infantile AD developed as early as at the second month of life, and its incidence peaked in the third month of life at 40.81%. The proportion of mild, moderate and severe AD was 67.40%, 30.57% and 2.03%, respectively. The most commonly seen manifestations in the infantile AD were facial dermatitis (72.07%), xerosis (42.72%) and scalp dermatitis (27.93%). We established the novel diagnostic criteria of infants, which included: (i) onset after 2 weeks of birth; (ii) pruritus and/or irritability and sleeplessness comparable with lesions; and (iii) all two items above with one of the following items can reach a diagnosis of AD: (i) eczematous lesions distributed on cheeks and/or scalp and/or extensor limbs, and (ii) eczematous lesions on any other parts of body accompanied by xerosis. CONCLUSIONS In China, the prevalence of AD in infancy is 30.48% according to clinical diagnosis of dermatologists. The novel Chinese diagnostic criteria for AD in infants show a higher sensitivity and comparable specificity.
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Vakharia N, Xiao F, O’Keeffe A, Sparks R, McEvoy W, Miserocchi A, Ourselin S, Duncan S. P30 A PRISMA systematic review and meta-analysis of open and novel ‘minimally invasive’ techniques for mesial temporal lobe epilepsy (MTLE). Journal of Neurology, Neurosurgery and Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectivesOne third of patients with focal epilepsy fail to achieve seizure freedom despite best medical therapy. Surgery may provide seizure freedom if the epileptogenic zone can be safely remove. We compare the outcomes following open surgery, laser interstitial thermal therapy (LITT), radiofrequency ablation (RFA) and radiosurgery (RS).DesignPRISMA systematic review and meta-analysis.SubjectsMTLEMethodsStructured searchs of PubMed, Embase and Cochrane databases. Random effects meta-analysis to calculate effects sizes and a pooled estimate of the probability of remaining seizure free at one year following intervention.ResultsFrom 1212 screened publications, 57 articles were included in the quantitative analysis. Open surgery included anterior temporal lobectomy as well as transcortical, subtemporal and transsylvian selective amygdalohippocampectomy. The probability of remaining seizure free at one year was 0.89 (95% CI 0.83–0.93) with open surgery based on Level 1 and 2 evidence. RS resulted in 0.88 (95% CI 0.84–0.90) probability and a single RCT revealed RS was less efficacious than open surgery. Follow up duration and study sizes were limited with LITT and RFA providing a probability of remaining seizure free at one year of 0.71 (95% CI 0.65–0.76) and 0.86 (95% CI 0.76–0.92) respectively.ConclusionsThere is no evidence supporting novel ‘minimally invasive’ approaches as being as efficacious as open surgery. Secondary outcome measures such as neuropsychological outcome and intervention morbidity are poorly reported.
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Watila MM, Xiao F, Keezer MR, Miserocchi A, Winkler AS, McEvoy AW, Sander JW. Epilepsy surgery in low- and middle-income countries: A scoping review. Epilepsy Behav 2019; 92:311-326. [PMID: 30738248 DOI: 10.1016/j.yebeh.2019.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/01/2019] [Accepted: 01/01/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Epilepsy surgery is an important treatment option for people with drug-resistant epilepsy. Surgical procedures for epilepsy are underutilized worldwide, but it is far worse in low- and middle-income countries (LMIC), and it is less clear as to what extent people with drug-resistant epilepsy receive such treatment at all. Here, we review the existing evidence for the availability and outcome of epilepsy surgery in LMIC and discuss some challenges and priority. METHODS We used an accepted six-stage methodological framework for scoping reviews as a guide. We searched PubMed, Embase, Global Health Archives, Index Medicus for South East Asia Region (IMSEAR), Index Medicus for Eastern Mediterranean Region (IMEMR), Latin American & Caribbean Health Sciences Literature (LILACS), African Journal Online (AJOL), and African Index Medicus (AIM) to identify the relevant literature. RESULTS We retrieved 148 articles on epilepsy surgery from 31 countries representing 22% of the 143 LMIC. Epilepsy surgery appears established in some of these centers in Asia and Latin America while some are in their embryonic stage reporting procedures in a small cohort performed mostly by motivated neurosurgeons. The commonest surgical procedure reported was temporal lobectomies. The postoperative seizure-free rates and quality of life (QOL) are comparable with those in the high-income countries (HIC). Some models have shown that epilepsy surgery can be performed within a resource-limited setting through collaboration with international partners and through the use of information and communications technology (ICT). The cost of surgery is a fraction of what is available in HIC. CONCLUSION This review has demonstrated the availability of epilepsy surgery in a few LMIC. The information available is inadequate to make any reasonable conclusion of its existence as routine practice. Collaborations with international partners can provide an opportunity to bring high-quality academic training and technological transfer directly to surgeons working in these regions and should be encouraged.
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Tong X, An D, Xiao F, Lei D, Niu R, Li W, Ren J, Liu W, Tang Y, Zhang L, Zhou B, Gong Q, Zhou D. Real‐time effects of interictal spikes on hippocampus and amygdala functional connectivity in unilateral temporal lobe epilepsy: AnEEG‐fMRIstudy. Epilepsia 2019; 60:246-254. [PMID: 30653664 DOI: 10.1111/epi.14646] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 12/16/2018] [Accepted: 12/19/2018] [Indexed: 02/05/2023]
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Li W, An D, Tong X, Liu W, Xiao F, Ren J, Niu R, Tang Y, Zhou B, Lei D, Jiang Y, Luo C, Yao D, Gong Q, Zhou D. Different patterns of white matter changes after successful surgery of mesial temporal lobe epilepsy. NEUROIMAGE-CLINICAL 2018; 21:101631. [PMID: 30553761 PMCID: PMC6411915 DOI: 10.1016/j.nicl.2018.101631] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/29/2018] [Accepted: 12/07/2018] [Indexed: 02/05/2023]
Abstract
Objectives To explore the dynamic changes of white matters following anterior temporal lobectomy (ATL) in mesial temporal lobe epilepsy (MTLE) patients who achieved seizure-free at two-year follow-up. Methods Diffusion tensor imaging (DTI) was obtained in ten MTLE patients at five serial time points: before surgery, three months, six months, 12 months and 24 months after surgery, as well as in 11 age- and sex-matched healthy controls at one time point. Regions with significant postoperative fractional anisotropy (FA) changes and their dynamic changes were confirmed by comparing all preoperative and postoperative data using Tract-Based Spatial Statistics (TBSS). Results After successful ATL, significant FA changes were found in widespread ipsilateral and contralateral white matter regions (P <.05, FWE correction). Ipsilateral external capsule, cingulum, superior corona radiate, body of corpus callosum, inferior longitudinal fasciculus, optic radiation and contralateral inferior cerebellar peduncle, inferior longitudinal fasciculus showed significant FA decrease at three months after surgery, without further changes. Ipsilateral superior cerebellar peduncle and contralateral corpus callosum, anterior corona radiate, external capsule, optic radiation showed significant FA decrease at three months follow up but increase later. Ipsilateral cerebral peduncle and contralateral middle cerebellar peduncle showed significant FA decrease at three months follow up, with further decrease after that. While ipsilateral posterior limb of internal capsule, retrolenticular part of internal capsule and contralateral posterior corona radiate showed significant FA increase after surgery. Conclusions FA changes after successful ATL presented as four distinct patterns, reflecting different structural adaptions following epilepsy surgery. Some FA increases indicated the reversibility of preoperative diffusion abnormalities and the possibility of structural reorganization, especially in the contralateral hemisphere. Widespread white matter abnormalities existed in mesial temporal lobe epilepsy. We explored longitudinal DTI changes at five serial time points before and after anterior temporal lobectomy. We found four distinct patterns of diffusion changes, reflecting different structural adaptions following epilepsy surgery. Structural reorganization did occur after surgery, especially in contralateral hemisphere.
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Xiao F, Wang XL, Bi Z, Zhang X. [Combined operation on chronic rhinosinusitis with nasal polyps and oboslete posttraumatic deviated nose]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2018; 30:657-659. [PMID: 29871102 DOI: 10.13201/j.issn.1001-1781.2016.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Indexed: 11/12/2022]
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Shi A, Zhang X, Xiao F, Zhu L, Yan W, Han M, Luo X, Chen T, Ning Q. CD56 bright natural killer cells induce HBsAg reduction via cytolysis and cccDNA decay in long-term entecavir-treated patients switching to peginterferon alfa-2a. J Viral Hepat 2018; 25:1352-1362. [PMID: 29888839 DOI: 10.1111/jvh.12946] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 04/30/2018] [Indexed: 12/12/2022]
Abstract
HBV surface antigen (HBsAg) reduction is well observed in chronic hepatitis B (CHB) patients treated with pegylated interferon alpha-2a (PegIFNα). However, the mechanism of HBsAg suppression has not been fully elucidated. Twenty-seven of 55 entecavir-treated CHB e antigen positive patients were switched to PegIFNα treatment (Group A) whereas 28 patients continued entecavir treatment (Group B). The percentage or absolute number of CD56bright /CD56dim NK cells, expression of receptors and cytokines were evaluated by flow cytometry for 48 weeks and correlated with treatment efficacy. In vitro, purified NK cells were co-cultured with HepAD38 cells for measurement of HBsAg, apoptosis and covalently closed circular DNA (cccDNA). In association with a reduction of HBsAg, the percentage and absolute number of CD56bright NK cells was significantly elevated in patients in group A, especially in Virologic Responders (VRs, HBsAg decreased). Furthermore, the percentage of NKp30+ , NKp46+ , TRAIL+ , TNF-α+ and IFNγ+ CD56bright NK cells were significantly expanded in Group A, which were positively correlated with the decline of HBsAg at week 48. In vitro, peripheral NK cells from Group A induced a decline of HBsAg in comparison with NK cells from Group B which was significantly inhibited by anti-TRAIL, anti-TNF-α and anti-IFNγ antibodies. Furthermore, apoptosis of HepAD38 cells and levels of cccDNA, were significantly reduced by TRAIL+ and TNF-α+ /IFNγ+ NK cells from Group A, respectively. A functional restoration of CD56bright NK cells in entecavir-treated patients who were switched to PegIFNα contributes to HBsAg and cccDNA clearance through TRAIL-induced cytolysis and TNF-α/IFNγ-mediated noncytolytic pathways.
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Tan G, Xiao F, Chen S, Wang H, Chen D, Zhu L, Xu D, Zhou D, Liu L. Frequency-specific alterations in the amplitude and synchronization of resting-state spontaneous low-frequency oscillations in benign childhood epilepsy with centrotemporal spikes. Epilepsy Res 2018; 145:178-184. [PMID: 30048931 DOI: 10.1016/j.eplepsyres.2018.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 07/15/2018] [Accepted: 07/18/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Spontaneous low-frequency oscillations in different frequency bands have diverse physiological meanings. The amplitude of low-frequency fluctuation (ALFF) and functional connectivity (FC) in different frequency bands in Benign Childhood Epilepsy with Centrotemporal Spikes (BECTS) are unknown and worth exploring. METHOD Resting-state functional magnetic resonance imaging data were collected in 51 drug-naïve BECTS patients and 76 healthy controls. The ALFF was calculated for the typical (0.01 - 0.08 Hz), slow-5 (0.01-0.027 Hz), slow-4 (0.027-0.073 Hz), and slow-3 (0.073-0.198 Hz) frequency bands. The bilateral precuneus/posterior cingulate cortex (PCU/PCC) showed a common alteration of ALFF in different frequency bands, and was selected as the seed for calculating FC per voxel. RESULTS In the typical band, BECTS patients showed increased ALFF in the left rolandic operculum and the right pre/postcentral gyrus, and decreased ALFF in the bilateral PCU/PCC, some of which were shared by the slow-5, slow-4, and slow-3 bands. Decreased ALFF in the left angular gyrus was also found in the slow-3 band. Only the bilateral PCU/PCC showed a frequency-dependent correlation with the total seizure frequency and full-scale intelligence quotient. Regions having degenerated FC with the bilateral PCU/PCC in BECTS patients were mainly in the left prefrontal cortex and bilateral anterior cingulate cortex for the typical and slow-5 bands, and in the bilateral temporal limbic system and striatum for the slow-4 and slow-3 bands. CONCLUSION Alteration of the ALFF and FC differed with distinct frequency bands. Therefore, employing different frequency bands would provide more meaningful findings for BECTS patients.
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Xiao F, Yan HZ, Zou J, Yi LN, Zhang JY, Xue YM, Xie FS. [Sclerosing angiomatoid nodular transformation of the spleen with serous microcystic adenoma of pancreas: report of a case]. ZHONGHUA BING LI XUE ZA ZHI = CHINESE JOURNAL OF PATHOLOGY 2018; 47:553-555. [PMID: 29996326 DOI: 10.3760/cma.j.issn.0529-5807.2018.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Xiao F, Caciagli L, Wandschneider B, Sander JW, Sidhu M, Winston G, Burdett J, Trimmel K, Hill A, Vollmar C, Vos SB, Ourselin S, Thompson PJ, Zhou D, Duncan JS, Koepp MJ. Effects of carbamazepine and lamotrigine on functional magnetic resonance imaging cognitive networks. Epilepsia 2018; 59:1362-1371. [PMID: 29897625 PMCID: PMC6216427 DOI: 10.1111/epi.14448] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the effects of sodium channel-blocking antiepileptic drugs (AEDs) on functional magnetic resonance imaging (fMRI) language network activations in patients with focal epilepsy. METHODS In a retrospective study, we identified patients who were treated at the time of language fMRI scanning with either carbamazepine (CBZ; n = 42) or lamotrigine (LTG; n = 42), but not another sodium channel-blocking AED. We propensity-matched 42 patients taking levetiracetam (LEV) as "patient-controls" and included further 42 age- and gender-matched healthy controls. After controlling for age, age at onset of epilepsy, gender, and antiepileptic comedications, we compared verbal fluency fMRI activations between groups and out-of-scanner psychometric measures of verbal fluency. RESULTS Patients on CBZ performed less well on a verbal fluency tests than those taking LTG or LEV. Compared to either LEV-treated patients or controls, patients taking CBZ showed decreased activations in left inferior frontal gyrus and patients on LTG showed abnormal deactivations in frontal and parietal default mode areas. All patient groups showed fewer activations in the putamen bilaterally compared to controls. In a post hoc analysis, out-of-scanner fluency scores correlated positively with left putamen activation. SIGNIFICANCE Our study provides evidence of AED effects on the functional neuroanatomy of language, which might explain subtle language deficits in patients taking otherwise well-tolerated sodium channel-blocking agents. Patients on CBZ showed dysfunctional frontal activation and more pronounced impairment of performance than patients taking LTG, which was associated only with failure to deactivate task-negative networks. As previously shown for working memory, LEV treatment did not affect functional language networks.
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Wang L, Wei C, Xiao F, Chang X, Zhang Y. Incidence and risk factors for chronic pain after elective caesarean delivery under spinal anaesthesia in a Chinese cohort: a prospective study. Int J Obstet Anesth 2018. [DOI: 10.1016/j.ijoa.2018.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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