The impact of a history of status epilepticus for epilepsy surgery outcome

OBJECTIVE

Patients with focal drug resistant epilepsy are excellent candidates for epilepsy surgery. Status epilepticus (SE) and seizure clusters (SC), described in a subset of patients, have both been associated with extended epileptogenic cerebral networks within one or both hemispheres. In this retrospective study, we were interested to determine if a history of SE or SC is associated with a worse surgical outcome.

METHODS

Data of 244 patients operated between 2000 to 2018 were reviewed, with a follow-up of at least 2 years. Patients with a previous history of SE or SC were compared to operated patients without these conditions (control group, CG).

RESULTS

We identified 27 (11%) and 38 (15.5%) patients with history of SE or SC, respectively. No difference in post-operative outcome was found for SE and SC patients. Compared to the control group, patients with a history of SE were diagnosed and operated significantly at earlier age(p = 0.01), and after a shorter duration of the disease (p = 0.027), but with a similar age of onset.

SIGNIFICANCE

A history of SE or SC was not associated with a worse post-operative prognosis. Earlier referral of SE patients for surgery suggests a heightened awareness regarding serious complications of recurrent SE by the referring neurologist or neuropediatrician. While the danger of SE is evident, policies to underline the impact for SC or very frequent seizures might be an efficient approach to accelerate patient referral also for this patient group.

Pressure and folding effects on the buckling of a freestanding compressed thin film

The combined effects of compressive stress, applied pressure, and edge folding of a freestanding thin film have been theoretically investigated on the buckle morphologies of the structure. In the framework of the Föppl-von Kármán theory of thin plates, the different buckle profiles have been analytically determined, and two buckling regimes have been identified for the film: one regime where the transition from upward to downward buckling is continuous, and one that is discontinuous (snap-through). The critical pressures characterizing the different regimes have then been determined, and an hysteresis cycle has been identified through the study of buckling versus pressure. The case in which the thin film is deposited on a substrate has also been discussed.

Alternative Transcription Start Site Usage and Functional Implications in Pathogenic Fungi

Pathogenic fungi require delicate gene regulation mechanisms to adapt to diverse living environments and escape host immune systems. Recent advances in sequencing technology have exposed the complexity of the fungal genome, thus allowing the gradual disentanglement of multiple layers of gene expression control. Alternative transcription start site (aTSS) usage, previously reported to be prominent in mammals and to play important roles in physiopathology, is also present in fungi to fine-tune gene expression. Depending on the alteration in their sequences, RNA isoforms arising from aTSSs acquire different characteristics that significantly alter their stability and translational capacity as well as the properties and biologic functions of the resulting proteins. Disrupted control of aTSS usage has been reported to severely impair growth, virulence, and the infectious capacity of pathogenic fungi. Here, we discuss principle concepts, mechanisms, and the functional implication of aTSS usage in fungi.

Mass Purification Protocol for Drosophila melanogaster Wing Imaginal Discs: An Alternative to Dissection to Obtain Large Numbers of Disc Cells

Drosophila melanogaster imaginal discs are larval internal structures that become the external organs of the adult. They have been used to study numerous developmental processes for more than fifty years. Dissecting these imaginal discs for collection is challenging, as the size of third-instar larvae organs is typically less than 1 mm. Certain experimental applications of the organs require many cells, which requires researchers to spend several hours dissecting them. This paper proposes an alternative to dissection in the form of a mass enrichment protocol. The protocol enables the recovery of many wing imaginal discs by grinding large quantities of third-instar larvae and separating the organs using filtration and a density gradient. The wing imaginal discs collected with this protocol in less than three hours are as well preserved as those collected by dissection. The dissociation and filtration of the extract allow the isolation of a large amount of wing imaginal disc cells.

A Modified Cross-Linking Analysis of cDNAs (CRAC ) Protocol for Detecting RNA-Protein Interactions and Transcription at Single-Nucleotide Resolution

Detecting protein-RNA interactions in vivo is essential for deciphering many important cellular pathways. Several methods have been described for this purpose, among which cross-linking analysis of cDNA, CRAC. This method relies on a first step of UV cross-linking of living yeast cells and several subsequent steps of purification of the protein-RNA complexes, some of which under denaturing condition. Without altering the general principle of the method, we have modified and improved the protocol, with the specific aim of sequencing the nascent RNA isolated from transcription complexes and generate high-resolution and directional transcription maps.

Ciprofloxacin Ophthalmic Solution in the Treatment of Conjunctivitis and Blepharitis: A Comparison with Fusidic Acid

The efficacy and safety of ciprofloxacin ophthalmic solution (0.3%) and fusidic acid gel (1%) were compared in the treatment of bacterial conjunctivitis and blepharitis in a randomized, open, parallel group study. Thirty-nine patients, 21 treated with ciprofloxacin solution and 18 treated with fusidic acid gel, were culture-positive on admission and were evaluable for efficacy. At the end of a 7-day treatment, the infecting organism was eradicated in 81% of those treated with ciprofloxacin and 72% of those treated with fusidic acid gel. There was clinical cure or improvement in 95% and 89% respectively. The clinical cure rate appeared to be higher with ciprofloxacin than fusidic acid (62% compared with 28%) but this was related to the higher proportion of patients with acute conjunctivitis in the ciprofloxacin group. Two patients using ciprofloxacin had mild discomfort and stinging on instillation and one given fusidic acid had moderate edema and discomfort; the latter patient stopped treatment. Topical ciprofloxacin is effective and well tolerated and is a useful treatment of bacterial conjunctivitis and blepharitis.

Ciprofloxacin Ophthalmic Solution versus Rifamycin Ophthalmic Solution for the Treatment of Conjunctivitis and Blepharitis

The efficacy and safety of ciprofloxacin (0.3%) ophthalmic solution and rifamycin (1%) ophthalmic solution for the treatment of bacterial conjunctivitis and blepharitis was compared in this randomized, double-masked, parallel-group study. Forty-one patients, 19 on ciprofloxacin and 22 on rifamycin, were culture-positive on admission and evaluated for efficacy. There was clinical improvement in more than 90% of patients in each group at the end of the seven-day treatment period. However, clinical cure rates on day 7 appeared to be higher with ciprofloxacin (53%) than rifamycin (23%; p = 0.061, Mann-Whitney test). Bacteriological eradication rates were comparable: the infecting organisms were eradicated in 68% of patients on ciprofloxacin and 77% with rifamycin. There were no serious adverse reactions to either treatment. One patient in each group was withdrawn on account of a mild allergy. In conclusion, topical ciprofloxacin was effective and well tolerated and would be a particularly useful agent for the treatment of bacterial conjunctivitis and blepharitis.

Comparative Evaluation of Efficacy and Safety of Ciprofloxacin and Norfloxacin Ophthalmic Solutions

The efficacy and safety of ciprofloxacin ophthalmic solution 0.3% and norfloxacin ophthalmic solution 0.3% in the treatment of bacterial conjunctivitis and blepharitis were compared in a double masked randomised study. A total of 131 patients, 65 treated with ciprofloxacin (42 with conjunctivitis and 23 with blepharitis) and 66 treated with norfloxacin (39 with conjunctivitis and 27 with blepharitis) were enrolled in the study at five centres in France. In the efficacy population, pathogens were eradicated or reduced in 96% (24/25) of patients in the ciprofloxacin group and 89% (24/27) in the norfloxacin group. There was no difference between treatments with regard to eradication of particular pathogens. In the efficacy population, clinical cure or improvement was seen in 96% of the patients (24/25 in the ciprofloxacin group and 26/27 in the norfloxacin group). There were no significant differences between ciprofloxacin and norfloxacin with respect to improvements in four symptoms or ten clinical signs. No serious treatment-related adverse events were reported and both ciprofloxacin and norfloxacin were well tolerated.

Comparison of the Efficacy and Safety of two Formulations of Diclofenac Sodium 0.1 % Eyedrops in Controlling Postoperative Inflammation after Cataract Surgery

PURPOSE

To compare the efficacy and safety of diclofenac sodium 0.1% eyedrops packaged in an Abak multidose container without preservative (Dicloabak) with the reference product, sodium merthiolate-preserved diclofenac sodium 0.1% eyedrops, in controlling postoperative inflammation after cataract surgery.

METHODS

The multicenter, controlled, randomized, single-masked study included 194 patients (Dicloabak 96, preserved diclofenac 98) scheduled to have cataract surgery by phacoemulsification with foldable intraocular lens. All were evaluated preoperatively and postoperatively after 1, 7, and 28 days. Postoperative inflammation was measured by the total score of anterior chamber cells and flare. Ocular plin, conjunctival hyperemia and ciliary flush were also assessed. Postoperative patient assessments also included visual acuity, objective tolerance by slit-lamp, fluorescein test, and subjective evaluation of local tolerance.

RESULTS

There was no statistically significant difference between the groups in the total score of flare and cells or the degree of conjunctival hyperemia and ciliary flush at any study visit. Dicloabak was demonstrated to be not inferior to preserved diclofenac at all assessment times. The overall assessment of local tolerance was similar for both study medications.

CONCLUSIONS

Preservative suppression did not alter diclofenac efficacy. Results support the good safety profile of both formulations when dosed three times daily for 4 weeks in absence of concomitant use of drugs potentially toxic for cornea. Preservative-free formulations like Dicloabak should be preferred to generic diclofenac formulations including other ingredients and may improve the safety profile of this topical nonsteroid anti-inflammatory drug.

High-resolution transcription maps reveal the widespread impact of roadblock termination in yeast

Transcription termination delimits transcription units but also plays important roles in limiting pervasive transcription. We have previously shown that transcription termination occurs when elongating RNA polymerase II (RNAPII) collides with the DNA-bound general transcription factor Reb1. We demonstrate here that many different DNA-binding proteins can induce termination by a similar roadblock (RB) mechanism. We generated high-resolution transcription maps by the direct detection of RNAPII upon nuclear depletion of two essential RB factors or when the canonical termination pathways for coding and non-coding RNAs are defective. We show that RB termination occurs genomewide and functions independently of (and redundantly with) the main transcription termination pathways. We provide evidence that transcriptional readthrough at canonical terminators is a significant source of pervasive transcription, which is controlled to a large extent by RB termination. Finally, we demonstrate the occurrence of RB termination around centromeres and tRNA genes, which we suggest shields these regions from RNAPII to preserve their functional integrity.

Global Survey of the Frequency of Atrial Fibrillation–Associated Stroke

Background and Purpose—

Atrial fibrillation (AF) is increasingly recognized as the single most important cause of disabling ischemic stroke in the elderly. We undertook an international survey to characterize the frequency of AF-associated stroke, methods of AF detection, and patient features.

Methods—

Consecutive patients hospitalized for ischemic stroke in 2013 to 2014 were surveyed from 19 stroke research centers in 19 different countries. Data were analyzed by global regions and World Bank income levels.

Results—

Of 2144 patients with ischemic stroke, 590 (28%; 95% confidence interval, 25.6–29.5) had AF-associated stroke, with highest frequencies in North America (35%) and Europe (33%) and lowest in Latin America (17%). Most had a history of AF before stroke (15%) or newly detected AF on electrocardiography (10%); only 2% of patients with ischemic stroke had unsuspected AF detected by poststroke cardiac rhythm monitoring. The mean age and 30-day mortality rate of patients with AF-associated stroke (75 years; SD, 11.5 years; 10%; 95% confidence interval, 7.6–12.6, respectively) were substantially higher than those of patients without AF (64 years; SD, 15.58 years; 4%; 95% confidence interval, 3.3–5.4; P <0.001 for both comparisons). There was a strong positive correlation between the mean age and the frequency of AF ( r =0.76; P =0.0002).

Conclusions—

This cross-sectional global sample of patients with recent ischemic stroke shows a substantial frequency of AF-associated stroke throughout the world in proportion to the mean age of the stroke population. Most AF is identified by history or electrocardiography; the yield of conventional short-duration cardiac rhythm monitoring is relatively low. Patients with AF-associated stroke were typically elderly (>75 years old) and more often women.

Screening of suppressors of bax-induced cell death identifies glycerophosphate oxidase-1 as a mediator of debcl-induced apoptosis in Drosophila

Members of the Bcl-2 family are key elements of the apoptotic machinery. In mammals, this multigenic family contains about twenty members, which either promote or inhibit apoptosis. We have previously shown that the mammalian pro-apoptotic Bcl-2 family member Bax is very efficient in inducing apoptosis in Drosophila, allowing the study of bax-induced cell death in a genetic animal model. We report here the results of the screening of a P[UAS]-element insertion library performed to identify gene products that modify the phenotypes induced by the expression of bax in Drosophila melanogaster. We isolated 17 putative modifiers involved in various function or process: the ubiquitin/proteasome pathway; cell growth, proliferation and death; pathfinding and cell adhesion; secretion and extracellular signaling; metabolism and oxidative stress. Most of these suppressors also inhibit debcl-induced phenotypes, suggesting that the activities of both proteins can be modulated in part by common signaling or metabolic pathways. Among these suppressors, Glycerophosphate oxidase-1 is found to participate in debcl-induced apoptosis by increasing mitochondrial reactive oxygen species accumulation.

Roadblock termination by reb1p restricts cryptic and readthrough transcription

Widely transcribed compact genomes must cope with the major challenge of frequent overlapping or concurrent transcription events. Efficient and timely transcription termination is crucial to control pervasive transcription and prevent transcriptional interference. In yeast, transcription termination of RNA polymerase II (RNAPII) occurs via two possible pathways that both require recognition of termination signals on nascent RNA by specific factors. We describe here an additional mechanism of transcription termination for RNAPII and demonstrate its biological significance. We show that the transcriptional activator Reb1p bound to DNA is a roadblock for RNAPII, which pauses and is ubiquitinated, thus triggering termination. Reb1p-dependent termination generates a class of cryptic transcripts that are degraded in the nucleus by the exosome. We also observed transcriptional interference between neighboring genes in the absence of Reb1p. This work demonstrates the importance of roadblock termination for controlling pervasive transcription and preventing transcription through gene regulatory regions.

Effect of plasticity and atmospheric pressure on the formation of donut- and croissantlike buckles

The formation of donut- and croissantlike buckles has been observed onto the free surface of gold thin films deposited on silicon substrates. Numerical simulations clearly evidence that the coupling effect between the atmospheric pressure acting on the free surface and the plastic folding of the ductile film is responsible for the circular blister destabilization and the formation of the donut- and croissantlike buckling patterns.

Proton computed tomography from multiple physics processes

Proton CT (pCT) nowadays aims at improving hadron therapy treatment planning by mapping the relative stopping power (RSP) of materials with respect to water. The RSP depends mainly on the electron density of the materials. The main information used is the energy of the protons. However, during a pCT acquisition, the spatial and angular deviation of each particle is recorded and the information about its transmission is implicitly available. The potential use of those observables in order to get information about the materials is being investigated. Monte Carlo simulations of protons sent into homogeneous materials were performed, and the influence of the chemical composition on the outputs was studied. A pCT acquisition of a head phantom scan was simulated. Brain lesions with the same electron density but different concentrations of oxygen were used to evaluate the different observables. Tomographic images from the different physics processes were reconstructed using a filtered back-projection algorithm. Preliminary results indicate that information is present in the reconstructed images of transmission and angular deviation that may help differentiate tissues. However, the statistical uncertainty on these observables generates further challenge in order to obtain an optimal reconstruction and extract the most pertinent information.

[AcrySof® Toric (SN60T) intraocular lens implantation: refractive predictibility and aberrometric impact of decentration]

PURPOSE

To evaluate refractive outcomes of toric intraocular lens (IOL) implantation with a detailed analysis of decentration and its effect on aberrometry.

METHODS

This retrospective study enrolled 19 eyes implanted with SN60T AcrySof(®) Toric (Alcon - USA) IOL's. Spherocylindric correction was studied in depth by the Alpins method, and retro-illumination images were used to analyze the alignment of the IOL with its intended axis. IOL decentration as well as its aberrometric impact were evaluated with a strict, novel protocol.

RESULTS

Three months postoperatively, uncorrected distance visual acuity was greater or equal to 20/40 in 94.74% of cases, postoperative subjective cylinder was less or equal to 0.5 D in 68.42% of eyes, with a mean index of success of 0.24. Mean error of toric IOL alignment was 5.68° (0 to 14). Mean IOL decentration was 0.78 mm (0 to 1.78) with a mean coma and trefoil of 0.18 μ (0.06 to 0.33) and 0.19 μ (0.05 to 0.51), respectively. The larger the IOL decentration, the higher the optical aberrations were.

CONCLUSION

Toric intraocular lens implantation is an effective, safe and predictable method of spherocylindrical correction during cataract surgery, with a refractive accuracy similar to that of LASIK in the treatment of astigmatism in young patients. IOL decentration produces optical aberrations including coma and trefoil, which interfere with visual performance.

[Using the superficial temporal fascia flap in orbital surgery]

The superficial temporal fascia flap gives a fine malleable well vascularized tissue and can be used as a pedicled or a free flap to cover large areas of loss of substance. Its dissection needs a period of training. Its use in orbital surgery is rare. However when it is about an anophthalmic socket following radiotherapy with orbital retraction syndrome, it provides tissue of good quality. This could allow later reconstruction by mucous grafts. When used on cavities of exenteration it allows fast re-epithelialisation even post-radiotherapy, while allowing the monitoring of the cavity and in particular the early detection of any tumor recurrence. Its use is advantageous in unfavorable conditions especially after radiotherapy.

I can see what you are doing: Action familiarity and affordance promote recovery from extinction

We assessed the effects of three factors on recovery from extinction in patients with lesions including the posterior parietal lobe: (a) whether objects were frequently used together in action versus whether they could be used in action together; (b) whether there was an effect of positioning objects for action; and (c) whether the surface properties of objects mediated performance. There was greater recovery from extinction for objects used frequently together, along with effects produced by objects that could be used together. There were also positive effects of correctly positioning objects for action. There were no effects of surface information on the benefit of reporting both members of a pair, though there were some effects on error trials. The results provide positive evidence for an effect on attention of affordances based on objects falling in plausible co-locations for action. Such affordances may also be influenced by the frequency with which objects are used together and can be generated from edge-based representations of objects (surface colour and depth are not necessary). However, surface-based representations may influence the speed with which action-related properties of objects engage attention.

Traumatic optic nerve avulsion: A case report

INTRODUCTION

Case report of a traumatic optic nerve avulsion.

OBSERVATION

We report the case of a traumatic right optic nerve avulsion in an 11-year-old boy as a result of a contusion with a surfboard. On initial examination, the patient exhibited bilateral mydriasis with a right afferent pupillary defect. Visual acuity was no light perception. A moderate microhyphema was noted along with intraocular pressure of 12mmHg and no open globe. Fundus examination revealed retinal ischemia with white retinal edema, attenuated arteries and segmentally occluded vasculature. In place of the optic nerve, there was a hole with associated vitreous hemorrhage. Non-contrast CT and MRI demonstrated vitreous prolapse into the optic nerve sheath, which still appeared securely attached to the globe. Spectral domain OCT and visual evoked potentials confirmed disruption of the ganglion cell layer.

DISCUSSION

While obvious in the presence of clear media, an avulsion may remain undetected in the case of associated vitreous hemorrhage. Orbital imaging may clarify the diagnosis.

CONCLUSION

Although rare, optic nerve avulsions exhibit the same risk profile as open globe injuries and arterial occlusions.

Cryptic transcription and early termination in the control of gene expression

Recent studies on yeast transcriptome have revealed the presence of a large set of RNA polymerase II transcripts mapping to intergenic and antisense regions or overlapping canonical genes. Most of these ncRNAs (ncRNAs) are subject to termination by the Nrd1-dependent pathway and rapid degradation by the nuclear exosome and have been dubbed cryptic unstable transcripts (CUTs). CUTs are often considered as by-products of transcriptional noise, but in an increasing number of cases they play a central role in the control of gene expression. Regulatory mechanisms involving expression of a CUT are diverse and include attenuation, transcriptional interference, and alternative transcription start site choice. This review focuses on the impact of cryptic transcription on gene expression, describes the role of the Nrd1-complex as the main actor in preventing nonfunctional and potentially harmful transcription, and details a few systems where expression of a CUT has an essential regulatory function. We also summarize the most recent studies concerning other types of ncRNAs and their possible role in regulation.

[Dural arteriovenous fistula of the sigmoid sinus with a clinical expression on the opposite eye: A case report]

We report the case of an 87-year-old patient who developed a dural arteriovenous fistula of the sigmoid sinus with progressive exophthalmia in the opposite eye. The patient had a unilateral decrease in visual acuity; the vessels of the conjunctiva were dilated, and a progressive central retinal vein occlusion occurred in the left eye. A dural carotid cavernous fistula of the right sigmoid sinus was diagnosed with an angiography exam and was successfully treated with embolization of the arteriovenous shunt using Onyx(®). A central partial facial nerve paralysis occurred after embolization and spontaneously resolved in 6 months. Six months after the treatment, visual acuity improved to 7/10 and the exophthalmia and central retinal vein occlusion signs regressed. Dural arteriovenous fistulae are abnormal shunts between a collateral vessel of the carotid artery and the cavernous sinus; the unilateral pulsating exophthalmia is the most frequent associated symptom. Cerebral MRI is useful to analyze indirect signs of the arteriovenous shunt showing an abnormal dilatation of the veins, but angiography of the carotid artery is essential to confirm the diagnosis. Furthermore, it allows treatment of the fistula at the same time, the main complication being the embolization of normal vessels close to the abnormal shunt. The clinical expression of the dural arteriovenous fistula on the opposite eye is infrequent and is related to the presence of complex septae within the cavernous sinus, resulting in a bilateral drainage of the cerebral venous system. The early diagnosis and management of the disease is necessary to improve the visual prognosis.

[Metronidazole: alternative treatment for ocular and cutaneous rosacea in the pediatric population]

OBJECTIVE

To assess the effectiveness and tolerance of systemic metronidazole in the treatment of childhood ocular and cutaneous rosacea.

METHOD

Single-center multidisciplinary retrospective study.

PATIENTS

Children aged between 1 and 15, with ocular and/or cutaneous rosacea, treated in the pediatric ophthalmology and dermatology department of Bordeaux, France, from January 1996 to September 2009.

RESULTS

Eleven patients out of 20 had ocular and cutaneous rosacea, three had ocular symptoms only, and six had cutaneous symptoms only. In 11 patients (55%), the ocular symptoms preceded the skin disease. Meibomian cyst and phlyctenular conjunctivitis were the main symptoms. Keratitis was seen in four patients and lower corneal ulcer in two cases. The papulopustular form was the most frequent dermatologic form. All patients with ocular involvement received first-line treatment of eyelid hygiene. No topical ophthalmic treatment such as corticosteroid or cyclosporine 0.5% or 2% was used. Thirteen patients who showed no improvement despite eyelid treatment, the association of ocular and cutaneous rosacea, severe ocular involvement with keratitis, and severe recurrent cutaneous rosacea were treated orally. Two patients, aged between 12 and 14 years, received treatment with an anti-inflammatory dose of doxycycline for 2 to 3 months and achieved complete remission. One 22-month-old patient received oral treatment with erythromycin at a dose of 250 mg three times daily for 4 months. Ten patients, aged 12 to 64 months, were treated with systemic Metronidazole. Treatment lasting at least 3 months at a dose between 20 and 30 mg/kg per day was necessary to obtain complete and lasting remission. An early cessation of treatment, before 3 months, seems associated with partial remission of the disease and early recurrence. In cases complicated by ocular keratitis and corneal ulcer, prolonged treatment lasting 6 months led to clinical remission. The short courses (3-6 months) were preferred to long-term administration to prevent neurological toxicity. Maintenance therapy was based on eyelid hygiene. No recurrences and no toxic effects were observed at a median of 48 ± 6 months.

CONCLUSION

Childhood ocular rosacea is not rare, but is often misdiagnosed. It often precedes skin symptoms but it can remain isolated. Metronidazole could be alternative treatment for ocular and cutaneous rosacea in the pediatric population.