Improved QSAR models for PARP-1 inhibition using data balancing, interpretable machine learning, and matched molecular pair analysis

The poly (ADP-ribose) polymerase-1 (PARP-1) enzyme is an important target in the treatment of breast cancer. Currently, treatment options include the drugs Olaparib, Niraparib, Rucaparib, and Talazoparib; however, these drugs can cause severe side effects including hematological toxicity and cardiotoxicity. Although in silico models for the prediction of PARP-1 activity have been developed, the drawbacks of these models include low specificity, a narrow applicability domain, and a lack of interpretability. To address these issues, a comprehensive machine learning (ML)-based quantitative structure-activity relationship (QSAR) approach for the informed prediction of PARP-1 activity is presented. Classification models built using the Synthetic Minority Oversampling Technique (SMOTE) for data balancing gave robust and predictive models based on the K-nearest neighbor algorithm (accuracy 0.86, sensitivity 0.88, specificity 0.80). Regression models were built on structurally congeneric datasets, with the models for the phthalazinone class and fused cyclic compounds giving the best performance. In accordance with the Organization for Economic Cooperation and Development (OECD) guidelines, a mechanistic interpretation is proposed using the Shapley Additive Explanations (SHAP) to identify the important topological features to differentiate between PARP-1 actives and inactives. Moreover, an analysis of the PARP-1 dataset revealed the prevalence of activity cliffs, which possibly negatively impacts the model's predictive performance. Finally, a set of chemical transformation rules were extracted using the matched molecular pair analysis (MMPA) which provided mechanistic insights and can guide medicinal chemists in the design of novel PARP-1 inhibitors.

An overview of compound properties, multiparameter optimization, and computational drug design methods for PARP-1 inhibitor drugs

Breast cancer treatment with PARP-1 inhibitors remains challenging due to emerging toxicities, drug resistance, and unaffordable costs of treatment options. How do we invent strategies to design better anti-cancer drugs? A part of the answer is in optimized compound properties, desirability functions, and modern computational drug design methods that drive selectivity and toxicity and have not been reviewed for PARP-1 inhibitors. Nonetheless, comparisons of these compound properties for PARP-1 inhibitors are not available in the literature. In this review, we analyze the physchem, PKPD space to identify inherent desirability functions characteristic of approved drugs that can be valuable for the design of better candidates. Recent literature utilizing ligand, structure-based drug design strategies and matched molecular pair analysis (MMPA) for the discovery of novel PARP-1 inhibitors are also reviewed. Thus, this perspective provides valuable insights into the medchem and multiparameter optimization of PARP-1 inhibitors that might be useful to other medicinal chemists.

Genetic risk for schizophrenia is associated with increased proportion of indirect connections in brain networks revealed by a semi-metric analysis: evidence from population sample stratified for polygenic risk

Research studies based on tractography have revealed a prominent reduction of asymmetry in some key white-matter tracts in schizophrenia (SCZ). However, we know little about the influence of common genetic risk factors for SCZ on the efficiency of routing on structural brain networks (SBNs). Here, we use a novel recall-by-genotype approach, where we sample young adults from a population-based cohort (ALSPAC:N genotyped = 8,365) based on their burden of common SCZ risk alleles as defined by polygenic risk score (PRS). We compared 181 individuals at extremes of low (N = 91) or high (N = 90) SCZ-PRS under a robust diffusion MRI-based graph theoretical SBN framework. We applied a semi-metric analysis revealing higher SMR values for the high SCZ-PRS group compared with the low SCZ-PRS group in the left hemisphere. Furthermore, a hemispheric asymmetry index showed a higher leftward preponderance of indirect connections for the high SCZ-PRS group compared with the low SCZ-PRS group (PFDR < 0.05). These findings might indicate less efficient structural connectivity in the higher genetic risk group. This is the first study in a population-based sample that reveals differences in the efficiency of SBNs associated with common genetic risk variants for SCZ.

Evaluation and comparison of conjunctival swab polymerase chain reaction results in SARS-CoV-2 patients with and without ocular manifestations

Purpose:

The aim of this study was to evaluate and compare the presence of SARS-CoV-2 in tears of patients with and without ocular symptoms in SARS-CoV-2 positive patients.

Methods:

The prospective observational study conducted on 60 consecutive SARS-CoV-2 positive patients with ocular complaints was compared with 60 controls who had no ocular manifestations. The tear samples were taken within 48 h of admission from both the eyes of the enrolled patients for evaluating the presence SARS-CoV-2 by reverse transcription-polymerase chain reaction.

Results:

Eleven cases (18.33%) tested positive for SARS-CoV-2 in tears on RT-PCR from cojunctival swab compared to 10 (16.66%) controls. The difference was not statistical significant. The difference between mean age of patients who tested positive or negative was also without statistical significance (P = 0.652), but the difference between patients who tested positive or negative by conjunctival swab for SARS-CoV-2 was statistically significant in terms of severity of COVID-19 disease (P = 0.0011), presence of comorbidity (P = 0.0015), mean TLC (P = 0.00498), and mean d dimer (P = 0.00465).

Conclusion:

Though the percentage of patients with positive RT PCR from conjunctival secretions is significantly less than nasopharyngeal swabs, potential risk of transmission of SARS-Co-2 through tears cannot be ruled out. Moreover, SARS-CoV-2 can be present in tears irrespective of ocular involvement.

A rare case of bullhorn-injury associated traumatic hernia of anterior abdominal wall managed by laparoscopic sutured tissue-only repair

Traumatic abdominal wall hernias (TAWHs) are relatively uncommon entities. Common mechanisms that predispose to such hernias include motor vehicle accidents, seat belt injuries, fall from height, handlebar injuries, and bullfighting. Bullhorn injury leading to TAWHs is an uncommon mechanism. We report here one such patient who was managed by laparoscopic transperitoneal anatomical repair of the defect using polypropylene suture. The patient recovered well without any complication and is being followed up. Such small defects can be managed laparoscopically and tissue-only repair using a nonabsorbable suture is a feasible option. Our case is the first reported case of bullhorn-injury associated traumatic hernia managed laparoscopically and first reported case of TAWH in an adult which was managed by laparoscopic sutured tissue-only repair.

Neurophysiologically-informed markers of individual variability and pharmacological manipulation of human cortical gamma

The ability to quantify synaptic function at the level of cortical microcircuits from non-invasive data would be enormously useful in the study of neuronal processing in humans and the pathophysiology that attends many neuropsychiatric disorders. Here, we provide proof of principle that one can estimate inter-and intra-laminar interactions among specific neuronal populations using induced gamma responses in the visual cortex of human subjects - using dynamic causal modelling based upon the canonical microcircuit (CMC; a simplistic model of a cortical column). Using variability in induced (spectral) responses over a large cohort of normal subjects, we find that the predominant determinants of gamma responses rest on recurrent and intrinsic connections between superficial pyramidal cells and inhibitory interneurons. Furthermore, variations in beta responses were mediated by inter-subject differences in the intrinsic connections between deep pyramidal cells and inhibitory interneurons. Interestingly, we also show that increasing the self-inhibition of superficial pyramidal cells suppresses the amplitude of gamma activity, while increasing its peak frequency. This systematic and nonlinear relationship was only disclosed by modelling the causes of induced responses. Crucially, we were able to validate this form of neurophysiological phenotyping by showing a selective effect of the GABA re-uptake inhibitor tiagabine on the rate constants of inhibitory interneurons. Remarkably, we were able to recover the pharmacodynamics of this effect over the course of several hours on a per subject basis. These findings speak to the possibility of measuring population specific synaptic function - and its response to pharmacological intervention - to provide subject-specific biomarkers of mesoscopic neuronal processes using non-invasive data. Finally, our results demonstrate that, using the CMC as a proxy, the synaptic mechanisms that underlie the gain control of neuronal message passing within and between different levels of cortical hierarchies may now be amenable to quantitative study using non-invasive (MEG) procedures.

Effect of different phases of menstrual cycle on brainstem auditory evoked response

Introduction:

The change in the hormonal levels during the three phases of menstrual cycle, namely, menstrual phase (hormonal withdrawal), proliferative phase (estrogen peak), and secretory phase (progesterone peak), influences the conduction velocities in the central auditory pathways. Variable findings of brainstem auditory evoked response (BAER) have been reported during different phases of menstrual cycle by different researchers.

Aim:

To study the effect of different phases of menstrual cycle on BAER.

Methodology:

A prospective observational study on 80 audiometrically normal, healthy, eumenorrheic female students in age group of 18–24 years was done at a medical college of northern India. BAER was recorded across the three phases of the menstrual cycle, i.e., menstrual phase (day 1–3), proliferative phase (day 10–12), and secretory phase (day 20–22). Recordings of peak latencies, interpeak latencies, and amplitude of waves of BAER were taken and statistically analyzed.

Results:

In this study, significant decrease in the latencies of wave III, wave V, and interpeak latency I-III and a trend of decrease in latencies of wave I and interpeak latency I-V (which was statistically insignificant) were observed in proliferative (estrogen peak) phase as compared to menstrual and secretory phase. However, there was no statistically significant difference found in the amplitude of waves of BAER during all the three phases of menstrual cycle.

Conclusion:

The hormonal changes during different phases of menstrual cycle do seem to influence BAER.

Effect of Different Phases of Menstrual Cycle on Heart Rate Variability (HRV)

BACKGROUND

Heart Rate Variability (HRV), which is a measure of the cardiac autonomic tone, displays physiological changes throughout the menstrual cycle. The functions of the ANS in various phases of the menstrual cycle were examined in some studies.

AIMS AND OBJECTIVES

The aim of our study was to observe the effect of menstrual cycle on cardiac autonomic function parameters in healthy females.

MATERIALS AND METHODS

A cross-sectional (observational) study was conducted on 50 healthy females, in the age group of 18-25 years. Heart Rate Variability (HRV) was recorded by Physio Pac (PC-2004). The data consisted of Time Domain Analysis and Frequency Domain Analysis in menstrual, proliferative and secretory phase of menstrual cycle. Data collected was analysed statistically using student's pair t-test.

RESULTS

The difference in mean heart rate, LF power%, LFnu and HFnu in menstrual and proliferative phase was found to be statistically significant. The difference in mean RR, Mean HR, RMSSD (the square root of the mean of the squares of the successive differences between adjacent NNs.), NN50 (the number of pairs of successive NNs that differ by more than 50 ms), pNN50 (the proportion of NN50 divided by total number of NNs.), VLF (very low frequency) power, LF (low frequency) power, LF power%, HF power %, LF/HF ratio, LFnu and HFnu was found to be statistically significant in proliferative and secretory phase. The difference in Mean RR, Mean HR, LFnu and HFnu was found to be statistically significant in secretory and menstrual phases.

CONCLUSION

From the study it can be concluded that sympathetic nervous activity in secretory phase is greater than in the proliferative phase, whereas parasympathetic nervous activity is predominant in proliferative phase.

Visual Evoked Potentials: Normative Values and Gender Differences

INTRODUCTION

Visual evoked potentials (VEP) are used to assess the visual pathways through the optic nerves and brain. A normal VEP response to a pattern-reversal stimulus is a positive mid occipital peak that occurs at a mean latency of 100 ms. VEP may be affected by variety of physiological factors including age, sex, visual acuity and pupillary size.

AIMS AND OBJECTIVES

The present study was performed on healthy medical students to determine the normative values and to investigate the effect of sex and anthropometric parameters on visual evoked potentials.

MATERIALS AND METHODS

The study was conducted on 100 healthy medical students of Government Medical College, Patiala in the age group of 17-20 years, in which there were 50 males and 50 females. The anthropometric parameters including age, height, weight, BMI, BSA and Head circumference were recorded in all the subjects. VEP was recorded with a PC based, 2 channel, RMS EMG EP mark II machine and standard silver-silver chloride disc electrodes. A VEP monitor displaying checker board was used to give the pattern reversal stimulus. The VEP parameters recorded were latencies to N70, P100 and N155 waves, and peak to peak amplitude of P100 wave.

RESULTS

Our results showed that the latencies of N70, P100 and N155 waves were significantly longer in males as compared to females. The amplitude of P100 wave was higher in females in both left and right eye as compared to males. No significant correlation was found between VEP parameters and head circumference in both male and female subjects in our study.

CONCLUSION

Gender is an important variable affecting the VEP. The exact reason of gender difference is not clear, but it may be related to anatomical or endocrinal differences in the two sexes.

A comparative study of visual and auditory reaction times on the basis of gender and physical activity levels of medical first year students

Background:

Reaction time (RT) is a measure of the response to a stimulus. RT plays a very important role in our lives as its practical implications may be of great consequences. Factors that can affect the average human RT include age, sex, left or right hand, central versus peripheral vision, practice, fatigue, fasting, breathing cycle, personality types, exercise, and intelligence of the subject.

Aim:

The aim was to compare visual RTs (VRTs) and auditory RTs (ARTs) on the basis of gender and physical activity levels of medical 1^st year students.

Materials and Methods:

The present cross-sectional study was conducted on 120 healthy medical students in age group of 18–20 years. RT for target stimulus that is, for the beep tone for measuring ART, and red circle for measuring VRT was determined using Inquisit 4.0 (Computer Software) in the laptop. The task was to press the spacebar as soon as the stimulus is presented. Five readings of each stimulus were taken, and their respective fastest RT's for each stimuli were recorded. Statistical analysis was done.

Results:

In both the sexes’ RT to the auditory stimulus was significantly less (P < 0.001) as compared to the visual stimulus. Significant difference was found between RT of male and female medical students (P < 0.001) as well as between sedentary and regularly exercising healthy medical 1^st year students.

Conclusion:

The ART is faster than the VRT in medical students. Furthermore, male medical students have faster RTs as compared to female medical students for both auditory as well as visual stimuli. Regularly exercising medical students have faster RTs when compared with medical students with sedentary lifestyles.

Increased visual gamma power in schizoaffective bipolar disorder

BACKGROUND

Electroencephalography and magnetoencephalography (MEG) studies have identified alterations in gamma-band (30-80 Hz) cortical activity in schizophrenia and mood disorders, consistent with neural models of disturbed glutamate (and GABA) neuron influence over cortical pyramidal cells. Genetic evidence suggests specific deficits in GABA-A receptor function in schizoaffective bipolar disorder (SABP), a clinical syndrome with features of both bipolar disorder and schizophrenia. This study investigated gamma oscillations in this under-researched disorder.

METHOD

MEG was used to measure induced gamma and evoked responses to a visual grating stimulus, known to be a potent inducer of primary visual gamma oscillations, in 15 individuals with remitted SABP, defined using Research Diagnostic Criteria, and 22 age- and sex-matched healthy controls.

RESULTS

Individuals with SABP demonstrated increased sustained visual cortical power in the gamma band (t 35 = -2.56, p = 0.015) compared to controls. There were no group differences in baseline gamma power, transient or sustained gamma frequency, alpha band responses or pattern onset visual-evoked responses.

CONCLUSIONS

Gamma power is increased in remitted SABP, which reflects an abnormality in the cortical inhibitory-excitatory balance. Although an interaction between gamma power and medication can not be ruled out, there were no group differences in evoked responses or baseline measures. Further work is needed in other clinical populations and at-risk relatives. Pharmaco-magnetoencephalography studies will help to elucidate the specific GABA and glutamate pathways affected.

BOLD Responses in Human Primary Visual Cortex are Insensitive to Substantial Changes in Neural Activity

The relationship between blood oxygenation level dependent-functional magnetic resonance imaging (BOLD-fMRI) and magnetoencephalography (MEG) metrics were explored using low-level visual stimuli known to elicit a rich variety of neural responses. Stimuli were either perceptually isoluminant red/green or luminance-modulated black/yellow square-wave gratings with spatial frequencies of 0.5, 3, and 6 cycles per degree. Neural responses were measured with BOLD-fMRI (3-tesla) and whole head MEG. For all stimuli, the BOLD response showed bilateral activation of early visual cortex that was greater in the contralateral hemisphere. There was variation between individuals but weak, or no evidence, of amplitude dependence on either spatial frequency or the presence of luminance contrast. In contrast, beamformer analysis of MEG data showed activation in contralateral early visual cortex and revealed: (i) evoked responses with stimulus-dependent amplitude and latency; (ii) gamma and high-beta oscillations, with spatial frequency dependent peaks at approximately 30 and 50 Hz, but only for luminance-modulated gratings; (iii) The gamma and beta oscillations appeared to show different spatial frequency tuning profiles; (iv) much weaker gamma and beta responses, and at higher oscillation frequencies, for isoluminant compared to luminance-modulated gratings. The results provide further evidence that the relationship between the fMRI-BOLD response and cortical neural activity is complex, with BOLD-fMRI being insensitive to substantial changes in neural activity. All stimuli were clearly visible to participants and so the paucity of gamma oscillations to isoluminant stimuli is inconsistent with theories of their role in conscious visual perception.

Visual gamma oscillations: the effects of stimulus type, visual field coverage and stimulus motion on MEG and EEG recordings

Increases in the power of neural oscillations in the gamma (>40 Hz) band are a key signature of information processing in cortical neuronal networks. However, non-invasive detection of these very small oscillations is difficult due to the presence of potential artefacts (both muscular and ocular) in the same frequency band and requires highly optimised paradigms. Numerous studies have shown that the properties of visual gamma-band responses to simple pattern stimuli are highly tuned to the stimuli parameters used. The aim of this work was to compare gamma oscillation response properties across some of the more commonly used stimulus configurations. To do this, MEG and EEG recordings were made during the presentation of eight different stimulus types in a 2 × 2 × 2 design. For the first stimulus factor, "Type", the stimulus pattern was either an annulus grating or a square wave grating. For the second stimulus factor, "Field", stimuli were presented in either four visual field quadrants simultaneously or only in the lower left quadrant. Finally, for the "Move" factor, stimuli either drifted at 1.33°s(-1) or were stationary. For MEG gamma band responses, the following main effects were observed, a) gamma-band power was increased for annular stimuli compared to square wave stimuli, b) gamma-band power was increased for full field stimuli compared to single quadrant stimuli and c) gamma-band power was larger for drifting compared to stationary stimuli and were of significantly higher frequency. For the detectors used, the signal to noise ratio was substantially higher for MEG than EEG. The advantages and disadvantages of the different types of stimulus types are discussed.

The effects of elevated endogenous GABA levels on movement-related network oscillations

The EEG/MEG signal is generated primarily by the summation of the post-synaptic potentials of cortical principal cells. At a microcircuit level, these glutamatergic principal cells are reciprocally connected to GABAergic interneurons and cortical oscillations are thought to be dependent on the balance of excitation and inhibition between these cell types. To investigate the dependence of movement-related cortical oscillations on excitation-inhibition balance, we pharmacologically manipulated the GABA system using tiagabine, which blocks GABA Transporter 1(GAT-1), the GABA uptake transporter and increases endogenous GABA activity. In a blinded, placebo-controlled, crossover design, in 15 healthy participants we administered either 15mg of tiagabine or a placebo. We recorded whole-head magnetoencephalograms, while the participants performed a movement task, prior to, one hour post, three hour post and five hour post tiagabine ingestion. Using time-frequency analysis of beamformer source reconstructions, we quantified the baseline level of beta activity (15-30Hz), the post-movement beta rebound (PMBR), beta event-related desynchronisation (beta-ERD) and movement-related gamma synchronisation (MRGS) (60-90Hz). Our results demonstrated that tiagabine, and hence elevated endogenous GABA levels causes, an elevation of baseline beta power, enhanced beta-ERD and reduced PMBR, but no modulation of MRGS. Comparing our results to recent literature (Hall et al., 2011) we suggest that beta-ERD may be a GABAA receptor mediated process while PMBR may be GABAB receptor mediated.

Relation between central corneal thickness and intraocular pressure in Punjabi population

OBJECTIVE

The motive of this study was to determine the variation of central corneal thickness (CCT) in the Punjabi population and to examine its relationship with intraocular pressure (IOP) using a non-contact tonometer. The study and results emphasize the effects of age, sex and refraction on this relationship, which is important for the diagnosis and prevention of glaucoma in adequate time.

METHODS

The study design was a cross-sectional, population-based survey. The participants were 279 females and 253 males of Punjab Province, India, in the age group of 21-70 years. The CCT was measured using an ultrasonic pachymeter, and the IOP was measured using an air-puff tonometer in all subjects.

RESULTS

The mean values of CCT and IOP were observed to vary imprecisely with age. The measurement of both parameters was also affected by sex and refraction. The linear regression analysis suggests that the mean value of CCT grows progressively with increasing value of mean IOP. A significant positive correlation was identified between CCT and IOP in the age group of 21-70 years. The authors inferred that this correlation value varies prominently with age for both sexes, which needs to be investigated further.

CONCLUSIONS

The authors suggest that CCT is a noteworthy source of variation in IOP measurements for males as well as females belonging to different age groups, when assessing IOP as a risk for glaucoma in the Punjabi population.

Spectral properties of induced and evoked gamma oscillations in human early visual cortex to moving and stationary stimuli

In two experiments, magnetoencephalography (MEG) was used to investigate the effects of motion on gamma oscillations in human early visual cortex. When presented centrally, but not peripherally, stationary and moving gratings elicited several evoked and induced response components in early visual cortex. Time-frequency analysis revealed two nonphase locked gamma power increases-an initial, rapidly adapting response and one sustained throughout stimulus presentation and varying in frequency across observers from 28 to 64 Hz. Stimulus motion raised the sustained gamma oscillation frequency by a mean of approximately 10 Hz. The largest motion-induced frequency increases were in those observers with the lowest gamma response frequencies for stationary stimuli, suggesting a possible saturation mechanism. Moderate gamma amplitude increases to moving versus stationary stimuli were also observed but were not correlated with the magnitude of the frequency increase. At the same site in visual cortex, sustained alpha/beta power reductions and an onset evoked response were observed, but these effects did not change significantly with the presence of motion and did not correlate with the magnitude of gamma power changes. These findings suggest that early visual areas encode moving and stationary percepts via activity at higher and lower gamma frequencies, respectively.

Spectral properties of induced and evoked gamma oscillations in human early visual cortex to moving and stationary stimuli

In two experiments, magnetoencephalography (MEG) was used to investigate the effects of motion on gamma oscillations in human early visual cortex. When presented centrally, but not peripherally, stationary and moving gratings elicited several evoked and induced response components in early visual cortex. Time-frequency analysis revealed two nonphase locked gamma power increases-an initial, rapidly adapting response and one sustained throughout stimulus presentation and varying in frequency across observers from 28 to 64 Hz. Stimulus motion raised the sustained gamma oscillation frequency by a mean of approximately 10 Hz. The largest motion-induced frequency increases were in those observers with the lowest gamma response frequencies for stationary stimuli, suggesting a possible saturation mechanism. Moderate gamma amplitude increases to moving versus stationary stimuli were also observed but were not correlated with the magnitude of the frequency increase. At the same site in visual cortex, sustained alpha/beta power reductions and an onset evoked response were observed, but these effects did not change significantly with the presence of motion and did not correlate with the magnitude of gamma power changes. These findings suggest that early visual areas encode moving and stationary percepts via activity at higher and lower gamma frequencies, respectively.

Population-level inferences for distributed MEG source localization under multiple constraints: Application to face-evoked fields

We address some key issues entailed by population inference about responses evoked in distributed brain systems using magnetoencephalography (MEG). In particular, we look at model selection issues at the within-subject level and feature selection issues at the between-subject level, using responses evoked by intact and scrambled faces around 170 ms (M170). We compared the face validity of subject-specific forward models and their summary statistics in terms of how estimated responses reproduced over subjects. At the within-subject level, we focused on the use of multiple constraints, or priors, for inverting distributed source models. We used restricted maximum likelihood (ReML) estimates of prior covariance components (in both sensor and source space) and show that their relative importance is conserved over subjects. At the between-subject level, we used standard anatomical normalization methods to create posterior probability maps that furnish inference about regionally specific population responses. We used these to compare different summary statistics, namely; (i) whether to test for differences between condition-specific source estimates, or whether to test the source estimate of differences between conditions, and (ii) whether to accommodate differences in source orientation by using signed or unsigned (absolute) estimates of source activity.

Microbial decolorization and bioremediation of melanoidin containing molasses spent wash

Molasses spent wash from cane-molasses based distilleries contains a brown coloured recalcitrantpolymer melanoidin, which if disposed untreated poses a great threat to environment. Microbial decolorization and chemical oxygen demand (COD) reduction was found to be dependent on specific carbon and nitrogen source. Under optimal condition of pH, carbon and nitrogen concentration for each treatment, it was found that Bacillus sp isolated from soil was capable of removing COD (85. 35%) and colour (81.10%) from distillery waste to the maximum extent after 9 days atpH 7 in the medium containing 0.5% peptone, 2% glucose and 10% (v/v), followed by Phanerochaete chrysosporium and lowest reduction was obtained by using native microbial consortium.

Semantic and phonological task-set priming and stimulus processing investigated using magnetoencephalography (MEG)

In this study the neural substrates of semantic and phonological task priming and task performance were investigated using single word task-primes. Magnetoencephalography (MEG) data were analysed using Synthetic Aperture Magnetometry (SAM) to determine the spatiotemporal and spectral characteristics of cortical responses. Comparisons were made between the task-prime conditions for evidence of differential effects as a function of the nature of the task being primed, and between the task-prime and the task performance responses for evidence of parallels in activation associated with preparation for and completion of a specific task. Differential priming effects were found. Left middle temporal and inferior frontal voxels showed a statistically significant power decrease associated with the semantic task-prime, and a power increase associated with the phonological task-prime, within beta and gamma frequency bands respectively. Similarities between the task-related differential effects associated with task-prime presentation and those associated with target stimulus presentation were also found. For example, within the semantic task condition, left superior frontal and middle temporal regions showed a significant power decrease within both task-prime and target epochs; within the phonological task condition there were significant parietal and cerebellar power decreases within both types of epoch. In addition there was evidence within the priming epochs of dissociable patterns of activity which could be interpreted as indices of de-activation of task-irrelevant networks. Following a phonological task-prime, significant power increases were observed in those inferior frontal and middle temporal regions in which significant power decreases were associated with semantic task priming and performance.

Sensitivity to optic flow in human cortical areas MT and MST

The macaque V5/MT complex comprises several sub-regions but little is known of their human homologues. We examined human V5/MT with fMRI in terms of specificity to optic flow stimuli, a key characteristic of macaque MST. Stimuli were large fields of moving dots, forming coherent global flow patterns. Random motion was used as a control. Retinotopic mapping was also conducted. The previously suggested existence of at least two distinct sub-regions, MT and MST, within the V5/MT complex was confirmed. Human MT is activated about equally by all moving dot patterns, including random motion, suggesting that it has little sensitivity to global flow structure. As previously described, this region shows strong signs of retinotopic organization and is only weakly activated by stimuli confined to the ipsilateral hemifield. In human MST, located immediately anterior to MT and strongly driven by ipsilateral stimuli, activation varies markedly with optic flow structure. The strongest activation is produced by complex flow that contains multiple flow components (expansion, contraction and rotation). Single components produce rather less response, while rigid translation and random motion produce less still. The results suggest that human MST is strongly specialized for encoding global flow properties, while human MT is less so.

Dissociating the spatio-temporal characteristics of cortical neuronal activity associated with human volitional swallowing in the healthy adult brain

Human swallowing represents a complex highly coordinated sensorimotor function whose functional neuroanatomy remains incompletely understood. Specifically, previous studies have failed to delineate the temporo-spatial sequence of those cerebral loci active during the differing phases of swallowing. We therefore sought to define the temporal characteristics of cortical activity associated with human swallowing behaviour using a novel application of magnetoencephalography (MEG). In healthy volunteers (n = 8, aged 28-45), 151-channel whole cortex MEG was recorded during the conditions of oral water infusion, volitional wet swallowing (5 ml bolus), tongue thrust or rest. Each condition lasted for 5 s and was repeated 20 times. Synthetic aperture magnetometry (SAM) analysis was performed on each active epoch and compared to rest. Temporal sequencing of brain activations utilised time-frequency wavelet plots of regions selected using virtual electrodes. Following SAM analysis, water infusion preferentially activated the caudolateral sensorimotor cortex, whereas during volitional swallowing and tongue movement, the superior sensorimotor cortex was more strongly active. Time-frequency wavelet analysis indicated that sensory input from the tongue simultaneously activated caudolateral sensorimotor and primary gustatory cortex, which appeared to prime the superior sensory and motor cortical areas, involved in the volitional phase of swallowing. Our data support the existence of a temporal synchrony across the whole cortical swallowing network, with sensory input from the tongue being critical. Thus, the ability to non-invasively image this network, with intra-individual and high temporal resolution, provides new insights into the brain processing of human swallowing.

Co-registration of magnetoencephalography with magnetic resonance imaging using bite-bar-based fiducials and surface-matching

OBJECTIVE

To introduce a new technique for co-registration of Magnetoencephalography (MEG) with magnetic resonance imaging (MRI). We compare the accuracy of a new bite-bar with fixed fiducials to a previous technique whereby fiducial coils were attached proximal to landmarks on the skull.

METHODS

A bite-bar with fixed fiducial coils is used to determine the position of the head in the MEG co-ordinate system. Co-registration is performed by a surface-matching technique. The advantage of fixing the coils is that the co-ordinate system is not based upon arbitrary and operator dependent fiducial points that are attached to landmarks (e.g. nasion and the preauricular points), but rather on those that are permanently fixed in relation to the skull.

RESULTS

As a consequence of minimizing coil movement during digitization, errors in localization of the coils are significantly reduced, as shown by a randomization test. Displacement of the bite-bar caused by removal and repositioning between MEG recordings is minimal ( approximately 0.5 mm), and dipole localization accuracy of a somatosensory mapping paradigm shows a repeatability of approximately 5 mm. The overall accuracy of the new procedure is greatly improved compared to the previous technique.

CONCLUSIONS

The test-retest reliability and accuracy of target localization with the new design is superior to techniques that incorporate anatomical-based fiducial points or coils placed on the circumference of the head.

Receiver operating characteristic curve analysis of BMI and percentage body fat in type 2 diabetics of Punjab

The present study attempted to establish appropriate cut off levels of Body Mass Index (BMI) for defining overweight as a risk for the development of type 2 diabetes considering percentage body fat (BF) as standard. A total of 300 patients of known type 2 diabetes participated in the study (150 males and 150 females, all > or = 40 years of age). Clinical examination was done. Anthropometric measurements as BMI, Waist Circumference (WC) and Waist-hip ratio (WHR) were calculated. Percentage BF was calculated using skinfold thickness method from the equation of Durnin and Womersley. Mean BMI for males was 24.97 (SD 4.3) kg/m2 and for females was 27.56 (SD 5.14) kg/m2. Mean percentage BF for males was 28.19 (SD 0.74) and for females was 38.22 (SD 5.29). A comparison of BF and BMI data with various ethnic groups revealed conspicuous differences. Receiver operating characteristic (ROC) curve analysis showed a low sensitivity of conventional cut off value of BMI (25 kg/m2) in identifying subjects with overweight as compared to the cut off values based on percentage BF (males > 25, females > 30). This results in substantial misclassification. Based on the ROC curve, a lower cut off value of BMI 22.3 kg/m2, displayed the optimal sensitivity and specificity, and less misclassification in identification of type 2 diabetics with high percentage BF. BF: BMI was calculated and was found to be higher in females.

Acanthamoeba adherence to soft contact lens and human corneal stroma

In the present study, the adhesibility of Acanthamoeba castellani trophozoites and cysts to hydrogel contact lenses and to human cornea was investigated. Segments of unworn contact lenses were prepared (120 segments in total). In addition, 8 corneal buttons were obtained from 8 enucleated eyes. And each cornea cut into 8 radial segments. To these lens and corneal segments, 1.2 x 106/ml and 1.3 x 106/ml of cysts and trophozoites respectively were added under varying conditions. The adhesion was checked at 0, 3 and 24 hours after the exposure. Adhesion analysis showed that the trophozoites adhered equally well to lens or cornea. There is an increase in the number of trophozoites adhering to contact lenses as well as cornea. This difference is more significant for contact lenses. Washing of contact lenses significantly decreased the adherence of the trophozoites after 3 hours of incubation. When the comparison of adhesion was done between the unwashed worn and unwashed unworn contact lenses, it was observed that there was a significant difference in adherence to new lenses where the adherence was much lower. The study shows that washing of contact lenses does decrease the chances of colonization by Acantamoeba catellani and also that older lenses have higher chances of getting colonized probably due to the occurrence of scratches et. on the surface which may help in colonization.

Estimating receptive field size from fMRI data in human striate and extrastriate visual cortex

Functional magnetic resonance imaging (fMRI) was used to estimate the average receptive field sizes of neurons in each of several striate and extrastriate visual areas of the human cerebral cortex. The boundaries of the visual areas were determined by retinotopic mapping procedures and were visualized on flattened representations of the occipital cortex. Estimates of receptive field size were derived from the temporal duration of the functional activation at each cortical location as a visual stimulus passed through the receptive fields represented at that location. Receptive fields are smallest in the primary visual cortex (V1). They are larger in V2, larger again in V3/VP and largest of all in areas V3A and V4. In all these areas, receptive fields increase in size with increasing stimulus eccentricity. The results are qualitatively in line with those obtained by others in macaque monkeys using neurophysiological methods.

An fMRI study of stimulus equivalence

In order to study brain activation during the formation of equivalence relations, 12 subjects underwent fMRI during matching-to-sample (MTS) tests of (1) previously trained arbitrary relationships between iconic stimuli and the untrained, emergent relations of (2) symmetry, (3) transitivity, and (4) symmetry with transitivity, plus a test of verbal fluency (VF). Brain activation was similar in all MTS tasks and in the VF task. In particular, both types of task activated dorsolateral prefrontal cortex (DLPFC) and posterior parietal cortex bilaterally. However VF, but not the MTS tasks, activated Broca's area. In three of the four MTS tasks, behavioural accuracy was significantly correlated with left lateralisation of DLPFC activity. Brain activation patterns during equivalence thus resembled those involved in semantic processing underlying language, without involving regions concerned with the simple sub-vocal articulation of stimulus names.

Spatiotemporal frequency and direction sensitivities of human visual areas measured using fMRI

Using functional magnetic resonance imaging (fMRI) we have studied the variation in response magnitude, in each visual area (V1-V5), as a function of spatial frequency (SF), temporal frequency (TF) and unidirectional motion versus counterphase flicker. Each visual area was identified in each subject using a combination of retinotopic mapping fMRI and cortical flattening techniques. A drifting (or counterphasing) sinusoidal grating was used as the stimulus in a study in which we parametrically varied SF between 0.4 and 7 cycles/degree and TF between 0 and 18 Hz. For each experiment we constructed fMRI amplitude tuning curves, averaged across subjects, for each visual area. The tuning curves that resulted are consistent with the known physiological properties of cells in the corresponding macaque visual areas, previous functional imaging studies, and in the case of V1, the psychophysically determined contrast sensitivity functions for spatial and temporal frequency. In the case of V3A, the SF tuning functions obtained were more similar to those found in single cell studies of macaque V3 rather than macaque V3A. All areas showed at least a moderate preference for directed versus counterphasing motion with V5 showing the largest preference. Visual areas V1, V2, V3, and V3A showed more direction sensitivity at low spatial frequencies, while VP, V4, and V5 had the highest drifting versus counterphasing ratios for higher spatial frequencies.

Effect of Giardia lamblia on duodenal disaccharidase levels in humans

The study was conducted to detect the effect of giardiasis on human disaccharidase levels. Forty patients attending the medical outpatient department of PGIMER, Chandigarh were enrolled. Twenty patients, positive for Giardia lamblia comprised the study group while 20 patients negative for Giardia lamblia were taken as controls. Upper gastrointestinal endoscopy was performed in all patients. Estimation of lactase, sucrase, maltase and trehalase was done in biopsies. Histopathological investigation was carried out in all biopsy specimens after Haematoxylin and Eosin staining. Complaints of pain abdomen and bloating occurred commonly in giardiasis. Four biopsy samples in study group showed mild increase in lymphomononuclear infiltrate. Giardia lamblia was detected in 7 biopsies. Lactase levels were decreased significantly (p < 0.05) in giardiasis. Rest of the enzymes were comparable to the controls. No differences in the enzyme activities were observed between males and females in either group and with the duration of symptoms.

Global motion adaptation

Image motion is initially detected locally. Local motion signals are then integrated across space in order to specify the global motion of objects or surfaces. It is well known that prolonged exposure to motion causes adaptation at the local motion level. We have investigated whether adaptation also occurs at the global motion level. We have devised a global motion stimulus (a random dot kinematogram) which has equal motion energy in opposite directions but nonetheless gives rise to global motion perception. At the local motion level, adaptation to this stimulus should cause equal adaptation in both directions and should not give rise to an aftereffect. Any aftereffect seen must therefore be attributable to adaptation at the global motion level. We find that following adaptation to this stimulus, judgements of the perceived direction of a test pattern are systematically biased towards the direction opposite to the adapting direction, suggesting that adaptation does occur at a level of visual processing at which global motion is represented.

Attentional suppression of activity in the human visual cortex

We have used fMRI to examine the nature of the changes that occur in the human visual cortex when an observer attends to a particular location in the visual image. Previous studies have shown that the magnitude of the response to a visual stimulus is increased when the observer attends to the stimulus. We show that, in addition, attention to a particular location results in a widespread suppression of activity levels at all other locations. This suggests that a key mechanism of attentional modulation may be that spontaneous (baseline) levels of neural activity are adjusted in a position-dependent manner across the entire visual field.

The cortical topography of human anorectal musculature

BACKGROUND & AIMS

The muscles of the anorectum are important in the volitional control of continence, yet virtually no information exists on their cortical representation in humans.

METHODS

Topographic cortical mapping of both cerebral hemispheres was performed in 9 healthy subjects by applying suprathreshold transcranial magnetic stimulation to individual points on a scalp grid centered over the vertex and then recording the electromyographic responses from the external anal sphincter, rectum, and tibialis anterior muscles.

RESULTS

Cortically evoked anal and rectal response latencies were similar (20.2 +/- 1.7 and 19.8 +/- 1.5 milliseconds, respectively) and were shorter than those from the anterior tibialis muscle (right, 29.7 +/- 2.3 milliseconds; left, 29.9 +/- 1.8 milliseconds; P < 0.0005). Cortical mapping showed that the anal responses were bilaterally represented on the superior motor cortex (Brodmann area 4) of both cerebral hemispheres; a similar topography was found for the rectal responses. By comparison, the tibialis responses showed predominantly contralateral medial motor cortex representation. Subtle but consistent differences in the degree of bilateral hemispheric representation were also apparent both between and within individuals for the anal responses and to a lesser extent for the rectal responses.

CONCLUSIONS

The anorectal musculature has bilateral motor cortex representation with similar topography, but there is intersubject variation in the degree of symmetry.

Recovery of swallowing after dysphagic stroke relates to functional reorganization in the intact motor cortex

BACKGROUND & AIMS

The aim of this study was to determine the mechanism for recovery of swallowing after dysphagic stroke.

METHODS

Twenty-eight patients who had a unilateral hemispheric stroke were studied 1 week and 1 and 3 months after the stroke by videofluoroscopy. Pharyngeal and thenar electromyographic responses to magnetic stimulation of multiple sites over both hemispheres were recorded, and motor representations were correlated with swallowing recovery.

RESULTS

Dysphagia was initially present in 71% of patients and in 46% and 41% of the patients at 1 and 3 months, respectively. Cortical representation of the pharynx was smaller in the affected hemisphere (5 +/- 1 sites) than the unaffected hemisphere (13 +/- 1 sites; P </= 0.001). Nondysphagic and persistently dysphagic patients showed little change in pharyngeal representation in either hemisphere at 1 and 3 months compared with presentation, but dysphagic patients who recovered had an increased pharyngeal representation in the unaffected hemisphere at 1 and 3 months (15 +/- 2 and 17 +/- 3 vs. 9 +/- 2 sites; P </= 0.02) without change in the affected hemisphere. In contrast, thenar representation increased in the affected hemisphere but not the unaffected hemisphere at 1 and 3 months (P </= 0.01).

CONCLUSIONS

Return of swallowing after dysphagic stroke is associated with increased pharyngeal representation in the unaffected hemisphere, suggesting a role for intact hemisphere reorganization in recovery.

Co-registration of cortical magnetic stimulation and functional magnetic resonance imaging

Functional magnetic resonance imaging (fMRI) and transcranial magnetic stimulation (TMS) are noninvasive techniques recently used to investigate cortical motor physiology. However, these modalities measure different phenomena, and in studies of human motor control they have given inconsistent results. We have developed a reproducible technique which co-registers TMS and fMRI, using a frameless method. In four normal subjects, the TMS map and fMRI activation were present on the primary motor cortex contralateral to the target hand, with some extension into primary sensory cortex. fMRI activation alone was also present in the medial motor cortex bilaterally and in the sensorimotor cortex ipsilateral to the target hand. This technique allows a more comprehensive evaluation of the physiologic events involved in motor control.

Efficacy of milk versus yogurt offered as part of a mixed diet in acute noncholera diarrhea among malnourished children

We compared the clinical outcome of acute diarrhea in 96 malnourished boys (aged 4 to 47 months) receiving full-strength milk compared with yogurt offered as part of a mixed diet. All had weight for height less than or equal to 80% of the National Centre for Health Statistics median. They were randomly assigned to receive milk formula (MF; 67 cal/100 ml) or yogurt formula (YF; prepared from the same milk formula) at the rate of 120 ml/kg body weight in seven divided feedings. Stool-reducing substances (> 1%) were detected more frequently in the MF group, and the differences were significant for day 3 of the study (p = 0.04). However, the geometric mean (95% confidence interval) of the total stool weights (gm/kg) during 0 to 72 hours (MF 128.8 [103, 161.4]; YF 110.9 [87, 142.2]) was comparable (p = 0.37) as was the median (range) duration of diarrhea (hours) (MF 45 [4, 183]; YF 52 [7, 173] p = 0.94). The treatment failure rates in the MF (8.2%) and YF (6.3%) groups were also similar (p = 0.67). The children consuming milk had higher median percent weight gain at the end of 72 hours of the study (p = 0.04) and at recovery (p = 0.02). Routine substitution of yogurt as small frequent feedings as an addition for semisolid food to malnourished children with acute diarrhea does not achieve any significant clinical benefit versus milk.

The processing of first- and second-order motion in human visual cortex assessed by functional magnetic resonance imaging (fMRI)

We have examined the activity levels produced in various areas of the human occipital cortex in response to various motion stimuli using functional magnetic resonance imaging (fMRI) methods. In addition to standard luminance-defined (first-order) motion, three types of second-order motion were used. The areas examined were the motion area V5 (MT) and the following areas that were delineated using retinotopic mapping procedures: V1, V2, V3, VP, V3A, and a new area that we refer to as V3B. Area V5 is strongly activated by second-order as well as by first-order motion. This activation is highly motion-specific. Areas V1 and V2 give good responses to all motion stimuli, but the activity seems to be related primarily to the local spatial and temporal structure in the image rather than to motion processing. Area V3 and its ventral counterpart VP also respond well to all our stimuli and show a slightly greater degree of motion specificity than do V1 and V2. Unlike V1 and V2, the response in V3 and VP is significantly greater for second-order motion than for first-order motion. This trend is evident, but less marked, in V3A and V3B and absent in V5. The results are consistent with the hypothesis that first-order motion sensitivity arises in V1, that second-order motion is first represented explicitly in V3 and VP, and that V5 (and perhaps also V3A and V3B) is involved in further processing of motion information, including the integration of motion signals of the two types.

Long-term reorganization of human motor cortex driven by short-term sensory stimulation

Removal of sensory input can induce changes in cortical motor representation that reverse when sensation is restored. Here we ask whether manipulation of sensory input can induce long-term reorganization in human motor cortex that outlasts the initial conditioning. We report that for at least 30 minutes after pharyngeal stimulation, motor cortex excitability and area of representation for the pharynx increased, while esophagus representation decreased, without parallel changes in the excitability of brainstem-mediated reflexes. Therefore increased sensory input can drive long-term cross-system changes in motor areas of the cerebral cortex, which suggests that sensory stimulation might rehabilitate dysphagia, a frequent consequence of cerebral injury.

Cortical localisation of magnetic fields evoked by oesophageal distension

Magnetoencephalographic source localisation techniques were used to measure oesophageal evoked magnetic fields from the cerebral cortex in 3 subjects. By using rapid balloon distension as a stimulus, a comparison of proximal and distal oesophageal cortical representation was made. The distal oesophagus was represented bilaterally in the insular cortex and SII as well as the inferior aspect of SI. The proximal oesophagus was represented unilaterally in superior and inferior SI, insular cortex and SII. Significantly, the superior portion of SI was consistently activated in subjects following stimulation of the proximal oesophagus, but similar activation was not found in response to distal stimulation. This may reflect the contribution from somatic afferent fibres in the striate muscle of the proximal segment. In conclusion, vagal afferents appear to contribute more to cortical activation following stimulation of the distal rather than the proximal oesophagus, while spinal afferents appear to be activated by both proximal and distal oesophageal stimulation.

Topographic mapping of trans-cranial magnetic stimulation data on surface rendered MR images of the brain

We present a method for the coregistration and topographic mapping of trans-cranial magnetic stimulation (TCMS) data on surface rendered images of the cortex, derived from Magnetic Resonance Images (MRI). We describe the TCMS procedure and the methods used to locate the TCM stimulation sites in the MRI coordinate system, and the algorithms needed to depict the TCMS distribution as a pseudocolour contour map on the cortical surface. The methods are validated using TCMS data from the hand (thenar) and leg (tibialis muscle). The methods used correctly depict the expected motor representations of each of these areas and we therefore propose that this technique may be used as a functional imaging tool in the investigation of cortical function in both normals and patients.

Higher-Order Motion Perception in Human Visual Cortex: Evidence from fMRI

fMRI was used to investigate human visual cortex responses to higher-order motion stimuli. Acquisition was on a Siemens 1.5 T scanner (T2*, gradient-recalled EPI, TR 3000 ms, TE 84 ms, flip angle 90°, 2 mm × 2 mm voxels, 256 mm FOV, 10 4-mm slices, 54 acquisitions per run). The measured volume included occipital and posterior parietal cortex. T1 scouts and, in some subjects, high resolution T1 volume images were also acquired. Visual stimuli were gamma-corrected movies (480 × 480 pixels), presented by a PowerMac via an LCD projector, shown through the rear of the scanner onto an adjustable mirror fixed above the subject's eyes. Three types of stimuli were used: (1) first-order motion, (2) second-order motion (both radial sine waves on random-dot backgrounds), (3) structure-from-motion consisting of two rotating circular patches (5 deg diameter) within which dots moved in a constant (centripetal) direction, superimposed on randomly moving dots. Three interleaved comparisons were made: stimulus vs blank, first-order vs second-order, and random motion vs structure-from-motion (27 s each phase, 3 repeats).

Analysis was based on a correlation coefficient method, after head-motion correction. Initial correlation was with the stimulus profile vector, then with an average BOLD response vector. Voxels with a correlation >0.5 (p<0.0003) were accepted as significant. In all subjects (seven- teen normals), all stimuli evoked bilateral activity in V1/V2 (BA17/18), and in extrastriate area V5/MT (BA37/19). Bilateral activation was also found in areas V3/V3a (BA19) and BA7. A more pronounced activation of area MST/V5a (BA37/39) was found in response to the structure-from-motion stimulus, compared with random motion.[Supported by: Wellcome Trust, Schilling Foundation.]

Magnetoencephalographic investigation of human cortical area V1 using color stimuli

The aim of this study was to determine the response properties of the human visual cortex to chromatic stimuli using magnetoencephalography (MEG). Evoked responses were recorded to isoluminant red/green sinusoidal gratings for a wide range of spatial and temporal frequencies. For each condition the response was dominated by a single major component which was well modeled by an equivalent current dipole. Coregistration of MEG and MRI data provided evidence that the principal evoked cortical activity originated from visual area V1. To investigate the chromatic response properties of this area, the maximum global field power of the evoked response was plotted as a function of stimulus spatial and temporal frequency. The spatial-frequency tuning was lowpass and the temporal-frequency tuning was multimodal, with peaks at 0 and 4 Hz. The results demonstrate the use of MEG as a technique for investigating activity from discrete regions of cortex.

Evaluation of MRI-MEG/EEG co-registration strategies using Monte Carlo simulation

We present a Monte Carlo analysis method for evaluating MRI-MEG/EEG co-registration techniques. The method estimates the error in co-registration as a function of position within the brain. Using this analysis technique, we demonstrate the limitations of conventional head-based fiducial point methods, and propose a new strategy utilising a dental bite-bar incorporating accurately machined fiducial markers. Results presented demonstrate the improved accuracy of MEG/EEG to MRI co-registration using the bite-bar.

Efficacy of milk-based diets in persistent diarrhea: a randomized, controlled trial

OBJECTIVE

Previous studies have shown increased stool output when children with persistent diarrhea (PD) received milk as the predominant source of nutrition.

METHODS

We evaluated the efficacy of milk given in modest amounts as a part of a mixed diet in children with PD. One hundred sixteen children 3 to 24 months of age with diarrhea for between 14 days and 12 weeks were allocated to milk-based (n = 60) or milk-free (n = 56) cereal dietary regimens. The two diets were isocaloric (86.9 calories/100 g for < or = 9 months; 95.6 cal/100 g for > 9 months) consisting of puffed rice cereal, sugar, and oil differing in only their source of protein, which was either milk or egg white, respectively. An average of 30% of the calories were constituted by milk in the milk-cereal diet. Both diets were offered at the rate of 150 kcal/kg per day. Children receiving milk-cereal consumed an average of 1.9 g/kg lactose per day.

RESULTS

The baseline characteristics in the two groups were similar. Comparable amounts of diet were consumed in both groups. The milk-cereal group did not have higher median (range) stool output (g/kg/h) compared with the milk-free group during a 0- to 48-hour (milk-cereal, 1.7 [0.2 to 8.7]; milk-free, 1.5 [0.1 to 6.6]) or 0- to 120-hour (milk-cereal, 1.6 [0.4 to 7.2]; milk-free, 1.3 [0.1 to 7.6]) period. The percentage of weight gain was similar in the two groups, and there were no significant differences in the duration of diarrhea. Overall, 23 children had treatment failures, 10 (17%) in the milk-cereal and 13 (23.6%) in the milk-free groups.

CONCLUSIONS

Our findings suggest that modest intakes of milk are well tolerated as a part of mixed diet during PD.

The cortical topography of human swallowing musculature in health and disease

Because no detailed information exists regarding the topographic representation of swallowing musculature on the human cerebral cortex in health or disease, we used transcranial magnetic stimulation to study the cortical topography of human oral, pharyngeal and esophageal musculature in 20 healthy individuals and the topography of pharyngeal musculature in two stroke patients, one with and one without dysphagia. Our results demonstrate that swallowing musculature is discretely and somatotopically represented on the motor and premotor cortex of both hemispheres but displays interhemispheric asymmetry, independent of handedness. Following stroke, dysphagia appeared to be associated with smaller pharyngeal representation on the intact hemisphere, which increases in size with recovery of swallowing.