Clinical characteristics and surgical outcomes of low-grade epilepsy-associated brain tumors

Background

Low-grade epilepsy-associated brain tumors (LEATs) are found to be the second most common lesion-related epilepsy. Malignant potential of LEATs is very low and the overall survival is good, so the focus of treatment is focused more on seizure outcome rather than oncological prognosis.

Objectives

This study was conducted to evaluate the risk factors of seizure outcomes after resection in patients with LEATs.

Design

A retrospective study.

Methods

A retrospective analysis of patients with LEATs who underwent resective surgery in our three epilepsy centers between October 2010 and April 2023 with a minimum follow-up of 1 year. Demography, clinical characters, neurophysiology, and molecular neuropathology were assessed for association with postoperative seizure outcomes at 1-, 2-, and 5-year follow-up. Synthetic minority oversampling technique (SMOTE) algorithm model was performed to handle the imbalance of data distribution. Gaussian Naïve Bayes (GNB) algorithms were created as a basis for classifying outcomes according to observation indicators.

Results

A total of 111 patients were enrolled in the cohort. The most common pathology was ganglioglioma (n = 37, 33.3%). The percentage of patients with seizure freedom was 91.0% (101/111) at 1-year follow-up, 87.5% (77/88) at 2-year follow-up, and 79.1% (53/67) at 5-year follow-up. Partial resection had a significantly poor seizure outcome compared to total resection and supratotal resection (p < 0.05). The epileptiform discharge on post-resective intraoperative electrocorticography (ECoG) or postoperative scalp electroencephalography (EEG) were negative factors on postoperative seizure freedom at 1-, 2-, or 5-year follow-ups (p < 0.05). The area under the receiver-operating characteristic curve value of the GNB-SMOTE model was 0.95 (95% CI, 0.876-1.000), 0.892 (95% CI, 0.656-0.934), and 0.786 (95% CI, 0.491-0.937) at 1-, 2-, and 5-year follow-up, respectively.

Conclusion

The partial resection, post-resective intraoperative ECoG, and postoperative scalp EEG were valuable indicators of poor seizure outcomes. The utilization of post-resective intraoperative ECoG is beneficial to improve seizure outcomes. Based on the data diversity and completeness of three medical centers, a multivariate correlation analysis model was established based on GNB algorithm.

Predictors of seizure outcomes in stereo-electroencephalography-guided radio-frequency thermocoagulation for MRI-negative epilepsy

Background

One-third of intractable epilepsy patients have no visually identifiable focus for neurosurgery based on imaging tests [magnetic resonance imaging (MRI)-negative cases]. Stereo-electroencephalography-guided radio-frequency thermocoagulation (SEEG-guided RF-TC) is utilized in the clinical treatment of epilepsy to lower the incidence of complications post-open surgery.

Objective

This study aimed to identify prognostic factors and long-term seizure outcomes in SEEG-guided RF-TC for patients with MRI-negative epilepsy.

Design

This was a single-center retrospective cohort study.

Methods

We included 30 patients who had undergone SEEG-guided RF-TC at Sanbo Brain Hospital, Capital Medical University, from April 2015 to December 2019. The probability of remaining seizure-free and the plotted survival curves were analyzed. Prognostic factors were analyzed using log-rank tests in univariate analysis and the Cox regression model in multivariate analysis.

Results

With a mean time of 31.07 ± 2.64 months (median 30.00, interquartile range: 18.00-40.00 months), 11 out of 30 patients (36.7%) were classified as International League Against Epilepsy class 1 in the last follow-up. The mean time of remaining seizure-free was 21.33 ± 4.55 months [95% confidence interval (CI) 12.41-30.25], and the median time was 3.00 ± 0.54 months (95% CI 1.94-4.06). Despite falling in the initial year, the probability of remaining seizure-free gradually stabilizes in the subsequent years. The patients were more likely to obtain seizure freedom when the epileptogenic zone was located in the insular lobe or with one focus on the limbic system (p = 0.034, hazard ratio 5.019, 95% CI 1.125-22.387).

Conclusion

Our findings may be applied to guide individualized surgical interventions and help clinicians make better decisions.

Sleep-wake dependent hippocampal regulation of fear memory

The hippocampus (HPC) plays a pivotal role in fear learning and memory. Our two recent studies suggest that rapid eye movement (REM) sleep via the HPC downregulates fear memory consolidation and promotes fear extinction. However, it is not clear whether and how the dorsal and the ventral HPC regulates fear memory differently; and how the HPC in wake regulates fear memory. By chemogenetic stimulating in the HPC directly and its afferent entorhinal cortex that selectively activated the HPC in REM sleep for 3-6 h post-fear-acquisition, we found that HPC activation in REM sleep consolidated fear extinction memory. In particular, dorsal HPC (dHPC) stimulation in REM sleep virtually eliminated fear memory by enhancing fear extinction and reducing fear memory consolidation. By contrast, chemogenetic stimulating HPC afferent the supramammillary nucleus (SUM) induced 3-hr wake with HPC activation impaired fear extinction. Finally, desipramine (DMI) injection that selectively eliminated REM sleep for >6 h impaired fear extinction. Our results demonstrate that the HPC is critical for fear memory regulation; and wake HPC and REM sleep HPC have an opposite role in fear extinction of respective impairment and consolidation.

Effects of transcutaneous auricular vagus nerve stimulation and exploration of brain network mechanisms in children with high-functioning autism spectrum disorder: study protocol for a randomized controlled trial

Background

Autism Spectrum Disorders (ASD) are a collection of neurodevelopmental diseases characterized by poor social interaction and communication, a limited range of interests, and stereotyped behavior. High-functioning autism (HFA) indicates a subgroup of individuals with autism who possess cognitive and/or language skills that are within the average to above-normal range for their age. Transcutaneous auricular vagus nerve stimulation (taVNS) holds promise in children with HFA. However, few studies have used randomized controlled trials to validate the effectiveness of taVNS. Therefore, in this study, we intend to provide a study protocol to examine the therapeutic effects of taVNS in individuals diagnosed with HFA and to investigate the process of brain network remodeling in individuals with ASD using functional imaging techniques to observe alterations in large-scale neural networks.

Methods and design

We planned to employ a randomized, double-blind experimental design, including 40 children receiving sham stimulation and 40 children receiving real stimulation. We will assess clinical scales and perform functional imaging examinations before and after the stimulation. Additionally, we will include age- and gender-matched healthy children as controls and conduct functional imaging examinations. We plan first to observe the therapeutic effects of taVNS. Furthermore, we will observe the impact of taVNS stimulation on the brain network.

Discussion

taVNS was a low-risk, easy-to-administer, low-cost, and portable option to modulate the vagus system. taVNS may improve the social performance of HFA. Changes in the network properties of the large-scale brain network may be related to the efficacy of taVNS.

Clinical trial registration

http://www.chictr.org.cn, identifier ChiCTR2300074035.

A filter-augmented auto-encoder with learnable normalization for robust multivariate time series anomaly detection

While existing reconstruction-based multivariate time series (MTS) anomaly detection methods demonstrate advanced performance on many challenging real-world datasets, they generally assume the data only consists of normal samples when training models. However, real-world MTS data may contain significant noise and even be contaminated by anomalies. As a result, most existing approaches easily capture the pattern of the contaminated data, making identifying anomalies more difficult. Although a few studies have aimed to mitigate the interference of the noise and anomalies by introducing various regularizations, they still employ the objective of fully reconstructing the input data, impeding the model from learning an accurate profile of the MTS's normal pattern. Moreover, it is difficult for existing methods to apply the most appropriate normalization schemes for each dataset in various complex scenarios, particularly for mixed-feature MTS. This paper proposes a filter-augmented auto-encoder with learnable normalization (NormFAAE) for robust MTS anomaly detection. Firstly, NormFAAE designs a deep hybrid normalization module. It is trained with the backbone end-to-end in the current training task to perform the optimal normalization scheme. Meanwhile, it integrates two learnable normalization sub-modules to deal with the mixed-feature MTS effectively. Secondly, NormFAAE proposes a filter-augmented auto-encoder with a dual-phase task. It separates the noise and anomalies from the input data by a deep filter module, which facilitates the model to only reconstruct the normal data, achieving a more robust latent representation of MTS. Experimental results demonstrate that NormFAAE outperforms 17 typical baselines on five real-world industrial datasets from diverse fields.

Application of machine learning algorithms to predict osteoporosis in postmenopausal women with type 2 diabetes mellitus

PURPOSE

The screening and diagnosis of osteoporosis in patients with type 2 diabetes mellitus (T2DM) based on bone mineral density remains challenging because of the limited availability and accessibility of dual-energy X-ray absorptiometry. We aimed to develop and validate models to predict the risk of osteoporosis in postmenopausal women with T2DM based on machine learning (ML) algorithms.

METHODS

This retrospective study included 303 postmenopausal women with T2DM. To develop prediction models for osteoporosis, we applied nine ML algorithms combined with demographic, clinical, and laboratory data. The least absolute shrinkage and selection operator were used to perform feature selection. We used the bootstrap resampling technique for model training and validation. To test the performance of the models, we calculated indices including the area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, specificity, positive predictive value, negative predictive value, F1 score, calibration curve, and decision curve analysis. Furthermore, we conducted fivefold cross-validation for parameter optimization and model validation. Feature importance was assessed using the SHapley additive explanation (SHAP).

RESULTS

We identified 10 independent predictors as the most valuable features. An AUROC of 0.616-1.000 was observed for nine ML algorithms. The extreme gradient boosting (XGBoost) model exhibited the best performance, outperforming conventional risk assessment tools and registering 0.993 in the training set, 0.798 in the validation set, and 0.786 in the test set for fivefold cross-validation. Using SHAP, we found that the explanatory variables contributed to the model and their relationship with osteoporosis occurrence. Furthermore, we developed a user-friendly tool for calculating the risk of osteoporosis.

CONCLUSIONS

With the integration of demographic and clinical risk factors, ML algorithms can accurately predict osteoporosis. The XGBoost model showed ideal performance. With the incorporation of these models in the clinic, patients may benefit from early osteoporosis diagnosis and treatment.

Effects of dietary supplement with licorice and rutin mixture on production performance, egg quality, antioxidant capacity, and gut microbiota in quails (Turnix tanki)

This study was conducted to evaluate the effect of licorice and rutin on production performance, egg quality, and mucosa antioxidant levels in Chinese yellow quail. A total of 240 Chinese Yellow Quail (400-day-old) were randomly distributed into 5 groups: the Control group, fed with a basic diet; the LR1 group, fed with basal diet supplemented with 300 + 100 mg licorice and rutin mixture/kg diet; the LR2 group, fed with basal diet supplemented with 300 + 200 mg licorice and rutin mixture/kg diet; the LR3 group, fed with basal diet supplemented with 600 + 100 mg licorice and rutin mixture/kg diet and the LR4 group, fed with basal diet supplemented with 600 + 200 mg licorice and rutin mixture/kg diet. Compared with the control, supplementation with the licorice and rutin mixture improved the laying rate and eggshell thickness whereas decreased the feed conversion ratio of quails. Moreover, dietary supplementation with the licorice and rutin mixture improved the antioxidant capacity by increasing the activity of the superoxide dismutase (SOD) level and decreasing the concentration of malondialdehyde (MDA) in the jejunal mucosa. The licorice and rutin mixture altered the composition of intestinal microbiota by influencing the relative abundances of Bacteroidetes and Bacteroides. The relative abundances of the Bacteroidetes were significantly related to the laying rate of quails. In addition, the mixture of licorice and rutin was also effective in reducing the relative abundance of intestinal Proteobacteria and Enterobacter in quails, reducing the accumulation of antibiotic-resistance genes. The results revealed that supplementation of licorice and rutin mixture to the diet improved production performance, egg quality, and antioxidant capacity and modified the composition of intestinal microbiota in quails. This study provides a reference for Chinese herbal additives to promote production performance by modulating quail gut microbes.

Ectopic expression of neuronal adenosine kinase, a biomarker in mesial temporal lobe epilepsy without hippocampal sclerosis

AIMS

Mesial temporal lobe epilepsy without hippocampal sclerosis (no-HS MTLE) refers to those MTLE patients who have neither magnetic resonance imaging (MRI) lesions nor definite pathological evidence of hippocampal sclerosis. They usually have resistance to antiepileptic drugs, difficulties in precise seizure location and poor surgical outcomes. Adenosine is a neuroprotective neuromodulator that acts as a seizure terminator in the brain. The role of adenosine in no-HS MTLE is still unclear. Further research to explore the aetiology and pathogenesis of no-HS MTLE may help to find new therapeutic targets.

METHODS

In surgically resected hippocampal specimens, we examined the maladaptive changes of the adenosine system of patients with no-HS MTLE. In order to better understand the dysregulation of the adenosine pathway in no-HS MTLE, we developed a rat model based on the induction of focal cortical lesions through a prenatal freeze injury.

RESULTS

We first examined the adenosine system in no-HS MTLE patients who lack hippocampal neuronal loss and found ectopic expression of the astrocytic adenosine metabolising enzyme adenosine kinase (ADK) in hippocampal pyramidal neurons, as well as downregulation of neuronal A1 receptors (A1 Rs) in the hippocampus. In the no-HS MTLE model rats, the transition of ADK from neuronal expression to an adult pattern of glial expression in the hippocampus was significantly delayed.

CONCLUSIONS

Ectopic expression of neuronal ADK might be a pathological hallmark of no-HS MTLE. Maladaptive changes in adenosine metabolism might be a novel target for therapeutic intervention in no-HS MTLE.

Deep brain stimulation suppresses epileptic seizures in rats via inhibition of adenosine kinase and activation of adenosine A1 receptors

AIMS

Deep brain stimulation (DBS) of the anterior nucleus of the thalamus, is an effective therapy for patients with drug-resistant epilepsy, yet, its mechanism of action remains elusive. Adenosine kinase (ADK), a key negative regulator of adenosine, is a potential modulator of epileptogenesis. DBS has been shown to increase adenosine levels, which may suppress seizures via A1 receptors (A₁ Rs). We investigated whether DBS could halt disease progression and the potential involvement of adenosine mechanisms.

METHODS

Control group, SE (status epilepticus) group, SE-DBS group, and SE-sham-DBS group were included in this study. One week after a pilocarpine-induced status epilepticus, rats in the SE-DBS group were treated with DBS for 4 weeks. The rats were monitored by video-EEG. ADK and A₁ Rs were tested with histochemistry and western blot, respectively.

RESULTS

Compared with the SE group and SE-sham-DBS group, DBS could reduce the frequency of spontaneous recurrent seizures (SRS) and the number of interictal epileptic discharges. The DPCPX, an A₁ R antagonist, reversed the effect of DBS on interictal epileptic discharges. In addition, DBS inhibited the overexpression of ADK and the downregulation of A₁ Rs.

CONCLUSION

The findings indicate that DBS can reduce SRS in epileptic rats via inhibition of ADK and activation of A₁ Rs. A₁ Rs might be a potential target of DBS for the treatment of epilepsy.

A new isolate of Streptomyces lateritius (Z1-26) with antibacterial activity against fish pathogens and immune enhancement effects on crucian carp (Carassius auratus)

The Streptomyces lateritius Z1-26 was isolated from soil samples which showed broad-spectrum antibacterial activity against a broad range of fish pathogens. The In Vivo Imaging System (IVIS) monitored that strain Z1-26 could survive and colonize in the gills and abdomen of crucian carp. The effects of dietary supplementation with strain Z1-26 were evaluated with respect to the growth performance, antioxidant capacity, and immune response of crucian carp. The results showed that the Z1-26-fed fish had a significantly higher growth rate than the fish fed the control diet. The immune and antioxidant parameters revealed that the non-specific immune indicators (AKP, SOD, and LZM) of the serum, the expression of immune-related genes (IgM, C3, and LZM), and antioxidant-related genes (Nrf2 and Keap1) of the immune organs were significantly increased, whereas the expression of pro-inflammatory factors (IL-1β, IL-8, and TNF-α) of the immune organs was significantly down-regulated in crucian carp fed strain Z1-26 compared with fish fed a control diet. Moreover, fish fed with Z1-26 supplemented diets showed a significantly improved survival rate after Aeromonas hydrophila infection. In addition, the whole genome analysis showed that strain Z1-26 possesses 28 gene clusters, including 6 polyketide synthetase (PKS), 4 non-ribosomal peptide-synthetase (NRPS), 1 bacteriocin, and 1 lantipeptide. In summary, these results indicated that strain Z1-26 could improve the growth performance and disease resistance in crucian carp, and has the potential to be developed as a candidate probiotics for the control of bacterial diseases in aquaculture.

Vagus nerve stimulation for pharmacoresistant epilepsy secondary to encephalomalacia: A single-center retrospective study

Objective

Vagus nerve stimulation (VNS) is an adjunctive treatment for pharmacoresistant epilepsy. Encephalomalacia is one of the most common MRI findings in the preoperative evaluation of patients with pharmacoresistant epilepsy. This is the first study that aimed to determine the effectiveness of VNS for pharmacoresistant epilepsy secondary to encephalomalacia and evaluate the potential predictors of VNS effectiveness.

Methods

We retrospectively analyzed the seizure outcomes of VNS with at least 1 year of follow-up in all patients with pharmacoresistant epilepsy secondary to encephalomalacia. Based on the effectiveness of VNS (≥50% or <50% reduction in seizure frequency), patients were divided into two subgroups: responders and non-responders. Preoperative data were analyzed to screen for potential predictors of VNS effectiveness.

Results

A total of 93 patients with epilepsy secondary to encephalomalacia who underwent VNS therapy were recruited. Responders were found in 64.5% of patients, and 16.1% of patients achieved seizure freedom at the last follow-up. In addition, the responder rate increased over time, with 36.6, 50.5, 64.5, and 65.4% at the 3-, 6-, 12-, and 24-month follow-ups, respectively. After multivariate analysis, seizure onset in adults (>18 years old) (OR: 0.236, 95%CI: 0.059-0.949) was found to be a positive predictor, and the bilateral interictal epileptic discharges (IEDs) (OR: 3.397, 95%CI: 1.148-10.054) and the bilateral encephalomalacia on MRI (OR: 3.193, 95%CI: 1.217-8.381) were found to be negative predictors of VNS effectiveness.

Conclusion

The results demonstrated the effectiveness and safety of VNS therapy in patients with pharmacoresistant epilepsy secondary to encephalomalacia. Patients with seizure onset in adults (>18 years old), unilateral IEDs, or unilateral encephalomalacia on MRI were found to have better seizure outcomes after VNS therapy.

Effectiveness of vagus nerve stimulation therapy in refractory hypoxic-ischemic encephalopathy-induced epilepsy

Background

Epilepsy is one of the important long-term sequelae of neonatal hypoxic-ischemic encephalopathy (HIE) and is typically characterized by drug resistance and poor surgical outcomes. Vagus nerve stimulation (VNS) is a promising neuromodulation therapy for refractory epilepsy.

Objectives

The present study aimed to first evaluate the effectiveness of VNS in patients with refractory HIE-induced epilepsy and scrutinize potential clinical predictors.

Methods

We retrospectively collected the outcomes of VNS in all patients with refractory HIE-induced epilepsy and at least 2 years of follow-up. Subgroups were classified as responders and nonresponders according to the effectiveness of VNS (⩾50% or <50% reduction in seizure frequency). Preoperative data were analyzed to screen for potential predictors of VNS effectiveness.

Results

A total of 55 patients with refractory HIE-induced epilepsy who underwent VNS therapy were enrolled. Responders represented 56.4% of patients, and 12.7% of patients achieved seizure freedom at the last follow-up. In addition, the responder rate increased over time with rates of 23.6%, 38.2%, 50.9%, and 56.4% at the 3-, 6-, 12- and 24-month follow-ups, respectively. After multivariate analysis, neonatal seizure was identified as a negative predictor (OR: 4.640, 95% CI: 1.129-19.066), and a predominant seizure type of generalized onset was identified as a positive predictor (OR: 0.261, 95% CI: 0.078-0.873) of VNS effectiveness.

Conclusion

VNS therapy was effective in patients with refractory HIE-induced epilepsy and was well tolerated over a 2-year follow-up period. VNS therapy demonstrated better effectiveness in patients without neonatal seizures or with a predominant seizure type of generalized onset.

A Privacy-Preserving, Two-Party, Secure Computation Mechanism for Consensus-Based Peer-to-Peer Energy Trading in the Smart Grid

Consumers in electricity markets are becoming more proactive because of the rapid development of demand-response management and distributed energy resources, which boost the transformation of peer-to-peer (P2P) energy-trading mechanisms. However, in the P2P negotiation process, it is a challenging task to prevent private information from being attacked by malicious agents. In this paper, we propose a privacy-preserving, two-party, secure computation mechanism for consensus-based P2P energy trading. First, a novel P2P negotiation mechanism for energy trading is proposed based on the consensus + innovation (C + I) method and the power transfer distribution factor (PTDF), and this mechanism can simultaneously maximize social welfare and maintain physical network constraints. In addition, the C + I method only requires a minimum set of information to be exchanged. Then, we analyze the strategy of malicious neighboring agents colluding to attack in order to steal private information. To defend against this attack, we propose a two-party, secure computation mechanism in order to realize safe negotiation between each pair of prosumers based on Paillier homomorphic encryption (HE), a smart contract (SC), and zero-knowledge proof (ZKP). The energy price is updated in a safe way without leaking any private information. Finally, we simulate the functionality of the privacy-preserving mechanism in terms of convergence performance, computational efficiency, scalability, and SC operations.

The Effect of the KDL Active School Plan on Children and Adolescents' Physical Fitness in China

The development of physical fitness among Chinese children and adolescents is not fundamentally improving, and an exploration of effective ways to promote it is an urgent need. Research into physical fitness promotion in schools is increasingly deepening worldwide. However, the implementation and verification of intervention programs with local characteristics in accordance with China's national conditions are relatively weak. This study conducted a randomized controlled trial to examine the effects of the KDL (Know it, Do it, Love it) Active School Plan (KDL-ASP) on children and adolescents' physical fitness. A total of 596 students from level two (2nd-grade students) to five (11th-grade students) in China were assessed in terms of their physical fitness. Of these, 308 students were randomly selected to participate in the KDL-ASP, which uses a combination of indoor and outdoor sports activities in which teachers, parents, and students participate together. The remaining 288 students performed conventional physical activities. After one school year of intervention with the KDL-ASP, the physical fitness of the children and adolescents improved. The improvements in the speed of level two girls, the strength of level four boys, and the lung capacity of level five boys were the most obvious. These results demonstrate the viability of indigenized intervention in schools to improve physical fitness and suggest that KDL-ASP needs to be considered throughout the whole progress of physical education learning for children and adolescents.

Progress of clinical research studies on tuberous sclerosis complex-related epilepsy in China

Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous syndrome, with 75.6%-83.5% and 54.1% patients presenting with epilepsy and drug-resistant epilepsy (DRE), respectively. Clinical studies on TSC, particularly surgical interventions, have achieved rapid and substantial progress. The TSC-Task Force Committee of the China Association Against Epilepsy (CAAE-TFTSC) was founded in 2012, and annual academic conferences on the surgical treatment of TSC-related epilepsy have been held since 2013. 'China experts' consensus on surgical treatment of TSC-related epilepsy' was published in 2019. This review focuses on surgical treatment, including resective surgery, neuromodulations, corpus callosotomy and mini-invasive ablations, as well as studies on phenotype, genotype and anti-seizure therapies of mammalian target of rapamycin inhibitor, vigabatrin and ketogenic diet in patients with TSC-related DRE in China.

Vagus nerve stimulation for refractory posttraumatic epilepsy: Efficacy and predictors of seizure outcome

Background

Traumatic brain injury (TBI) has been recognized as an important and common cause of epilepsy since antiquity. Posttraumatic epilepsy (PTE) is usually associated with drug resistance and poor surgical outcomes, thereby increasing the burden of the illness on patients and their families. Vagus nerve stimulation (VNS) is an adjunctive treatment for medically refractory epilepsy. This study aimed to determine the efficacy of VNS for refractory PTE and to initially evaluate the potential predictors of efficacy.

Methods

We retrospectively collected the outcomes of VNS with at least a 1-year follow-up in all patients with refractory PTE. Subgroups were classified as responders and non-responders according to the efficacy of VNS (≥50% or <50% reduction in seizure frequency). Preoperative data were analyzed to screen for potential predictors of VNS efficacy.

Results

In total, forty-five patients with refractory PTE who underwent VNS therapy were enrolled. Responders were found in 64.4% of patients, and 15.6% of patients achieved seizure freedom at the last follow-up. In addition, the responder rate increased over time, with 37.8, 44.4, 60, and 67.6% at the 3-, 6-, 12-, and 24-month follow-ups, respectively. After multivariate analysis, generalized interictal epileptic discharges (IEDs) were found to be a negative predictor (OR: 4.861, 95% CI: 1.145–20.632) of VNS efficacy.

Conclusion

The results indicated that VNS therapy was effective in refractory PTE patients and was well tolerated over a 1-year follow-up period. Patients with focal or multifocal IEDs were recognized to have better efficacy after VNS therapy.

Role of HMGB1/TLR4 and IL-1β/IL-1R1 Signaling Pathways in Epilepsy

Epilepsy is a chronic disorder of the nervous system characterized by recurrent seizures. Inflammation is one of the six major causes of epilepsy, and its role in the pathogenesis of epilepsy is gaining increasing attention. Two signaling pathways, the high mobility group box-1 (HMGB1)/toll-like receptor 4 (TLR4) and interleukin-1β (IL-1β)/interleukin-1 receptor 1 (IL-1R1) pathways, have become the focus of research in recent years. These two signaling pathways have potential as biomarkers in the prediction, prognosis, and targeted therapy of epilepsy. This review focuses on the association between epilepsy and the neuroinflammatory responses mediated by these two signaling pathways. We hope to contribute further in-depth studies on the role of HMGB1/TLR4 and IL-1β/IL-1R1 signaling in epileptogenesis and provide insights into the development of specific agents targeting these two pathways.

Privacy-Preserving Outsourcing Algorithms for Multidimensional Data Encryption in Smart Grids

With the development of the Internet of Things, smart grids have become indispensable in our daily life and can provide people with reliable electricity generation, transmission, distribution and control. Therefore, how to design a privacy-preserving data aggregation protocol has been a research hot-spot in smart grid technology. However, these proposed protocols often contain some complex cryptographic operations, which are not suitable for resource-constrained smart meter devices. In this paper, we combine data aggregation and the outsourcing of computations to design two privacy-preserving outsourcing algorithms for the modular exponentiation operations involved in the multi-dimensional data aggregation, which can allow these smart meter devices to delegate complex computation tasks to nearby servers for computing. By utilizing our proposed outsourcing algorithms, the computational overhead of resource-constrained smart meter devices can be greatly reduced in the process of data encryption and aggregation. In addition, the proposed algorithms can protect the input’s privacy of smart meter devices and ensure that the smart meter devices can verify the correctness of results from the server with a very small computational cost. From three aspects, including security, verifiability and efficiency, we give a detailed analysis about our proposed algorithms. Finally, through carrying out some experiments, we prove that our algorithms can improve the efficiency of performing the data encryption and aggregation on the smart meter device side.

Comparison of Coated and Uncoated Trace Minerals on Growth Performance, Tissue Mineral Deposition, and Intestinal Microbiota in Ducks

Abnormally low or high levels of trace elements in poultry diets may elicit health problems associated with deficiency and toxicity, and impact poultry growth. The optimal supplement pattern of trace mineral also impacts the digestion and absorption in the body. For ducks, the limited knowledge of trace element requirements puzzled duck production. Thus, the objective of this study was to investigate the influence of dietary inclusions of coated and uncoated trace minerals on duck growth performance, tissue mineral deposition, serum antioxidant status, and intestinal microbiota profile. A total of 1,080 14-day-old Cherry Valley male ducks were randomly divided into six dietary treatment groups in a 2 (uncoated or coated trace minerals) × 3 (300, 500, or 1,000 mg/kg supplementation levels) factorial design. Each treatment was replicated 12 times (15 birds per replicate). Coated trace minerals significantly improved average daily gain (p < 0.05), increased Zn, Se, and Fe content of serum, liver, and muscle, increased serum antioxidant enzyme (p < 0.05) and decreased the excreta Fe, Zn, and Cu concentrations. Inclusions of 500 mg/kg of coated trace minerals had a similar effect on serum trace minerals and tissue metal ion deposition as the 1,000 mg/kg inorganic trace minerals. Higher concentrations of Lactobacillus, Sphaerochatea, Butyricimonas, and Enterococcus were found in birds fed with coated trace minerals. In conclusion, diets supplemented with coated trace minerals could reduce the risk of environmental contamination from excreted minerals without affecting performance. Furthermore, coated trace minerals may improve the bioavailability of metal ions and the colonization of probiotic microbiota to protect microbial barriers and maintain gut health.

Sustainable Production of Reduced Phosphorus Compounds: Mechanochemical Hydride Phosphorylation Using Condensed Phosphates as a Route to Phosphite

In pursuit of a more sustainable production of phosphorous acid (H₃PO₃), a versatile chemical with phosphorus in the +3 oxidation state, we herein report that condensed phosphates can be employed to phosphorylate hydride reagents under solvent-free mechanochemical conditions to furnish phosphite (HPO₃ ^2-). Using potassium hydride as the hydride source, sodium trimetaphosphate (Na₃P₃O₉), triphosphate (Na₅P₃O₁₀), pyrophosphate (Na₄P₂O₇), fluorophosphate (Na₂PO₃F), and polyphosphate ("(NaPO₃) _n ") engendered phosphite in optimized yields of 44, 58, 44, 84, and 55% based on total P content, respectively. Formation of overreduced products including hypophosphite (H₂PO₂ ^-) was identified as a competing process, and mechanistic investigations revealed that hydride attack on in-situ-generated phosphorylated phosphite species is a potent pathway for overreduction. The phosphite generated from our method was easily isolated in the form of barium phosphite, a useful intermediate for production of phosphorous acid. This method circumvents the need to pass through white phosphorus (P₄) as a high-energy intermediate and mitigates involvement of environmentally hazardous chemicals. A bioproduced polyphosphate was found to be a viable starting material for the production of phosphite. These results demonstrate the possibility of accessing reduced phosphorus compounds in a more sustainable manner and, more importantly, a means to close the modern phosphorus cycle.

Independent temporal lobe epilepsy in patients with tuberous sclerosis complex

Tuberous sclerosis complex (TSC) is a rare disease that involves multiple organs, including the brain; approximately 80%–90% of TSC patients exhibit TSC‐associated epilepsy. Independent temporal lobe epilepsy (TLE), TSC‐unrelated epilepsy, is particularly rare in patients with TSC. Here, we describe three patients with TSC with independent TLEs that were confirmed by stereo‐electroencephalography (EEG), postoperative pathological findings, and seizure outcome at follow‐up. The patients were retrospectively enrolled at two centers; their ictal epileptiform discharge onsets were determined using electrode contacts in the hippocampus during stereo‐EEG. The three patients underwent anterior temporal lobectomies and remained seizure‐free at 1–5 years after surgery. Postoperative pathological examinations confirmed hippocampal sclerosis in all three patients. Furthermore, postoperative intelligence quotient improvement was evident in one patient, while the quality of life was improved in two patients at 12 months after surgery.

Genetic variations of adenosine kinase as predictable biomarkers of efficacy of vagus nerve stimulation in patients with pharmacoresistant epilepsy

OBJECTIVE

Vagus nerve stimulation (VNS) is an alternative treatment option for individuals with refractory epilepsy, with nearly 40% of patients showing no benefit after VNS and only 6%-8% achieving seizure freedom. It is presently unclear why some patients respond to treatment and others do not. Therefore, identification of biomarkers to predict efficacy of VNS is of utmost importance. The objective of this study was to explore whether genetic variations in genes involved in adenosine kinase (ADK), ecto-5'-nucleotidase (NT5E), and adenosine A1 receptor (A1R) are linked to outcome of VNS in patients with refractory epilepsy.

METHODS

Thirty single-nucleotide polymorphisms (SNPs), including 9 in genes encoding ADK, 3 in genes encoding NT5E, and 18 in genes encoding A1R, were genotyped in 194 refractory epilepsy patients who underwent VNS. The chi-square test and binary logistic regression were used to determine associations between genetic differences and VNS efficacy.

RESULTS

A significant association between ADK SNPs rs11001109, rs7899674, and rs946185 and seizure reduction with VNS was found. Regardless of sex, age, seizure frequency and type, antiseizure drug use, etiology, and prior surgical history, all patients (10/10 patients [100%]) with minor allele homozygosity at rs11001109 (genotype AA) or rs946185 (AA) achieved > 50% seizure reduction and 4 patients (4/10 [40%]) achieved seizure freedom. VNS therapy demonstrated higher efficacy among carriers of minor allele rs7899674 (CG + GG) (68.3% vs 48.8% for patients with major allele homozygosity).

CONCLUSIONS

Homozygous ADK SNPs rs11001109 (AA) and rs946185 (AA), as well as minor allele rs7899674 (CG + GG), may serve as useful biomarkers for prediction of VNS therapy outcome.

The influencing factors and changes of cognitive function within 40 Rasmussen encephalitis patients that received a hemispherectomy

OBJECTIVE

To evaluate the influencing factors and cognitive functional changes in Rasmussen encephalitis (RE) patients who received a hemispherectomy.

METHODS

Forty RE patients underwent a hemispherectomy with at least a 2 years follow- up were included in this study . Postoperative seizure outcomes were evaluated according to the Engle classification scale. Univariate analysis and a multivariate logistic regression model in a backward fashion were used to identify the potential predictors of cognitive function.

RESULTS

All 40 patients had an Engle classification outcome at a 2 years follow-up. Univariate and multivariate analyses revealed that seizure duration (OR 10.06, 95% CI 1.54-3.85, p = 0.038), age at surgery (OR 3.06, 95% CI 1.21-3.56, p = 0.043), and MRI score (OR 0.09, 95% CI 0.01-0.67 p = 0.024) are associated with postoperative cognitive outcomes respectively. Moreover,  VIQ and PIQ were negatively correlated linearly with duration of seizures and MRI score. Patients with a good VIQ and PIQ before the operation were more likely to have a better VIQ and PIQ postoperatively (p < 0.001 and p < 0.001, respectively). And, operation side is an important factor affecting cognitive function; therefore, a left hemispherectomy has a greater impact on the patient's IQ and language.

CONCLUSIONS

RE patients' cognitive dysfunctions are improved after a hemispherectomy. Right-side operation can achieve better postoperative cognitive outcomes especially in VIQ and language. A shorter duration of seizures, early age at surgery, and less severe brain atrophy suggest better cognitive outcomes after a hemispherectomy.

Efficacy and potential predictors of vagus nerve stimulation therapy in refractory postencephalitic epilepsy

BACKGROUND

Vagus nerve stimulation (VNS) is a therapeutic approach for patients with refractory postencephalitic epilepsy (PEE), which is characterized by drug resistance and disappointing surgical outcomes. However, the efficacy of VNS has not yet been studied in patients with refractory PEE. The present study aimed to demonstrate the efficacy of VNS and evaluate potential clinical predictors in patients with refractory PEE.

METHODS

We retrospectively collected the outcomes of VNS with at least a 1-year follow-up in all patients with refractory PEE. Subgroups were classified as responders and non-responders according to the efficacy of VNS (⩾50% or < 50% reduction in seizure frequency). Preoperative data were analyzed to screen for potential predictors of VNS responsiveness.

RESULTS

A total of 42 refractory PEE patients who underwent VNS therapy were enrolled, with an average age of 21.13 ± 9.70 years. Seizure frequency was reduced by more than 50% in 64.25% of patients, and 7.14% of patients achieved seizure-free events after VNS therapy. In addition, the response rates increased over time, with 40.5%, 50.0% and 57.1%, respectively at 6 months, 12 months, and 24 months after VNS therapy. Preoperative duration of epilepsy, monthly seizure frequency, and spatial distribution of interictal epileptic discharges (IEDs) were correlated with responders (p < 0.05) in the univariate analysis. Further multivariate regression analysis demonstrated that refractory PEE patients with high monthly seizure frequency or Focal IEDs (focal or multifocal epileptiform discharges) achieved better efficacy on VNS (p = 0.010, p = 0.003, respectively).

CONCLUSION

VNS is an effective palliative therapy for patients with refractory PEE. Focal IEDs (focal or multifocal epileptiform discharges) and high seizure frequency were potential preoperative predictors of effectiveness after VNS therapy.

Analysis of power spectrum and phase lag index changes following deep brain stimulation of the anterior nucleus of the thalamus in patients with drug-resistant epilepsy: A retrospective study

OBJECTIVES

The mechanisms underlying the anterior nucleus of the thalamus (ANT) deep brain stimulation (DBS) for the treatment of drug-resistant epilepsy (DRE) have not been fully explored. The present study aimed to measure the changes in whole-brain activity generated by ANT DBS using interictal electroencephalography (EEG).

MATERIALS AND METHODS

Interictal EEG signals were retrospectively collected in 20 DRE patients who underwent ANT DBS surgery. Patients were classified as responders or non-responders depending on their response to ANT DBS treatment. The power spectrum (PS) and Phase Lag Index (PLI) were determined and data analyzed using a paired sample t-test to evaluate activity differences between pre-and-post-treatment on different frequency categories. Student's t-test, Mann-Whitney test (non-parametric test) and Fisher exact test were used to compare groups in terms of clinical variables and EEG metrics. P values < 0.05 were considered statistically significant, and FDR-corrected values were used for multiple testing.

RESULTS

PS analysis revealed that whole-brain spectral power had a significant decrease in the beta (p = 0.005) and gamma (p = 0.037) bands following ANT DBS treatment in responders. The analysis of scalp topographic images of all patients showed that ANT DBS decreases PS in the beta band at the F3, F7 and Cz electrode sites. The findings indicated a decrease in PS in the gamma band at the Fp2, F3, Cz, T3, T5 and Oz electrode sites. After ANT DBS treatment, PLI analysis showed a significant decrease in PLI between Fp1 and T3 in the gamma band in responders.

CONCLUSION

The findings showed that ANT DBS induces a decrease in power in the left frontal lobe, left temporal lobe and midline areas in the beta and gamma bands. Lower whole-brain power in the beta and gamma bands can be used as biomarkers for a favorable therapeutic response to ANT DBS, and decreased synchronization between the left frontal pole and temporal lobe in the gamma band can also be used as a biomarker for effective clinical stimulation to guide postoperative programming.

[Clinical characteristics, surgical treatment and prognosis of rolandic and perirolandic drug-resistant epilepsies]

Objective: To explore the clinical characteristics, treatment strategies and prognosis of rolandic and perirolandic drug-resistant epilepsies (DREs). Methods: The clinical data of 53 patients diagnosed with rolandic or perirolandic DRE who were admitted to Epilepsy Center, Sanbo Brain Hospital of Capital Medical University from January 2008 to January 2019 were retrospectively analyzed. The patients were divided into resective therapy group and non-resective therapy group [bipolar electrocoagulation on cortex, stereotactic electroencephalography (SEEG)-guided radiofrequency thermocoagulation, and vagus nerve stimulation]. The outcomes of epilepsy and post-surgical limb function were compared and analyzed. Results: A total of 53 patients were included, aged from 3 to 45 years old [(19±11) years], with 33 males and 20 females. Thirty patients received resective therapy and 23 patients received non-resective therapy. The curative effect of the resective therapy group was significantly better than that of the non-resective therapy group. The rate of Engel Ⅰ in resective therapy group was higher than that of non-resective group [83.3% (25/30) vs 39.1% (9/23), P=0.011). Compared with the non-resective group, the incidence of muscle strength decline in the resective group was higher both at 1 week [73.3% (22/30) vs 21.7% (5/23), P=0.006] and 3 months [30% (9/30) vs 0, P=0.016] after surgery. Conclusions: During the diagnosis and treatment, the multimodal method is conducive to the qualitative and localized diagnosis of the rolandic or perirolandic epilepsy, while SEEG has important value in the diagnosis, functional localization and treatment of the disease. Resective therapy is still the most effective method to terminate epilepsy, but it has a higher risk of post-surgical dysfunction.

Prognostic value of histopathologic pattern for long-term surgical outcomes of 198 patients with confirmed mesial temporal lobe epilepsy

Hippocampal sclerosis (HS) is the most common neuropathologic findings in patients with intractable temporal lobe epilepsy (TLE). The international league against epilepsy has proposed a new classification of HS based on pyramidal cell loss on different subfields to facilitate the study of HS pathology in patients after anterior temporal lobectomy (ATL), and the influence of these HS patterns on the prognosis of patients with TLE is contradictory. This study aims to investigate the relationship between different HS subtypes and postoperative seizure outcomes for intractable patients with TLE. From January 2008 to December 2018, we retrospectively reviewed 198 TLE patients with ATL surgery, and all patients had a complete preoperative evaluation, a specimen of hippocampal tissue after surgery, cognitive test after surgery, and more than 2 years of postoperative follow-up. The main findings were as follows: 1) temporal neocortical gray matter heterotopia were more common in the no-HS group; 2) HS type 1 was associated with a longer duration of epilepsy; 3) history of meningitis was the independent predictor of HS type 1; 4) no-HS patients experienced worse postoperative seizure outcomes than those with HS type1 and type 2, whereas no difference in seizure outcomes was obtained between HS type 1 and type 2; 5) no-HS patients were at increased risk for verbal memory decline after left hippocampal resection. The HS subtypes were associated with the prognosis of patients with TLE, and other variables were the predictors of different HS types. `Further study was to identify the HS subtypes by noninvasive evaluation to approve better postoperative outcomes.

Boosting the Metathesis Activity of Molybdenum Oxo Alkylidenes by Tuning the Anionic Ligand σ Donation

The catalytic performances of molecular and silica-supported molybdenum oxo alkylidene species bearing anionic O ligands [OR_F9, OTPP, OHMT - where OR_F9 = OC(CF₃)₃, OTPP = 2,3,5,6-tetraphenylphenoxy, OHMT = hexamethylterphenoxy] with different σ-donation abilities and sizes are evaluated in the metathesis of both internal and terminal olefins. Here, we show that the presence of the anionic nonafluoro-tert-butoxy X ligand in Mo(O){═CH-4-(MeO)C₆H₄}(THF)₂{X}₂ (1; X = OR_F9) significantly increases the catalytic performances in the metathesis of both terminal and internal olefins. Its silica-supported equivalent displays slightly lower activity, albeit with improved stability. In sharp contrast, the molecular complexes with large aryloxy anionic X ligands show little activity, whereas the activity of the corresponding silica-supported systems is greatly improved, illustrating that surface siloxy groups are significantly smaller anionic ligands. Of all of the systems, compound 1 stands out because of its unique high activity for both terminal and internal olefins. Density functional theory modeling indicates that the OR_F9 ligand is ideal in this series because of its weak σ-donating ability, avoiding overstabilization of the metallacyclobutane intermediates while keeping low barriers for [2 + 2] cycloaddition and turnstile isomerization.

Automated detection of hippocampal sclerosis: Comparison of a composite MRI-based index with conventional MRI measures

PURPOSE

This study aims to compare the performance of an MRI-based composite index (HSI) with conventional MRI-based measures in hippocampal sclerosis (HS) detection and postoperative outcome estimation.

METHODS

Seventy-two temporal lobe epilepsy (TLE) patients with pathologically confirmed HS and fifteen TLE patients without HS were included retrospectively. The T1-weighted and FLAIR images of these patients were processed with AccuBrain to quantify the hippocampal volume (HV) and the hippocampal FLAIR signal. The HSI index that considered both HV and hippocampal FLAIR signal was also calculated. Two experienced neuropathologists rated the HS severity with the resected tissue and reached an agreement for all cases. The asymmetry indices of the MRI measures were used to lateralize the sclerotic side, and the original MRI measures were applied to detect HS vs. normal hippocampi. Operating characteristic curve (ROC) analyses were performed for these predictions. We also investigated the sensitivity of the ipsilateral MRI measures in characterizing the pathological severity of HS and the associations of the MRI measures with postoperative outcomes (Engel class categories).

RESULTS

With the optimal cutoffs, the asymmetry indices of HSI and HV both achieved excellent performance in differentiating left vs. right HS (accuracy = 100 %), and the absolute value of the asymmetry index of HSI performed best in differentiating unilateral vs. bilateral HS (accuracy = 91.7 %). Regarding the detection of HS, HSI performed better in sensitivity (94.4 % vs. 87.5 %) while HV performed better in specificity (93.6 % vs. 89.4 %) when the contralateral site of unilateral HS and both sides of non-HS patients were considered as the normal reference, and HSI performed even better than HV when only both sides of non-HS patients were considered as the normal reference (AUC: 0.956 vs. 0.934, p = 0.038). The ipsilateral HSI presented the strongest association with the pathological rating of HS severity (r = 0.405, p < 0.001). None of the ipsilateral or contralateral MRI measures was associated with the postoperative outcomes. Among the asymmetry indices, only the absolute value of the asymmetry index of HV presented a significant association with the Engel classifications for the Year 2∼3 visit (r = -0.466, p = 0.004) or the latest visit with >1 year follow-up (r = -0.374, p = 0.003) while controlling for disease duration and follow-up duration.

CONCLUSION

The HSI index and HV presented comparable good performance in HS detection, and HSI may have better sensitivity than HV in differentiating pathological HS severity. Higher magnitude of HV dissymmetry may indicate better post-surgical outcomes for HS patients.

Risk Factors for Failure in First-Time Hearing Screening Tests among High-Risk Neonates in Neonatal Intensive Care Unit

OBJECTIVE

The aim of the study was to investigate into the risk factors for failure in the first-time screening test among high-risk neonates in neonatal intensive care unit (NICU) in order to further clarify the etiology of neonatal hearing impairment, thus providing insights into early prevention and intervention.

METHODS

We performed automated auditory brainstem response (AABR), distortion product otoacoustic emission (DPOAE), and acoustic immittance (AI) on 2,194 high-risk neonates admitted into the NICU of Shanghai Children's Medical Center from January 2015 to December 2019, and the risk factors, including premature birth, hyperbilirubinemia, and infant respiratory distress syndrome, were analyzed retrospectively by the univariate χ2 test and multivariate stepwise logistic regression analysis.

RESULTS

The pass rates of AABR, DPOAE, and AI were 70.21, 78.44, and 93.12%, respectively, in 2,194 cases of high-risk neonates screened, which are significantly lower than those of healthy controls. The most common diagnoses included artificial feeding, preterm birth, C-section, low birth weight (LBW), neonatal hyperbilirubinemia (NHB), neonatal respiratory distress syndrome (NRDS), congenital heart disease (CHD), gestational diabetes mellitus, pregnancy-induced hypertension syndrome, advanced maternal age (AMA), twins, and in vitro fertilization. Stepwise logistic regression analysis indicated that the AABR pass rate was negatively correlated with LBW (p = 0.002), NHB (p < 0.001), NRDS (p = 0.007), artificial or mixed feeding (p = 0.018), and CHD (p = 0.005). The pass rate of DPOAE was negatively correlated with artificial or mixed feeding (p = 0.041), NHB (p < 0.001), LBW (p = 0.007), very LBW (VLBW) (p = 0.008), and C-section (p < 0.001). The pass rate of AI was negatively correlated with revised AMA (≥40 year) (p < 0.001), NHB (p = 0.043), C-section (p = 0.005), and artificial/mixed feeding (p = 0.036).

CONCLUSION

The hearing screening pass rates of high-risk neonates in the NICU were lower than those of normal neonates, among which the rate of AABR was significantly lower than that of DPOAE. NRDS, NHB, LBW, revised AMA, CHD, C-section, and artificial feeding are potential risk factors of hearing impairment. The combination of different hearing screening tests is necessary for accurate diagnosis of congenital hearing disorders.

Predictors and Long-term Outcome of Resective Epilepsy Surgery in Patients with Tuberous Sclerosis Complex: A Single-centre Retrospective Cohort Study

OBJECTIVE

To identify prognostic factors and long-term seizure outcomes for patients with tuberous sclerosis complex (TSC) who underwent resective treatment for epilepsy.

METHODS

We enrolled 81 patients with TSC who had undergone resective epilepsy surgery at Sanbo Brain Hospital, Capital Medical University, between April 2004 and June 2019. We estimated cumulative probability of remaining seizure-free and plotted survival curves. Variables were compared using Mann-Whitney U, Pearson's correlation, continuity correction, and Fisher's exact chi-square tests. Prognostic predictors were analysed using log-rank (Mantel-Cox) tests and Cox regression models.

RESULTS

At the last follow-up, 48 (59.3%) patients were classified as International League Against Epilepsy Class 1 (including 14 patients who had seizures <3 times postoperatively on the same or different day and were seizure-free at all other times). The estimated cumulative probability of remaining seizure-free postoperatively was 69.0% (95% confidence interval [CI] 58.8-79.2%), 61.9% (95% CI 51.1-72.7%), and 55.0% (95% CI 42.8-67.2%) at 2, 5, and 10 years, respectively. The mean time of remaining seizure-free was 7.24 ± 0.634 years (95% CI 6.00-8.49); en bloc resection was an essential positive predictor of postoperative seizure freedom, as was age at seizure onset, regional interictal video-electroencephalography pattern, and temporal lobe surgery. The longer the seizure-free time, the less likely a relapse. Patients who postoperatively experienced seizures remained likely to recover.

CONCLUSIONS

We demonstrated the efficacy of surgical treatment for patients with TSC and intractable epilepsy. Detailed perioperative tests are a reliable predictor of postoperative seizure freedom.

Anisotropic and gate-tunable valley filtering based on 8-Pmmn borophene

We propose a valley filter based on 8-Pmmn borophene which hosts two tilted Dirac cones. It is found that the application of a magnetic-electric barrier provided by a single ferromagnetic gate is sufficient to create valley-polarized current in 8-Pmmn borophene. The valley polarization of output current depends on the barrier orientation. Due to an intrinsic symmetry, it vanishes when the barrier orientation is along the tilted direction of Dirac cones. For the barrier orientation perpendicular to the tilted direction, the valley polarization for a realistic magnetic barrier can approach nearly 100% at proper Fermi energy and gate voltage. The remarkable valley contrast of conductance in this case is attributed to a new transmission resonance. The tilting of Dirac cones is essential for the predicted valley filtering. Our findings are helpful for valleytronic applications of two-dimensional materials with tilted Dirac cones.

Mental Health of Parents and Preschool-Aged Children During the COVID-19 Pandemic: The Mediating Role of Harsh Parenting and Child Sleep Disturbances

In the context of the coronavirus disease-2019 (COVID-19) pandemic, mental health problems of parents and children have become a public issue. Herein, we explored the association between parental well-being index and child mental health problems during the pandemic and the mediating role of harsh parenting and child sleep disturbances. An online survey was conducted among 16,398 parents of children aged 3-6 years (48.1% girls, M_age = 4.69 years, SD_age = 0.75 years) from March 15 to 29, 2020. Child mental health (Strengths and Difficulties Questionnaire, SDQ), sleep problems (Children's Sleep Habits Questionnaire, CSHQ), and parental well-being index (World Health Organization-Five Well-Being Index, WHO-5), and harsh parenting were reported by parents. The results revealed that a higher parental well-being index was associated with lower child mental health problems. Harsh parenting and child sleep problems were significant mediators within the association. This study indicates the association between parental well-being index and child mental health during the pandemic and underlying mechanism, and has important implications for reducing parental and child mental health problems.

The association between the seasonality of pediatric pandemic influenza virus outbreak and ambient meteorological factors in Shanghai

BACKGROUND AND OBJECTIVES

The number of pediatric patients diagnosed with influenza types A and B is increasing annually, especially in temperate regions such as Shanghai (China). The onset of pandemic influenza viruses might be attributed to various ambient meteorological factors including temperature, relative humidity (Rh), and PM₁ concentrations, etc. The study aims to explore the correlation between the seasonality of pandemic influenza and these factors.

METHODS

We recruited pediatric patients aged from 0 to 18 years who were diagnosed with influenza A or B from July 1st, 2017 to June 30th, 2019 in Shanghai Children's Medical Centre (SCMC). Ambient meteorological data were collected from the Shanghai Meteorological Service (SMS) over the same period. The correlation of influenza outbreak and meteorological factors were analyzed through preliminary Pearson's r correlation test and subsequent time-series Poisson regression analysis using the distributed lag non-linear model (DLNM).

RESULTS

Pearson's r test showed a statistically significant correlation between the weekly number of influenza A outpatients and ambient meteorological factors including weekly mean, maximum, minimum temperature and barometric pressure (P < 0.001), and PM₁ (P < 0.01). While the weekly number of influenza B outpatients was statistically significantly correlated with weekly mean, maximum and minimum temperature (P < 0.001), barometric pressure and PM₁ (P < 0.01), and minimum Rh (P < 0.05). Mean temperature and PM₁ were demonstrated to be the statistically significant variables in the DLNM with influenza A and B outpatients through time-series Poisson regression analysis. A U-shaped curve relationship was noted between the mean temperature and influenza A cases (below 15 °C and above 20 °C), and the risks increased for influenza B with mean temperature below 10 °C. PM₁ posed a risk after a concentration of 23 ppm for both influenza A and B. High PM₁, low and the high temperature had significant effects upon the number of influenza A cases, whereas low temperature and high PM₁ had significant effects upon the number of influenza B cases.

CONCLUSION

This study indicated that mean temperature and PM₁ were the primary factors that were continually associated with the seasonality of pediatric pandemic influenza A and B and the recurrence in the transmission and spread of influenza viruses.

Prognostic factors of postoperative seizure outcomes in older patients with temporal lobe epilepsy

OBJECTIVE

The authors of this study aimed to investigate surgical outcomes and prognostic factors in older patients with drug-resistant temporal lobe epilepsy (TLE) who had undergone resective surgery.

METHODS

Data on patients older than 45 years of age with drug-resistant TLE who had undergone resective surgery at Sanbo Brain Hospital, Capital Medical University, between January 2009 and August 2017 were retrospectively collected. Postoperative seizure outcomes were evaluated according to the International League Against Epilepsy (ILAE) classification. Patients belonging to ILAE classes 1 and 2 were classified as having a favorable outcome, whereas patients belonging to ILAE classes 3-6 were classified as having an unfavorable outcome. Univariate analysis and multivariate logistic regression analysis were used to identify the potential predictors of seizure outcomes.

RESULTS

A total of 45 patients older than 45 years of age who had undergone resective epilepsy surgery for TLE were included in the present study. Eight (17.8%) of 45 patients had preoperative comorbidity in addition to seizures. The average age at the time of surgery was 51.76 years, and the average duration of epilepsy at the time surgery was 18.01 years. After an average follow-up period of 4.53 ± 2.82 years (range 2-10 years), 73.3% (33/45) of patients were seizure free. Surgical complications were observed in 13.3% of patients. Univariate and multivariate analyses revealed that an MRI-negative finding is the only independent predictor of unfavorable seizure outcomes (OR 0.06, 95% CI 0.01-0.67, p = 0.023).

CONCLUSIONS

Resective surgery is a safe and effective treatment for older patients with drug-resistant TLE. An MRI-negative finding independently predicts unfavorable seizure outcomes.

Epileptic seizures in a heterogeneous excitatory network with short-term plasticity

Epilepsy involves a diverse group of abnormalities, including molecular and cellular disorders. These abnormalities prove to be associated with the changes in local excitability and synaptic dynamics. Correspondingly, the epileptic processes including onset, propagation and generalized seizure may be related with the alterations of excitability and synapse. In this paper, three regions, epileptogenic zone (EZ), propagation area and normal region, were defined and represented by neuronal population model with heterogeneous excitability, respectively. In order to describe the synaptic behavior that the strength was enhanced and maintained at a high level for a short term under a high frequency spike train, a novel activity-dependent short-term plasticity model was proposed. Bifurcation analysis showed that the presence of hyperexcitability could increase the seizure susceptibility of local area, leading to epileptic discharges first seen in the EZ. Meanwhile, recurrent epileptic activities might result in the transition of synaptic strength from weak state to high level, augmenting synaptic depolarizations in non-epileptic neurons as the experimental findings. Numerical simulation based on a full-connected weighted network could qualitatively demonstrate the epileptic process that the propagation area and normal region were successively recruited by the EZ. Furthermore, cross recurrence plot was used to explore the synchronization between neuronal populations, and the global synchronization index was introduced to measure the global synchronization. Results suggested that the synchronization between the EZ and other region was significantly enhanced with the occurrence of seizure. Interestingly, the desynchronization phenomenon was also observed during seizure initiation and propagation as reported before. Therefore, heterogeneous excitability and short-term plasticity are believed to play an important role in the epileptic process. This study may provide novel insights into the mechanism of epileptogenesis.

Maturation of Voltage-induced Shifts in SLC26a5 (Prestin) Operating Point during Trafficking and Membrane Insertion

Prestin (SLC26a5) is an integral membrane motor protein in outer hair cells (OHC) that underlies cochlear amplification. As a voltage-dependent protein, it relies on intrinsic sensor charge to respond to transmembrane voltage (receptor potentials), thereby effecting conformational changes. The protein's electromechanical actively is experimentally monitored as a bell-shaped nonlinear capacitance (NLC), whose magnitude peaks at a characteristic voltage, V_h. This voltage denotes the midpoint of prestin's charge-voltage (Q-V) Boltzmann distribution and region of maximum gain of OHC electromotility. It is an important factor in hearing capabilities for mammals. A variety of biophysical forces can influence the distribution of charge, gauged by shifts in V_h, including prior holding voltage or membrane potential. Here we report that the effectiveness of prior voltage augments during the delivery of prestin to the membranes in an inducible HEK cell line. The augmentation coincides with an increase in prestin density, maturing at a characteristic membrane areal density of 870 functional prestin units per square micrometer, and is likely indicative of prestin-prestin cooperative interactions.

The impact of MEG results on surgical outcomes in patients with drug-resistant epilepsy associated with focal encephalomalacia: a single-center experience

PURPOSE

To analyze the impact of magnetoencephalography (MEG) results on surgical outcomes in patients with drug-resistant epilepsy secondary to encephalomalacia.

METHODS

We retrospectively reviewed 121 patients with drug-resistant epilepsy associated with encephalomalacia who underwent MEG followed by resection surgery. Patients were subdivided into concordant MEG group and dis-concordant MEG group for analysis based on whether the MEG results were in concordance with epileptogenic zones or not.

RESULTS

121 patients were included in the present study. The MEG spike sources of 73 (60.33%) patients were in concordance with epileptogenic zones while the MEG spike sources of the other 48 (39.67%) were in dis-concordance with epileptogenic zones. Favorable seizure outcomes were achieved in 79.45% (58 of 73) of patients with concordant MEG results while only 62.50% (30 of 48) of patients with dis-concordant MEG results were seizure free with a follow-up of 2-10 years. The differences of seizure-free rate between patients with concordant MEG results and dis-concordant MEG results were statistically significant. For patients with concordant MEG results, bilateral lesions on MRI are the only independent predictor of unfavorable seizure outcomes. For patients with discordant MEG results, duration of seizures is the only independent predictor of unfavorable seizure outcomes.

CONCLUSIONS

Concordant MEG results are associated with favorable seizure outcomes. Bilateral lesions on MRI independently predict unfavorable seizure outcomes in patients with concordant MEG results while longer seizure durations independently predict unfavorable seizure outcomes in patients with dis-concordant MEG results.

Extreme nonlinear strong-field photoemission from carbon nanotubes

Strong-field photoemission produces attosecond (10-18 s) electron pulses that are synchronized to the waveform of the incident light. This nonlinear photoemission lies at the heart of current attosecond technologies. Here we report a new nonlinear photoemission behaviour-the nonlinearity in strong-field regime sharply increases (approaching 40th power-law scaling), making use of sub-nanometric carbon nanotubes and 800 nm pulses. As a result, the carrier-envelope phase sensitive photoemission current shows a greatly improved modulation depth of up to 100% (with a total modulation current up to 2 nA). The calculations reveal that the behaviour is an interplay of valence band optical-field emission with charge interaction, and the nonlinear dynamics can be tunable by changing the bandgap of carbon nanotubes. The extreme nonlinear photoemission offers a new means of producing extreme temporal-spatial resolved electron pulses, and provides a new design philosophy for attosecond electronics and photonics.

Resective surgery for drug-resistant posttraumatic epilepsy: predictors of seizure outcome

OBJECTIVE

The object of this study was to evaluate surgical outcomes and prognosis factors in patients with drug-resistant posttraumatic epilepsy (PTE) who had undergone resective surgery.

METHODS

The authors retrospectively reviewed the records of all patients with drug-resistant PTE who had undergone resective surgery at Sanbo Brain Hospital, Capital Medical University, in the period from January 2008 to December 2016. All patients had a follow-up period of at least 2 years. Seizure outcomes were evaluated according to the International League Against Epilepsy (ILAE) classification. Patients in ILAE classes 1 and 2 during the last 2 years of follow-up were classified as having a favorable outcome; patients in all other classes were considered to have an unfavorable outcome. Univariate analysis and a multivariate logistic regression model in a backward fashion were used to identify the potential predictors of seizure outcomes.

RESULTS

Among 90 patients with a follow-up of 2-10 years (mean ± standard deviation, 5.79 ± 2.84 years), 70% (63 patients) were seizure free, of whom 68.9% (62 patients) had an ILAE class 1 outcome and 1.1% (1 patient) had an ILAE class 2 outcome. Permanent neurological deficits were observed in 10 patients (11.1%). Univariate and multivariate analyses revealed that only the duration of seizures ≤ 8 years was an independent predictor of a favorable seizure outcome (OR 0.34, 95% CI 0.13-0.92).

CONCLUSIONS

Resective surgery is an effective treatment for patients with drug-resistant PTE with an acceptable incidence of complications. The information on prognosis factors suggests that early surgery may offer more benefits to patients with drug-resistant PTE.

Upregulation of adenosine A2A receptor and downregulation of GLT1 is associated with neuronal cell death in Rasmussen's encephalitis

Rasmussen encephalitis (RE) is a severe pediatric inflammatory brain disease characterized by unilateral inflammation and atrophy of the cerebral cortex, drug-resistant focal epilepsy and progressive neurological and cognitive deterioration. The etiology and pathogenesis of RE remain unclear. Our previous results demonstrated that the adenosine A1 receptor (A1R) and the major adenosine-removing enzyme adenosine kinase play an important role in the etiology of RE. Because the downstream pathways of inhibitory A1R signaling are modulated by stimulatory A2AR signaling, which by itself controls neuro-inflammation, glial activation and glial glutamate homeostasis through interaction with glutamate transporter GLT-1, we hypothesized that maladaptive changes in adenosine A2A receptor (A2AR) expression are associated with RE. We used immunohistochemistry and Western blot analysis to examine the expression of A2ARs, glutamate transporter-I (GLT-1) and the apoptotic marker Bcl-2 in surgically resected cortical specimens from RE patients (n = 18) in comparison with control cortical tissue. In lesions of the RE specimen we found upregulation of A2ARs, downregulation of GLT-1 and increased apoptosis of both neurons and astroglia. Double staining revealed colocalization of A2ARs and Bcl-2 in RE lesions. These results suggest that maladaptive changes in A2AR expression are associated with a decrease in GLT-I expression as a possible precipitator for apoptotic cell loss in RE. Because A2AR antagonists are already under clinical evaluation for Parkinson's disease, the A2AR might likewise be a tractable target for the treatment of RE.

Silica-Supported Molybdenum Oxo Alkylidenes: Bridging the Gap between Internal and Terminal Olefin Metathesis

Grafting a molybdenum oxo alkylidene on silica (partially dehydroxylated at 700 °C) affords the first example of a well-defined silica-supported Mo oxo alkylidene, which is an analogue of the putative active sites in heterogeneous Mo-based metathesis catalysts. In contrast to its tungsten analogue, which shows poor activity towards terminal olefins because of the formation of a stable off-cycle metallacyclobutane intermediate, the Mo catalyst shows high metathesis activity for both terminal and internal olefins that is consistent with the lower stability of Mo metallacyclobutane intermediates. This Mo oxo metathesis catalyst also outperforms its corresponding neutral silica-supported Mo and W imido analogues.

Surgical outcomes and prognostic factors of drug-resistant epilepsy secondary to encephalomalacia

OBJECTIVE

To evaluate long-term outcomes and prognostic factors in patients who underwent surgical resection for drug-resistant epilepsy secondary to encephalomalacia.

METHODS

A total of 143 patients with drug-resistant epilepsy who underwent surgical resection with a follow-up of at least 5 years were included. Seizure outcomes were evaluated based on the International League Against Epilepsy classification. Univariate analysis and a multivariate logistic regression model in a backward fashion were used to identify the potential predictors of seizure outcomes.

RESULTS

Three months after surgery, 102 of 143 (71.3%) patients had achieved favorable seizure outcomes. Five years after surgery, 107 of 143 (74.8%) patients had achieved favorable seizure outcomes. Changes in the postoperative seizure status were observed in 22 of 143 (15.4%) patients during follow-up, but the difference in the seizure-free rate between 3 months and 5 years after surgery was not significant. Univariate and multivariate analyses revealed that only a monthly seizure frequency of >30 seizures (odds ratio = 3.42, 95% confidence interval = 1.19-9.76) and bilateral ictal onset rhythms (odds ratio = 4.46, 95% confidence interval = 1.61-12.39) were independent predictors of unfavorable seizure outcomes.

SIGNIFICANCE

Surgical resection is an effective treatment for patients with drug-resistant epilepsy secondary to encephalomalacia. Knowledge of the predictors of seizure outcomes may help during preoperative counseling and selection of optimal candidates for epilepsy surgery among patients with drug-resistant epilepsy secondary to encephalomalacia.

Multiple harmonics control of edge pseudomagnetoplasmons in strained grapheme

Valley-resolved edge plasmons are relevant to nano-optics at subwavelength scales. However, less attention has been paid to their tunable properties in time domain. In this work we investigate edge pseudomagnetoplasmons in a strained graphene modulated by multiple harmonics with frequency in the THz regime. The edge plasmon is described by a set of nonlinear hydrodynamic equations, which are self-consistently solved by the flux-corrected transport method. Without the applied voltage, there exist two unidirectional-propagating edge-plasmon modes with weak valley polarization P. It is demonstrated that by varying the amplitude of multiple harmonics one can alter both the amplitude and the polarity of the valley polarization in the edge plasmon. One can achieve a full valley polarization P=1 at the instant of half cycle of the multiple harmonics and P=-1 at the instant of one cycle. The edge-plasmon density and the transverse velocity vanish for the frozen valley.