Altered Connectivity in Autistic Adults during Complex Facial Emotion Recognition: A Study of EEG Imaginary Coherence

Difficulties in Facial Emotion Recognition (FER) are commonly associated with individuals diagnosed with Autism Spectrum Disorder (ASD). However, the mechanisms underlying these impairments remain inconclusive. While atypical cortical connectivity has been observed in autistic individuals, there is a paucity of investigation during cognitive tasks such as FER. It is possible that atypical cortical connectivity may underlie FER impairments in this population. Electroencephalography (EEG) Imaginary Coherence was examined in 22 autistic adults and 23 typically developing (TD) matched controls during a complex, dynamic FER task. Autistic adults demonstrated reduced coherence between both short and long range inter-hemispheric electrodes. By contrast, short range intra-hemispheric connectivity was increased in frontal and occipital regions during FER. These findings suggest altered network functioning in ASD.

Association of interleukin 22 gene polymorphisms and serum IL-22 level with risk of systemic lupus erythematosus in a Chinese population

The aim of this study was to investigate the association between the single-nucleotide polymorphisms (SNPs) of the interleukin 22 (IL-22) gene and systemic lupus erythematosus (SLE) in a Chinese population. Three IL-22 SNPs (rs2227485, rs2227513 and rs2227491) were genotyped using SNaPshot SNP genotyping assays and identified by sequencing in 314 SLE patients and 411 healthy controls. The IL-22 level of serum was assessed by enzyme-linked immunosorbent assay (ELISA) kits. Data were analysed by spss version 17.0 software. We found that rs2227513 was associated with an increased risk of SLE [AG versus AA: adjusted odds ratio (aOR) = 2·24, 95% confidence interval (CI) = 1·22-4·12, P = 0·010; G versus· A: adjusted OR = 2·18, 95% CI = 1·20-3·97, P = 0·011]. Further analysis in patients with SLE showed that the AG genotype and G allele were associated with an increased risk of renal disorder in SLE (G versus A: aOR = 3·09, 95% CI = 1·30-7·33, P = 0·011; AG versus· AA: aOR = 3·25, 95% CI = 1·35-7·85, P = 0·009). In addition, the concentration of IL-22 was significantly lower in the rs2227513 AG genotype compared with AA genotype (P = 0·028). These results suggest that rs2227513 polymorphism might contribute to SLE susceptibility, probably by decreasing the expression of IL-22.

Increased postoperative glucose variability is associated with adverse outcomes following orthopaedic surgery

Aims

The aim of this study was to examine the association between postoperative glycaemic variability and adverse outcomes following orthopaedic surgery.

Patients and Methods

This retrospective study analyzed data on 12 978 patients (1361 with two operations) who underwent orthopaedic surgery at a single institution between 2001 and 2017. Patients with a minimum of either two postoperative measurements of blood glucose levels per day, or more than three measurements overall, were included in the study. Glycaemic variability was assessed using a coefficient of variation (CV). The length of stay (LOS), in-hospital complications, and 90-day readmission and mortality rates were examined. Data were analyzed with linear and generalized linear mixed models for linear and binary outcomes, adjusting for various covariates.

Results

The cohort included 14 339 admissions, of which 3302 (23.0%) involved diabetic patients. Patients with CV values in the upper tertile were twice as likely to have an in-hospital complication compared with patients in the lowest tertile (19.4% versus 9.0%, p < 0.001), and almost five times more likely to die compared with those in the lowest tertile (2.8% versus 0.6%, p < 0.001). Results of the adjusted analyses indicated that the mean LOS was 1.28 days longer in the highest versus the lowest CV tertile (p < 0.001), and the odds of an in-hospital complication and 90-day mortality in the highest CV tertile were respectively 1.91 (p < 0.001) and 2.10 (p = 0.001) times larger than the odds of these events in the lowest CV tertile. These associations were significant even for non-diabetic patients. After adjusting for hypoglycaemia, the relationships remained significant, except that the CV tertile no longer predicted mortality in diabetics.

Conclusion

These results indicate that higher glycaemic variability is associated with longer LOS and in-hospital complications. Glycaemic variability also predicted death, although that primarily held for non-diabetic patients in the highest CV tertile following orthopaedic surgery. Prospective studies should examine whether ensuring low postoperative glycaemic variability may reduce complication rates and mortality. Cite this article: Bone Joint J 2018;100-B:1125–32.

EEG Based Network Connectivity Classification in 7 and 9 Years- Old Children

Investigating the brain neural pathways requires extensive knowledge of childrens' cognitive development. Significant variations in the cognitive process of a child, across ages, were assessed through the success in recognizing various stimuli. Longitudinal EEG data were gathered from 45 healthy children at the ages of seven and nine years. During the EEG data acquisition, children were asked to respond to the Flanker stimuli for investigating the development of the response conflict process. In each age group, the coherence and imaginary component of coherency were used to assess the network connectivity of each child. The congruent and incongruent stimuli were tried within delta, theta, alpha and beta bands. Following that, efficacies of various classification algorithms were tested in discriminating the coherency data of the two age groups. It was observed that brain connectivity was more helpful in distinguishing between two age groups using the incongruent Flanker stimuli. For the incongruent condition, the imaginary part of the coherency provides better features for classification. Using the features derived from the theta, alpha and beta bands, a classification accuracy of more than 94.31% could be achieved using the naïve Bayes classifier.

Stable actively Q-switched single-frequency fiber laser at 1.5 μm based on self-injecting polarization modulation

A new technique for the realization of a stable Q-switched operation in a single-frequency fiber laser based on self-injecting polarization modulation is demonstrated, for the first time to the best of our knowledge. A piezoelectric fiber stretcher was utilized to introduce periodic stress-induced polarization changes. Then the modulation of polarization state transformed into Q switching by virtue of a designed distributed Bragg reflector (DBR) resonant cavity with polarizations loss anisotropy. Finally, a stable actively Q-switched single-frequency fiber laser at 1.5 μm with Gaussian-shape pulse output was achieved. We experimentally found that, the repetition frequency (several hundred kHz) coincided with the working frequency of the polarization modulation, and the pulse width (several hundred ns) reduced with the increasing of the modulating frequency, the modulating amplitude, as well as the pump power. This stable Q-switched single-frequency fiber laser is promising for applications in optical time-domain reflectometry, coherent Doppler wind radar, and optical coherent detection. More importantly, this novel Q-switched technology may be applicable to other DBR single-frequency fiber lasers.

Oxyntomodulin analogue increases energy expenditure via the glucagon receptor

The gut hormone oxyntomodulin (OXM) causes weight loss by reducing appetite and increasing energy expenditure. Several analogues are being developed to treat obesity. Exactly how oxyntomodulin works, however, remains controversial. OXM can activate both glucagon and GLP-1 receptors but no specific receptor has been identified. It is thought that the anorectic effect occurs predominantly through GLP-1 receptor activation but, to date, it has not been formally confirmed which receptor is responsible for the increased energy expenditure. We developed OX-SR, a sustained-release OXM analogue. It produces a significant and sustained increase in energy expenditure in rats as measured by indirect calorimetry. We now show that this increase in energy expenditure occurs via activation of the glucagon receptor. Blockade of the GLP-1 receptor with Exendin 9-39 does not block the increase in oxygen consumption caused by OX-SR. However, when activity at the glucagon receptor is lost, there is no increase in energy expenditure. Glucagon receptor activity therefore appears to be essential for OX-SR's effects on energy expenditure. The development of future 'dual agonist' analogues will require careful balancing of GLP-1 and glucagon receptor activities to obtain optimal effects.

Low-Level Tragus Stimulation for the Treatment of Ischemia and Reperfusion Injury in Patients With ST-Segment Elevation Myocardial Infarction: A Proof-of-Concept Study

OBJECTIVES

The aim of this study was to investigate whether low-level tragus stimulation (LL-TS) treatment could reduce myocardial ischemia-reperfusion injury in patients with ST-segment elevation myocardial infarction (STEMI).

BACKGROUND

The authors' previous studies suggested that LL-TS could reduce the size of myocardial injury induced by ischemia.

METHODS

Patients who presented with STEMI within 12 h of symptom onset, treated with primary percutaneous coronary intervention, were randomized to the LL-TS group (n = 47) or the control group (with sham stimulation [n = 48]). LL-TS, 50% lower than the electric current that slowed the sinus rate, was delivered to the right tragus once the patients arrived in the catheterization room and lasted for 2 h after balloon dilatation (reperfusion). All patients were followed for 7 days. The occurrence of reperfusion-related arrhythmia, blood levels of creatine kinase-MB, myoglobin, N-terminal pro-B-type natriuretic peptide and inflammatory markers, and echocardiographic characteristics were evaluated.

RESULTS

The incidence of reperfusion-related ventricular arrhythmia during the first 24 h was significantly attenuated by LL-TS. In addition, the area under the curve for creatine kinase-MB and myoglobin over 72 h was smaller in the LL-TS group than the control group. Furthermore, blood levels of inflammatory markers were decreased by LL-TS. Cardiac function, as demonstrated by the level of N-terminal pro-B-type natriuretic peptide, the left ventricular ejection fraction, and the wall motion index, was markedly improved by LL-TS.

CONCLUSIONS

LL-TS reduces myocardial ischemia-reperfusion injury in patients with STEMI. This proof-of-concept study raises the possibility that this noninvasive strategy may be used to treat patients with STEMI undergoing primary percutaneous coronary intervention.

Mass Segmentation in Automated 3-D Breast Ultrasound Using Adaptive Region Growing and Supervised Edge-Based Deformable Model

Automated 3-D breast ultrasound has been proposed as a complementary modality to mammography for early detection of breast cancers. To facilitate the interpretation of these images, computer aided detection systems are being developed in which mass segmentation is an essential component for feature extraction and temporal comparisons. However, automated segmentation of masses is challenging because of the large variety in shape, size, and texture of these 3-D objects. In this paper, the authors aim to develop a computerized segmentation system, which uses a seed position as the only priori of the problem. A two-stage segmentation approach has been proposed incorporating shape information of training masses. At the first stage, a new adaptive region growing algorithm is used to give a rough estimation of the mass boundary. The similarity threshold of the proposed algorithm is determined using a Gaussian mixture model based on the volume and circularity of the training masses. In the second stage, a novel geometric edge-based deformable model is introduced using the result of the first stage as the initial contour. In a data set of 50 masses, including 38 malignant and 12 benign lesions, the proposed segmentation method achieved a mean Dice of 0.74 ± 0.19 which outperformed the adaptive region growing with a mean Dice of 0.65 ± 0.2 (p-value < 0.02). Moreover, the resulting mean Dice was significantly (p-value < 0.001) better than that of the distance regularized level set evolution method (0.52 ± 0.27). The supervised method presented in this paper achieved accurate mass segmentation results in terms of Dice measure. The suggested segmentation method can be utilized in two aspects: 1) to automatically measure the change in volume of breast lesions over time and 2) to extract features for a computer aided detection or diagnosis system.

An EEG coherence-based analysis approach for investigating response conflict processes in 7 and 9-year old children

Understanding the development of the brain's neural networks can reveal critical insights into the cognitive changes that occur from infancy to late childhood. Behavioural metrics including: task accuracy, stimuli recognition, and reaction time show dramatic changes over childhood. In this study we investigated response control using the Erikson Flanker task. In a dataset of 45 EEG recordings, we calculated spectral coherence to measure connectivity between all possible electrode pairs. Coherence measures were performed on two different trial conditions -congruent (where there is no response conflict) and incongruent (where response conflict is induced). The increase in incongruent coherence compared to the congruent was investigated for each electrode pair over 45 healthy subjects aged seven years. The same calculation was then performed on the same group of subjects two years later when they were aged nine years. The results revealed that at age seven years, increased coherence was detected in the left prefrontal to right and left parieto-occipital - i.e. an anatomical region located between the parietal and occipital lobes - within theta band. No increase was found for the older group-at age nine years- which may indicate cognitive development in conflict processing mechanism.

Abstract OT3-04-02: The DORA trial: A non-comparator randomised phase II multi-center maintenance study of olaparib alone or olaparib in combination with durvalumab in platinum treated advanced triple negative breast cancer (TNBC)

Background: Recent data from the OlympiaD study revealed an improvement in response rate and progression-free survival (PFS) with the PARP inhibitor (PARPi) olaparib vs. standard of care chemotherapy in patients with metastatic breast cancer who harbor germline BRCA (gBRCA) mutations. Maintenance PARPi has improved median PFS in relapsed ovarian cancer regardless of gBRCA mutation status or HRD status. The similarities between the molecular aberration profiles of high-grade serous ovarian cancer and TNBC invites exploration of maintenance PARPi in mTNBC. Furthermore, because durable responses have been reported in subsets of patients with metastatic TNBC (mTNBC) with checkpoint blockade and because high mutational load is associated with both gBRCA and TNBC, these patients may be particularly susceptible to immunotherapy with PARPi. Thus, we hypothesize that olaparib either alone or in combination with the PD-L1 inhibitor durvalumab will be active in TNBC subjects who have responded to platinum-based chemotherapy.

Trial design: DORA is a non-comparator randomized, international, multicenter phase II study designed to explore the efficacy of olaparib with or without durvalumab as maintenance therapy in platinum-treated mTNBC. Subjects will be enrolled following four cycles of treatment with a platinum-based (cisplatin or carboplatin) chemotherapy as single agent or combination therapy. Subjects deriving clinical benefit (CR / PR / SD) with platinum-based therapy as determined by the treating physician will be eligible and randomized in a 1:1 ratio. Patients in arm 1 will receive olaparib orally 300mg BID continuously and in arm 2 will receive olaparib orally 300mg BID continuously in combination with durvalumab 1500mg IV every 4 wks. Tumor responses will be assessed every 8 wks.

Eligibility criteria: Subjects with mTNBC who are receiving platinum-based chemotherapy and who have had no more than 2 lines of chemotherapy in the metastatic or advanced setting, with one of those being a platinum, will be included in this trial. Eligible patients must have been assessed by their treating physicians to have derived clinical benefit with platinum based therapy. Archival tissue or fresh biopsy samples are mandated for biomarker analyses.

Aims:The primary endpoint is PFS; the key secondary endpoint is overall survival.

Statistical methods: The sample size is calculated based upon data derived from contemporary trials of chemotherapy in mTNBC. In both arms of the study, it is proposed to test a null hypothesis of a median PFS of 2 months against an alternative hypothesis of a median PFS of 4 months; there is no intention to make a formal statistical comparison between the two treatment arms. To test this hypothesis, assuming an exponential PFS distribution, use of an exponential MLE test, a two-sided significance level of 5% and a power of 90%, 25 subjects are required per arm.

Target accrual: To allow for a drop-out rate of approximately 20%, the sample size per arm will be inflated to 30 subjects. We plan to enroll approximately 60 subjects with mTNBC from 6 centers.

ClinicalTrials.gov Identifier: NCT03167619

Citation Format: Dent R, Tan T, Kim S-B, Traina T, McArthur H, Im Y-H, Creel T, Blackwell K. The DORA trial: A non-comparator randomised phase II multi-center maintenance study of olaparib alone or olaparib in combination with durvalumab in platinum treated advanced triple negative breast cancer (TNBC) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT3-04-02.

Venous thromboembolic prophylaxis after simultaneous bilateral total knee arthroplasty: aspirin versus warfarin

Aims

The aims of this study were to compare the efficacy of two agents, aspirin and warfarin, for the prevention of venous thromboembolism (VTE) after simultaneous bilateral total knee arthroplasty (SBTKA), and to elucidate the risk of VTE conferred by this procedure compared with unilateral TKA (UTKA).

Patients and Methods

A retrospective, multi-institutional study was conducted on 18 951 patients, 3685 who underwent SBTKA and 15 266 who underwent UTKA, using aspirin or warfarin as VTE prophylaxis. Each patient was assigned an individualised baseline VTE risk score based on a system using the Nationwide Inpatient Sample. Symptomatic VTE, including pulmonary embolism (PE) and deep vein thrombosis (DVT), were identified in the first 90 days post-operatively. Statistical analyses were performed with logistic regression accounting for baseline VTE risk.

Results

The adjusted incidence of PE following SBTKA was 1.0% (95% confidence interval (CI) 0.86 to 1.2) with aspirin and 2.2% (95% CI 2.0 to 2.4) with warfarin. Similarly, the adjusted incidence of VTE following SBTKA was 1.6% (95% CI 1.1 to 2.3) with aspirin and 2.5% (95% CI 1.9 to 3.3) with warfarin. The risk of PE and VTE were reduced by 66% (odds ratio (OR) 0.44, 95% CI 0.25 to 0.78) and 38% (OR 0.62, 95% CI 0.38 to 1.0), respectively, using aspirin. In addition, the risk of PE was 204% higher for patients undergoing SBTKA relative to those undergoing UTKA. For each ten-point increase in baseline VTE risk, the risk of PE increased by 25.5% for patients undergoing SBTKA compared with 10.5% for those undergoing UTKA. Patients with a history of myocardial infarction or peripheral vascular disease had the greatest increase in risk from undergoing SBTKA instead of UTKA.

Conclusion

Aspirin is more effective than warfarin for the prevention of VTE following SBTKA, and serves as the more appropriate agent for VTE prophylaxis for patients in all risk categories. Furthermore, patients undergoing SBTKA are at a substantially increased risk of VTE, even more so for those with significant underlying risk factors. Patients should be informed about the risks associated with undergoing SBTKA.

Cite this article: Bone Joint J 2018;100-B(1 Supple A):68–75.