Transplacental transfer of maternal antibodies following immunization with recombinant pertussis vaccines during pregnancy: real-world evidence

AIM/OBJECTIVE

This study investigates placental antibody transfer following recombinant pertussis vaccination in pregnancy in a real-world setting.

METHODS

This post-marketing observational study recruited pregnant women vaccinated with monovalent recombinant acellular pertussis vaccine (aPgen; n=199) or combined to tetanus-diphtheria (TdaPgen; n=200), or Td-vaccine only (n=54). Pregnancy, delivery, and neonatal outcomes were assessed. Cord blood was collected post-delivery and pertussis toxin (PT)-IgG, filamentous hemagglutinin (FHA)-IgG and PT-neutralizing antibodies (PT-Nab) were assessed.

RESULTS

No adverse pregnancy, delivery, or neonatal outcomes attributed to aPgen TdaPgen or Td vaccination were reported. High anti-PT antibody levels were detected in cord samples from women vaccinated with aPgen (GMC PT-IgG 206.1 IU/mL, 95% CI 164.3‒258.6; GMT PT-Nab 105.3 IU/mL, 95% CI 81.7‒135.8) or TdaPgen (GMC PT-IgG 153.1 IU/mL, 95% CI 129.1‒181.5; GMT PT-Nab 81.5 IU/mL, 95% CI 66.4‒100.0). In the Td-only group, anti-PT antibodies were low (GMC PT-IgG 6.5 IU/mL, 95% CI 4.9‒8.8; GMT PT-Nab 3.8 IU/mL, 95% CI 2.8-5.1). The same was found for FHA-IgG. Recombinant pertussis vaccination at <27 or 27‒36 weeks gestation induced similar cord pertussis antibody levels.

CONCLUSION

This first real-world study confirms that recombinant pertussis vaccination in the 2nd or 3rd trimester of pregnancy results in high levels of passive immunity in infants.

Effective and safe transfer of maternal antibodies persisting two months postpartum following maternal immunization with different doses of recombinant pertussis-containing vaccines

INTRODUCTION

Recombinant acellular pertussis (ap) vaccines containing genetically inactivated pertussis toxin (PTgen) and filamentous hemagglutinin (FHA) with or without tetanus (TT) and diphtheria (DT) vaccines (Td) were found safe and immunogenic in non-pregnant and pregnant women. We report here maternal antibody transfer and safety data in mothers and neonates.

METHODS

This is the follow up of a phase 2 trial in 2019 among 400 pregnant women who randomly received one dose of recombinant pertussis-only vaccine containing 1 µg PTgen and 1 µg FHA (ap1gen), or Td combined with ap1gen (Tdap1gen), or with 2 µg PTgen and 5 µg FHA (Tdap2gen), or with 5 µg PTgen and 5 µg FHA (TdaP5gen, Boostagen®, BioNet, Thailand) or chemically-inactivated acellular pertussis comparator (Tdap8chem, Boostrix™, GSK, Belgium), either in the second or third trimester of gestation. IgG against PT, FHA, TT and DT were assessed by ELISA, PT-neutralizing antibodies (PTNA) by Chinese Hamster Ovary cell assay and safety outcomes at delivery in mothers and at birth.

RESULTS

Anti-PT and anti-FHA geometric mean concentration (GMC) ratio between infants at birth and mothers at delivery was above 1 in all groups. PT GMC in infants at birth were ≥30 IU/mL in all groups with the highest titers in infants found in TdaP5gen group at birth (118.8 [95% CI 93.9-150.4]). At 2 months, PT GMC ratio to Tdap8chem (98.75% CI) was significantly higher for TdaP5gen (2.6 [1.7-4.0]) and comparable for other recombinant vaccines. No difference in PTNA titers at birth was observed between all groups nor between time of vaccination. Adverse events were comparable in all vaccine groups.

CONCLUSIONS

BioNet licensed (TdaP5gen and Tdap2gen) and candidate vaccines (Tdap1gen and ap1gen) when given to pregnant women in the second or third trimester of gestation are safe and have induced passive pertussis immunity to infants.

A phase 2 randomized controlled dose-ranging trial of recombinant pertussis booster vaccines containing genetically inactivated pertussis toxin in pregnant women

INTRODUCTION

Despite a decrease in infections caused by Bordetella pertussis due to COVID-19 pandemic, booster vaccination of pregnant women is still recommended to protect newborns. Highly immunogenic vaccines containing genetically inactivated pertussis toxin (PT_gen) and filamentous hemagglutinin (FHA) may generate comparable anti-PT antibody concentrations, even at lower doses, to chemically inactivated acellular pertussis vaccines (Tdap_chem) shown effective for maternal immunization.

METHODS

This phase 2 randomized, observer-blind, active-controlled non-inferiority trial was conducted in healthy Thai pregnant women randomly assigned to receive one dose of low-dose recombinant pertussis-only vaccine containing 1 µg PT_gen and 1 µg FHA (ap1_gen), or tetanus, reduced-dose diphtheria combined with ap1_gen (Tdap1_gen), or combined with 2 µg PT_gen and 5 µg FHA (Tdap2_gen), or with 5 µg PT_gen and 5 µg FHA (TdaP5_gen, Boostagen®) or comparator containing 8 µg of chemically inactivated pertussis toxoid, 8 µg FHA, and 2.5 µg pertactin (Boostrix™, Tdap8_chem). Blood was collected at Day 0 and Day 28 post-vaccination. The non-inferiority of the study vaccines was assessed based on anti-PT IgG antibody levels on Day 28 pooled with results from a similarly structured previous trial in non-pregnant women.

RESULTS

400 healthy pregnant women received one dose of vaccine. Combined with data from 250 non-pregnant women, all study vaccines containing PT_gen were non-inferior to comparator vaccine (Tdap8_chem). Both ap1_gen and TdaP5_gen vaccines could be considered to have superior immunogenicity to Tdap8_chem. Local and systemic solicited reactions were similar among all vaccine groups.

CONCLUSIONS

Vaccine formulations containing PT_gen were safe and immunogenic in pregnant women. The ap1_gen vaccine, with the lowest cost and reactogenicity, may be suitable for use in pregnant women when diphtheria and tetanus toxoids are not needed. This study is registered in the Thai Clinical Trial Registry (www.

CLINICALTRIALS

in.th), number TCTR20180725004.

Gastric Antral Vascular Ectasia (GAVE) a case report, review of the literature and update of techniques

Introduction and importance

Gastric Antral Vascular Ectasia is a rare disorder that causes up to 4 % of severe acute gastrointestinal bleeding. It affects elderly females with iron deficiency anemia due to chronic blood loss as a common presenting sign.

Case presentation

We report the case of a 70-year-old man admitted to the Urgency Department for severe asthenia associated with abdominal pain and severe anemia. An urgent upper endoscopic examination showed antral hyperemic streaks and vascular ectasias extending from the pyloric ring to the gastric body as well as signs of recent bleeding. Histological results demonstrated the pathognomonic features of GAVE.

Clinical discussion

The first line treatment is considered argon plasma coagulation (APC), given its wider availability, safety, efficacy and cost-effectiveness. In current literature, other therapies and different types of endoscopic treatments have been proposed, such as EBL, RFA and Yag: laser. To date, there is no specific recommendation that privileges one method over another in the treatment of GAVE, although APC has proven effective and even better in terms of complications and costs than the other techniques.

Conclusion

In our experience, endoscopic coagulation with APC probes is a relatively easy-to-use technique with low cost, minimal invasiveness and provides immediate results.

On the other hand, a standardized algorithm is also required concerning to the different subtypes to give the best treatment in every case.

Antibody persistence 2 and 3 years after booster vaccination of adolescents with recombinant acellular pertussis monovalent aPgen or combined TdaPgen vaccines

BACKGROUND

Recombinant pertussis vaccines inducing long-lasting immune responses could help to control the rise in pertussis. We here report on persisting antibody responses 2 and 3 years after booster vaccination with a new generation recombinant acellular pertussis vaccine.

METHODS

Participants of a phase 2/3 randomised-controlled clinical trial with a monovalent pertussis vaccine containing genetically inactivated pertussis toxin (aP_gen) or its tetanus and diphtheria toxoids combination (TdaP_gen), or a chemically detoxified comparator vaccine (Tdap_chem), (originally conducted between July and August 2015) were invited to participate in observational studies of persisting antibody responses 2 and 3 years after vaccination. Serum IgG against pertussis toxin (PT-IgG) and filamentous hemagglutinin (FHA-IgG) were assessed by ELISA, and PT-neutralising antibodies (PT-Nab) by Chinese Hamster Ovary cell assay.

FINDINGS

Waning of antibodies stabilised in aP_gen and TdaP_gen vaccinees 2 and 3 years after vaccination. Three years post-vaccination PT-neutralising antibodies remained 4·6-fold (95% Confidence Interval (CI) 2·6-8·1) and 3·7-fold (95% CI 2·2-6·1) higher, PT-IgG antibodies 3·0-fold (95% CI 2·2-4·1) and 2·5-fold (95% CI 1·9-3·3) higher, and FHA-IgG antibodies 1·8-fold (95% CI 1·3-2·5) and 1·6-fold (95% CI 1·2-2·1) higher than baseline in aP_gen and TdaP_gen recipients, respectively. In the Tdap_chem group, PT-neutralising and PT-IgG and FHA-IgG antibodies were back at baseline levels 2 years post-vaccination. Three years post-vaccination seroconversion rates for PT-neutralising antibodies were 65·0% (95% CI 44·1-85·9) and 55·0% (95% CI 33·2-76·8) in aP_gen and TdaP_gen recipients, respectively.

INTERPRETATION

Considering the persistence of elevated antibody responses 3 years post-booster vaccination, genetically detoxified monovalent aP_gen and TdaP_gen vaccines can be expected to induce longer-lasting protection than chemically inactivated Tdap vaccines.

FUNDING

BioNet-Asia.

Enhanced post-licensure safety surveillance of a new recombinant acellular pertussis vaccine licensed as a monovalent (aP, Pertagen®) and tetanus, reduced-dose diphtheria combination (TdaP, Boostagen®) vaccine for immunization of adolescents and adults in Thailand

A new generation of recombinant acellular pertussis vaccine containing genetically inactivated pertussis toxin (PTgen) was licensed as a monovalent pertussis vaccine (aP_gen; Pertagen®) and in combination with tetanus and reduced-dose diphtheria (TdaP_gen; Boostagen®) for active immunization in individuals aged 11 years and older in Thailand in 2016. We here report post-marketing safety data on the use of the vaccines in individuals in the community obtained through active pharmacovigilance surveillance including pregnant women participating in a prospective observational study. Between May 2017 and February 2020 for TdaP_gen and between June 2018 and February 2020 for aP_gen, participating health care providers vaccinated and collected safety data for 11,429 exposed adolescents and adults. This included 1778 pregnant women. The incidence rate of adverse events following immunization (AEFIs) was 11.5 per 1000 of vaccinated individuals (95% confidence interval (95% CI) 9.7-13.6). AEFIs mostly concerned local pain at the injection site and muscle pain, and symptoms were mild and mostly resolved within a few days with no complications. The incidence rate of AEFIs in women vaccinated during pregnancy was 1.1 per 1000 (95% CI 0.3-4.1). Of 833 pregnant women vaccinated with recombinant aP_gen or TdaP_gen, 91.4% (95% CI 89.3-93.3) had uncomplicated pregnancies and 98.7% (95% CI 97.7-99.4) of the 855 babies delivered by these women were born healthy, which exceeds rates generally reported in Thailand. There were no vaccine-related serious adverse events reported during the surveillance period. In conclusion, active pharmacovigilance confirms that the recombinant pertussis vaccines aP_gen (Pertagen) and TdaP_gen (Boostagen) are safe in adolescents and adults, including pregnant women vaccinated in the second or third trimester of pregnancy.

Antibody persistence after vaccination of adolescents with monovalent and combined acellular pertussis vaccines containing genetically inactivated pertussis toxin: a phase 2/3 randomised, controlled, non-inferiority trial

BACKGROUND

The immunogenicity of acellular pertussis vaccines and persistence of immunity after vaccination might be improved by using genetically inactivated pertussis toxin (PTgen) instead of chemically inactivated pertussis toxin (PTchem) because of the preservation of conformational epitopes. We assessed the safety and immunogenicity of two vaccines containing PTgen 1 year after vaccination.

METHODS

We did a phase 2/3 non-inferiority, randomised, controlled trial involving 450 adolescents (age 12-17 years) enrolled between July 6, 2015, and Aug 20, 2015. Participants were randomised 1:1:1 to receive one dose of vaccine containing PTgen and filamentous haemagglutinin (FHA) either in a monovalent formulation (aP_[PTgen/FHA]) or in a combined formulation with tetanus and reduced-dose diphtheria toxoids (TdaP_[PTgen/FHA]) or to receive a commercial vaccine containing reduced-dose PTchem (Tdap) as a comparator. We report a secondary trial outcome, namely antibody persistence 1 year after vaccination, assessed per protocol in 150 randomly preselected participants (50 per group). Seroconversion was defined as antibody titres at least four times greater than at baseline. Safety was assessed in all trial participants. This study is registered in the Thai Clinical Trial Registry, number TCTR20150703002.

FINDINGS

Between June 5, 2016, and Aug 9, 2016, 442 (98%) of 450 enrolled participants attended a 1-year follow-up visit. After 1 year, persistent seroconversion for pertussis toxin neutralising antibodies was seen in 38 (76%, 95% CI 64-88) participants in the aP_(PTgen/FHA) group and 41 (81%, 70-92) in the TdaP_(PTgen/FHA) group, but in only four (8%, 1-16) in the Tdap comparator group. Seroconversion rates for IgG antibodies against pertussis toxin and FHA were also greater in the aP_(PTgen/FHA) group (82%, 95% CI 71-93 and 64%, 51-77, respectively) and TdaP_(PTgen/FHA) group (75%, 63-87 and 56%, 42-70, respectively) than in the Tdap group (4%, 0-9, p<0·0001, and 28%, 16-41, p=0·0007, respectively). 13 serious adverse events were reported in 12 participants and all were judged to be unrelated to the study vaccines. Five pregnancies were reported during follow-up, none of which had any maternal or neonatal complications.

INTERPRETATION

A monovalent and a combined recombinant acellular pertussis vaccine containing PTgen induced antibody responses that were greater and sustained for longer than those achieved with the Tdap comparator vaccine. New recombinant pertussis vaccines containing PTgen might offer new opportunities to limit pertussis resurgence and can be widely used, including in pregnant women.

FUNDING

BioNet-Asia.

A Nonlinear Circuit Architecture for Magnetoencephalographic Signal Analysis

Objectives: The objective of this paper was to face the complex spatio-temporal dynamics shown by Magnetoencephalography (MEG) data by applying a nonlinear distributed approach for the Blind Sources Separation. The effort was to characterize and differentiate the phases of a yogic respiratory exercise used in the treatment of obsessive compulsive disorders.

Methods: The patient performed a precise respiratory protocol, at one breath per minute for 31 minutes, with 10 minutes resting phase before and after. The two steps of classical Independent Component Approach have been performed by using a Cellular Neural Network with two sets of templates. The choice of the couple of suitable templates has been carried out using genetic algorithm optimization techniques.

Results: Performing BSS with a nonlinear distributed approach, the outputs of the CNN have been compared to the ICA ones. In all the protocol phases, the main components founded with CNN have similar trends compared with that ones obtained with ICA. Moreover, using this distributed approach, a spatial location has been associated to each component.

Conclusions: To underline the spatio-temporal and the nonlinearly of the neural process a distributed nonlinear architecture has been proposed. This strategy has been designed in order to overcome the hypothesis of linear combination among the sources signals, that is characteristic of the ICA approach, taking advantage of the spatial information.

Sleep disturbances and substance use disorders: An international study of primary care and mental health specialty care patients

Introduction

There is no comprehensive evidence on the influence of sleep disturbances (SD) on substance use disorders (SUD) or treatment use patterns of individuals with comorbid disturbances.

Objective/aim

To better understand comorbidities and treatment use patterns of individuals with SD and SUD.

Methods

We combine 2010–2012 electronic health record (EHR) data from healthcare system in Boston (n = 131,966 person-years) and Madrid, Spain (n = 43,309 person-years). Patients with sleep disturbances (SD) were identified in the EHR through ICD-9 codes and medical records and substance use disorders (SUD) identified by documented treatment for drug or alcohol abuse or dependence. Rates of SUD are compared between individuals with and without SD. Among those with both, adequacy of mental health treatment (defined as eight or more outpatient visits or four or more outpatient visits with a psychotropic prescription) and ER use is compared.

Results

Among the individuals, 21.1% with SD also report SUD, compared to only 10.6% of individuals without SD (P < .01). Those with comorbidities were more likely than their specialty care counterparts without comorbidities to be seen in the ER (57.1% vs. 36.6%, respectively, P < .05). Limiting the sample to only those with both SD and SUD in specialty mental health care (n = 268 in Boston and n = 28 in Madrid), 49.2% of Boston patients received adequate care compared to 38.5% of Madrid patients, and 57.8% of Boston patients had any ER use in the last year vs. 50% of Madrid patients.

Conclusions

SD is correlated with SUD and comorbid patients are more likely to use emergency services.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Gender differences in medical and psychiatric comorbidities in patients with posttraumatic stress disorder

Introduction

PTSD is associated with medical and psychiatric comorbidities. Less is known regarding differences in PTSD comorbidities and service use by gender.

Objectives

To examine variations in comorbidities for PTSD by gender and implications for quality of care.

Aims

We identify the prevalence of PTSD, medical and psychiatric comorbidities diagnosed by gender within outpatient, inpatient and emergency services.

Methods

We conducted a retrospective analysis using existing medical records from all outpatient, inpatient and emergency department (ED) encounters in 2010–2012 in a safety net health care system in the US. We identified the rates of PTSD diagnosis by gender, co-occurring diagnoses in ED and inpatient care, and rate of different comorbid diagnoses following initial PTSD diagnosis.

Results

Women in the sample had twice the likelihood of having a diagnosis of PTSD as compared to men (1.9% vs. 3.6%, P > 0.001), the most common comorbid diagnoses for ED visits were substance use disorder (SUD), depression, anxiety and pain. Men were more likely to have pain as a diagnosis in the ED as compared to women (P > 0.001). In inpatient services, men with PTSD were more likely to be diagnosed with a SUD (35% vs. 26%, P > 0.001) and women more likely diagnosed with comorbid depression (32% vs. 43%, P > 0.001). Men were more likely to have combined medical and substance use disorders and women more likely to have combined medical and psychiatric disorders.

Conclusions

Given the different patterns of comorbidity by gender, services should focus on tailoring services early to contend with these differences.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

ADVERSE EVENTS POST-DTAP AND DTwP VACCINATION IN THAI CHILDREN

We conducted a prospective study to compare the development of fever (axillary T ≥ 37.9 °C) within 4 hours of vaccination, determine the proportion of children who develop high fever (T ≥ 39°C) and evaluate parental days missed from work due to their children's vaccination with either the diphtheria-tetanus-whole cell pertussis (DTwP) or diphtheria-tetanus-acellular pertussis (DTaP) vaccine. The results of this study can help physicians and parents decide whether to have their child vaccinated with the DTwP or more expensive DTaP vaccine. We studied 140 healthy Thai children aged 2 months to 6 years from December 2011 to March 2012 who presented for vaccination. Parents recorded their child's temperature, local and systemic adverse reactions and missed days from work due to these adverse events on a diary card. Of the 140 participants, 72 received the DTwP vaccine and 68 received the DTaP vaccine. The median (IQR) age was 4 (2-6) months and the median weight was 7.1 (5.6-8.7) kg. Twenty children developed fever (axillary T ≥ 37.9°C) within 4 hours following vaccination, 17 (23.6%) had received the DTwP vaccine and 3 (4.4%) had received the DTaP vaccine (p = 0.040). One child (1.4%) who had received the DTwP vaccine and none who received the DTaP vaccine developed high fever (T ≥ 39°C) within 4 hours of vaccination (p = 0.329). Parents of two children who received the DTwP vaccine and one child who received the DTaP vaccine missed work following vaccination (p = 0.059). In conclusion, children who received the DTwP vaccines were more likely to have early post-vaccination fever and higher fever but there was no significant difference between the two groups in parental days lost from work.

Remote synchronization in star networks

We study phase synchronization in a network motif with a starlike structure in which the central node's (the hub's) frequency is strongly detuned against the other peripheral nodes. We find numerically and experimentally a regime of remote synchronization (RS), where the peripheral nodes form a phase synchronized cluster, while the hub remains free with its own dynamics and serves just as a transmitter for the other nodes. We explain the mechanism for this RS by the existence of a free amplitude and also show that systems with a fixed or constant amplitude, such as the classic Kuramoto phase oscillator, are not able to generate this phenomenon. Further, we derive an analytic expression which supports our explanation of the mechanism.

Recurrence-based detection of the hyperchaos-chaos transition in an electronic circuit

Some complex measures based on recurrence plots give evidence about hyperchaos-chaos transitions in coupled nonlinear systems [E. G. Souza et al., "Using recurrences to characterize the hyperchaos-chaos transition," Phys. Rev. E 78, 066206 (2008)]. In this paper, these measures are combined with a significance test based on twin surrogates to identify such a transition in a fourth-order Lorenz-like system, which is able to pass from a hyperchaotic to a chaotic behavior for increasing values of a single parameter. A circuit analog of the mathematical model has been designed and implemented and the robustness of the recurrence-based method on experimental data has been tested. In both the numerical and experimental cases, the combination of the recurrence measures and the significance test allows to clearly identify the hyperchaos-chaos transition.

A comparison between HMLP and HRBF for attitude control

In this paper the problem of controlling the attitude of a rigid body, such as a Spacecraft, in three-dimensional space is approached by introducing two new control strategies developed in hypercomplex algebra. The proposed approaches are based on two parallel controllers, both derived in quaternion algebra. The first is a feedback controller of the proportional derivative (PD) type, while the second is a feedforward controller, which is implemented either by means of a hypercomplex multilayer perceptron (HMLP) neural network or by means of a hypercomplex radial basis function (HRBF) neural network. Several simulations show the performance of the two approaches. The results are also compared with a classical PD controller and with an adaptive controller, showing the improvements obtained by using neural networks, especially when an external disturbance acts on the rigid body. In particular the HMLP network gave better results when considering trajectories not presented during the learning phase.

Prevalence of dementia and cognitive impairment in Southeastern Spain: the Ariadna study

OBJECTIVES

To estimate the prevalence of amnestic mild cognitive impairment (aMCI), cognitive impairment, no dementia (CIND) and dementia in a general elderly population and to examine the associated socio-demographic factors.

METHODS

The Ariadna study is a population-based cross-sectional study of cognitive function involving 1074 individuals aged 65-96 years from the Murcia Region of southeastern Spain. Prevalence, adjusted odds ratio (OR) and 95% confidence intervals (CI) were calculated.

RESULTS

The overall prevalence was 8.7% (95% CI 7.1-10.5) for aMCI, 14.5% (95% CI 12.4-16.8) for CIND and 5.5% (95% CI 4.3-7.1) for dementia. Dementia was associated with age (OR 1.13 95% CI 1.09-1.18 for a 1-year increase in age). Illiterate subjects were more likely to present aMCI (OR 2.59; 95% CI 1.09-6.14) and dementia (OR 4.09; 95% CI 1.28-13.08) than subjects with secondary or higher education. Rural area residents (OR 2.13, 95% CI 1.07-4.24) and women (OR 1.53, 95% CI 1.06-2.22) were more likely to have CIND.

CONCLUSION

The prevalence of dementia was low, despite a high prevalence of aMCI and CIND. Dementia was strongly associated with age and education. CIND was associated with living in a rural area and with female sex, while aMCI was associated with illiteracy.

Effects of mobility in a population of prisoner's dilemma players

We address the problem of how the survival of cooperation in a social system depends on the motion of the individuals. Specifically, we study a model in which prisoner's dilemma players are allowed to move in a two-dimensional plane. Our results show that cooperation can survive in such a system provided that both the temptation to defect and the velocity at which agents move are not too high. Moreover, we show that when these conditions are fulfilled, the only asymptotic state of the system is that in which all players are cooperators. Our results might have implications for the design of cooperative strategies in motion coordination and other applications including wireless networks.

Magnetic resonance spectroscopy performance for detection of dementia, Alzheimer's disease and mild cognitive impairment in a community-based survey

BACKGROUND/AIMS

To evaluate (1)H-labelled magnetic resonance spectroscopy (MRS) in patients with a low Mini Mental State Examination (MMSE) score identified during a dementia community-based survey.

METHODS

A population sample of 1,500 individuals (>64 years old) was randomly selected. Two hundred and fifteen individuals (MMSE < or =24) were sorted into clinical groups: dementia, Alzheimer's disease, mild cognitive impairment (MCI), normal. Up to 56 of these individuals attended the MRS appointment. Two single-voxel sequences (TR 1,500, TE 35/144 ms) were carried out in the posterior cingulate gyrus of each individual, and the ratios N-acetylaspartate (NAA)/creatine (Cr), choline (Cho)/Cr, myo-inositol (mI)/Cr, NAA/mI and NAA/Cho were compared statistically. The ability of MRS to distinguish clinical groups was assessed by receiver-operating characteristics analysis. Cognition effects on metabolite ratios were estimated, with gender and cognition as categorical variables and age as a continuous covariate.

RESULTS

NAA/Cr and NAA/Cho ratios were lower in dementia or Alzheimer's disease than in MCI and normal groups. The NAA/Cr ratio at TE 35 ms performed best when distinguishing dementia or Alzheimer's disease from non-demented subjects (cut-off point 1.40). MRS could not distinguish between MCI patients and normal subjects. Dementia was an independent predictor of metabolite values.

CONCLUSION

In a population sample, conventional MRS still proved to be a useful tool for dementia discrimination, but it is potentially far less useful as a surrogate marker for MCI.

Recurrence analysis of strange nonchaotic dynamics in driven excitable systems

Numerous studies have shown that strange nonchaotic attractors (SNAs) can be observed generally in quasiperiodically forced systems. These systems could be one- or high-dimensional maps, continuous-time systems, or experimental models. Recently introduced measures of complexity based on recurrence plots can detect the transitions from quasiperiodic to chaotic motion via SNAs in the previously cited systems. We study here the case of continuous-time systems and experimental models. In particular, we show the performance of the recurrence measures in detecting transitions to SNAs in quasiperiodically forced excitable systems and experimental time series.

Real time blood flow velocity monitoring in the microcirculation

A real-time monitoring system based on the dual slit methodology for the characterization of the red blood cell velocity at the level of microcirculation has been developed. The analog photometric signals are acquired and processed using a hybrid hardware-software system that exploits a A/D conversion and an optimized correlation algorithm on an embedded system. It is implemented exploiting the resources of a general purpose board capable to extract the useful information from the noisy photometric signals, to process them, to show and save the results and, therefore, to make the experiments reproducible. Two different approaches to the crosscorrelation algorithm have been tested and their performances have been compared to each. The system has been tested in in vivo experiments on anaesthetized hamsters. Several microvessels have been observed and the results have been compared to the output of an analog crosscorrelator to verify their coherence.

Real-time estimation of oxygen concentration in micro-hemo-vessels

In this paper, a real-time measurement system for non-invasive evaluation of oxygen concentration (PO2) at the microcirculation level is developed. The system has been designed by exploiting the phenomenon of fluorescence quenching. The skin of an anaesthetized hamster, injected with porphyrin, is lighted with pulses; the fluorophore reacts with the oxygen in the blood, producing a fluorescence signal, and the value of the fluorescence lifetime is related to the oxygen concentration. This microcirculation-based instrumentation consists of an electro-optical system, a control circuit and signal processing procedure. The system allows the measurement of PO2 in the range of 0-700 (mmHg) with a standard deviation of 4 (mmHg). Several experiments have been performed in order to characterize and test this system.

A cellular nonlinear network: real-time technology for the analysis of microfluidic phenomena in blood vessels

A new approach to the observation and analysis of dynamic structural and functional parameters in the microcirculation is described. The new non-invasive optical system is based on cellular nonlinear networks (CNNs), highly integrated analogue processor arrays whose processing elements, the cells, interact directly within a finite local neighbourhood. CNNs, thanks to their parallel processing feature and spatially distributed structure, are widely used to solve high-speed image processing and recognition problems and in the description and modelling of biological dynamics through the solution of time continuous partial differential equations (PDEs). They are therefore considered extremely suitable for spatial-temporal dynamic characterization of fluidic phenomena at micrometric to nanometric scales, such as blood flow in microvessels and its interaction with the cells of the vessel wall. A CNN universal machine (CNN-UM) structure was used to implement, via simulation and hardware (ACE16k), the algorithms to determine the functional capillarity density (FCD) and red blood cell velocity (RBCV) in capillaries obtained by intravital microscopy during in vivo experiments on hamsters. The system exploits the moving particles to distinguish the functional capillaries from the stationary background. This information is used to reconstruct a map and to calculate the velocity of the moving objects.

A programmable electronic circuit for modelling CO2 laser dynamics

We introduce a programmable electronic circuit implementing the rich dynamics of CO2 laser models. The design and the implementation of the circuit are accomplished by using a programmable analog device, which permits an experimental characterization of the laser dynamics. The experimental results shown in the paper demonstrate that the circuit exhibits homoclinic chaos typical of CO2 laser with feedback modulation of cavity losses. Moreover, experimental results showing that noise regularizes the dynamical time scales of the system are reported.

A nonlinear circuit architecture for magnetoencephalographic signal analysis

OBJECTIVES

The objective of this paper was to face the complex spatio-temporal dynamics shown by Magnetoencephalography (MEG) data by applying a nonlinear distributed approach for the Blind Sources Separation. The effort was to characterize and differ-entiate the phases of a yogic respiratory exercise used in the treatment of obsessive compulsive disorders.

METHODS

The patient performed a precise respiratory protocol, at one breath per minute for 31 minutes, with 10 minutes resting phase before and after. The two steps of classical Independent Component Approach have been performed by using a Cellular Neural Network with two sets of templates. The choice of the couple of suitable templates has been carried out using genetic algorithm optimization techniques.

RESULTS

Performing BSS with a nonlinear distributed approach, the outputs of the CNN have been compared to the ICA ones. In all the protocol phases, the main components founded with CNN have similar trends compared with that ones obtained with ICA. Moreover, using this distributed approach, a spatial location has been associated to each component.

CONCLUSIONS

To underline the spatio-temporal and the nonlinearly of the neural process a distributed nonlinear architecture has been proposed. This strategy has been designed in order to overcome the hypothesis of linear combination among the sources signals, that is characteristic of the ICA approach, taking advantage of the spatial information.

Chaotic behavior in noninteger-order cellular neural networks

In this paper, a simple system showing chaotic behavior is introduced. It is based on the well-known concept of cellular neural networks (CNNs), which have already given good results in generating complex dynamics. The peculiarity of the CNN model consists in the fact that it replaces the traditional first-order cell with a noninteger-order one. The introduction of the fractional cell, with a suitable choice of the coupling parameters, leads to the onset of chaos in a simple two-cell system. A theoretical approach, based on the harmonic balance theory, has been used to investigate the existence of chaos. A circuit realization of the proposed fractional two-cell chaotic CNN is reported and the corresponding strange attractor is also shown.

Multilayer Perceptrons to Approximate Quaternion Valued Functions

In this paper a new type of multilayer feedforward neural network is introduced. Such a structure, called hypercomplex multilayer perceptron (HMLP), is developed in quaternion algebra and allows quaternionic input and output signals to be dealt with, requiring a lower number of neurons than the real MLP, thus providing a reduced computational complexity. The structure introduced represents a generalization of the multilayer perceptron in the complex space (CMLP) reported in the literature. The fundamental result reported in the paper is a new density theorem which makes HMLPs universal interpolators of quaternion valued continuous functions. Moreover the proof of the density theorem can be restricted in order to formulate a density theorem in the complex space. Due to the identity between the quaternion and the four-dimensional real space, such a structure is also useful to approximate multidimensional real valued functions with a lower number of real parameters, decreasing the probability of being trapped in local minima during the learning phase. A numerical example is also reported in order to show the efficiency of the proposed structure. Copyright 1997 Elsevier Science Ltd. All Rights Reserved.

Multi-layer neural network analysis of cerebrospinal fluid pressure patterns in idiopathic normal-pressure hydrocephalus

The cerebrospinal fluid (CSF) pressure patterns have been reported as one of the most relevant indexes for the diagnosis and treatment of idiopathic normal-pressure hydrocephalus (INPH). Forty consecutive patients coming from our observations with the classic Hakim's triad underwent continuous CSF pressure monitoring via lumbar puncture for at least 12 hours. Twenty-eight patients were diagnosed as having INPH and underwent CSF shunt. A multi-layer neural network (perceptron) was employed to study the pressure patterns in order to try an alternative classification to the "expert" neurosurgeon one. Differences between expert and neural network classifications were indeed observed. Such differences may depend on the small group studied or on the inadequacy of CFS pressure patterns in correctly individuating those INPH patients who benefit from shunt surgery. The authors think that neural network processing of INPH could add relevant information to select the "responder" patients to surgery: in fact neural networks represent a powerful methodology for aiding the expert to select the proper choice on the basis of "what learnt" by the networks themselves.

Multilayer perceptrons to approximate complex valued functions

In this paper the approximation capabilities of different structures of complex feedforward neural networks, reported in the literature, have been theoretically analyzed. In particular a new density theorem for Complex Multilayer Perceptrons with complex valued non-analytical sigmoidal activation functions has been proven. Such a result makes Multilayer Perceptrons with complex valued neurons universal interpolators of continuous complex valued functions. Moreover the approximation properties of superpositions of analytic activation functions have been investigated, proving that such combinations are not dense in the set of continuous complex valued functions. Several numerical examples have also been reported in order to show the advantages introduced by Complex Multilayer Perceptrons in terms of computational complexity with respect to the classical real MLP.