Between bodily action and conventionalized structure: The neural mechanisms of constructed action in sign language comprehension

Sign languages (SLs) are expressed through different bodily actions, ranging from re-enactment of physical events (constructed action, CA) to sequences of lexical signs with internal structure (plain telling, PT). Despite the prevalence of CA in signed interactions and its significance for SL comprehension, its neural dynamics remain unexplored. We examined the processing of different types of CA (subtle, reduced, and overt) and PT in 35 adult deaf or hearing native signers. The electroencephalographic-based processing of signed sentences with incongruent targets was recorded. Attenuated N300 and early N400 were observed for CA in deaf but not in hearing signers. No differences were found between sentences with CA types in all signers, suggesting a continuum from PT to overt CA. Deaf signers focused more on body movements; hearing signers on faces. We conclude that CA is processed less effortlessly than PT, arguably because of its strong focus on bodily actions.

Learning to express causal events in Mandarin Chinese: A multimodal perspective

Previous research has shown language-specific features play a guiding role in how children develop expression of events with speech and gestures. This study adopts a multimodal approach and examines Mandarin Chinese, a language that features context use and verb serializations. Forty children (four-to-seven years old) and ten adults were asked to describe fourteen video stimuli depicting different types of causal events involving location/state changes. Participants' speech was segmented into clauses and co-occurring gestures were analyzed in relation to causation. The results show that the older the children, the greater the use of contextual clauses which contribute meaning to event descriptions. It is not until the age of six that children used adult-like structures - namely, using single gestures representing causing actions and aligning them with verb serializations in single clauses. We discuss the implications of these findings for the guiding role of language specificity in multimodal language development.

Active and passive microrheology with large tracers in hard colloids

The dynamics of a tracer particle in a bath of quasi-hard colloidal spheres is studied by Langevin dynamics simulations and mode coupling theory (MCT); the tracer radius is varied from equal to up to seven times larger than the bath particles radius. In the simulations, two cases are considered: freely diffusing tracer (passive microrheology) and tracer pulled with a constant force (active microrheology). Both cases are connected by linear response theory for all tracer sizes. It links both the stationary and transient regimes of the pulled tracer (for low forces) with the equilibrium correlation functions; the velocity of the pulled tracer and its displacement are obtained from the velocity auto-correlation function and the mean squared displacement, respectively. The MCT calculations give insight into the physical mechanisms: At short times, the tracer rattles in its cage of neighbours, with the frequency increasing linearly with the tracer radius asymptotically. The long-time tracer diffusion coefficient from passive microrheology, which agrees with the inverse friction coefficient from the active case, arises from the transport of transverse momentum around the tracer. It can be described with the Brinkman equation for the transverse flow field obtained in extension of MCT, but cannot be recovered from the MCT kernel coupling to densities only. The dynamics of the bath particles is also studied; for the unforced tracer the dynamics is unaffected. When the tracer is pulled, the velocity field in the bath follows the prediction of the Brinkman model, but different from the case of a Newtonian fluid.

Advanced echocardiography with left atrial strain and indexed left atrial 3D volume for predicting underlying atrial fibrillation after cryptogenic stroke

Introduction

Cryptogenic stroke (CS) represents one-third of ischemic strokes. Atrial fibrillation (AF) can be detected in up to 30% of CS. Therefore, there is a clinical need for predicting AF to guide the optimal secondary prevention strategy. The evidence about the role of advanced echocardiography, including left atrial 3D index volume and left atrial strain (LAS) techniques, to predict underlying AF in this setting is lacking.

Methods

From April 2019 to November 2021 seventy-eight consecutive patients with ischemic stroke or transient ischemic attack with ABCD2 scale ≥4 of unknown etiology were prospectively recruited. Echocardiography was performed during admission. All patients underwent 15 days wearable Holter monitoring. The primary outcome measure was AF detection during follow-up.

Results

Twenty -two patients (28%) developed AF. Patients in the AF group were older (81±6.3 vs 76.5±7.8 years; p=0.012). Left atrial (LA) diastolic indexed volume was higher in AF group (37.2±12.8 vs 29.7±11 ml/m2 p=0.01). 3D LA indexed volume were also higher in patients with AF (41.4±14 vs 32.2±10 ml/m2 p=0.009). LAS reservoir, LAS conduct and LAS contraction (LASct) were significantly lower in patients with AF (19±5.6 vs 32±10.3%; 9±4.5 vs 15±7.6; 10±5.3 vs 17±6.4, respectively, all p<0.001). On multivariate analysis LASct <13.5% and LA 3D indexed volume >44.5 ml/m2 were independent predictors of AF (OR 10.9 [95% CI 1.09–108.2], p=0.042) (Table 1, Figure 1)

Conclusion

LASct <13.5% and LA 3D indexed volume >44.5 ml/m2 are independent predictors of underlying AF in patients with CS. Our results demonstrate the usefulness of advanced echocardiography in this challenging clinical setting.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Spanish Society of Cardiology

CHA2DS2VASC score for predicting atrial fibrillation in patients with cryptogenic stroke

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Spanish Society of Cardiology

Introduction

CHA2DS2-VASc Score is widely used to predict thromboembolic risk in patients with Atrial Fibrillation (AF). However the role of CHA2DS2-VASC score for predicting AF in patients with cryptogenic stroke (CS) remains unknown.

Methods

Sixty-three consecutive patients with ischemic stroke or transient ischemic attack with ABCD2 scale≥4 of unknown etiology, were prospectively recruited. They were classified according to

CHA2DS2-VASc Score: group 1 (score ≤ 5), and group 2 (score >5). The primary outcome measure was the occurrence of AF during clinical follow-up.

Results

Twenty-six (41%) patients had a CHA2DS2VASC score > 5 (group 2). Patients in this group were older (81 ± 5.5 vs 75 ± 8 years; p < 0.001) and more frequently female (73% vs 43% p = 0.019). Patients in group 2 present more often hypertension (84% vs 43% p = 0.001), diabetes (38% vs 11%, p = 0.009) , dyslipidemia 77% vs 49%, p = 0.024), and a prior history of coronary artery disease (27% vs 5%, p = 0.026). Notably, patients with higher CHA2DS2VASC showed worse left atrial ejection fraction (41.7 ± 13.1 vs 52.2 ± 15%, p = 0.009) and worse left atrial strain reservoir (21.5 ± 7.1 vs 33.8 ± 11%, p < 0.001), conduct (9.5 ± 4.8 vs 16.6 ± 8.4%;p < 0.001) and contraction (12 ± 4.6 vs 17.2 ± 7.3, p = 0.002). During follow-up AF was detected more often in group 2 (42% vs 11% p = 0.006). In multivariate analysis CHA2SD2VAS > 5 was an independent predictor of AF in patients with CS (HR 7.3 [95% CI 1.2-45.6] p = 0.032)

Conclusion

A CHA2DS2VASC score >5 is an independent predictor of AF in patients with CS. This score provides a new clinical tool to inform clinicians with regards to the optimal treatment of these challenging patients

Evaluation of the Feasibility, Safety and Efficacy of the Use of Intravenous Infusions of Adenosine Triphosphate (ATP) in People Affected by Moderate to Severe Alzheimer's Disease: A Double-Blind Masked Clinical Trial for Dose Finding

BACKGROUND

There are currently no drug therapies modifying the natural history of patients suffering Alzheimer's disease (AD). Most recent clinical trials in the field include only subjects in early stage of the disease, while patients with advanced AD are usually not represented.

OBJECTIVES

To evaluate the feasibility, safety and efficacy of systemic infusions of adenosine triphosphate (ATP) in patients with moderate to severe AD, and to select the minimum effective dose of infusion.

DESIGN

A phase IIb, randomized, double-blind, placebo-controlled clinical trial investigates.

PARTICIPANTS

A total of 20 subjects with moderate or severe AD were included, 16 in the treatment group and 4 in the placebo group (4:1 randomization) at two dosage regimens, 6-hour or 24-hour infusions.

RESULTS

The proof-of-concept study was successfully conducted, with no significant deviations from the study protocol and no serious adverse events reported. Regarding efficacy, only marginal differences were observed between ATP and placebo arms for H-MRS and MMSE variables.

CONCLUSIONS

Our study demonstrates that the use of ATP infusion as therapy is feasible and safe. Larger studies are however needed to assess the efficacy of ATP in moderate to severe AD.

A comprehensive model to estimate underlying atrial fibrillation in cryptogenic stroke: the decrypting score

Introduction

Cryptogenic stroke (CS) represents up to 30% of ischemic strokes. Since atrial fibrillation (AF) can be detected in up to one-third of CS, there is a clinical need for estimating the probability of underlying AF in CS to guide the optimal secondary prevention strategy.

Surrogate markers of left atrial dysfunction such as left atrial size, left atrial strain (LAS) and NTproBNP has been described as predictors of AF in patients with CS. However the evidence about AF markers in comprehensive and prospective studies in CS is still limited.

Purpose

The present study was designed to develop the first score to predict underlying AF in CS patients that includes markers of atrial dysfunction. To reach our aim we developed a comprehensive analysis including clinical, laboratory, electrocardiografic and advanced echocardiographic variables in patients with CS.

Methods

Sixty-three consecutive patients with ischemic stroke or transient ischemic attack with ABCD2 scale ≥4 of unknown etiology were prospectively recruited. Clinical, laboratory, electrocardiografic and echocardiographic variables were collected. All patients underwent 15 days wearable Holter monitoring. Main objective was the Decryptoring score creation to predict AF in CS. Score variables were initially selected by a univariate logistic regression and, thereafter, the score points were derived according to a multivariant analysis.

Results

AF was detected in 15 patients (24%). Patients in the AF group were older (81.4±6.9 vs 76.5±7.8 years; p=0.035. There was no difference in sex between groups. Regarding cardiovascular risk factors patients who developed AF had more often hypertension (87% vs 52%; p=0.018) without differences in diabetes, dyslipidemia and tobacco consumption. T troponin and NTproBNP were higher in the AF group (47±55.9 vs 16.8±12.4 ng/L; p=0.018 and 1379±1650 vs 317±496 ng/ml; p=0.001 respectively). There were no differences in ECG parameters such as p wave voltage, interatrial block, PR interval or QRS.

LAS reservoir, LAS conduct and LAS contraction were lower in patients with AF (18.6±4.6 vs 32.1±10.9%; 8±4.3 vs 15.6±8%; 10.5±3.4 vs 16.6±7 respectively, all p<0.001).

Age >75 (9 points), hypertension (1 point), Troponin T >40 ng/L (8.5 points), NTproBNP >200 pg/ml (0.5 points), LAS reservoir <25.3% (24.5 points) and LAS conduct <10.4% (0.5 points) were included in the score. The rate of AF detection was 0% among patients with a score of <10 and 80% among patients with a score >35.

Conclusion

The proposed score offers an accurate AF prediction in patients with CS providing a new clinical tool to orient the optimal treatment in these patients.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Spanish Society of Cardiology

Combination of white matter hyperintensities and Aβ burden is related to cognitive composites domain scores in subjective cognitive decline: the FACEHBI cohort

BACKGROUND

To explore whether the combination of white matter hyperintensities (WMHs) and amyloid-beta (Aβ) deposition is associated with worse cognitive performance on cognitive composites (CCs) domain scores in individuals with subjective cognitive decline (SCD).

METHODS

Two hundred participants from the FACEHBI cohort underwent structural magnetic resonance imaging (MRI), 18F-florbetaben positron emission tomography (FBB-PET), and neuropsychological assessment. WMHs were addressed through the Fazekas scale, the Age-Related White Matter Changes (ARWMC) scale, and the FreeSurfer pipeline. Eight CCs domain scores were created using the principal component analysis (PCA). Age, sex, education, and apolipoprotein E (APOE) were used as adjusting variables.

RESULTS

Adjusted multiple linear regression models showed that FreeSurfer (B - .245; 95% CI - .1.676, - .393, p = .016) and β burden (SUVR) (B - .180; 95% CI - 2.140, - .292; p = .070) were associated with face-name associative memory CCs domain score, although the latest one was not statistically significant after correction for multiple testing (p = .070). There was non-significant interaction of these two factors on this same CCs domain score (p = .54). However, its cumulative effects on face-name associative performance indicated that those individuals with either higher WMH load or higher Aβ burden showed the worst performance on the face-name associative memory CCs domain score.

CONCLUSIONS

Our results suggest that increased WMH load and increased Aβ are independently associated with poorer episodic memory performance in SCD individuals, indicating a cumulative effect of the combination of these two pathological conditions in promoting lower cognitive performance, an aspect that could help in terms of treatment and prevention.

Evidence for visual simulation during sign language processing

What are the mental processes that allow us to understand the meaning of words? A large body of evidence suggests that when we process speech, we engage a process of perceptual simulation whereby sensorimotor states are activated as a source of semantic information. But does the same process take place when words are expressed with the hands and perceived through the eyes? To date, it is not known whether perceptual simulation is also observed in sign languages, the manual-visual languages of deaf communities. Continuous flash suppression is a method that addresses this question by measuring the effect of language on detection sensitivity to images that are suppressed from awareness. In spoken languages, it has been reported that listening to a word (e.g., "bottle") activates visual features of an object (e.g., the shape of a bottle), and this in turn facilitates image detection. An interesting but untested question is whether the same process takes place when deaf signers see signs. We found that processing signs boosted the detection of congruent images, making otherwise invisible pictures visible. A boost of visual processing was observed only for signers but not for hearing nonsigners, suggesting that the penetration of the visual system through signs requires a fully fledged manual language. Iconicity did not modulate the effect of signs on detection, neither in signers nor in hearing nonsigners. This suggests that visual simulation during language processing occurs regardless of language modality (sign vs. speech) or iconicity, pointing to a foundational role of simulation for language comprehension. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Dynamics and friction of a large colloidal particle in a bath of hard spheres: Langevin dynamics simulations and hydrodynamic description

The analysis of the dynamics of tracer particles in a complex bath can provide valuable information about the microscopic behavior of the bath. In this work, we study the dynamics of a forced tracer in a colloidal bath by means of Langevin dynamics simulations and a theory model within continuum mechanics. In the simulations, the bath is comprised of quasihard spheres with a volume fraction of 50% immersed in a featureless quiescent solvent, and the tracer is pulled with a constant small force (within the linear regime). The theoretical analysis is based on the Navier-Stokes equation, where a term proportional to the velocity arises from coarse-graining the friction of the colloidal particles with the solvent. As a result, the final equation is similar to the Brinkman model, although the interpretation is different. A length scale appears in the model, k_{0}^{-1}, where the transverse momentum transport crosses over to friction with the solvent. The effective friction coefficient experienced by the tracer grows with the tracer size faster than the prediction from Stokes's law. Additionally, the velocity profiles in the bath decay faster than in a Newtonian fluid. The comparison between simulations and theory points to a boundary condition of effective partial slip at the tracer surface. We also study the fluctuations in the tracer position, showing that it reaches diffusion at long times, with a subdiffusive regime at intermediate times. The diffusion coefficient, obtained from the long-time slope of the mean-squared displacement, fulfills the Stokes-Einstein relation with the friction coefficient calculated from the steady tracer velocity, confirming the validity of the linear response formalism.

Iconic gestures serve as manual cognates in hearing second language learners of a sign language: An ERP study

When learning a second spoken language, cognates, words overlapping in form and meaning with one's native language, help breaking into the language one wishes to acquire. But what happens when the to-be-acquired second language is a sign language? We tested whether hearing nonsigners rely on their gestural repertoire at first exposure to a sign language. Participants saw iconic signs with high and low overlap with the form of iconic gestures while electrophysiological brain activity was recorded. Upon first exposure, signs with low overlap with gestures elicited enhanced positive amplitude in the P3a component compared to signs with high overlap. This effect disappeared after a training session. We conclude that nonsigners generate expectations about the form of iconic signs never seen before based on their implicit knowledge of gestures, even without having to produce them. Learners thus draw from any available semiotic resources when acquiring a second language, and not only from their linguistic experience. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Correlations between plasma and PET beta-amyloid levels in individuals with subjective cognitive decline: the Fundació ACE Healthy Brain Initiative (FACEHBI)

BACKGROUND

Peripheral biomarkers that identify individuals at risk of developing Alzheimer's disease (AD) or predicting high amyloid beta (Aβ) brain burden would be highly valuable. To facilitate clinical trials of disease-modifying therapies, plasma concentrations of Aβ species are good candidates for peripheral AD biomarkers, but studies to date have generated conflicting results.

METHODS

The Fundació ACE Healthy Brain Initiative (FACEHBI) study uses a convenience sample of 200 individuals diagnosed with subjective cognitive decline (SCD) at the Fundació ACE (Barcelona, Spain) who underwent amyloid florbetaben(18F) (FBB) positron emission tomography (PET) brain imaging. Baseline plasma samples from FACEHBI subjects (aged 65.9 ± 7.2 years) were analyzed using the ABtest (Araclon Biotech). This test directly determines the free plasma (FP) and total plasma (TP) levels of Aβ40 and Aβ42 peptides. The association between Aβ40 and Aβ42 plasma levels and FBB-PET global standardized uptake value ratio (SUVR) was determined using correlations and linear regression-based methods. The effect of the APOE genotype on plasma Aβ levels and FBB-PET was also assessed. Finally, various models including different combinations of demographics, genetics, and Aβ plasma levels were constructed using logistic regression and area under the receiver operating characteristic curve (AUROC) analyses to evaluate their ability for discriminating which subjects presented brain amyloidosis.

RESULTS

FBB-PET global SUVR correlated weakly but significantly with Aβ42/40 plasma ratios. For TP42/40, this observation persisted after controlling for age and APOE ε4 allele carrier status (R2 = 0.193, p = 1.01E-09). The ROC curve demonstrated that plasma Aβ measurements are not superior to APOE and age in combination in predicting brain amyloidosis. It is noteworthy that using a simple preselection tool (the TP42/40 ratio with an empirical cut-off value of 0.08) optimizes the sensitivity and reduces the number of individuals subjected to Aβ FBB-PET scanners to 52.8%. No significant dependency was observed between APOE genotype and plasma Aβ measurements (p value for interaction = 0.105).

CONCLUSION

Brain and plasma Aβ levels are partially correlated in individuals diagnosed with SCD. Aβ plasma measurements, particularly the TP42/40 ratio, could generate a new recruitment strategy independent of the APOE genotype that would improve identification of SCD subjects with brain amyloidosis and reduce the rate of screening failures in preclinical AD studies. Independent replication of these findings is warranted.

FACEHBI: A Prospective Study of Risk Factors, Biomarkers and Cognition in a Cohort of Individuals with Subjective Cognitive Decline. Study Rationale and Research Protocols

BACKGROUND

Long-term longitudinal studies with multimodal biomarkers are needed to delve into the knowledge of preclinical AD. Subjective cognitive decline has been proposed as a risk factor for the development of cognitive impairment. Thus, including individuals with SCD in observational studies may be a cost-effective strategy to increase the prevalence of preclinical AD in the sample.

OBJECTIVES

To describe the rationale, research protocols and baseline characteristics of participants in the Fundació ACE Healthy Brain Initiative (FACEHBI).

DESIGN

FACEHBI is a clinical trial (EudraCT: 2014-000798-38) embedded within a long-term observational study of individuals with SCD.

SETTING

Participants have been recruited at the memory clinic of Fundació ACE (Barcelona) from two different sources: patients referred by a general practitioner and individuals from an Open House Initiative.

PARTICIPANTS

200 individuals diagnosed with SCD with a strictly normal performance in a comprehensive neuropsychological battery.

MEASUREMENTS

Individuals will undergo an extensive neuropsychological protocol, risk factor assessment and a set of multimodal biomarkers including florbetaben PET, structural and functional MRI, diffusion tensor imaging, determination of amyloid species in plasma and neurophthalmologic assessment with optical coherence tomography.

RESULTS

Two hundred individuals have been recruited in 15 months. Mean age was 65.9 years; mean MMSE was 29.2 with a mean of 14.8 years of education.

CONCLUSIONS

FACEHBI is a long-term study of cognition, biomarkers and lifestyle that has been designed upon an innovative symptom-based approach using SCD as target population. It will shed light on the pathophysiology of preclinical AD and the role of SCD as a risk marker for the development of cognitive impairment.

[Social cognition and cognitive functions in patients with epilepsy treated with eslicarbazepine acetate]

INTRODUCTION

Epilepsy is accompanied by cognitive disorders, frequently aggravated by the use of antiepileptic drugs, which can affect social empathy.

AIM

To analyse the impact of treatment with eslicarbazepine acetate (ESL) on social cognition and prefrontal cognitive functions in adults with focal epilepsy.

PATIENTS AND METHODS

We conducted a prospective single-centre study with patients aged between 18 and 65 years with focal seizures treated with ESL. The patients were evaluated in their baseline visit and at six months after starting ESL treatment by means of tasks designed for theory of mind, executive and attentional functions, auditory-verbal memory, quality of life, and anxiety and depression.

RESULTS

Forty-one patients were treated with ESL, and 30 completed the follow-up. A significant improvement was observed in the theory of mind tasks. In the analysis stratified by sex, the men showed greater improvement. A cognitive improvement was observed in the Wisconsin Card Sorting Test, Symbol Digit, Backward Digit Span and Stroop tests. No differences were found in the Quality of Life in Epilepsy-31 Inventory or in the Hospital Anxiety and Depression Scale. These results were independent of the reduction in the number of seizures and the ESL dosage.

CONCLUSION

Treatment with ESL could improve some aspects of theory of mind in patients with epilepsy, especially in men and independently of the control of seizures, with no changes in quality of life, anxiety or depression.

Iconicity and Sign Lexical Acquisition: A Review

The study of iconicity, defined as the direct relationship between a linguistic form and its referent, has gained momentum in recent years across a wide range of disciplines. In the spoken modality, there is abundant evidence showing that iconicity is a key factor that facilitates language acquisition. However, when we look at sign languages, which excel in the prevalence of iconic structures, there is a more mixed picture, with some studies showing a positive effect and others showing a null or negative effect. In an attempt to reconcile the existing evidence the present review presents a critical overview of the literature on the acquisition of a sign language as first (L1) and second (L2) language and points at some factor that may be the source of disagreement. Regarding sign L1 acquisition, the contradicting findings may relate to iconicity being defined in a very broad sense when a more fine-grained operationalisation might reveal an effect in sign learning. Regarding sign L2 acquisition, evidence shows that there is a clear dissociation in the effect of iconicity in that it facilitates conceptual-semantic aspects of sign learning but hinders the acquisition of the exact phonological form of signs. It will be argued that when we consider the gradient nature of iconicity and that signs consist of a phonological form attached to a meaning we can discern how iconicity impacts sign learning in positive and negative ways.

Morbidity and mortality outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients aged 75 years and over: Spanish group of peritoneal cancer surgery (GECOP) multicenter study

BACKGROUND

The aim of this study is to report the perioperative outcomes of cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) in patients ≥75 years from a Spanish multi-institutional experience.

METHODS

This multi-institutional retrospectively analyzed a prospectively collected clinical data from 10 Spanish hospitals that are part of the Spanish Group Peritoneal Cancer Surgery (GECOP). We assessed postoperative morbidity rates and performed univariate and multivariate analyses of factors associated with overall (grade I-IV) and major (grade III-IV) postoperative morbidity.

RESULTS

A total of 85 patients aged ≥75 years were included. Forty six postoperative adverse events were detected in 37 patients (43.5%). Twenty five complications in 20 patients (23.5%) were mild (grade I-II) and 16 complications in 12 patients (14.1%) were moderate-severe (grade III-IV). Five patients died in the first 90 days after the procedure (5.9%). After multivariate analysis, independent factors associated with postoperative complications were: PCI> 12 (OR: 4.14, 95% CI 1.22-14.12, p = 0.043) and the need for perioperative blood transfusion (OR: 14.91, 95% CI 3.87-57.46, p < 0.001). Regarding grade III-IV complications, after multivariate analysis, the presence of preoperative albumin levels <3.5 mgr/dl (OR: 9.15, 95% CI 1.38-60.57, p = 0.017), need for diaphragmatic peritonectomy procedures (OR: 11.32, 95% CI 1.40-91.32, p = 0.023) and perioperative blood transfusion (OR: 8.58, 95% CI 1.44-51.16, p = 0.018) were independent factors.

CONCLUSIONS

Cytoreductive surgery and performing HIPEC by experienced groups in selected patients aged ≥75 years can be performed with morbidity and mortality similar to that described in the literature.

Ethical Consideration in Wound Treatment of the Elderly Patient

Today, an advance in clinical medicine and public health has given patients the opportunity to live longer and more productive lives despite progressive illnesses. For some patients, however, this progress has resulted in prolonged dying which is associated with huge emotional and financial expenses. A review article is written based on proceedings of panel discussion on Ethical Consideration in wound treatment of the elderly patient on July 25, 2015, Baptist Wound Symposium at Marriot Northwest, San Antonio, Texas.

Prenatal stress-induced programming of genome-wide promoter DNA methylation in 5-HTT-deficient mice

The serotonin transporter gene (5-HTT/SLC6A4)-linked polymorphic region has been suggested to have a modulatory role in mediating effects of early-life stress exposure on psychopathology rendering carriers of the low-expression short (s)-variant more vulnerable to environmental adversity in later life. The underlying molecular mechanisms of this gene-by-environment interaction are not well understood, but epigenetic regulation including differential DNA methylation has been postulated to have a critical role. Recently, we used a maternal restraint stress paradigm of prenatal stress (PS) in 5-HTT-deficient mice and showed that the effects on behavior and gene expression were particularly marked in the hippocampus of female 5-Htt+/- offspring. Here, we examined to which extent these effects are mediated by differential methylation of DNA. For this purpose, we performed a genome-wide hippocampal DNA methylation screening using methylated-DNA immunoprecipitation (MeDIP) on Affymetrix GeneChip Mouse Promoter 1.0 R arrays. Using hippocampal DNA from the same mice as assessed before enabled us to correlate gene-specific DNA methylation, mRNA expression and behavior. We found that 5-Htt genotype, PS and their interaction differentially affected the DNA methylation signature of numerous genes, a subset of which showed overlap with the expression profiles of the corresponding transcripts. For example, a differentially methylated region in the gene encoding myelin basic protein (Mbp) was associated with its expression in a 5-Htt-, PS- and 5-Htt × PS-dependent manner. Subsequent fine-mapping of this Mbp locus linked the methylation status of two specific CpG sites to Mbp expression and anxiety-related behavior. In conclusion, hippocampal DNA methylation patterns and expression profiles of female prenatally stressed 5-Htt+/- mice suggest that distinct molecular mechanisms, some of which are promoter methylation-dependent, contribute to the behavioral effects of the 5-Htt genotype, PS exposure and their interaction.

Usefulness of a head mounted monitor device for viewing intraoperative fluoroscopy during orthopaedic procedures

We report our case series involving the use of a MicroOptical (MicroOptical Corporation, Westwood, MA, USA) head mounted, computer display monitor during orthopaedic procedures such as open reduction and internal fracture fixations and spinal pedicle screw placement. Since the MicroOptical viewer does not fully obstruct the surgeon's direct vision, he/she may continue to operate and focus on the operative field while viewing the MicroOptical image. Our first 50 clinical applications demonstrate that when viewing the MicroOptical monitor there is a significant reduction in the total number of times the surgeon left the attention of the operative field and/or may have been exposed to fluoroscopy radiation by unprotected body turn exposure. In addition, the MicroOptical viewer did not cause any surgical field viewing obstruction during surgical procedures and there was not a difference in reported surgeon eye fatigue when comparing the MicroOptical viewer to standard fluoroscopy.

Preliminary clinical experience using a newly developed minimal-invasive reference base in computer assisted foot surgery

In recent years, many new tools and techniques have been developed in computer assisted orthopaedic surgery primarily with an industry led effort in software innovation and development. Only a few research and clinical projects have focused on intraoperative difficulties. A common operative challenge in computer assisted orthopaedic surgery is the positioning of the reference base. Rigid fixation of a dynamic reference base is essential in navigated surgery of the extremities. The aim of this study was to develop a minimal-invasive screw which could be placed effectively and efficiently with rotational stability during computer assisted orthopaedic surgery. The minimal-invasive screw was initially evaluated in an artificial bone experiment. After successful results with the artificial bone experiment, it underwent testing in seven human cadaver thighs with ISO-C3D navigated drilling. Finally the screw was transferred into a clinical application during five foot surgeries. In 10 ISO-C3D navigated drillings, the lesions were targeted 100% of the drillings. A screw dislocation was not observed. In comparison to conventional one or two pin fixation systems, the newly designed small screw did not have any observed side effects such as artifacts. In addition, the screw generated less heterodyning than a conventional fixation system. The small screw design is an advantage in theatre. We believe the minimally-invasive screw allows the surgeon to use a tool that helps avoid common pitfalls from conventional fixation systems, and it may improve efficiency.

Prevalence, resource utilization and costs of vascular dementia compared to Alzheimer's dementia in a population setting

OBJECTIVES

To determine the prevalence of dementia and to measure the monetary impact and health resources utilization of vascular dementia (VD) compared to Alzheimer's dementia (AD) in persons aged over 64 years in a population setting.

METHODS

Retrospective, cross-sectional study. In the initial phase, information was obtained on specific clinical characteristics from the subjects with an active diagnosis of dementia. The second phase consisted of a clinical evaluation and validation of the cases. Mini-Mental State Examination was used to assess cognitive impairment. Dementia and its subtypes were determined using established diagnostic criteria. Information was obtained on the use of health care resources (direct costs) and the number of hours devoted by the primary caregiver (indirect costs) for patients with a documented diagnosis of AD or VD within the last 6 months prior to the interview. A multiple logistic regression analysis was performed to correct the model.

RESULTS

A total of 6,004 subjects were analyzed, 258 with diagnosis of dementia (overall prevalence: 4.3%). An evaluation was made of 224 patients, and gross prevalence of AD and VD was 2.4 and 1.0%, respectively. Cost per patient per semester was EUR 8,086 for AD and EUR 11,039 for VD (p = 0.016). 85.5% of the cost was attributable to primary caregiver time in AD and 84.4% in VD.

CONCLUSIONS

The prevalence of AD and VD increases with age. No sociodemographic differences were seen between AD and VD. Costs associated with health care resource and primary caregiver utilization were high, being higher in VD than in AD.

The genomic organization of the murine Mlc1 (Wkl1, KIAA0027) gene

The human MLC1( WKL1, KIAA0027) gene encodes a putative transmembrane protein expressed exclusively in brain. Recessive mutations within this gene cause megalencephalic leukoencephalopathy with subcortical cysts (MLC, MIM 604004, 605908). Furthermore, a missense mutation in this gene is suggestively linked with hereditary catatonic schizophrenia in a large pedigree. The murine gene Mlc1is composed of 12 exons spanning approximately 20 kb, and all exon-intron boundaries conform to the GT/AG consensus. The single copy transcript after splicing is approximately 2.8 kb in length, it contains 496 bp of 5' untranslated region (5'-UTR) and 1143 bp of 3'-UTR, and encodes a protein of 382 amino acids. Potential binding sites for transcription factors including CCAAT-boxes are present in the 5'-flanking region. Fluorescent in situ hybridization localizes the gene to mouse chromosome 15E-F, a region syntenic to human chromosome 22q13. The characterization of the genomic structure of the murine gene will facilitate studies of gene function and physiological properties of the encoded protein in transgenic mouse models.

Exclusion of the neuronal nicotinic acetylcholine receptor alpha7 subunit gene as a candidate for catatonic schizophrenia in a large family supporting the chromosome 15q13-22 locus

The gene encoding the neuronal nicotinic acetylcholine receptor alpha7 subunit (CHRNA7) is located on chromosome 15q13.2. This region was suggested to be involved in the etiopathogenesis of: (a) schizophrenia combined with a neurophysiological deficit; (b) lithium-responsive bipolar disorder; and (c) familial catatonic schizophrenia (periodic catatonia). Therefore, members of a large family with periodic catatonia strongly supporting the chromosome 15q13-22 region were genotyped with polymorphic markers localized around the CHRNA7 locus. A recombination event distally of marker D15S144 leading to the exclusion of the CHRNA7 locus from this candidate region was detected in one branch of the pedigree. This result provides strong evidence that a gene located telomeric to CHRNA7 is causative for the pathogenesis of catatonic schizophrenia in this family.

Effects of fluctuations on electrical properties of gap-junction connected cells in the turtle retina

Electrical properties of gap-junction connected cells (input voltage and length constant) are shown to depend strongly on fluctuations in membrane and contact conductances. This opens new possibilities and incorporates a further difficulty to the analysis of electrophysiological data, since four, instead of two, parameters (the average values and the magnitude of fluctuations of the two conductances) have to be used in fitting the experimental data. The discussion is illustrated by investigating the effects of dopamine on signal spreading in horizontal cells of turtle retina, assuming a linear cell arrangement. It is shown that while a standard fitting with the average values of the two conductances leads to the conclusion that both are equally affected by dopamine, including fluctuations allows fitting the data by varying just the average contact conductance plus the magnitude of fluctuations.