Multicentric clinical evaluation of a computed tomography-based fully automated deep neural network for aortic maximum diameter and volumetric measurements

OBJECTIVE

This study aims to evaluate a fully automatic deep learning-based method (augmented radiology for vascular aneurysm [ARVA]) for aortic segmentation and simultaneous diameter and volume measurements.

METHODS

A clinical validation dataset was constructed from preoperative and postoperative aortic computed tomography angiography (CTA) scans for assessing these functions. The dataset totaled 350 computed tomography angiography scans from 216 patients treated at two different hospitals. ARVA's ability to segment the aorta into seven morphologically based aortic segments and measure maximum outer-to-outer wall transverse diameters and compute volumes for each was compared with the measurements of six experts (ground truth) and thirteen clinicians.

RESULTS

Ground truth (experts') measurements of diameters and volumes were manually performed for all aortic segments. The median absolute diameter difference between ground truth and ARVA was 1.6 mm (95% confidence interval [CI], 1.5-1.7; and 1.6 mm [95% CI, 1.6-1.7]) between ground truth and clinicians. ARVA produced measurements within the clinical acceptable range with a proportion of 85.5% (95% CI, 83.5-86.3) compared with the clinicians' 86.0% (95% CI, 83.9-86.0). The median volume similarity error ranged from 0.93 to 0.95 in the main trunk and achieved 0.88 in the iliac arteries.

CONCLUSIONS

This study demonstrates the reliability of a fully automated artificial intelligence-driven solution capable of quick aortic segmentation and analysis of both diameter and volume for each segment.

Relativistic moduli space and critical velocity in kink collisions

One important tool in the analysis of the collision of kinks and other topological solitons is the reduction of the original field theory to a finite-dimensional system of so-called collective coordinates. Here we study one recent proposal of a collective coordinate model (CCM), the perturbative relativistic moduli space (pRMS), where the amplitudes of the Derrick modes are promoted to collective coordinates. In particular, we analyze the possibility to calculate within the pRMS the critical velocity, i.e., the initial velocity of kinks at which single bounce scattering changes into a multibounce or annihilation collision. We find that for a growing number of Derrick modes the critical velocity of the CCM approaches the full field theory value. In particular, in the case of the ϕ^{4} model we reach a 99% accuracy. We also see this convergence for a wide range of models belonging to the family of the double sine-Gordon and Christ-Lee theories, especially in those cases where the kinks do not reveal a too well-pronounced half-kink inner structure.

Molecular and clinical diversity in primary central nervous system lymphoma

BACKGROUND

Primary central nervous system lymphoma (PCNSL) is a rare and distinct entity within diffuse large B-cell lymphoma presenting with variable response rates probably to underlying molecular heterogeneity.

PATIENTS AND METHODS

To identify and characterize PCNSL heterogeneity and facilitate clinical translation, we carried out a comprehensive multi-omic analysis [whole-exome sequencing, RNA sequencing (RNA-seq), methylation sequencing, and clinical features] in a discovery cohort of 147 fresh-frozen (FF) immunocompetent PCNSLs and a validation cohort of formalin-fixed, paraffin-embedded (FFPE) 93 PCNSLs with RNA-seq and clinico-radiological data.

RESULTS

Consensus clustering of multi-omic data uncovered concordant classification of four robust, non-overlapping, prognostically significant clusters (CS). The CS1 and CS2 groups presented an immune-cold hypermethylated profile but a distinct clinical behavior. The 'immune-hot' CS4 group, enriched with mutations increasing the Janus kinase (JAK)-signal transducer and activator of transcription (STAT) and nuclear factor-κB activity, had the most favorable clinical outcome, while the heterogeneous-immune CS3 group had the worse prognosis probably due to its association with meningeal infiltration and enriched HIST1H1E mutations. CS1 was characterized by high Polycomb repressive complex 2 activity and CDKN2A/B loss leading to higher proliferation activity. Integrated analysis on proposed targets suggests potential use of immune checkpoint inhibitors/JAK1 inhibitors for CS4, cyclin D-Cdk4,6 plus phosphoinositide 3-kinase (PI3K) inhibitors for CS1, lenalidomide/demethylating drugs for CS2, and enhancer of zeste 2 polycomb repressive complex 2 subunit (EZH2) inhibitors for CS3. We developed an algorithm to identify the PCNSL subtypes using RNA-seq data from either FFPE or FF tissue.

CONCLUSIONS

The integration of genome-wide data from multi-omic data revealed four molecular patterns in PCNSL with a distinctive prognostic impact that provides a basis for future clinical stratification and subtype-based targeted interventions.

[Peripheral neuropathies during systemic diseases: Part I (connective tissue diseases and granulomatosis)]

Systemic diseases (connective disease, granulomatosis) may be associated with peripheral neuropathies. The diagnosis can be complex when the neuropathy is the presenting manifestation of the disease, requiring close collaboration between neurologists and internists. Conversely, when the systemic disease is already known, the main question remaining is its imputability in the neuropathy. Regardless of the situation, the positive diagnosis of neuropathy is based on a systematic and rigorous electro-clinical investigation, specifying the topography, the evolution and the mechanism of the nerve damage. Certain imaging examinations, such as nerve and/or plexus MRI, or other more invasive examinations (skin biopsy, neuromuscular biopsy) enable to specify the topography and the mechanism of the injury. The imputability of the neuropathy in the course of a known systemic disease is based mainly on its electro-clinical pattern, on which the alternatives diagnoses depend. In the case of an inaugural neuropathy, a set of arguments orients the diagnosis, including the underlying terrain (young subject), possible associated systemic manifestations (inflammatory arthralgias, polyadenopathy), results of first-line laboratory tests (lymphopenia, hyper-gammaglobulinemia, hypocomplementemia), autoantibodies (antinuclear, anti-native DNA, anti-SSA/B) and sometimes invasive examinations (neuromuscular biopsy).

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

Deep learning to detect anterior cruciate ligament tear on knee MRI: multi-continental external validation

OBJECTIVES

To develop a deep-learning algorithm for anterior cruciate ligament (ACL) tear detection and to compare its accuracy using two external datasets.

METHODS

A database of 19,765 knee MRI scans (17,738 patients) issued from different manufacturers and magnetic fields was used to build a deep learning-based ACL tear detector. Fifteen percent showed partial or complete ACL rupture. Coronal and sagittal fat-suppressed proton density or T2-weighted sequences were used. A Natural Language Processing algorithm was used to automatically label reports associated with each MRI exam. We compared the accuracy of our model on two publicly available external datasets: MRNet, Bien et al, USA (PLoS Med 15:e1002699, 2018); and KneeMRI, Stajduhar et al, Croatia (Comput Methods Prog Biomed 140:151-164, 2017). Receptor operating characteristics (ROC) curves, area under the curve (AUC), sensitivity, specificity, and accuracy were used to evaluate our model.

RESULTS

Our neural networks achieved an AUC value of 0.939 for detection of ACL tears, with a sensitivity of 87% (0.875) and a specificity of 91% (0.908). After retraining our model on Bien dataset and Stajduhar dataset, our algorithm achieved AUC of 0.962 (95% CI 0.930-0.988) and 0.922 (95% CI 0.875, 0.962) respectively. Sensitivity, specificity, and accuracy were respectively 85% (95% CI 75-94%, 0.852), 89% (95% CI 82-97%, 0.894), 0.875 (95% CI 0.817-0.933) for Bien dataset, and 68% (95% CI 54-81%, 0.681), 93% (95% CI 89-97%, 0.934), and 0.870 (95% CI 0.821-0.913) for Stajduhar dataset.

CONCLUSION

Our algorithm showed high performance in the detection of ACL tears with AUC on two external datasets, demonstrating its generalizability on different manufacturers and populations. This study shows the performance of an algorithm for detecting anterior cruciate ligament tears with an external validation on populations from countries and continents different from the study population.

KEY POINTS

• An algorithm for detecting anterior cruciate ligament ruptures was built from a large dataset of nearly 20,000 MRI with AUC values of 0.939, sensitivity of 87%, and specificity of 91%. • This algorithm was tested on two external populations from different other countries: a dataset from an American population and a dataset from a Croatian population. Performance remains high on these two external validation populations (AUC of 0.962 and 0.922 respectively).

Motivations of the participants who post a message in an online health forum: a qualitative and quantitative descriptive study in French health forum Doctissimo

BACKGROUND

For more than 20 years, and despite the development of new social networks, health forums have remained a privileged place for people to discuss health issues. This study investigates the motivations of participants to post a message on a French online health forum (called 'Doctissimo') (Forum Santé - Doctissimo,  2022).

METHOD

Between January 1, 2017 and December 31, 2019, all the first messages recorded on the health forum doctissimo ( www.forum.doctissimo.fr ) were selected in their initial format by a crawler. The transcripts were imported into the qualitative analysis software Nvivo. Two researchers coded the data until a theoretical saturation was obtained.

RESULTS

We identified four categories of motivation: 1) 'Questioning' allows the exchange of mainly medical information, or sharing of feedback on experiences with the disease: 1722 codes, 44.8%, 2) Worry, need for reassurance: 1066 codes, 27.7% about symptoms or anticipatory anxiety, 3) 'Expressing oneself' mainly allows a catharsis and thus an emotional release, especially negative, but also to share a personal experience: 764 codes 19.9%, 4) Community spirit is a central element to create an emotional support group for psychological support, exchange ideas, meet people in similar situations: 291 codes, 7.6%. The relationship with a health professional when mentioned is generally marked by doubts 39.5%, confusion, or lack of information and the need for additional elements 64.6% or reassurance 60%. The relationship and the obstacles to a medical consultation are described in relation to the use of the forum: immediate availability, anonymity, absence of taboo and community spirit.

CONCLUSION

The use of information sources offered by the Internet is a way to ask questions, to be reassured, to express oneself or to be confirmed by the community in the hypothesis emitted by a health professional. Patients are looking for an immediate answer, they come to the community for reassurance, they feel free and legitimate.

Pre-surgical and Post-surgical Aortic Aneurysm Maximum Diameter Measurement: Full Automation by Artificial Intelligence

OBJECTIVE

The aim of this study was to evaluate an automatic, deep learning based method (Augmented Radiology for Vascular Aneurysm [ARVA]), to detect and assess maximum aortic diameter, providing cross sectional outer to outer aortic wall measurements.

METHODS

Accurate external aortic wall diameter measurement is performed along the entire aorta, from the ascending aorta to the iliac bifurcations, on both pre- and post-operative contrast enhanced computed tomography angiography (CTA) scans. A training database of 489 CTAs was used to train a pipeline of neural networks for automatic external aortic wall measurements. Another database of 62 CTAs, including controls, aneurysmal aortas, and aortic dissections scanned before and/or after endovascular or open repair, was used for validation. The measurements of maximum external aortic wall diameter made by ARVA were compared with those of seven clinicians on this validation dataset.

RESULTS

The median absolute difference with respect to expert's measurements ranged from 1 mm to 2 mm among all annotators, while ARVA reported a median absolute difference of 1.2 mm.

CONCLUSION

The performance of the automatic maximum aortic diameter method falls within the interannotator variability, making it a potentially reliable solution for assisting clinical practice.

Neuropathies périphériques associées aux syndromes lymphoprolifératifs : spectre clinique et démarche diagnostique

Lymphoproliferative syndromes (multiple myeloma, Waldenström's disease, chronic lymphocytic leukemia, lymphomas) may be associated with peripheral neuropathies. The mechanism can be dysimmune, associated or not with monoclonal gammopathies; paraneoplastic; infiltrative; or more commonly, iatrogenic or due to vitamin deficiency. The diagnosis can be complex, especially when the neuropathy is the presenting manifestation, requiring a close cooperation between internists and neurologists. The positive diagnosis of the neuropathy is based on a systematic electro-clinical investigation, which specifies the topography and the mechanism of the nerve damage, sometimes reinforced by imaging examinations, in particular, nerve and/or plexus MRI. The imputability of the neuropathy to a lymphoproliferative syndrome is based on a set of arguments including the clinical context (B signs, tumour syndrome), first-line laboratory tests (hemogram, protein electrophoresis, viral serologies, complement), auto-antibodies discussed according to the neuropathy (anti-MAG, anti-gangliosides) and sometimes more invasive examinations (bone marrow or neuro-muscular biopsies).

Visual Information Routes in the Posterior Dorsal and Ventral Face Network Studied with Intracranial Neurophysiology and White Matter Tract Endpoints

Occipitotemporal regions within the face network process perceptual and socioemotional information, but the dynamics and information flow between different nodes of this network are still debated. Here, we analyzed intracerebral EEG from 11 epileptic patients viewing a stimulus sequence beginning with a neutral face with direct gaze. The gaze could avert or remain direct, while the emotion changed to fearful or happy. N200 field potential peak latencies indicated that face processing begins in inferior occipital cortex and proceeds anteroventrally to fusiform and inferior temporal cortices, in parallel. The superior temporal sulcus responded preferentially to gaze changes with augmented field potential amplitudes for averted versus direct gaze, and large effect sizes relative to other network regions. An overlap analysis of posterior white matter tractography endpoints (from 1066 healthy brains) relative to active intracerebral electrodes in the 11 patients showed likely involvement of both dorsal and ventral posterior white matter pathways. Overall, our data provide new insight into the timing of face and social cue processing in the occipitotemporal brain and anchor the superior temporal cortex in dynamic gaze processing.

753 Sesamoid Alignment After MIS Chevron Osteotomy and Its Role to Prevent Hallux Valgus Recurrence

Introduction

Incomplete correction of the sesamoid position after corrective osteotomy is a risk factor for recurrence of the hallux valgus deformity. This study was done to report the results of sesamoid alignment after chevron osteotomy.

Method

92 patients (111 feet) had minimally invasive (MIS) distal chevron osteotomy and release of fibular sesamoid ligaments done, sesamoid position was assessed in the weight-bearing views of the foot, tibial sesamoid position in relation to the mechanical axis of the first metatarsal was classified as grades 0-3 where the normal position was graded (0) and the most lateral sublaxation was graded (3). There were 2 groups; the reduced (grade 0-1) & the dislocated (grade 2,3) groups. Preoperative and post-operative radiographs were compared. Postoperative images were done 6-8 weeks post-operatively to ensure osteotomy healing.

Results

Sesamoids alignment was corrected following the MIS chevron osteotomy; 84 feet (75.7%) were from the dislocated group and 27 feet (24.3%) were from the reduced group pre-operatively improved to 102 feet (91.9%) reduced and only 9 feet (8.1%) dislocated following the procedure with P-value < 0.00001. To ensure inter-observer reliability, images were assessed by 2 observers with Cohen’s Kappa coefficient 0.477.

Conclusions

MIS chevron osteotomy can produce significant improvement of sesamoid position which is crucial to prevent recurrence of hallux valgus.

Kink-antikink collisions in a weakly interacting ϕ^{4} model

Kink-antikink scattering in nonintegrable field theories like ϕ^{4} theory is still rather poorly understood beyond brute-force numerical calculations, even after several decades of investigation. Recently, however, some progress has been made based on the introduction of certain self-dual background fields in these field theories which imply both the existence of static kink-antikink solutions of the Bogomol'nyi type and the possibility of an adiabatic scattering (moduli space approximation). Here we continue and generalize these investigations by introducing a one-parameter family of models interpolating between the Bogomol'nyi-Prasad-Sommerfield (BPS) model with the self-dual background field and the original ϕ^{4} theory. More concretely, we study kink-antikink scattering in a parameter range between the limit of no static force (BPS limit) and the regime where the static interaction between kink and antikink is small (non-BPS regime). This allows us to study the impact of the strength of the intersoliton static force on the soliton dynamics. In particular, we analyze how the transition of a bound mode through the mass threshold affects the soliton dynamics in a generic process, i.e., when a static intersoliton force shows up. We show that the thin, precisely localized spectral wall which forms in the limit of no static force broadens in a well-defined manner when a static force is included, giving rise to what we call a thick spectral wall. This phenomenon results from the appearance of a stationary saddle point solution where the acceleration of the solitons owing to the attractive force is compensated by the dynamics of the sufficiently excited mode. Thus, this barrier shows up before the mode crosses the mass threshold.

Applying “Acting Within Contexts” to intervention evaluation and equitable intervention design

With the rise of chronic illness in the last century, notably diabetes, cardiovascular disease, and obesity, public health has worked to identify the causes of these diseases in order to develop effective interventions and improve population health. Research has shown that these chronic diseases are strongly linked to lifestyle-related risk factors such as smoking, poor eating habits, and physical inactivity. Based on this knowledge, public health interventions have focused on health information and education programs that target these lifestyle-related risk factors. However, these programs have been found to be ineffective because these lifestyle-related strategies do not take into account the contexts that influence behaviour change. This has been found to be particularly true for vulnerable populations who tend to live in contexts of poverty. We therefore asked: how do contexts of vulnerability influence the way people act in their daily lives? To address this question, findings from a qualitative project led to the development of the “Acting Within Contexts” framework. It is a system of five interrelated components (i.e. agency, resources, capacities, threats, and opportunities), which offers an analytical lens to better understand the influence of vulnerable contexts on how people carry out their daily actions.

This presentation will first propose an explanation of the limits of public health interventions that aim to change behaviours. Secondly, based on the two previous presentations, it will present how “Acting Within Contexts” can be used: 1) to develop a better understanding of contexts in which vulnerable populations live, based on how the five components interact in people's lives to either hinder or facilitate their access to health; and 2) to design interventions that will shift the focus away from lifestyle-related risk factors, and rather, towards targeting the five components that make up people's everyday contexts.

[Cervical spinal sarcoidosis mimicking compressive cervical myelopathy: Poor prognosis after surgery]

INTRODUCTION

Cervical spinal sarcoidosis can mimic compressive cervical myelopathy leading to potentially harmful surgical procedures before the diagnosis can be made.

METHODS

Retrospective description of 3 patients and review of the literature.

RESULTS

Twenty-seven patients (16 men/11 women), median age 58 years [range 29-74] were described. Neurosurgical procedures consisted of laminectomy (n=10), laminoplasty (n=15) and anterior discectomy (n=2). Immediately after surgery, 17 patients (63%) worsened or remained disabled. Among the 10 patients who improved, 9 worsened secondarily. The analysis of preoperative MRI showed T2 hypersignal lesions and contrast enhancement in all patients. Neurological symptoms were inaugural in 25/27 patients, and systemic involvement of the sarcoidosis was found after surgery in 15/27 patients. After surgery, all patients received corticosteroids, along with immunosuppressive therapy in 8 cases/27. After a follow-up of 24 [16-72] months; 13 patients were stabilized or worsened, 7 were partially improved. Three died of other cause. Only 5 recovered without sequelae.

CONCLUSION

In patients with compressive cervical myelopathy, leptomeningeal contrast enhancement, a T2-weighted hypersignal exceeding the compression level on MRI, and the presence of extraneurological symptoms should point to inflammatory disease. These rare manifestations may be the first symptoms of sarcoidosis and should be recognized to avoid harmful surgical procedures and to provide appropriate medical treatment.

Improving participation of detained men in organised screening of colorectal cancer in Toulon

Key messages

Awareness program adapted to prison improved participation in colorectal cancer organised screening. Proximity guidance helped to detect cancer and to improve medical care of detained persons.

Spectral Walls in Soliton Collisions

During defect-antidefect scattering, bound modes frequently disappear into the continuous spectrum before the defects themselves collide. This leads to a structural, nonperturbative change in the spectrum of small excitations. Sometimes the effect can be seen as a hard wall from which the defect can bounce off. We show the existence of these spectral walls and study their properties in the ϕ^{4} model with Bogomol'nyi-Prasad-Sommerfield preserving impurity, where the spectral wall phenomenon can be isolated because the static force between the antikink and the impurity vanishes. We conclude that such spectral walls should surround all solitons possessing internal modes.

Influence of wood ash pre-treatment on leaching behaviour, liming and fertilising potential

In Denmark, increasing amounts of woody biomass are being used for the production of renewable energy, resulting in more wood ashes being generated. While these materials have been mainly landfilled, wood ashes may also be utilised for fertilizing and liming purposes on top of soils. Pre-treatments involving hardening or granulation may be carried out prior to soil application. In this study, two Danish wood ash samples were hardened and/or granulated. Lab-hardening induced rapid changes in the shape of the acid neutralisation capacity curve of the ashes. Up-flow column tests, assuming local equilibrium conditions, were employed to investigate the leaching from pre-treated ashes. Granules and loose ashes demonstrated similar leaching behaviours, indicating that similar geochemical processes were governing their leaching. In comparison with untreated fresh ashes, the hardened ashes demonstrated reduced leaching of Ca, Ba, Pb and Zn with concentration levels generally below or close to the analytical limits of quantification; to the contrary, the leaching of As, P, Sb, Si, V and Mg was enhanced in the hardened ashes. The release of alkalinity was reduced by hardening. In general, all granules were barely breakable by finger-pinching and they could withstand one month of continuous leaching, preserving their overall shape. The solubility of phosphorous in neutral ammonium citrate indicated that about 30-51% of the total P content in the ash samples was released, suggesting that the ashes could be potentially valuable as P-fertiliser if applied onto soil.

Upper limb onset of hereditary transthyretin amyloidosis is common in non-endemic areas

BACKGROUND AND PURPOSE

The aim is to describe an uncommon phenotype of hereditary ATTR neuropathy with upper limb onset.

METHODS

The French TTR Familial Amyloid Polyneuropathy database was used for a retrospective evaluation of 32 consecutive patients with upper limb onset of the neuropathy (study group) and they were compared to 31 Portuguese early-onset patients and 99 late-onset patients without upper limb onset.

RESULTS

Initial upper limb symptoms were mostly sensory. Lower limb symptoms began 2.3 ± 3 years after upper limb symptoms. Twenty-four (75%) patients were initially misdiagnosed, with 15 different diagnoses. More patients in the study group had a Neuropathy Impairment Score upper limb/lower limb ratio > 1 compared to the late-onset patient group. The study group had significantly more pronounced axonal loss in the median and ulnar motor nerves and the ulnar sensory and sural nerves. On radial nerve biopsies (n = 11), epineurial vessels were abnormal in six cases, including amyloid deposits in vessel walls (3/11), with vessel occlusion in two cases.

CONCLUSION

Upper limb onset of hereditary ATTR neuropathy is not rare in non-endemic areas. It is important to propose early TTR sequencing of patients with idiopathic upper limb neuropathies, as specific management and treatment are required.

Lateralizing value of semiology in medial temporal lobe epilepsy

OBJECTIVES

Analysing the clinical characteristics of seizures constitutes a fundamental aspect of the presurgical evaluation of patients with medial temporal lobe epilepsy and unilateral hippocampal sclerosis (MTLE-HS), the most frequent form of focal epilepsy accessible to surgery. We sought to retrospectively determine whether objective manifestations could have a reliable lateralizing value in a large population of MTLE-HS patients and if their presence could help to identify those patients who would be seizure free after surgery.

MATERIAL AND METHODS

We analysed the frequency and predictive lateralizing value of objective ictal and postictal signs in 391 patients with MTLE-HS (183 left/208 right). Data were derived from chart review and not from blinded videoEEG analysis. Correlation between the presence of reliable lateralizing signs and postoperative outcome was performed in a subgroup of 302 patients who underwent surgery.

RESULTS

Contralateral dystonic posturing was the most frequent and reliable lateralizing sign that correctly lateralized the focus in 96% of patients. Unilateral head/eye deviation was noted in 42% of the patients and predicted unilateral focus in 67%. Ipsilateral postictal nose wiping, contralateral clonus and hypokinesia correctly lateralized the focus in 75%, 81%, respectively, and 100 of patients but were less frequently depicted. Postictal aphasia was a strong lateralizing sign for left MLE-HS. The presence of reliable lateralizing signs was not a predictor of seizure freedom.

CONCLUSION

Seizure semiology is a simple tool that may permit reliable lateralization of the seizure focus in MTLE-HS. The presence of reliable lateralizing signs is not associated with a better postoperative outcome.

The Spirodela polyrhiza genome reveals insights into its neotenous reduction fast growth and aquatic lifestyle

The subfamily of the Lemnoideae belongs to a different order than other monocotyledonous species that have been sequenced and comprises aquatic plants that grow rapidly on the water surface. Here we select Spirodela polyrhiza for whole-genome sequencing. We show that Spirodela has a genome with no signs of recent retrotranspositions but signatures of two ancient whole-genome duplications, possibly 95 million years ago (mya), older than those in Arabidopsis and rice. Its genome has only 19,623 predicted protein-coding genes, which is 28% less than the dicotyledonous Arabidopsis thaliana and 50% less than monocotyledonous rice. We propose that at least in part, the neotenous reduction of these aquatic plants is based on readjusted copy numbers of promoters and repressors of the juvenile-to-adult transition. The Spirodela genome, along with its unique biology and physiology, will stimulate new insights into environmental adaptation, ecology, evolution and plant development, and will be instrumental for future bioenergy applications.

Spirodela, or duckweed, is a basal monocotyledonous plant with both pharmaceutical and commercial value. Here, the authors sequence the genome of Spirodela polyrhiza, suggesting its genome has evolved by neotenous reduction and clonal propagation, and provide a platform for future comparative genomic studies in angiosperms.

Increased intra-cortical porosity reduces bone stiffness and strength in pediatric patients with osteogenesis imperfecta

Osteogenesis imperfecta (OI) is a heritable disease occurring in one out of every 20,000 births. Although it is known that Type I collagen mutation in OI leads to increased bone fragility, the mechanism of this increased susceptibility to fracture is not clear. The aim of this study was to assess the microstructure of cortical bone fragments from patients with osteogenesis imperfecta (OI) using polarized light microscopy, and to correlate microstructural observations with the results of previously performed mechanical compression tests on bone from the same source. Specimens of cortical bone were harvested from the lower limbs of three (3) OI patients at the time of surgery, and were divided into two groups. Group 1 had been subjected to previous micro-mechanical compression testing, while Group 2 had not been subjected to any prior testing. Polarized light microscopy revealed disorganized bone collagen architecture as has been previously observed, as well as a large increase in the areal porosity of the bone compared to typical values for healthy cortical bone, with large (several hundred micron sized), asymmetrical pores. Importantly, the areal porosity of the OI bone samples in Group 1 appears to correlate strongly with their previously measured apparent Young's modulus and compressive strength. Taken together with prior nanoindentation studies on OI bone tissue, the results of this study suggest that increased intra-cortical porosity is responsible for the reduction in macroscopic mechanical properties of OI cortical bone, and therefore that in vivo imaging modalities with resolutions of ~100 μm or less could potentially be used to non-invasively assess bone strength in OI patients. Although the number of subjects in this study is small, these results highlight the importance of further studies in OI bone by groups with access to human OI tissue in order to clarify the relationship between increased porosity and reduced macroscopic mechanical integrity.

BK polyomavirus-specific cellular immune responses are age-dependent and strongly correlate with phases of virus replication

BK polyomavirus (BKPyV) infection is widespread and typically asymptomatic during childhood, but may cause nephropathy in kidney transplant recipients. However, there is only limited knowledge on BKPyV-specific immunity in children and adults, and its role in BKPyV-replication and disease posttransplant. We therefore characterized BKPyV-specific immunity from 122 immunocompetent individuals (1-84 years), 38 adult kidney recipients with (n = 14) and without BKPyV-associated complications (n = 24), and 25 hemodialysis (HD) patients. Blood samples were stimulated with overlapping peptides of BKPyV large-T antigen and VP1 followed by flow-cytometric analysis of activated CD4 T cells expressing interferon-γ, IL-2 and tumor necrosis factor-α. Antibody-levels were determined using enzyme-linked immunosorbent assay. Both BKPyV-IgG levels and BKPyV-specific CD4 T cell frequencies were age-dependent (p = 0.0059) with maximum levels between 20 and 30 years (0.042%, interquartile range 0.05%). Transplant recipients showed a significantly higher BKPyV-specific T cell prevalence (57.9%) compared to age-matched controls (21.7%) or HD patients (28%, p = 0.017). Clinically relevant BKPyV-replication was associated with elevated frequencies of BKPyV-specific T cells (p = 0.0002), but decreased percentage of cells expressing multiple cytokines (p = 0.009). In conclusion, BKPyV-specific cellular immunity reflects phases of active BKPyV-replication either after primary infection in childhood or during reactivation after transplantation. Combined analysis of BKPyV-specific T cell functionality and viral loads may improve individual risk assessment.

Bogomol'nyi-Prasad-Sommerfield Skyrme model and nuclear binding energies

We use the classical Bogomol'nyi-Prasad-Sommerfield (BPS) soliton solutions of the BPS Skyrme model together with corrections from the collective coordinate quantization of spin and isospin, the electrostatic Coulomb energies, and a small explicit breaking of the isospin symmetry-accounting for the proton-neutron mass difference-to calculate nuclear binding energies. We find that the resulting binding energies are already in excellent agreement with their physical values for heavier nuclei, demonstrating thereby that the BPS Skyrme model is a distinguished starting point for a detailed quantitative investigation of nuclear and low-energy strong interaction physics.

Optimization of the inclusion of Alzheimer's disease patients in international multicenter randomized trials: results of a national survey conducted in memory research centers in france

INTRODUCTION

Since 2002, with the creation of Centers of Memory Resources and Research (CMRR), considerable progress has been made in France regarding the administrative and institutional framework within which Alzheimer's disease (AD) is managed. In this study, we explore three approaches that can help optimize the inclusion of patients in clinical trials related to AD. They are as follows: to assess communication concerning clinical trials on AD in French CMRR, to analyze the internal organization of these centers concerning the dynamics of inclusion, and to evaluate screening tools used.

METHODS

A national, descriptive, cross-sectional survey was conducted in all CMRR in France between May 1 and July 31, 2011, using a self-administered questionnaire. All investigators, subinvestigators and the relevant CMRR personnel were involved.

RESULTS

A total of 75% of the CMRR participated, and about 30% of the physicians contacted responded positively to the survey. Only 50% reported having communicated with health care professionals at least once in the previous 3 months, and less than 50% had communicated occasionally with the general public. A total of 75% of those surveyed had a research group but only half of the groups were active, 50% of the physicians did not have a consultation time dedicated to study recruitment, and 75% of the respondents had a screening tool in their CMRR but over half of them were not satisfied with it.

CONCLUSION

This investigation provides a basis for improving the screening of patients by both internal organizational development and adaptation of tools already available. Improvement requires promoting regular communication that is appropriate and targeted to health care professionals, smaller memory centers, associations and the public, and therefore, familiarizing the whole population with clinical research on AD.