Safety and efficacy of tenecteplase in patients with wake-up stroke assessed by non-contrast CT (TWIST): a multicentre, open-label, randomised controlled trial

BACKGROUND

Current evidence supports the use of intravenous thrombolysis with alteplase in patients with wake-up stroke selected with MRI or perfusion imaging and is recommended in clinical guidelines. However, access to advanced imaging techniques is often scarce. We aimed to determine whether thrombolytic treatment with intravenous tenecteplase given within 4·5 h of awakening improves functional outcome in patients with ischaemic wake-up stroke selected using non-contrast CT.

METHODS

TWIST was an investigator-initiated, multicentre, open-label, randomised controlled trial with blinded endpoint assessment, conducted at 77 hospitals in ten countries. We included patients aged 18 years or older with acute ischaemic stroke symptoms upon awakening, limb weakness, a National Institutes of Health Stroke Scale (NIHSS) score of 3 or higher or aphasia, a non-contrast CT examination of the head, and the ability to receive tenecteplase within 4·5 h of awakening. Patients were randomly assigned (1:1) to either a single intravenous bolus of tenecteplase 0·25 mg per kg of bodyweight (maximum 25 mg) or control (no thrombolysis) using a central, web-based, computer-generated randomisation schedule. Trained research personnel, who conducted telephone interviews at 90 days (follow-up), were masked to treatment allocation. Clinical assessments were performed on day 1 (at baseline) and day 7 of hospital admission (or at discharge, whichever occurred first). The primary outcome was functional outcome assessed by the modified Rankin Scale (mRS) at 90 days and analysed using ordinal logistic regression in the intention-to-treat population. This trial is registered with EudraCT (2014-000096-80), ClinicalTrials.gov (NCT03181360), and ISRCTN (10601890).

FINDINGS

From June 12, 2017, to Sept 30, 2021, 578 of the required 600 patients were enrolled (288 randomly assigned to the tenecteplase group and 290 to the control group [intention-to-treat population]). The median age of participants was 73·7 years (IQR 65·9-81·1). 332 (57%) of 578 participants were male and 246 (43%) were female. Treatment with tenecteplase was not associated with better functional outcome, according to mRS score at 90 days (adjusted OR 1·18, 95% CI 0·88-1·58; p=0·27). Mortality at 90 days did not significantly differ between treatment groups (28 [10%] patients in the tenecteplase group and 23 [8%] in the control group; adjusted HR 1·29, 95% CI 0·74-2·26; p=0·37). Symptomatic intracranial haemorrhage occurred in six (2%) patients in the tenecteplase group versus three (1%) in the control group (adjusted OR 2·17, 95% CI 0·53-8·87; p=0·28), whereas any intracranial haemorrhage occurred in 33 (11%) versus 30 (10%) patients (adjusted OR 1·14, 0·67-1·94; p=0·64).

INTERPRETATION

In patients with wake-up stroke selected with non-contrast CT, treatment with tenecteplase was not associated with better functional outcome at 90 days. The number of symptomatic haemorrhages and any intracranial haemorrhages in both treatment groups was similar to findings from previous trials of wake-up stroke patients selected using advanced imaging. Current evidence does not support treatment with tenecteplase in patients selected with non-contrast CT.

FUNDING

Norwegian Clinical Research Therapy in the Specialist Health Services Programme, the Swiss Heart Foundation, the British Heart Foundation, and the Norwegian National Association for Public Health.

Subjective Cognitive Decline in a Registry Sample: Relation to Psychiatric History, Loneliness, and Personality

BACKGROUND

With the increasing focus on prevention of Alzheimer's disease, there is need for characterization of preclinical populations. Local participant registries offer an opportunity to facilitate research engagement via remote data collection, inform recruitment, and characterize preclinical samples, including individuals with subjective cognitive decline.

OBJECTIVES

We sought to characterize subjective cognitive decline in a registry sample, as related to psychiatric history and related variables, including personality and loneliness, quality of life, and factors related to dementia risk (e.g., family history of dementia).

DESIGN, SETTING, PARTICIPANTS

Participants were 366 individuals (mean age=67.2 (range 50-88), 65% female, 94% white, 97% non-Hispanic or Latino, 82% with at least a bachelor's degree) with no reported history of mild cognitive impairment or dementia. All participants had expressed interest in research, primarily via community outreach events and prior research involvement. Data was collected via electronic surveys, distributed using REDCap. Electronic questionnaires included questions on demographic variables, subjective cognitive decline, quality of life, loneliness, and personality.

RESULTS

There was a high prevalence of risk factors for dementia in the registry sample (68% with family history of dementia, 31% with subjective cognitive decline). Subjective cognitive decline was more common in women and associated with history of depression, but not with family history of dementia. Subjective cognitive decline was also associated with lower conscientiousness and lower emotional stability, as well as higher loneliness and lower quality of life. Among participants who endorsed a psychiatric history, most reported onset more than 10 years prior, rather than within the last 10 years.

CONCLUSIONS

Subjective cognitive decline in a registry sample may be more strongly associated with longstanding psychiatric and personality variables, rather than family history of dementia, adding to the literature on characterization of subjective cognitive decline across different settings. These findings highlight the acceptability of remote data collection and the potential of registries to inform recruitment by characterizing registrants, which may help to stratify dementia risk and match participants to eligible trials.

Assessing the impact of mailing self-sampling kits for human papillomavirus testing to unscreened non-responder women in Manitoba

Background

CervixCheck, Manitoba's cervical cancer screening program, conducted a pilot study to assess whether screening participation could be improved in unscreened women by offering a mailed self-sampling kit for human papillomavirus (hpv) testing instead of a Pap test.

Methods

In a prospective cohort study design, a sample of unscreened women (n = 1052) who had been sent an invitation letter from CervixCheck in the past but who did not respond were randomized to either an intervention group or a control group. The intervention group received a mailed hpv self-sampling kit; the control group received no additional communication. Returned hpv self-sampling swabs were analyzed by a provincial laboratory. After 6 months, screening participation in the two study groups was compared using a logistic regression model adjusted for age and area of residence (urban or rural). Secondary outcomes included hpv positivity, specimen inadequacy, compliance with follow-up, and time to colposcopy.

Results

Screening participation was significantly higher in the intervention group than in the control group (n = 51, 9.6%, vs. n = 13, 2.5%; odds ratio: 4.7; 95% confidence interval: 2.56 to 8.77). Geographic area of residence (urban or rural) and age were not statistically significant.

Conclusions

The study demonstrated that hpv self-sampling kits can enhance screening participation in unscreened non-responder women in the setting of an organized screening program. Next steps should include additional research to determine the best implementation strategy for hpv self-sampling in Manitoba.

Memories defining the self in Alzheimer's disease

There is a debate over the extent to which personal identity or the self is preserved in patients with Alzheimer's disease (AD). Autobiographical memory deficits at early stages of AD could contribute to altering patients' self. However, the nature of the relationship between autobiographical memory deficits and the self in AD has not been much investigated experimentally. In the present study, we aimed to investigate the integrative meaning of self-defining memories (SDMs) in early stages of AD and to analyse its relationship with the self-concept. The results showed that, when compared to the control group, AD patients less frequently extracted meaning from their SDMs and the meaning was less frequently tied to the self. Patients exhibited some altered aspects of the self-concept (i.e., complexity and strength), though some other components still persisted (i.e., valence and certainty). Correlation analyses showed that the impaired integrative meaning in the AD group was correlated with some changes in self-concept. We suggest that integrative meaning may act as a bridge between autobiographical memories and the self-concept, with reduced integration abilities appearing as a potential mechanism for the deterioration of the self-concept in AD.

Severe lower limb cellulitis: defining the epidemiology and risk factors for primary episodes in a population-based case-control study

OBJECTIVE

To describe the epidemiology and risk factors for primary episodes of severe lower leg cellulitis (LLC).

METHODS

This was a longitudinal cohort study using state-wide data linkage of adults presenting to Western Australian (WA) hospitals with a first ever LLC from January 2002 to December 2013. The study aimed at determining risk factors, medical records from the index patient, together with comparable data from controls matched by age, sex, postcode, and month of admission.

RESULTS

During the period, 36 276 patients presented with their first episode of LLC. The incidence increased by 4.7% per annum, reaching 204.8 (95% CI 198.6-211.1) per 100 000 population by December 2013. Analysis of 29 062 case-control pairs showed several conditions with lower limb pathology were independently associated with LLC, including varicose veins (AOR 2.95, 95% CI 2.50-3.48, p < 0.001), lymphoedema (AOR 2.65, 95% CI 1.71-4.10, p < 0.001), tinea pedis (AOR 3.05, 95% CI 1.45-6.42, p 0.003), and saphenous vein harvest during coronary artery bypass grafting (AOR 1.74, 95% CI 1.32-2.30, p < 0.001). Also associated with LLC was obesity (AOR 2.05, 95% CI 1.82-2.31, p < 0.001), renal disease (AOR 1.28, 95% CI 1.14-1.44, p < 0.001), rheumatologic conditions (AOR 2.12, 95% CI 1.72-2.60, p < 0.001), hemiplegia/paraplegia (AOR 1.31, 95% CI 1.13-1.52, p < 0.001), and liver disease (AOR 1.77, 95% CI 1.51-2.06, p < 0.001).

CONCLUSIONS

LLC presents a major burden to the health sector and is increasing with an ageing population. Given the high rates of recurrence, long-term morbidity, and economic impact, efforts to reduce primary episodes should be incorporated into the infectious diseases and healthy ageing research agenda.

Epidemiology and risk factors for recurrent severe lower limb cellulitis: a longitudinal cohort study

OBJECTIVE

To describe the epidemiology and risk factors for recurrence of severe lower leg cellulitis (LLC).

METHODS

A longitudinal cohort study using state-wide data of adults presenting with recurrent LLC following a primary episode occurring between January 2002 and December 2013. The incidence of recurrent LLC was estimated using the cumulative incidence function, accounting for mortality. Independent risk factors for recurrence were identified using Fine-Gray sub-distribution and Cox proportional hazards models.

RESULTS

Of 36 276 patients presenting with their first episode of LLC, 4598 had at least one recurrence during the follow-up period. The cumulative incidence of first, second, and third recurrences at 12 months since previous infection was 6.3% (95% CI 6.0-6.5), 17.2% (95% CI 16.1-18.4), and 29.4% (95% CI 26.8-31.9), respectively, and at 5 years was 13.9% (95% CI 13.5-14.3), 35.9% (95% CI 34.2-37.5), and 52.9% (95% CI 49.5-56.2), respectively. The length of hospitalization increased from 3 days for the primary episode to 4 and 5 days for first and all subsequent recurrences, respectively. Independent risk factors for recurrent LLC included age, ethnicity (Indigenous Australian), local factors relating to lower leg pathology, conditions that commonly result in peripheral oedema, and systemic conditions that may be associated with increased leg size.

CONCLUSIONS

LLC recurrences are frequent, and each episode increases the likelihood of subsequent recurrence and length of hospitalization. These data provide context and scope to develop workable and effective strategies to prevent secondary episodes for all cases of primary LLC.

Behaviour of Arctic charr Salvelinus alpinus during an induced mating season in captivity: how male relative size influences male behavioural investment and female preference over time

The behaviour of sexually mature Arctic charr Salvelinus alpinus specimens (fifth farm generation) was observed in captivity for four consecutive days. Only agonistic interactions between males of different size were facilitated on the first 2 days, while both agonistic and courtship interactions were possible from the third day up to the end of the experiment. The reliability of behavioural analysis was assessed in order to reduce the possibility of observer errors within the generated datasets. The behavioural investment of big males, small males and females was analysed using general linear models (two-way repeated measures ANOVAs with time and male size as factors). A peak in the agonistic interactions between males occurred during the first day of interactions, where the agonistic investment of big males was significantly higher than that of small males. This resulted in an increased investment in submissive behaviour by the small males, who consistently performed submissive behaviours from the second day of interactions up to the end of the trial. Big males were found to invest significantly more than small males in courtship behaviours for the duration of the trial. Even though females performed inter-sexual behaviours towards both big and small males for the entire observation period, female interaction rate towards big males was higher than towards small males. This study suggests that both male investment in mating behaviour and female preference might be related to male characteristics such as body length and that S. alpinus behavioural patterns and mate choice cues might be strongly context-related and characterized by high levels of behavioural plasticity (i.e. presence-absence of certain behavioural units or potential reversal of a mate choice cue) within the same species. Finally, in light of this, some conservation measures are discussed. In particular, effective management plans should take into account the high level of behavioural plasticity likely to be occurring in this species.

Benefits from an autobiographical memory facilitation programme in relapsing-remitting multiple sclerosis patients: a clinical and neuroimaging study

While the efficacy of mental visual imagery (MVI) to alleviate autobiographical memory (AM) impairment in multiple sclerosis (MS) patients has been documented, nothing is known about the brain changes sustaining that improvement. To explore this issue, 20 relapsing-remitting MS patients showing AM impairment were randomly assigned to two groups, experimental (n = 10), who underwent the MVI programme, and control (n = 10), who followed a sham verbal programme. Besides the stringent AM assessment, the patients underwent structural and functional MRI sessions, consisting in retrieving personal memories, within a pre-/post-facilitation study design. Only the experimental group showed a significant AM improvement in post-facilitation, accompanied by changes in brain activation (medial and lateral frontal regions), functional connectivity (posterior brain regions), and grey matter volume (parahippocampal gyrus). Minor activations and functional connectivity changes were observed in the control group. The MVI programme improved AM in MS patients leading to functional and structural changes reflecting (1) an increase reliance on brain regions sustaining a self-referential process; (2) a decrease of those reflecting an effortful research process; and (3) better use of neural resources in brain regions sustaining MVI. Functional changes reported in the control group likely reflected ineffective attempts to use the sham strategy in AM.

Neural correlates of episodic future thinking impairment in multiple sclerosis patients

BACKGROUND

Recent clinical investigations showed impaired episodic future thinking (EFT) abilities in multiple sclerosis (MS) patients. On these bases, the aim of the current study was to explore the structural and functional correlates of EFT impairment in nondepressed MS patients.

METHOD

Twenty-one nondepressed MS patients and 20 matched healthy controls were assessed with the adapted Autobiographical Interview (AI), and patients were selected on the bases of an EFT impaired score criterion. The 41 participants underwent a functional magnetic resonance imaging (fMRI) session, distinguishing the construction and elaboration phases of the experimental EFT, and the categorical control tests. Structural images were also acquired.

RESULTS

During the EFT fMRI task, increased cerebral activations were observed in patients (relative to healthy controls) within the EFT core network. These neural changes were particularly important during the construction phase of future events and involved mostly the prefrontal region. This was accompanied by an increased neural response mostly in anterior, and also posterior, cerebral regions, in association with the amount of detail produced by patients. In parallel, structural measures corroborated a main positive association between the prefrontal regions' volume and EFT performance. However, no association between the hippocampus and EFT performance was observed in patients, at both structural and functional levels.

CONCLUSION

We have documented significant overlaps between the structural and functional underpinnings of EFT impairment, with a main role of the prefrontal region in its clinical expression in MS patients.

Tigecycline use in the outpatient parenteral antibiotic therapy setting

In the context of globally increasing antimicrobial resistance, tigecycline appears to be a useful therapeutic option. The need for prolonged courses for complex infections has prompted consideration of its use via outpatient parenteral antibiotic therapy (OPAT) programmes, although clinical outcomes when used in this setting remain unknown. We retrospectively reviewed the patient characteristics and outcomes of 11 patients who received tigecycline, most commonly delivered as 100 mg once daily, via OPAT at three tertiary Australian hospitals. Rates of co-morbidity and prior antibiotic use were high. Patients had a wide range of infections including bone and/or joint (n = 5), intra-abdominal (n = 3), lower respiratory tract (n = 2) and parapharyngeal abscess (n = 1). Mycobacterial species (n = 5) were the most frequent pathogen, and multi-resistant organisms were common (n = 4). The median OPAT duration was 14 days (IQR 6-30). Nausea was encountered in 45 % of cases. At completion of OPAT, 1 patient (9 %) was cured, 2 (18 %) had improved and 8 (73 %) failed therapy. Failure occurred due to either progression or non-response of infection (n = 4), re-admission (n = 3), premature cessation of tigecycline due to nausea (n = 3) or death (n = 1). Whilst OPAT delivery of tigecycline is a therapeutic option, when used as second-line therapy for complex, often multi-resistant infections in patients with multiple comorbidities, high rates of clinical failure, readmissions and adverse effects, especially nausea, should be anticipated.

A Toll-like receptor-1 variant and its characteristic cellular phenotype is associated with severe malaria in Papua New Guinean children

Genetic factors are likely to contribute to low severe malaria case fatality rates in Melanesian populations, but association studies can be underpowered and may not provide plausible mechanistic explanations if significant associations are detected. In preparation for a genome-wide association study, 29 candidate single-nucleotide polymorphisms (SNPs) with minor allele frequencies >5% were examined in a case-control study of 504 Papua New Guinean children with severe malaria. In parallel, an immunological substudy was performed on convalescent peripheral blood mononuclear cells (PBMCs) from cases and controls. Following stimulation with a Toll-like receptor (TLR) 1/2 agonist, effector cytokines and chemokines were assayed. The only significant genetic association observed involved a nonsynonymous SNP (TLR1rs4833095) in the TLR1 gene. A recessive (TT) genotype was associated with reduced odds of severe malaria of 0.52 (95% confidence interval (0.29-0.90), P=0.006). Concentrations of pro-inflammatory cytokines interleukin-1β and tumour necrosis factor α were significantly higher in severe malaria cases compared with healthy controls, but lower in children with the protective recessive (TT) genotype. A genetic variant in TLR1 may contribute to the low severe malaria case fatality rates in this region through a reduced pro-inflammatory cellular phenotype.

Polarization-resolved spectroscopy imaging of grain boundaries and optical excitations in crystalline organic thin films

Exploration of optical properties of organic crystalline semiconductors thin films is challenging due to submicron grain sizes and the presence of numerous structural defects, disorder and grain boundaries. Here we report on the results of combined linear dichroism (LD)/ polarization-resolved photoluminescence (PL) scanning microscopy experiments that simultaneously probe the excitonic radiative recombination and the molecular ordering in solution-processed metal-free phthalocyanine crystalline thin films with macroscopic grain sizes. LD/PL images reveal the relative orientation of the singlet exciton transition dipoles at the grain boundaries and the presence of a localized electronic state that acts like a barrier for exciton diffusion across the grain boundary. We also show how this energy barrier can be entirely eliminated through the optimization of deposition parameters that results in films with large grain sizes and small-angle boundaries. These studies open an avenue for exploring the influence of long-range order on exciton diffusion and carrier transport.

In-depth understanding of organic crystalline semiconductor thin films is critical for the development of many electronic and photonic devices. Here, the authors use combined linear dichroism and polarization-resolved photoluminescence scanning microscopy to unveil the nature of excited states in such systems.

Preserved anterograde and remote memory in drug-responsive temporal lobe epileptic patients

PURPOSE

To investigate cognition, particularly anterograde and remote memory, in patients suffering from unilateral drug-responsive mesial temporal lobe epilepsy (mTLE) patients and to compare their performance with that observed in drug-resistant mTLE patients.

METHODS

Sixteen drug-responsive mTLE patients, with only infrequent seizures in their lifetime, were matched for demographic and clinical variables to 18 patients suffering from drug-resistant unilateral mTLE. A comprehensive neuropsychological examination, including baseline, anterograde memory tasks, and a large range of remote memory tests was carried out.

RESULTS

Patients with drug-responsive epilepsy obtained average scores on every anterograde memory test. Although in general, they obtained lower scores than the healthy controls on remote memory tests, the differences failed to reach significance. Moreover, the drug-responsive group performed significantly better than the drug-resistant group on anterograde recall tests and an episodic autobiographical memory test. Performance was not significantly different between the patient groups in personal semantics or memory for public events.

CONCLUSION

Our results show that a mild clinical course of mTLE with no cognitive deficits can occur notwithstanding hippocampal sclerosis. The differences in cognitive function between the two groups are likely due to distinct pathophysiology of the underlying cause of epilepsy. Drug-resistant seizures and cognitive deficits may be the consequence of a more severe underlying cerebral process. Better understanding of the variety of pathogenesis of mTLE could help to answer this open question.

Impaired emotional autobiographical memory associated with right amygdalar-hippocampal atrophy in Alzheimer's disease patients

We studied the influence of emotions on autobiographical memory (AbM) in patients with Alzheimer’s disease (AD), characteristically triggering atrophy in the hippocampus and the amygdala, two crucial structures sustaining memory and emotional processing. Our first aim was to analyze the influence of emotion on AbM in AD patients, on both the proportion and the specificity of emotional memories. Additionally, we sought to determine the relationship of emotional AbM to amygdalar-hippocampal volumes. Eighteen prodromal to mild AD patients and 18 age-matched healthy controls were included. We obtained 30 autobiographical memories per participant using the modified Crovitz test (MCT). Analyses were performed on global scores, rates and specificity scores of the emotional vs. neutral categories of memories. Amygdalar-hippocampal volumes were extracted from 3D T1-weighted MRI scans and tested for correlations with behavioral data. Overall, AD patients displayed a deficit in emotional AbMs as they elicited less emotional memories than the controls, however, the specificity of those memories was preserved. The deficit likely implied retrieval or storage as it was extended in time and without reminiscence bump effect. Global scores and rates of emotional memories, but not the specificity scores, were correlated to right amygdalar and hippocampal volumes, indicating that atrophy in these structures has a central role in the deficit observed. Conversely, emotional memories were more specific than neutral memories in both groups, reflecting an enhancement effect of emotion that could be supported by other brain regions that are spared during the early stages of the disease.

FMRI contributions to addressing autobiographical memory impairment in temporal lobe pathology

Episodic autobiographical memory (AM) allows one, through the recollection of sensory-perceptual details, thoughts and feelings, to become aware of an event as belonging to one’s own past as well as being able to project into one’s future. Because AM provides a sense of self-continuity, contributes to the integrity of the self, and helps predicting future experiences, any deficit of AM may have debilitating consequences for everyday life functioning. Understanding AM failure and the underlying neural mechanisms has the potential to shed light on brain reorganization mechanisms and engagement of compensatory processes. Functional magnetic resonance imaging (fMRI) provides the most promising imaging method to tackle these issues. We reviewed evidence from the few studies that used fMRI to investigate the functionality of the residual tissue, the neural reorganization and compensatory mechanisms in patients with neurological conditions due to impaired medial temporal lobe. Overall, these studies highlight the importance of the left hippocampus, which when atrophied and not functional leads to AM deficits but its residual functionality may support relatively normal AM recollection. When damaged hippocampal tissue is not functional, other brain regions (e.g., the medial prefrontal cortex) may be involved to compensate impairment, but they appear generally ineffective to support detailed episodic recollection.

St. Augustine's Reflections on Memory and Time and the Current Concept of Subjective Time in Mental Time Travel

Reconstructing the past and anticipating the future, i.e., the ability of travelling in mental time, is thought to be at the heart of consciousness and, by the same token, at the center of human cognition. This extraordinary mental activity is possible thanks to the ability of being aware of 'subjective time'. In the present study, we attempt to trace back the first recorded reflections on the relations between time and memory, to the end of the fourth century's work, the Confessions, by the theologian and philosopher, St. Augustine. We concentrate on Book 11, where he extensively developed a series of articulated and detailed observations on memory and time. On the bases of selected paragraphs, we endeavor to highlight some concepts that may be considered as the product of the first or, at least, very early reflections related to our current notions of subjective time in mental time travel. We also draw a fundamental difference inherent to the frameworks within which the questions were raised. The contribution of St. Augustine on time and memory remains significant, notwithstanding the 16 centuries elapsed since it was made, likely because of the universality of its contents.

Autobiographical significance in past and future public semantic memory: a case-study

Refined investigation of infrequent dissociations within remote memory, such as preservation of autobiographical episodic memory and selective impairment of public semantic memory could provide some insight on the interactions of long-term memory systems and their underlying brain correlates. Combining clinical neuropsychological and neuroimaging methods in the present study, we examined a patient surgically treated for temporal lobe epilepsy showing this rare pattern of dissociation. Specifically, we investigated along the two temporal directions, past and future, his autobiographical episodic memory, semantic memory for public events and famous people and their interaction through the concept of autobiographical significance (AS). The results showed impaired ability not only to recall past but also to imagine future public events in a context of preserved past and future personal episodic memory. Remarkably, impersonal future thinking was impaired regardless of AS, while the autobiographical-significant public past knowledge relied exclusively on the patient's spared autobiographical episodic memory. These results were corroborated by neuroimaging data showing the absence of brain activation for public knowledge devoid of personal significance and activation of the autobiographical memory cerebral network for personally significant public knowledge. Our findings suggest that AS did not 'restore' the code to access public semantic memory, but bypassed it by using personal memory sources successful only for past public recollections. Therefore, remembering impersonal and imagining public events seems to require the contribution of public semantic knowledge per se. The patient's cognitive profile suggested a reorganization of memory systems.

Induced brain plasticity after a facilitation programme for autobiographical memory in multiple sclerosis: a preliminary study

This preliminary study tackles the assessment and treatment of autobiographical memory (AbM) in relapsing-remitting multiple sclerosis (RR-MS) patients. Our aim was to investigate cerebral activation changes, following clinical improvement of AbM due to a cognitive training based on mental visual imagery (MVI). We assessed AbM using the Autobiographical Interview (AI) in eight patients and 15 controls. The latter subjects established normative data. The eight patients showed selective defective performance on the AI. Four patients were trained cognitively and underwent pre- and post-AI and fMRI. The remaining four patients took a second AI, at the same interval, but with no intervention in between. Results showed a significant improvement of AbM performance after the facilitation programme that could not be explained by learning effects since the AI scores remained stable between the two assessments in the second group of patients. As expected, AbM improvement was accompanied by an increased cerebral activity in posterior cerebral regions in post-facilitation fMRI examination. We interpret this activation changes in terms of reflecting the emphasis made on the role of MVI in memory retrieval through the facilitation programme. These preliminary significant clinical and neuroimaging changes suggest the beneficial effects of this technique to alleviate AbM retrieval deficit in MS patients.

Autobiographical memory in multiple sclerosis patients: assessment and cognitive facilitation

The multifocal nature of lesions in multiple sclerosis hints at the occurrence of autobiographical memory (AbM) impairment. However, the dearth of studies on AbM in multiple sclerosis is noticeable, notwithstanding the importance of AbM in everyday life. In the first section of this study, 25 multiple sclerosis patients and 35 controls underwent a detailed episodic AbM assessment. Results obtained by means of ANOVA suggested an AbM retrieval deficit in every patient. That pattern of performance paved the way for the second section of the study, in which we followed up 10 out of the 25 patients. Our objective was to assess the effectiveness of a cognitive facilitation programme designed to alleviate AbM retrieval deficits, based on the key role of mental visual imagery on AbM. Statistical group analyses by means of ANOVA and individual analyses using the χ(2) test showed significant differences in AbM test results, in post-facilitation relative to pre-facilitation training, in all 10 patients. Moreover, the patients' comments showed that the positive effects were transferred in their daily life functioning. We would like to suggest that the facilitation programme efficiently enhanced the process of self-centred mental visual imagery, which might have compensated for poor retrieval of personal memories by providing better access to visual details and detailed visual scenes of personal recollections.

Pathology and viral antigen distribution following experimental infection of sheep and goats with capripoxvirus

Current understanding of capripoxvirus pathogenesis is limited since there have been no detailed studies examining cell tropism at well-defined intervals following infection. We undertook time-course studies in sheep and goats following inoculation of sheeppox or goatpox viruses in their respective homologous hosts, and examined tissues by light microscopy. A monoclonal antibody generated to a sheeppox virus core protein was used for immunohistochemical detection of viral antigen in tissue sections. Lesions and virus antigen were observed consistently in the skin, lung and lymph nodes. Antigen was detected at 6 and 8 days post inoculation for skin and lung, respectively, within cells which appeared to be of monocyte/macrophage lineage. In sheep skin capripoxvirus immunoreactivity was detected within previously unreported large multinucleated cells. In the lung, double immunolabelling detected the simultaneous expression of capripoxvirus antigen and cytokeratin indicating the presence of virus within pneumocytes. Lung double immunolabelling also detected the expression of capripoxvirus antigen in CD68(+) cells, confirming the presence of viral antigen within macrophages. Based on early detection of infected macrophages, dissemination of virus within the host and localization to tissues likely occurred through cells of the monocyte/macrophage lineage. Histological findings revealed similarities with both monkeypox and smallpox, thus capripoxvirus infection in sheep and goats may represent useful models with which to study strategies for poxvirus-specific virus vaccine concepts and therapeutics.

The impact of overnight consolidation upon memory for emotional and neutral encoding contexts

Sleep plays a role in the consolidation of declarative memories. Although this influence has attracted much attention at the level of behavioural performance, few reports have searched for neural correlates. Here, we studied the impact of sleep upon memory for the context in which stimuli were learned at both behavioural and neural levels. Participants retrieved the association between a presented foreground object and its encoding context following a 12-h retention interval including either wake only or wake plus a night of sleep. Since sleep has been shown to selectively enhance some forms of emotional memory, we examined both neutral and emotionally valenced contexts. Behaviourally, less forgetting was observed across retention intervals containing sleep than retention intervals containing only wakefulness, and this benefit was accompanied by stronger responses in hippocampus and superior parietal cortex. This sleep-related reduction in forgetting did not differ between neutral and negative contexts, but there was a clear interaction between sleep and context valence at the functional level, with left amygdala, right parahippocampus, and other components of the episodic memory system all responding more strongly during correct memory for emotional contexts post-sleep. Connectivity between right parahippocampus and bilateral amygdala/periamygdala was also enhanced during correct post-sleep attribution of emotional contexts. Because there was no interaction between sleep and valence in terms of context memory performance these functional results may be associated with memory for details about the emotional encoding context rather than for the link between that context and the foreground object. Overall, our data show that while context memory decays less across sleep than across an equivalent period of wake, the sleep-related protection of such associations is not influenced by context emotionality in the same way as direct recollection of emotional information.

[Memory improvement in patients with temporal lobe epilepsy at one-year postoperative]

INTRODUCTION

Several studies have assessed the impact of surgery on both anterograde and remote memory in patients with temporal lobe epilepsy (TLE). The majority of results have shown an extensive memory deficit in patients after temporal resection (TL). However, few protocols have used a prospective longitudinal design. Moreover, the postoperative delays were variable from one study to the next, instead of regular monitoring to identify the potential effect of time elapsed after surgery on memory performance. In addition, some studies have not used strict inclusion criteria to establish homogeneous patient groups. Finally, the impact of surgery on memory has been often assessed by comparing memory skills between epileptic patients and healthy controls. Our aim was to examine the impact of TL on memory in patients with TLE, recruited according to clear-cut clinical criteria. Moreover, we focused on memory performance progression per se in epileptic patients pre- and postoperatively, rather than on memory performance analysis expressed as "deficient" or "normal".

METHODS

We assessed 30 patients with unilateral TLE (17 right TLE and 13 left TLE) on four anterograde memory tests and six remote memory tasks. Patients completed all tests preoperatively, and 5 and 12 months after TL.

RESULTS

Five months after surgery, performance was equivalent to the preoperative scores for both groups in anterograde memory tasks and remote memory tests. One year after TL, patients with right TLE showed enhanced performance in the verbal anterograde memory tests and in retrieving recent autobiographical memories. Results for left TL showed improved scores only in a recognition memory test of faces.

CONCLUSIONS

In the present study, surgical patients were "double winners" gaining seizure freedom and potential of memory stability or recovery. The gain was observed only 12 months after surgery and following temporal resection lateralisation. Our data showed postoperative memory improvement in patients with temporal lobe epilepsy presenting with specific clinical characteristics.

Cryptococcal meningitis in immunocompetent Papua New Guinean children

We report three cases of meningo-encephalitis caused by Cryptococcous neoformans var. gattii in apparently immunocompetent children presenting to a provincial hospital in Papua New Guinea (PNG) over a nine-month period. After a postmortem diagnosis was made in the first case, a further two were identified quickly using Indian ink staining of cerebrospinal fluid (CSF). The second case had a complicated course and recovered after relapse. The third made a full recovery with appropriate antifungal therapy. Despite the fact that an environmental reservoir has not been established, cryptococcal meningo-encephalitis occurs regularly in PNG. In developing countries such as PNG, a lack of laboratory resources and limited therapeutic options can complicate the management of severe infections such as cryptococcosis. Nevertheless, with inexpensive diagnostic tests (such as Indian ink staining of CSF), a high index of suspicion and a pragmatic approach to antifungal therapy, good therapeutic outcomes can be achieved.

Pathology of highly pathogenic avian influenza virus (H5N1) infection in Canada geese (Branta canadensis): preliminary studies

Susceptibility of Canada geese (Branta canadensis) to highly pathogenic avian influenza (HPAI) virus (H5N1) infection was studied by inoculating 10 naïve (antibody-negative) animals (5 adults and 5 juveniles) with A/chicken/Vietnam/14/05 (H5N1) virus. In the adults, 1 of 5 became infected, and 4 of 5 remained normal; in the juvenile group, 5 of 5 became infected. The pathology observed in the affected animals was similar to that reported in natural occurrences. Peripheral and parasympathetic nervous systems were examined and found infected, as well as cerebrospinal fluid-contacting neurons. In some locations with significant virus infection in cells, the expected inflammatory reaction was absent or very mild. Immunohistochemistry was used to locate influenza A virus nucleoprotein in brain, spinal cord, respiratory and digestive systems, pancreas, heart, and peripheral and parasympathetic nervous systems. Further studies are needed to explain age-related differences in susceptibility.

Quantification of lumpy skin disease virus following experimental infection in cattle

Lumpy skin disease along with sheep pox and goatpox are the most serious poxvirus diseases of livestock, and are caused by viruses that belong to the genus Capripoxvirus within the subfamily Chordopoxvirinae, family Poxviridae. To facilitate the study of lumpy skin disease pathogenesis, we inoculated eight 4- to 6-month-old Holstein calves intravenously with lumpy skin disease virus (LSDV) and collected samples over a period of 42 days for analysis by virus isolation, real-time PCR and light microscopy. Following inoculation, cattle developed fever and skin nodules, with the extent of infection varying between animals. Skin nodules remained visible until the end of the experiment on day post-inoculation (DPI) 42. Viremia measured by real-time PCR and virus isolation was not observed in all animals but was detectable between 6 and 15 DPI. Low levels of viral shedding were observed in oral and nasal secretions between 12 and 18 DPI. Several tissues were assessed for the presence of virus at DPI 3, 6, 9, 12, 15, 18 and 42 by virus isolation and real-time PCR. Virus was consistently detected by real-time PCR and virus isolation at high levels in skin nodules indicating LSDV has a tropism for skin. In contrast, relatively few lesions were observed systemically. Viral DNA was detected by real-time PCR in skin lesions collected on DPI 42. Cattle developing anti-capripoxvirus antibodies starting at DPI 21 was detected by serum neutralization. The disease in this study varied from mild with few secondary skin nodules to generalized infection of varying severity, and was characterized by morbidity with no mortality.

Déficit sélectif de la mémoire des faits publics associé à un oubli accéléré chez un patient atteint d’épilepsie du lobe temporal gauche

BACKGROUND

Memory for the past has been much less explored than anterograde memory in temporal lobe epilepsy. No data are available about the course after surgical treatment. Moreover, case-reports showing isolated memory deficit for publics events with preserved autobiographical memory are notorious for their paucity.

METHODS

We report the case of a patient with a left hippocampal lesion associated with intractable temporal lobe epilepsy. Comprehensive neuropsychological assessments were carried out before and after temporal lobectomy, stressing particularly memory for the past by means of standardised and tailor-made tests.

RESULTS

The patient exhibited preserved memory for autobiographical events and facts but impaired scores on several public event tests, in the context of preserved general abilities. Furthermore, we found an accelerated forgetting rate for verbal and non verbal material.

CONCLUSION

Our findings suggest that the patient's impaired long-term consolidation might have contributed to the impaired performance on public event memory tests. We discuss the specific features of new events processing that may contribute to its increased vulnerability relative to autobiographical memory, in the event of accelerated forgetting.

Anterior and non-anterior ruptured aneurysms: Memory and frontal lobe function performance following coiling

Our aim was to compare memory and frontal function performance between two groups of patients treated with Guglielmi detachable coil (GDC) following intracranial ruptured aneurysm. The subgroups drawn following the localization of the aneurysm consisted of 19 patients presenting with anterior communicating artery aneurysms and 16 patients exhibiting middle cerebral artery and posterior communicating artery aneurysms. The 35 patients and 35 normal controls were administered extensive neuropsychological assessment. Additionally, a scale of qualitative changes of mood was presented to the patients and patients' relatives. The patients showed a better general performance on memory compared with the executive function performance, which was similarly impaired in both groups. We suggest that executive functions are more vulnerable to differently located lesions than memory functions.

Improving tapping mode atomic force microscopy with piezoelectric cantilevers

This article summarizes improvements to the speed, simplicity and versatility of tapping mode atomic force microscopy (AFM). Improvements are enabled by a piezoelectric microcantilever with a sharp silicon tip and a thin, low-stress zinc oxide (ZnO) film to both actuate and sense deflection. First, we demonstrate self-sensing tapping mode without laser detection. Similar previous work has been limited by unoptimized probe tips, cantilever thicknesses, and stress in the piezoelectric films. Tests indicate self-sensing amplitude resolution is as good or better than optical detection, with double the sensitivity, using the same type of cantilever. Second, we demonstrate self-oscillating tapping mode AFM. The cantilever's integrated piezoelectric film serves as the frequency-determining component of an oscillator circuit. The circuit oscillates the cantilever near its resonant frequency by applying positive feedback to the film. We present images and force-distance curves using both self-sensing and self-oscillating techniques. Finally, high-speed tapping mode imaging in liquid, where electric components of the cantilever require insulation, is demonstrated. Three cantilever coating schemes are tested. The insulated microactuator is used to simultaneously vibrate and actuate the cantilever over topographical features. Preliminary images in water and saline are presented, including one taken at 75.5 microm/s-a threefold improvement in bandwidth versus conventional piezotube actuators.