Local recurrence following a complete radiologic response in hepatocellular carcinoma patients: comparison of transarterial chemoembolisation and transarterial radioembolisation

AIM

To evaluate and compare the rates of local recurrence in hepatocellular carcinoma (HCC) patients who undergo selective transarterial radioembolisation (TARE) or transarterial chemoembolisation (TACE) and achieve a complete response (CR) radiologically.

MATERIALS AND METHODS

All patients undergoing treatment with TARE or TACE at a single academic institution were reviewed retrospectively. Those who had been treated previously, presented with multifocal disease, had non-selective TARE or TACE, or did not achieve a complete response (CR) radiologically were excluded.

RESULTS

In total 110 patients were included (TACE n=60 [54.5%]; TARE n=50 [45.5%]). TARE patients were older (66.4 ± 9.4 versus 61.2 ± 5.6 years, p<0.001) and had larger tumours (4.4 ± 2.2 versus 3 ± 1.4 cm, p=0.002). TACE patients were significantly more likely to suffer a local recurrence (31/60, 51.7% versus 9/50, 18%, p<0.001) and had a significantly shorter time to recurrence (median 8.3 {interquartile range [IQR]}: 12 versus median 17.9 [IQR: 23.5] months, p=0.001). A local time to progression (TTP) Kaplan-Meier curve demonstrated TACE patients had a significantly shorter local TTP (hazard ratio [HR]: 7.2; 95% confidence interval [CI]: 3.64-14.24; p<0.001) and treatment modality (TACE or TARE; HR: 0.05; 95% CI: 0.005-0.5; p=0.01) was found to be associated with local recurrences on multivariate Cox proportional HR analysis. When overall TTP was evaluated, again TACE patients were found to have a significantly shorter TTP (HR: 2.13 [1.28-3.53], p=0.004).

CONCLUSION

In HCC patients undergoing selective treatment who achieve a CR radiologically, those treated with TARE may be less likely to suffer recurrence, either local or general, than those treated with TACE.

Precursors to infant sensorimotor synchronization to speech and non-speech rhythms: A longitudinal study

Impaired sensorimotor synchronization (SMS) to acoustic rhythm may be a marker of atypical language development. Here, Motion Capture was used to assess gross motor rhythmic movement at six time points between 5- and 11 months of age. Infants were recorded drumming to acoustic stimuli of varying linguistic and temporal complexity: drumbeats, repeated syllables and nursery rhymes. Here we show, for the first time, developmental change in infants' movement timing in response to auditory stimuli over the first year of life. Longitudinal analyses revealed that whilst infants could not yet reliably synchronize their movement to auditory rhythms, infant spontaneous motor tempo became faster with age, and by 11 months, a subset of infants decelerate from their spontaneous motor tempo, which better accords with the incoming tempo. Further, infants became more regular drummers with age, with marked decreases in the variability of spontaneous motor tempo and variability in response to drumbeats. This latter effect was subdued in response to linguistic stimuli. The current work lays the foundation for using individual differences in precursors of SMS in infancy to predict later language outcomes. RESEARCH HIGHLIGHT: We present the first longitudinal investigation of infant rhythmic movement over the first year of life Whilst infants generally move more quickly and with higher regularity over their first year, by 11 months infants begin to counter this pattern when hearing slower infant-directed song Infant movement is more variable to speech than non-speech stimuli In the context of the larger Cambridge UK BabyRhythm Project, we lay the foundation for rhythmic movement in infancy to predict later language outcomes.

Decoding speech information from EEG data with 4-, 7- and 11-month-old infants: Using convolutional neural network, mutual information-based and backward linear models

BACKGROUND

Computational models that successfully decode neural activity into speech are increasing in the adult literature, with convolutional neural networks (CNNs), backward linear models, and mutual information (MI) models all being applied to neural data in relation to speech input. This is not the case in the infant literature.

NEW METHOD

Three different computational models, two novel for infants, were applied to decode low-frequency speech envelope information. Previously-employed backward linear models were compared to novel CNN and MI-based models. Fifty infants provided EEG recordings when aged 4, 7, and 11 months, while listening passively to natural speech (sung or chanted nursery rhymes) presented by video with a female singer.

RESULTS

Each model computed speech information for these nursery rhymes in two different low-frequency bands, delta and theta, thought to provide different types of linguistic information. All three models demonstrated significant levels of performance for delta-band neural activity from 4 months of age, with two of three models also showing significant performance for theta-band activity. All models also demonstrated higher accuracy for the delta-band neural responses. None of the models showed developmental (age-related) effects.

COMPARISONS WITH EXISTING METHODS

The data demonstrate that the choice of algorithm used to decode speech envelope information from neural activity in the infant brain determines the developmental conclusions that can be drawn.

CONCLUSIONS

The modelling shows that better understanding of the strengths and weaknesses of each modelling approach is fundamental to improving our understanding of how the human brain builds a language system.

Neural responses to natural and enhanced speech edges in children with and without dyslexia

Sensory-neural studies indicate that children with developmental dyslexia show impairments in processing acoustic speech envelope information. Prior studies suggest that this arises in part from reduced sensory sensitivity to amplitude rise times (ARTs or speech "edges") in the envelope, accompanied by less accurate neural encoding of low-frequency envelope information. Accordingly, enhancing these characteristics of the speech envelope may enhance neural speech processing in children with dyslexia. Here we applied an envelope modulation enhancement (EME) algorithm to a 10-min story read in child-directed speech (CDS), enhancing ARTs and also enhancing low-frequency envelope information. We compared neural speech processing (as measured using MEG) for the EME story with the same story read in natural CDS for 9-year-old children with and without dyslexia. The EME story affected neural processing in the power domain for children with dyslexia, particularly in the delta band (0.5-4 Hz) in the superior temporal gyrus. This may suggest that prolonged experience with EME speech could ameliorate some of the impairments shown in natural speech processing by children with dyslexia.

Decoding of speech information using EEG in children with dyslexia: Less accurate low-frequency representations of speech, not "Noisy" representations

The amplitude envelope of speech carries crucial low-frequency acoustic information that assists linguistic decoding. The sensory-neural Temporal Sampling (TS) theory of developmental dyslexia proposes atypical encoding of speech envelope information < 10 Hz, leading to atypical phonological representations. Here a backward linear TRF model and story listening were employed to estimate the speech information encoded in the electroencephalogram in the canonical delta, theta and alpha bands by 9-year-old children with and without dyslexia. TRF decoding accuracy provided an estimate of how faithfully the children's brains encoded low-frequency envelope information. Between-group analyses showed that the children with dyslexia exhibited impaired reconstruction of speech information in the delta band. However, when the quality of speech encoding for each child was estimated using child-by-child decoding models, then the dyslexic children did not differ from controls. This suggests that children with dyslexia encode neither "noisy" nor "normal" representations of the speech signal, but different representations.

Local Temporal Regularities in Child-Directed Speech in Spanish

PURPOSE

The purpose of this study is to characterize the local (utterance-level) temporal regularities of child-directed speech (CDS) that might facilitate phonological development in Spanish, classically termed a syllable-timed language.

METHOD

Eighteen female adults addressed their 4-year-old children versus other adults spontaneously and also read aloud (CDS vs. adult-directed speech [ADS]). We compared CDS and ADS speech productions using a spectrotemporal model (Leong &amp; Goswami, 2015), obtaining three temporal metrics: (a) distribution of modulation energy, (b) temporal regularity of stressed syllables, and (c) syllable rate.

RESULTS

CDS was characterized by (a) significantly greater modulation energy in the lower frequencies (0.5-4 Hz), (b) more regular rhythmic occurrence of stressed syllables, and (c) a slower syllable rate than ADS, across both spontaneous and read conditions.

DISCUSSION

CDS is characterized by a robust local temporal organization (i.e., within utterances) with amplitude modulation bands aligning with delta and theta electrophysiological frequency bands, respectively, showing greater phase synchronization than in ADS, facilitating parsing of stress units and syllables. These temporal regularities, together with the slower rate of production of CDS, might support the automatic extraction of phonological units in speech and hence support the phonological development of children.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21210893.

Cortical Tracking of Sung Speech in Adults vs Infants: A Developmental Analysis

Here we duplicate a neural tracking paradigm, previously published with infants (aged 4 to 11 months), with adult participants, in order to explore potential developmental similarities and differences in entrainment. Adults listened and watched passively as nursery rhymes were sung or chanted in infant-directed speech. Whole-head EEG (128 channels) was recorded, and cortical tracking of the sung speech in the delta (0.5–4 Hz), theta (4–8 Hz) and alpha (8–12 Hz) frequency bands was computed using linear decoders (multivariate Temporal Response Function models, mTRFs). Phase-amplitude coupling (PAC) was also computed to assess whether delta and theta phases temporally organize higher-frequency amplitudes for adults in the same pattern as found in the infant brain. Similar to previous infant participants, the adults showed significant cortical tracking of the sung speech in both delta and theta bands. However, the frequencies associated with peaks in stimulus-induced spectral power (PSD) in the two populations were different. PAC was also different in the adults compared to the infants. PAC was stronger for theta- versus delta- driven coupling in adults but was equal for delta- versus theta-driven coupling in infants. Adults also showed a stimulus-induced increase in low alpha power that was absent in infants. This may suggest adult recruitment of other cognitive processes, possibly related to comprehension or attention. The comparative data suggest that while infant and adult brains utilize essentially the same cortical mechanisms to track linguistic input, the operation of and interplay between these mechanisms may change with age and language experience.

Neural sampling of the speech signal at different timescales by children with dyslexia

Phonological difficulties characterize individuals with dyslexia across languages. Currently debated is whether these difficulties arise from atypical neural sampling of (or entrainment to) auditory information in speech at slow rates (<10 Hz, related to speech rhythm), faster rates, or neither. MEG studies with adults suggest that atypical sampling in dyslexia affects faster modulations in the neurophysiological gamma band, related to phoneme-level representation. However, dyslexic adults have had years of reduced experience in converting graphemes to phonemes, which could itself cause atypical gamma-band activity. The present study was designed to identify specific linguistic timescales at which English children with dyslexia may show atypical entrainment. Adopting a developmental focus, we hypothesized that children with dyslexia would show atypical entrainment to the prosodic and syllable-level information that is exaggerated in infant-directed speech and carried primarily by amplitude modulations <10 Hz. MEG was recorded in a naturalistic story-listening paradigm. The modulation bands related to different types of linguistic information were derived directly from the speech materials, and lagged coherence at multiple temporal rates spanning 0.9-40 Hz was computed. Group differences in lagged speech-brain coherence between children with dyslexia and control children were most marked in neurophysiological bands corresponding to stress and syllable-level information (<5 Hz in our materials), and phoneme-level information (12-40 Hz). Functional connectivity analyses showed network differences between groups in both hemispheres, with dyslexic children showing significantly reduced global network efficiency. Global network efficiency correlated with dyslexic children's oral language development and with control children's reading development. These developmental data suggest that dyslexia is characterized by atypical neural sampling of auditory information at slower rates. They also throw new light on the nature of the gamma band temporal sampling differences reported in MEG dyslexia studies with adults.

Delta- and theta-band cortical tracking and phase-amplitude coupling to sung speech by infants

The amplitude envelope of speech carries crucial low-frequency acoustic information that assists linguistic decoding at multiple time scales. Neurophysiological signals are known to track the amplitude envelope of adult-directed speech (ADS), particularly in the theta-band. Acoustic analysis of infant-directed speech (IDS) has revealed significantly greater modulation energy than ADS in an amplitude-modulation (AM) band centred on ∼2 Hz. Accordingly, cortical tracking of IDS by delta-band neural signals may be key to language acquisition. Speech also contains acoustic information within its higher-frequency bands (beta, gamma). Adult EEG and MEG studies reveal an oscillatory hierarchy, whereby low-frequency (delta, theta) neural phase dynamics temporally organize the amplitude of high-frequency signals (phase amplitude coupling, PAC). Whilst consensus is growing around the role of PAC in the matured adult brain, its role in the development of speech processing is unexplored. Here, we examined the presence and maturation of low-frequency (<12 Hz) cortical speech tracking in infants by recording EEG longitudinally from 60 participants when aged 4-, 7- and 11- months as they listened to nursery rhymes. After establishing stimulus-related neural signals in delta and theta, cortical tracking at each age was assessed in the delta, theta and alpha [control] bands using a multivariate temporal response function (mTRF) method. Delta-beta, delta-gamma, theta-beta and theta-gamma phase-amplitude coupling (PAC) was also assessed. Significant delta and theta but not alpha tracking was found. Significant PAC was present at all ages, with both delta and theta -driven coupling observed.

Machine learning accurately classifies neural responses to rhythmic speech vs. non-speech from 8-week-old infant EEG

Currently there are no reliable means of identifying infants at-risk for later language disorders. Infant neural responses to rhythmic stimuli may offer a solution, as neural tracking of rhythm is atypical in children with developmental language disorders. However, infant brain recordings are noisy. As a first step to developing accurate neural biomarkers, we investigate whether infant brain responses to rhythmic stimuli can be classified reliably using EEG from 95 eight-week-old infants listening to natural stimuli (repeated syllables or drumbeats). Both Convolutional Neural Network (CNN) and Support Vector Machine (SVM) approaches were employed. Applied to one infant at a time, the CNN discriminated syllables from drumbeats with a mean AUC of 0.87, against two levels of noise. The SVM classified with AUC 0.95 and 0.86 respectively, showing reduced performance as noise increased. Our proof-of-concept modelling opens the way to the development of clinical biomarkers for language disorders related to rhythmic entrainment.

Speech Processing to Improve the Perception of Speech in Background Noise for Children With Auditory Processing Disorder and Typically Developing Peers

Auditory processing disorder (APD) may be diagnosed when a child has listening difficulties but has normal audiometric thresholds. For adults with normal hearing and with mild-to-moderate hearing impairment, an algorithm called spectral shaping with dynamic range compression (SSDRC) has been shown to increase the intelligibility of speech when background noise is added after the processing. Here, we assessed the effect of such processing using 8 children with APD and 10 age-matched control children. The loudness of the processed and unprocessed sentences was matched using a loudness model. The task was to repeat back sentences produced by a female speaker when presented with either speech-shaped noise (SSN) or a male competing speaker (CS) at two signal-to-background ratios (SBRs). Speech identification was significantly better with SSDRC processing than without, for both groups. The benefit of SSDRC processing was greater for the SSN than for the CS background. For the SSN, scores were similar for the two groups at both SBRs. For the CS, the APD group performed significantly more poorly than the control group. The overall improvement produced by SSDRC processing could be useful for enhancing communication in a classroom where the teacher's voice is broadcast using a wireless system.

MRI Evidence of Altered Callosal Sodium in Mild Traumatic Brain Injury

BACKGROUND AND PURPOSE

Mild traumatic brain injury is a leading cause of death and disability worldwide with 42 million cases reported annually, increasing the need to understand the underlying pathophysiology because this could help guide the development of targeted therapy. White matter, particularly the corpus callosum, is susceptible to injury. Animal models suggest stretch-induced mechanoporation of the axonal membrane resulting in ionic shifts and altered sodium ion distribution. The purpose of this study was to compare the distribution of total sodium concentration in the corpus callosum between patients with mild traumatic brain injury and controls using sodium (²³Na) MR imaging.

MATERIALS AND METHODS

Eleven patients with a history of mild traumatic brain injury and 10 age- and sex-matched controls underwent sodium (²³Na) MR imaging using a 3T scanner. Total sodium concentration was measured in the genu, body, and splenium of the corpus callosum with 5-mm ROIs; total sodium concentration of the genu-to-splenium ratio was calculated and compared between patients and controls.

RESULTS

Higher total sodium concentration in the genu (49.28 versus 43.29 mmol/L, P = .01) and lower total sodium concentration in the splenium (which was not statistically significant; 38.35 versus 44.06 mmol/L, P = .08) was seen in patients with mild traumatic brain injury compared with controls. The ratio of genu total sodium concentration to splenium total sodium concentration was also higher in patients with mild traumatic brain injury (1.3 versus 1.01, P = .001).

CONCLUSIONS

Complex differences are seen in callosal total sodium concentration in symptomatic patients with mild traumatic brain injury, supporting the notion of ionic dysfunction in the pathogenesis of mild traumatic brain injury. The total sodium concentration appears to be altered beyond the immediate postinjury phase, and further work is needed to understand the relationship to persistent symptoms and outcome.

The temporal modulation structure of illiterate versus literate adult speech

The temporal modulation structure of speech plays a key role in neural encoding of the speech signal. Amplitude modulations (AMs, quasi-rhythmic changes in signal energy or intensity) in speech are encoded by neuronal oscillations (rhythmic variations in neural excitability in large cell networks) that oscillate at matching temporal rates. To date, however, all neural studies have investigated adult-directed speech (ADS) as produced and perceived by highly literate adults. Whether temporal features of ADS vary with the skills of the speaker, for example literacy skills, is currently unknown. Here we analyse the temporal structure of ADS spoken by illiterate, low literate (≤ 4 years of literacy) and highly literate (≥ 12 years of literacy) adults. We find that illiterates produce speech differently. Spontaneous conversational speech produced by illiterate adults showed significantly less synchronised coupling between AM bands (less phase synchronisation) than conversational speech produced by low literate and highly literate adults, and contained significantly fewer syllables per second. There was also a significant relationship between years of literacy and the amount of theta-band energy in conversational speech. When asked to produce rhythmic proverbs learned in childhood, all groups could produce speech with similar AM phase synchronisation, suggesting that the differences in spontaneous conversational speech were not caused by physiological constraints. The data suggest that the temporal modulation structure of spoken language changes with the acquisition of cultural skills like literacy that are usually a product of schooling. There is a cultural effect on the temporal modulation structure of spoken language.

A cluster of five nuclear proteins regulates keratin gene transcription

A common feature of all epithelial cells is the presence of keratin proteins that assemble into an intermediate filament cytoskeletal network. Whereas other cell types often use a specific master transcription factor to coordinate cell type-specific transcription, analysis of transcriptional regulation of keratin genes suggests that specific groupings of widely expressed transcription factors, acting on clusters of recognition elements in the promoter regions, confer epithelia-specific transcription. We define such a cluster of three sites that binds five transcription factors in the human K5 keratin gene. Within this cluster, an unusual Sp1 site binds the Sp1 transcription factor and two additional proteins. Flanking the Sp1 site are an AP2 site and another sequence, Site A; each binds a transcription factor. Similar clusters of recognition sites for the same five transcription factors have been also identified in other keratin genes. Such clusters may play a role in epithelia-specific expression of keratins.

The role of phase synchronisation between low frequency amplitude modulations in child phonology and morphology speech tasks

Recent models of the neural encoding of speech suggest a core role for amplitude modulation (AM) structure, particularly regarding AM phase alignment. Accordingly, speech tasks that measure linguistic development in children may exhibit systematic properties regarding AM structure. Here, the acoustic structure of spoken items in child phonological and morphological tasks, phoneme deletion and plural elicitation, was investigated. The phase synchronisation index (PSI), reflecting the degree of phase alignment between pairs of AMs, was computed for 3 AM bands (delta, theta, beta/low gamma; 0.9-2.5 Hz, 2.5-12 Hz, 12-40 Hz, respectively), for five spectral bands covering 100-7250 Hz. For phoneme deletion, data from 94 child participants with and without dyslexia was used to relate AM structure to behavioural performance. Results revealed that a significant change in magnitude of the phase synchronisation index (ΔPSI) of slower AMs (delta-theta) systematically accompanied both phoneme deletion and plural elicitation. Further, children with dyslexia made more linguistic errors as the delta-theta ΔPSI increased. Accordingly, ΔPSI between slower temporal modulations in the speech signal systematically distinguished test items from accurate responses and predicted task performance. This may suggest that sensitivity to slower AM information in speech is a core aspect of phonological and morphological development.

A Re-examination of the Effect of Masker Phase Curvature on Non-simultaneous Masking

Forward masking of a sinusoidal signal is determined not only by the masker's power spectrum but also by its phase spectrum. Specifically, when the phase spectrum is such that the output of an auditory filter centred on the signal has a highly modulated ("peaked") envelope, there is less masking than when that envelope is flat. This finding has been attributed to non-linearities, such as compression, reducing the average neural response to maskers that produce more peaked auditory filter outputs (Carlyon and Datta, J Acoust Soc Am 101:3636-3647, 1997). Here we evaluate an alternative explanation proposed by Wotcjzak and Oxenham (Wojtczak and Oxenham, J Assoc Res Otolaryngol 10:595-607, 2009). They reported a masker phase effect for 6-kHz signals when the masker components were at least an octave below the signal frequency. Wotcjzak and Oxenham argued that this effect was inconsistent with cochlear compression, and, because it did not occur at lower signal frequencies, was also inconsistent with more central compression. It was instead attributed to activation of the efferent system reducing the response to the subsequent probe. Here, experiment 1 replicated their main findings. Experiment 2 showed that the phase effect on off-frequency forward masking is similar at signal frequencies of 2 and 6 kHz, provided that one equates the number of components likely to interact within an auditory filter centred on the signal, thereby roughly equating the effect of masker phase on the peakiness of that filter output. Experiment 3 showed that for some subjects, masker phase also had a strong influence on off-frequency backward masking of the signal, and that the size of this effect correlated across subjects with that observed in forward masking. We conclude that the masker phase effect is mediated mainly by cochlear non-linearities, with a possible additional effect of more central compression. The data are not consistent with a role for the efferent system.

Evaluation of near-end speech enhancement under equal-loudness constraint for listeners with normal-hearing and mild-to-moderate hearing loss

Four algorithms designed to enhance the intelligibility of speech when noise is added after processing were evaluated under the constraint that the speech should have the same loudness before and after processing, as determined using a loudness model. The algorithms applied spectral modifications and two of them included dynamic-range compression. On average, the methods with dynamic-range compression required the least level adjustment to equate loudness for the unprocessed and processed speech. Subjects with normal-hearing (experiment 1) and mild-to-moderate hearing loss (experiment 2) were tested using unmodified and enhanced speech presented in speech-shaped noise (SSN) and a competing speaker (CS). The results showed (a) the algorithms with dynamic-range compression yielded the largest intelligibility gains in both experiments and for both types of background; (b) the algorithms without dynamic-range compression either yielded benefit only with the SSN or yielded no consistent benefit; (c) speech reception thresholds for unprocessed speech were higher for hearing-impaired than for normal-hearing subjects, by about 2 dB for the SSN and 6 dB for the CS. It is concluded that the enhancement methods incorporating dynamic-range compression can improve intelligibility under the equal-loudness constraint for both normal-hearing and hearing-impaired subjects and for both steady and fluctuating backgrounds.

Incorporating HIV/hepatitis B virus/hepatitis C virus combined testing into routine blood tests in nine UK Emergency Departments: the "Going Viral" campaign

OBJECTIVES

Routine HIV screening is recommended in those UK hospitals and primary care settings where the HIV prevalence is > 0.2%. For hepatitis B virus (HBV) and hepatitis C virus (HCV), however, testing is targeted at at-risk groups. We investigated the prevalence of these blood-borne viruses (BBVs) during a routine testing pilot in UK Emergency Departments (EDs).

METHODS

During the "Going Viral" campaign (13-19 October 2014), nine UK EDs in areas of high HIV prevalence offered routine tests for HIV, HBV and HCV to adults having blood taken as part of routine care. Patients who tested positive were linked to care.

RESULTS

A total of 7807 patients had blood taken during their ED visit; of these, 2118 (27%) were tested for BBVs (range 9-65%). Seventy-one BBV tests were positive (3.4%) with 32 (45.1%) new diagnoses. There were 39 HCV infections (15 newly diagnosed), 17 HIV infections (six newly diagnosed), and 15 HBV infections (11 newly diagnosed). Those aged 25-54 years had the highest prevalence: 2.46% for HCV, 1.36% for HIV and 1.09% for HBV. Assuming the cost per diagnosis is £7, the cost per new case detected would be £988 for HCV, £1351 for HBV and £2478 for HIV.

CONCLUSIONS

In the first study in the UK to report prospectively on BBV prevalence in the ED, we identified a high number of new viral hepatitis diagnoses, especially hepatitis C, in addition to the HIV diagnoses. Testing for HIV alone would have missed 54 viral hepatitis diagnoses (26 new), supporting further evaluation of routine BBV testing in UK EDs.

Effectiveness of a loudness model for time-varying sounds in equating the loudness of sentences subjected to different forms of signal processing

A model for the loudness of time-varying sounds [Glasberg and Moore (2012). J. Audio. Eng. Soc. 50, 331-342] was assessed for its ability to predict the loudness of sentences that were processed to either decrease or increase their dynamic fluctuations. In a paired-comparison task, subjects compared the loudness of unprocessed and processed sentences that had been equalized in (1) root-mean square (RMS) level; (2) the peak long-term loudness predicted by the model; (3) the mean long-term loudness predicted by the model. Method 2 was most effective in equating the loudness of the original and processed sentences.

Lopinavir and atazanavir in pregnancy: comparable infant outcomes, virological efficacies and preterm delivery rates

OBJECTIVES

The aim of the study was to identify differences in infant outcomes, virological efficacy, and preterm delivery (PTD) outcome between women exposed to lopinavir/ritonavir (LPV/r) and those exposed to atazanavir/ritonavir (ATV/r).

METHODS

A retrospective case note review was carried out. The case notes of 493 women who conceived while on LPV/r or ATV/r or initiated LPV/r or ATV/r during pregnancy and who delivered between 1 September 2007 and 30 August 2012 were reviewed. Data collected included demographics, antiretroviral use, HIV markers, and pregnancy and infant outcomes. Infant outcomes, virological efficacies and PTD rates for LPV/r and ATV/r were compared.

RESULTS

A total of 306 women received LPV/r (82 conceiving while on the drug and 224 commencing it post-conception) and 187 received ATV/r (96 conceiving while on the drug and 91 commencing it post-conception). Comparing the two protease inhibitors (PIs), viral suppression rates were similar and, in women starting antiretroviral therapy (ART) post-conception, the median times to first undetectable HIV viral load were not significantly different (P = 0.64). PTD rates did not differ by therapy overall (ATV/r, 13%; LPV/r, 14%) or when considering the timing of first exposure (conceiving on ART, P = 0.81; commencing ART in pregnancy, P = 0.08). Poor fetal outcomes were very uncommon. There were two transmissions, giving a mother-to-child transmission (MTCT) rate of 0.4% (95% confidence interval 0.05-1.5%).

CONCLUSIONS

Both ART regimens were well tolerated and successful in preventing MTCT. No significant differences in tolerability or in pregnancy or infant outcomes were observed, which supports the provision of a choice of PI in pregnancy.

Current practice of periprocedural haematological management for patients undergoing image-guided procedures

OBJECTIVE

To evaluate current UK practice of periprocedural haematological management for image-guided procedures in relation to Cardiovascular and Interventional Radiological Society guidelines, which provide recommendations according to bleeding risk of procedures from Category 1 (lowest) to 3 (highest).

METHODS

Survey of practice in UK radiology departments conducted over a 1-year period

RESULTS

48 radiology departments responded. The percentage of departments that stop antithrombotics pre-procedurally are as follows (for Category 1, 2 and 3, respectively): aspirin (31.3%, 43.8%, 54.2%); clopidogrel (54.2%, 68.8%, 72.9%); therapeutic low-molecular-weight heparin (56.3%, 77.1%, 75.0%). The percentage of departments that perform pre-procedural laboratory testing are as follows (for Category 1, 2 and 3, respectively): international normalized ratio (INR; 81.3%, 95.8%, 93.8%); activated partial thrombin time ratio (APTTR; 60.4%, 75.0%, 93.8%); platelet (77.1%, 91.7%, 95.7%); haemoglobin (70.8%, 85.4%, 87.5%). Mean threshold (standard deviation) of laboratory results for conducting procedures (Level 1, 2 and 3, respectively) are as follows: INR [1.53 (0.197), 1.47 (0.186), 1.47 (0.188)]; APTTR [1.50 (0.392), 1.50 (0.339), 1.48 (0.344)]; platelet count (x10(3) cells per microlitre) [74.4 (28.7), 79.9 (29.1), 80.5 (29.3)]; haemoglobin (grams per decilitre) [9.05 (1.40), 9.00 (1.33), 8.92 (1.21)]. No department practices conformed to current recommendations for (1) pre-procedural cessation of antithrombotics and (2) pre-procedural laboratory testing. Two (4.2%) department practices conformed to recommendations for thresholds of haematological parameters.

CONCLUSION

Current peri-procedural haematological management is variable and often does not conform to existing recommendations. Further research into the impact of this variation in practice on patient outcome is required.

ADVANCES IN KNOWLEDGE

This study demonstrates wide variation in practice in haematological management for image-guided procedures.

Isocitrate dehydrogenase mutations in diffuse gliomas: clinical and aetiological implications

The discovery of isocitrate dehydrogenase (IDH) mutations in gliomas is one example of the large impact that next-generation sequencing is having on the understanding of tumour biology and human disease in general. IDH mutations are early and common events in the development of astrocytomas, oligodendrogliomas and oligoastrocytomas. IDH mutations are also found in some myeloid malignancies and soft tissue tumours, but are rare in other malignancies. IDH mutation detection can be incorporated into routine pathology practice via immunohistochemistry and/or standard sequencing techniques and has great diagnostic value. An emerging theme is that IDH mutation status in gliomas is of great prognostic relevance, and there are proposals to include IDH mutation status in the next iteration of the WHO classification of gliomas. The mechanisms of action(s) of mutant IDH are not fully understood, but the understanding is progressing rapidly, and may provide a mechanism to link diverse proneoplastic processes such as oxidative damage and epigenetic dysregulation. There are exciting prospects of novel therapies for glioma patients emerging from the elucidation of these mechanisms. Given the diagnostic and prognostic implications of IDH mutation, and the potential for new therapies, all gliomas should be assessed for IDH mutation status in the future.

In vitro friction and lubrication of large bearing hip prostheses

New material combinations and designs of artificial hip implants are being introduced in an effort to improve proprioception and functional longevity. Larger joints in particular are being developed to improve joint stability, and it is thought that these larger implants will be more satisfactory for younger and more physically active patients. The study detailed here used a hip friction simulator to assess the friction and lubrication properties of large-diameter hip bearings of metal-on-metal and ceramic-on-reinforced-polymer couplings. Joints of different diameters were evaluated to determine what effect, if any, bearing diameter had on lubrication. In addition, the effects of lubricant type are considered, using carboxymethyl cellulose and bovine calf serum, and the physiological lubricant is shown to be considerably more effective at reducing friction. The frictional studies showed that the metal-on-metal joints worked under a mixed lubrication regime, producing similar friction factor values to each other. The addition of bovine calf serum (BCS) reduced the friction. The ceramic-on-reinforced-polymer samples were shown to operate with high friction factors and mixed lubrication. When tested with BCS, the larger-diameter bearings showed a decrease in friction compared with the smaller-size bearings, and the addition of BCS resulted in an increase in friction, unlike the metal-on-metal system. The study demonstrated that the component's diameter had little or no influence on the lubrication and friction of the large bearing combinations tested.