Effect of prepartum dietary energy sources on productive and reproductive performance in Nili Ravi buffaloes

Feeding of dietary energy sources has been extensively studied in dairy cows but not well described in dairy buffaloes. The objective of this study was to evaluate the effect of prepartum dietary energy sources on productive and reproductive performance in Nili Ravi buffaloes (n = 21). The buffaloes were offered isocaloric (1.55 Mcal/kg DM NE_L (net energy for lactation)) glucogenic (GD), lipogenic (LD), and mixed diet (MD) during 63 days prepartum and maintained (1.27 Mcal/kg DM NE_L) at lactation diet (LCD) during 14 weeks postpartum. Effects of dietary energy sources and week on animals were analyzed with the mixed model. The DMI, BCS, and body weights remained similar during the pre- and postpartum periods. The prepartum diets did not affect birth weight, blood metabolites, milk yield, and composition. The GD tended to early uterine involution, more follicle numbers, and early follicle formation. The prepartum feeding of dietary energy source had a similar effect on first estrus expression, days open, conception rate, pregnancy rate, and calving interval. So, it could be concluded that prepartum feeding of an isocaloric dietary energy source had a similar effect on the performance of buffaloes.

Feeding behavior in relation to ovarian cyclicity in cows with no or a short dry period

The objective of this study was to investigate relations between feeding behavior (FB) variables focusing on intake of the basal ration during 3 wk prepartum until 3 wk postpartum, and postpartum onset of luteal activity (OLA) in dairy cows subjected to no (0-d) or a short (30-d) dry period (DP). Feeding behavior of the basal ration intake (concentrate intake excluded) was continuously recorded by computerized feeders for 123 dairy cows and analyzed from 3 wk prepartum to 3 wk postpartum. Cows were subjected to a DP length: 0-d DP (n = 81), or 30-d DP (n = 42). Milk progesterone concentration was determined 3 times per week until 100 DIM to determine OLA, which was classified as early OLA (<21 DIM) and late OLA (≥21 DIM). Relations between FB and OLA class were analyzed using mixed models. During 3 wk prepartum, FB differed between parity class (parity 2 or ≥3 after calving). Cows with a 30-d DP prepartum, regardless of their OLA class, had more visits per meal, higher meal duration, total meal time, total daily feeding time, and lower feed intake and feeding rate compared with cows with 0-d DP. During the first 2 d postpartum, cows with OLA <21 had more visits per day and visits per meal compared with cows with OLA ≥21. During the first 3 wk postpartum, cows within the 30-d DP group with OLA <21 had greater meal size, feed intake, and feeding rate compared with cows with OLA ≥21 of this group. Cows within the 0-d DP group with OLA <21 had higher meal duration, total daily meal time, total daily feeding time, and meal size, but a lower feeding rate compared with cows with OLA ≥21 of this group. Concluding from the current study, cows with OLA <21 had a postpartum FB that reflected a cow with faster recovery from parturition and better adaptation to onset of lactation compared with OLA ≥21. No or a short DP affected prepartum FB, suggesting that prepartum management affects FB. This study provides evidence of different FB between cows with different timing of resumption of ovarian cyclicity.

Microdosimetric investigation for multi-ion therapy by means of silicon on insulator (SOI) microdosimeter

[Objective] Ion radiotherapy with protons or carbon ions is one of the most advanced clinical methods for cancer treatment. To further improve the local tumor control, ion radiotherapy using multiple ion species has been investigated. Due to complexity of dose distributions delivered by multi-ion therapy in a tumor, a validation strategy for the planned treatment efficacy must be established that can be potentially used in the quality assurance (QA) protocol for the multi-ion treatment plans. In previous work, we demonstrated that the microdosimetric approach using the silicon on insulator (SOI) microdosimeter is practical for validating cell surviving fraction of MIA PaCa-2 cells in the independent fields of helium, carbon, oxygen, and neon ion beams. [Approach] This paper extends the previous study, and we demonstrate a microdosimetry based approach as a pilot study to build the QA protocol in the multi-ion therapy predicting the cell surviving fraction along the SOBP obtained by combined irradiations of He+O and C+Ne ions. Across the study, the SOI microdosimeter system MicroPlus was used for measurement of the lineal energy in individual ion fields followed by deriving the lineal energy of combined ion fields delivered by a pencil beam scanning system at HIMAC. [Main results] The predicted cell surviving fraction based on derived lineal energy and dose in the combined fields was in good agreement with the planned cell surviving fraction byour in-house treatment planning system (TPS) [Significance] The presented results indicated the potential benefit of the SOI microdosimeter system MicroPlus as the QA system in the multi-ion radiotherapy.

The impact of the COVID-19 pandemic and behavioral restrictions on electricity consumption and the daily demand curve in Turkey

The rapid spread of COVID-19 has severely impacted many sectors, including the electricity sector. The reliability of the electricity sector is critical to the economy, health, and welfare of society; therefore, supply and demand need to be balanced in real-time, and the impact of unexpected factors should be analyzed. During the pandemic, behavioral restrictions such as lockdowns, closure of factories, schools, and shopping malls, and changing habits, such as shifted work and leisure hours at home, significantly affected the demand structure. In this research, the restrictions and their corresponding timing are classified and mapped with the Turkish electricity demand data to analyze the estimated impact of the restrictions on total demand and daily demand profile. A modulated Fourier Series Expansion evaluates deviations from normal conditions in the aggregate demand and the daily consumption profile. The aggregate demand shows a significant decrease in the early phase of the pandemic, during the period March-June 2020. The shape of the daily demand curve is analyzed to estimate how much demand shifted from daytime to night-time. A population-based restriction index is proposed to analyze the relationship between the strength and coverage of the restrictions and the total demand. The persistency of the changes in the daily demand curve in the post-contingency period is analyzed. These findings imply that new scheduling approaches for daily and weekly loads are required to avoid supply-demand mismatches in the future. The long-term policy implications for the energy transition and lessons learned from the COVID-19 pandemic experience are also presented.

Short communication: Variance and autocorrelation of deviations in daily milk yield are related with clinical mastitis in dairy cows

Daily milk production, and fluctuations therein, can provide information on health and resilience of dairy cows. We studied variance and autocorrelation of deviations in daily milk yield in relation to the occurrence of clinical mastitis (no, early or later in lactation). Individual lactation curves were fitted to 305-d lactations of 414 dairy cows using quantile regression. Log-transformed variance (lnVar) and autocorrelation of the quantile residuals of daily milk yield (predicted - observed) were evaluated for intervals until 30 and until 305 days in milk (DIM). Cows were classified as having no mastitis (n = 249), early mastitis that first occurred before 30 DIM (n = 29); or later mastitis (n = 136). Subsequently, linear models were used to assess effects of mastitis and parity class (primiparous or multiparous) on lnVar and autocorrelations; and logistic regression analyses were performed to predict mastitis from lnVar or autocorrelation and parity. From 10 to 30 DIM, lnVar was greater for cows with early mastitis than for cows with no or late mastitis, and autocorrelation tended to be lower for cows with early mastitis than for cows with no mastitis. The lnVar and autocorrelation from 10 to 30 DIM were not predictive of late mastitis. From 10 to 305 DIM, lnVar was greater and autocorrelation was lower for both cows with early and late mastitis than for cows with no mastitis; and both were predictive of having mastitis in the 305-d lactation. Primiparous cows had lower lnVar than multiparous cows. In cows without mastitis, autocorrelation values were positively correlated with lnVar. Results confirm that increased lnVar is associated with clinical mastitis.

In-field and out-of-field microdosimetric characterisation of a 62 MeV proton beam at CATANA

PURPOSE

A 5 and 10 μm thin silicon on insulator (SOI) 3D mushroom microdosimeter was used to characterize both the in-field and out-of-field of a 62 MeV proton beam.

METHODS

The SOI mushroom microdosimeter consisted of an array of cylindrical sensitive volumes (SVs), developed by the Centre for Medical Radiation Physics, University of Wollongong, was irradiated with 62 MeV protons at the CATANA (Centro di AdroTerapia Applicazioni Nucleari Avanzate) facility in Catania, Italy, a facility dedicated to the radiation treatment of ocular melanomas. Dose mean lineal energy, ( y D ¯ ), values were obtained at various depths in PMMA along a pristine and spread out Bragg peak (SOBP). The measured microdosimetric spectra at each position were then used as inputs into the modified Microdosimetric Kinetic Model (MKM) to derive the RBE for absorbed dose in a middle of the SOBP 2Gy (RBE_D ). Microdosimetric spectra were obtained with both the 5 and 10 μm 3D SOI microdosimeters, with a focus on the distal part of the BP. The in-field and out-of-field measurement configurations along the Bragg curve were modeled in Geant4 for comparison with experimental results. Lateral out-of-field measurements were performed to study secondary particles' contribution to normal tissue's dose, up to 12 mm from the edge of the beam field, and quality factor and dose equivalent results were obtained.

RESULTS

Comparison between experimental and simulation results showed good agreement between one another for both the pristine and SOBP beams in terms of y D ¯ and RBED. Though a small discrepancy between experiment and simulation was seen at the entrance of the Bragg curve, where experimental results were slightly lower than Geant4. The dose equivalent value measured 12 mm from the edge of the target volume was 1.27 ± 0.15 mSv/Gy with a Q ¯ value of 2.52 ± 0.30, both of which agree within uncertainty with Geant4 simulation.

CONCLUSIONS

These results demonstrate that SOI microdosimeters are an effective tool to predict RBED in-field as well as dose equivalent monitoring out-of-field to provide insight to probability of second cancer generation.

Effects of extended voluntary waiting period from calving until first insemination on body condition, milk yield, and lactation persistency

A 1-yr calving interval (CInt) is usually associated with maximized milk output, due to the calving-related peak in milk yield. Extending CInt could benefit cow health and production efficiency due to fewer transition periods per unit of time. Extending CInt can affect lactation performance by fewer days dry per year, delayed pregnancy effect on milk yield, and greater milk solid yield in late lactation. This study first investigated the effects of 3 different voluntary waiting periods (VWP) from calving until first insemination on body weight, body condition, milk yield, and lactation persistency. Second, individual cow characteristics in early lactation were identified that contributed to milk yield and persistency of cows with different VWP. Holstein-Friesian dairy cows (n = 154) within 1 herd were blocked for parity, calving season, and expected milk yield. Cows were randomly assigned within the blocks to 1 of 3 VWP (50, 125, or 200 d: VWP50, VWP125, or VWP200, respectively) and monitored through 1 complete lactation and the first 6 wk of the subsequent lactation, or until culling. Minimum and mean CInt (384 vs. 452 vs. 501 d for VWP50 vs. VWP125 vs. VWP200) increased with increasing VWP, but maximum CInt was equal for the 3 VWP. Fat- and protein-corrected milk yield (FPCM) was analyzed weekly. Milk yield and FPCM were also expressed per day of CInt, to compare yields of cows with different VWP. Persistency was determined between d 100 and d 200 of the lactation, as well as between d 100 and dry-off. Values are presented as least squares means ± standard error of the mean. During the first 44 wk of lactation, VWP did not affect FPCM yield in both primiparous and multiparous cows. The VWP did not affect milk yield per day of CInt. The VWP did not affect FPCM yield per day of calving interval for primiparous cows. Multiparous cows in VWP125 had FPCM yield per day of CInt similar to that of VWP50. Multiparous cows in VWP200 had lower FPCM yield per day of CInt compared with VWP50 (27.2 vs. 30.4 kg/d). During the last 6 wk before dry-off, cows in VWP125 had lower yield compared with cows in VWP50, which could benefit their udder health in the dry period and after calving. Persistency was better for cows in VWP200 compared with cows in VWP50 (-0.05 vs. -0.07 kg/d). Body weight was not different among VWP groups. Multiparous cows in VWP200 had a higher body condition score in the last 3 mo before dry-off and the first 6 wk of the next lactation, compared with multiparous cows in VWP125 and VWP50. The VWP could be extended from 50 d to 125 d without an effect on daily yield per day of calving interval. Extending VWP until 200 d for primiparous cows did not affect their daily milk yield, but multiparous cows with a 200-d VWP had a reduced milk yield per day of calving interval and an increased body condition in late lactation and the subsequent lactation, compared with multiparous cows with a 50-d VWP.

Evaluation of customized dry-period strategies in dairy cows

Shortening or omitting the dry period to improve the energy balance in early lactation have the trade-offs of reduction in milk production and loss of opportunity for dry-cow therapy (DCT; i.e., intramammary antibiotic use at dry-off). Customized dry-period strategies (i.e., deciding upon DCT and dry-period length per cow) could mitigate negative effects of short or no dry periods on milk production and udder health and simultaneously retain benefits from improved energy balance and fertility. In this study, we evaluated 3 decision trees to customize dry-period strategies for individual cows. In the control tree (CT), all cows had a 60-d dry period, with DCT if somatic cell count (SCC) was >150,000 cells/mL before dry-off. In decision tree 1 (T1), parity 1 and parity >1 cows were assigned DCT if SCC was ≥150,000 cells/mL and SCC ≥50,000 cells/mL, respectively; whereas in decision tree 2 (T2), the threshold for DCT was SCC ≥200,000 cells/mL for all animals. In T1 and T2, cows with DCT were assigned a 60-d dry period, whereas cows without DCT were assigned a 30-d or 0-d dry period if their milk production remained >12 kg/d at 67 and 37 d before calving, respectively. Cows were monitored from 8 wk before to 14 wk after calving. Milk production and composition, SCC, body condition score, body weight, and occurrence of treatment for disease (related to calving and start of lactation) were compared between CT (n = 61 cows), T1 (n = 59 cows), and T2 (n = 63 cows). Effects of decision trees (CT, T1, T2) and of dry-period strategies (60-d dry with or without antibiotics, 30-d dry, or 0-d dry) on measured variables were analyzed separately with mixed models, effects on udder-health status with a logistic regression, and occurrence of treatment for diseases with a Pearson chi-squared test. In T1, 36% of cows qualified for 30-d and 2% for 0-d dry periods, whereas in T2 this was 51% and 30% for 30-d and 0-d dry periods, respectively. Compared with CT, cows in T1 and T2 on average produced more milk in the 8 wk before calving (0.2 vs. 3.9 vs. 7.1 kg/d in CT vs. T1 vs. T2), and less in the 14 wk after calving (40.0 vs. 37.0 vs. 35.2 kg/d in CT vs. T1 vs. T2). There was no difference in udder-health status in the transition period among decision trees. In the first 14 wk after calving, recovery of body weight was greater for T2 than CT and T1. Overall, 30-d and 0-d dry periods reduced milk revenues, but this might be financially compensated by improved cow health with customized dry-period strategies.

Fertility and milk production on commercial dairy farms with customized lactation lengths

Drying-off, calving, and start of lactation are critical transition events for a dairy cow. As a consequence, most animal health issues occur during these periods. By extending the voluntary waiting period for first insemination after calving, calving interval (CInt) can be extended, with possible positive effects for fertility and health. Some cows might be better suited for an extended CInt than others, due to differences in milk yield level, lactation persistency, or health status, which would justify a customized CInt based on individual cow characteristics. This study aims to investigate 13 farms with customized CInt, with respect to calving to first service interval (CFSI), accomplished CInt, services per conception (SC), conception rate at first artificial insemination (CR1AI), peak yield, lactation persistency, 305-d yield, and effective lactation yield. In total, 4,858 complete lactations of Holstein Friesian cows between 2014 and 2019 from the 13 farms were grouped by parity (1 or 2+) and CFSI (CFSI class; CFSI-1 < 84; 84 ≤ CFSI-2 < 140; 140 ≤ CFSI-3 < 196; 196 ≤ CFSI-4 < 252, CFSI-5 ≥ 252 d) or CInt (CInt class; CInt-1 < 364; 364 ≤ CInt-2 < 420; 420 ≤ CInt-3 < 476; 476 ≤ CInt-4 < 532, CInt-5 ≥ 532 d). Cow inseminations, available for 11 out of 13 farms (3,597 complete lactations), were grouped by parity (1 and 2+) and CFSI class or CInt class. The fertility and milk production characteristics were analyzed with generalized and general linear mixed models. The CFSI class was not associated with SC, but extended CInt class was associated with increased SC (CInt-1-5; 1.11-3.70 SC). More than 50% of cows in the CFSI class <84 d ended up in longer than expected CInt (>364 d), showing that these cows were not able to conceive for the desired CInt. More than 50% of cows in CInt classes 3 and higher (CInt ≥ 420 d) had an earlier first insemination before successful insemination (CFSI class 1; <196 d), showing that these extended CInt classes consisted of both cows with an extended waiting period for first insemination and cows that failed to conceive at earlier insemination(s). On most farms, lactation persistency was greatest in CInt class 1 (<364 d), probably related to the low peak yield in this class. When this shortest CInt class was excluded, persistency increased with extended CInt classes on most farms. Although at the majority of farms 305-d yield was greater in CInt ≥ 532 d, effective lactation yield at most farms was greatest in CInt from 364 to 531 d, especially for multiparous cows. Based on the results of this study, a CInt between 364 and 531 days seems most optimal for milk production, when high-yielding cows were selected.

Treatment and Outcome of Patients with Uterine Carcinosarcoma in a Comprehensive Cancer Network

Aim

To determine clinical characteristics, treatment modalities and survival of uterine carcinosarcoma (UCS).

Methods

Data on treatment of UCS patients in the Comprehensive Cancer Network south region in the Netherlands between 2004 and 2014 were retrospectively evaluated.

Results

Data of 62 patients with UCS were retrieved. Mean age at diagnosis was 69.2 years (45–95 years). Data of six patients were excluded because they did not receive any treatment. Of the 56 patients included in this study, 57.1% presented with early-stage (FIGO I–II) disease and 42.9% with late-stage (FIGO III–IV) disease. 46.9% of the patients with FIGO early-stage disease received only surgical treatment, whereas 9.4% received adjuvant chemotherapy and 43.8% received adjuvant radiotherapy. Median DFS in patients with early-stage disease was 47.0 months (17.5–72.0). Adjuvant therapy did not seem to alter prognosis (p = 0.261). 16.7% of the patients with late-stage disease received only surgical treatment, 12.5% received only chemotherapy, whereas 50% received adjuvant chemotherapy and 20.8% adjuvant radiotherapy after surgery. Median DFS in late-stage disease was 8.5 months (2.5–23.5). Adjuvant therapy did not seem to alter prognosis (p = 0.30).

Conclusion

UCS with both FIGO stages I–II and III–IV has a dismal prognosis. The addition of adjuvant treatment did not seem to increase survival.

Validation of linear energy transfer computed in a Monte Carlo dose engine of a commercial treatment planning system

The relative biological effectiveness (RBE) of protons is highly variable and difficult to quantify. However, RBE is related to the local ionization density, which can be related to the physical measurable dose weighted linear energy transfer (LET_D). The aim of this study was to validate the LET_D calculations for proton therapy beams implemented in a commercially available treatment planning system (TPS) using microdosimetry measurements and independent LET_D calculations (Open-MCsquare (MCS)). The TPS (RayStation v6R) was used to generate treatment plans on the CIRS-731-HN anthropomorphic phantom for three anatomical sites (brain, nasopharynx, neck) for a spherical target (Ø  =  5 cm) with uniform target dose to calculate the LET_D distribution. Measurements were performed at the University Medical Center Groningen proton therapy center (Proteus Plus, IBA) using a µ ⁺-probe utilizing silicon on insulator microdosimeters capable of detecting lineal energies as low as 0.15 keV µm^-1 in tissue. Dose averaged mean lineal energy [Formula: see text] depth-profiles were measured for 70 and 130 MeV spots in water and for the three treatment plans in water and an anthropomorphic phantom. The [Formula: see text] measurements were compared to the LET_D calculated in the TPS and MCS independent dose calculation engine. D · [Formula: see text] was compared to D · LET_D in terms of a gamma-index with a distance-to-agreement criteria of 2 mm and increasing dose difference criteria to determine the criteria for which a 90% pass rate was accomplished. Measurements of D · [Formula: see text] were in good agreement with the D · LET_D calculated in the TPS and MCS. The 90% passing rate threshold was reached at different D · LET_D difference criteria for single spots (TPS: 1% MCS: 1%), treatment plans in water (TPS: 3% MCS: 6%) and treatment plans in an anthropomorphic phantom (TPS: 6% MCS: 1%). We conclude that D · LET_D calculations accuracy in the RayStation TPS and open MCSquare are within 6%, and sufficient for clinical D · LET_D evaluation and optimization. These findings remove an important obstacle in the road towards clinical implementation of D · LET_D evaluation and optimization of proton therapy treatment plans. Novelty and significance The dose weighed linear energy transfer (LET_D) distribution can be calculated for proton therapy treatment plans by Monte Carlo dose engines. The relative biological effectiveness (RBE) of protons is known to vary with the LET_D distribution. Therefore, there exists a need for accurate calculation of clinical LET_D distributions. Previous LET_D validations have focused on general purpose Monte Carlo dose engines which are typically not used clinically. We present the first validation of mean lineal energy [Formula: see text] measurements of the LET_D against calculations by the Monte Carlo dose engines of the Raystation treatment planning system and open MCSquare.

New research criteria for the diagnosis of Alzheimer's disease applied in a memory clinic population

BACKGROUND

In the newly proposed research criteria for Alzheimer's disease (AD), patients are defined as having memory dysfunction in addition to either hippocampal atrophy or an abnormal cerebrospinal fluid (CSF) profile. This study applies the criteria in a memory clinic population, using clinical criteria as the reference criterion.

METHODS

138 AD patients, 145 nondemented subjects, 78 patients with other dementias and 91 patients with mild cognitive impairment (MCI) were included. Dichotomized medial temporal lobe atrophy (MTA) score on MRI and dichotomized CSF profiles (based on beta-amyloid1-42, tau and phosphorylated tau at threonine 181 levels) were used in combination with an episodic memory test to assess sensitivity, specificity and likelihood ratios (LR) of the newly proposed criteria and their components separately.

RESULTS

We found specificities of 95 and 49% for comparison with nondemented subjects and other demented patients, respectively, with a sensitivity of 86% for AD. Specificity was highest (100 and 77%, respectively, LR+ = 48) when both MTA score and CSF profile were abnormal in addition to the episodic memory test, at the cost of a low sensitivity (48%).

CONCLUSION

The newly proposed research criteria for AD yield a good specificity for comparison with nondemented subjects. When the type of dementia is clinically doubted, however, at least two supportive features should be considered (i.e. abnormal MTA score and CSF profile) in addition to memory impairment as core diagnostic criterion.

Never injected, but hepatitis C virus-infected: a study among self-declared never-injecting drug users from the Amsterdam Cohort Studies

The aim of this study was to gain insight in transmission routes of hepatitis C virus (HCV) infection among never-injecting drug users (DU) by studying, incidence, prevalence, determinants and molecular epidemiology of HCV infection. From the Amsterdam Cohort Studies among DU, 352 never-injecting DU were longitudinally tested for HCV antibodies. Logistic regression was used to identify factors associated with antibody prevalence. Part of HCV NS5B was sequenced to determine HCV genotype and for phylogenetic analyses, in which sequences were compared with those from injecting DU. HCV antibody prevalence was 6.3% and HCV incidence was 0.49/1000 PY. HIV-positive status, female sex and starting injection drug use during follow-up (a putative marker of past injection drug use), were independently associated with HCV prevalence. The main genotypes found were genotype 3a (50%) and 1a (30%). Phylogenetic analysis revealed that HCV strains in never-injecting DU did not cluster together and did not differ from HCV strains circulating in injecting DU. We found a higher HCV prevalence in never-injecting DU than in the general population. Phylogenetic analysis shows a strong link with the injecting DU population. The increased risk could be related to underreporting of injecting drug use or to household or sexual transmission from injectors to noninjectors. Our findings stress the need for HCV testing of DU who report never injecting, especially given the potential to treat HCV infection effectively.

Interferon-beta bioactivity measurement in multiple sclerosis: feasibility for routine clinical practice

BACKGROUND

Neutralising antibodies (NAb) to interferon beta (IFN beta) are associated with a reduced bioactivity and efficacy of IFN beta in multiple sclerosis (MS). Unclear is how to apply IFN beta bioactivity measurements (quantification of Myxovirus resistance protein A (MxA) mRNA) in clinical practice.

OBJECTIVES

To evaluate value and feasibility of IFN beta bioactivity measurement with a single MxA mRNA measurement for screening and a second measurement before and after IFN beta administration for definite confirmation of IFN beta bioactivity status.

METHODS

In 79 MS patients MxA mRNA expression was determined 4 hours after IFN beta administration. If inadequate, MxA mRNA expression testing was repeated 3 months afterwards, comparing post- and pre injection samples to determine whether IFNb bioactivity was persistently lacking. MxA mRNA expression was compared to NA beta titres, determined by the cytopathic effect assay (CPE).

RESULTS

NAb titres correlated significantly with MxA mRNA expression and MxA mRNA induction. Of all screened patients, only one patient had adequate MxA mRNA expression and high NAb titres simultaneously. Of the biological non-responders at second measurement (21/55), 17 (81%) were high-titre NAb positive, 1 (5%) was low-titre NAb positive and 3 (14%) were NAb negative. Without considering the pre-injection measurement, two more NAb negative patients would have tested negative for IFN beta bioactivity, emphasizing the need of a pre-injection sample.

CONCLUSIONS

Our data suggest that for IFN beta bioactivity screening a single post-injection measurement seems reasonable. However, MxA induction measurement based on both pre- and post-IFN beta injection samples at second measurement is somewhat more precise in determining ultimate IFN beta bioactivity status.

Antibiotic treatment is associated with reduced risk of a subsequent exacerbation in obstructive lung disease: an historical population based cohort study

OBJECTIVES

The risk of a subsequent exacerbation after treatment of an exacerbation with oral corticosteroids without (OS) or with (OSA) antibiotics was evaluated in a historical population based cohort study comprising patients using maintenance medication for obstructive lung disease.

METHODS

The Pharmo database includes drug dispensing records of more than 2 million subjects in The Netherlands. Eligible were patients >or=50 years who in 2003 were dispensed >or=2 prescriptions of daily used inhaled beta(2) agonists, anticholinergics and/or corticosteroids, and experienced at least one exacerbation before 1 January 2006. Exacerbation was defined as a prescription of OS or OSA. The times to the second and third exacerbations were compared using Kaplan-Meier survival analysis. Independent determinants of new exacerbations were identified using multivariable Cox recurrent event survival analysis.

RESULTS

Of 49,599 patients using maintenance medication, 18 928 had at least one exacerbation; in 52%, antibiotics had been added. The OS and OSA groups were comparable for potential confounding factors. Median time to the second exacerbation was 321 days in the OS group and 418 days in the OSA group (p<0.001); and between the second and third exacerbation 127 vs 240 days (p<0.001). The protective effect of OSA was most pronounced during the first 3 months following treatment (hazard ratio (HR) 0.62; 99% CI 0.60 to 0.65). In the OSA group, mortality during follow-up was lower (HR 0.82; 99% CI 0.66 to 0.98).

CONCLUSION

Treatment with antibiotics in addition to oral corticosteroids was associated with a longer time to the next exacerbation, and a decreased risk of developing a new exacerbation.

[Hepatitis C in the Netherlands: sparse data on the current prevalence and the necessity for epidemiological studies and innovative methods for detecting infected individuals]

Hepatitis C is a blood-borne virus infection with an estimated 180 million infected individuals worldwide. Hepatitis C virus (HCV) infection may lead to liver failure and cancer of the liver. In 2004, in view of the improved treatment options, the Dutch Health Council again recommended that the groups at risk of HCV infection should be tracked down and informed, and that epidemiological studies should be conducted. Currently, there are few data on the prevalence of HCV infection in the Netherlands. HCV risk groups are (former) injecting drug users, haemodialysis patients and haemophiliacs, people treated with blood or blood products before 1992, people who have undergone certain invasive or medical procedures with insufficiently sterilised instruments, household contacts and partners of HCV-infected individuals and children born to HCV-infected mothers. Insight into the epidemiology of HCV infection in the Netherlands is necessary so that reliable estimates of the magnitude of hepatitis C as a public health problem can be made. Several projects for the detection of HCV infected individuals and epidemiological studies have started in 2007.

Longitudinal changes of CSF biomarkers in memory clinic patients

OBJECTIVE

In Alzheimer disease (AD), longitudinal changes of beta-amyloid(1-42) (Abeta(1-42)), tau, and phosphorylated tau at threonine 181 (ptau-181) in CSF have been reported in small studies only. We evaluated the natural course of CSF biomarkers in patients with AD, subjective complaints, and mild cognitive impairment (MCI).

METHODS

One hundred five patients (50 AD, 38 MCI, 17 subjective complaints) underwent two lumbar punctures, with a mean interval of 21 +/- 9 months. CSF levels of Abeta(1-42), tau, and ptau-181 were measured.

RESULTS

CSF Abeta(1-42) and tau levels showed main effects for both diagnosis and time (all p < 0.05), with average increases of 47 +/- 72 and 49 +/- 143 pg/mL. The interaction terms were not significant, which implies a similar time effect for all diagnostic groups. CSF ptau-181 levels showed a main effect for diagnosis (p = 0.01) but not for time (p = 0.27, increase of 1.0 +/- 12 pg/mL).

CONCLUSION

Levels of CSF beta-amyloid(1-42) and tau but not phosphorylated tau at threonine 181 increased over time in this memory clinic patient cohort with comparable change in all diagnostic groups. The cross-sectional difference between diagnostic groups, however, exceeded by far the longitudinal changes within individuals, suggesting that these biomarkers are not sensitive as markers of disease progression.

fMRI evidence for both generalized and specialized components of attentional control

A central question in the study of selective attention is whether top-down attentional control mechanisms are generalized or specialized for the type of information that is to be attended. The current study examined this question using a voluntary orienting task that cued observers to attend to either one of two locations or to one of two colors. Location (spatial) and color (nonspatial) conditions were presented either randomly intermixed within the same block of trials or in separate blocks. Functional magnetic resonance imaging revealed that directing attention to a location or to a color activated a network of overlapping dorsal frontal and parietal areas, previously implicated in attentional control. The pattern of observed overlap was not affected by the intermixed versus blocked presentation of location and color conditions. Although portions of the frontal-parietal network were more active in response to location cues than to color cues, a secondary analysis also revealed that medial dorsal frontal and parietal cortex were specifically engaged in shifting visual attention regardless of the cued dimension (location or color). Together, the present results support the conclusion that attentional control is the combination of a generalized network that works in concert with subregions of the frontoparietal network that are highly specialized for directing attention based on the content of the to-be-attended information.

Brain regions activated by endogenous preparatory set shifting as revealed by fMRI

An ongoing controversy concerns whether executive control mechanisms can actively reconfigure the cognitive system in preparation for switching to a new task set. To address this question, we recorded brain activity from 14 healthy participants, using event-related functional magnetic resonance imaging, while they performed a cued attention task. Critically, in any particular trial, the cued task set was either the same as that in the previous trial or switched. As was hypothesized, cue-related, switch-specific preparatory activity was observed in a network of dorsal frontal and parietal brain areas that are typically associated with cognitive control processes. Moreover, the magnitude of switch-specific preparatory activity varied with the number of possible task sets that could be presented in a given trial block. These findings provide compelling support for the existence of top-down, preparatory control processes that enable set switching. Furthermore, they demonstrate that global task structure is a critical determinant of whether switch-specific preparatory activity is observed.

Effects of stop-signal modality on the N2/P3 complex elicited in the stop-signal paradigm

The principal aim of the present study was to clarify how stop-signal modality affected the speed and efficacy of stopping, using ERP components as converging measures of stop processes. Both performance and ERP latency findings suggested faster processing of stop signals in the auditory than visual version of the stop task. The effects of successful versus unsuccessful stopping on the amplitude and topography of N2/P3 components elicited by the stop signals appeared to be largely independent of the modality of the stop signals. Stop signals elicited a fronto-central N2 that was much larger on unsuccessful than successful stop trials in stimulus-locked waveforms. N2 was followed by a P3 component that showed a fronto-central distribution on successful stop trials. P3 elicited on unsuccessful stop trials showed a posterior-parietal focus, but this topography was manifested more clearly in response-locked than stimulus-locked waveforms. A dipole source analyses confirmed these topographical differences of P3, and further showed that the location of the corresponding dipoles remained largely identical across the visual and auditory versions of the stop-signal task. Taken together, the present findings support the suggestion that ERP components in the stop task reflect endogenous aspects of stop-signal processing, such as effective inhibition of responses on successful stop trials and detection of errors on failed inhibition trials.

Decrease of CD4+CD25+ T Cells in Peripheral Blood After Liver Transplantation: Association With Immunosuppression

CD25 (IL-2 receptor alpha-chain) marks a population of CD4-positive T cells with a suppressor phenotype. These CD4+CD25+ regulatory T cells can suppress both effector T cells and antigen-presenting cells and have been identified as a principle regulator of tolerance in experimental transplantation models. In the setting of human liver transplantation, however, little is known about the dynamics of these cells in relation to rejection, tolerance, and immunosuppression. In the current study we determined CD4+CD25+ T cell in blood of liver transplant recipients using flow cytometry and investigated a possible link with immunosuppressive therapies. Peripheral blood mononuclear cells (PBMC) of 27 liver transplant patients (pretransplantation and 12 months posttransplantation) and 16 healthy controls were included. We found that the percentages of CD25+ cells within the CD4 T-cell population was significantly reduced in more than two-thirds of patients 1 year after transplantation. Also the total percentage of CD4-positive T cells declined significantly within this period, making the absolute reduction of regulatory T cells after transplantation even more profound. Comparing PBMC samples of patients and healthy controls revealed an increased percentage of CD4+ T cells in the patients before transplantation, probably related to the chronic liver illness. The reduction in CD4+CD25+ T cells after transplantation was similar for different immunosuppression regiments. All patients, however, received calcineurin inhibitors, suggesting a possible suppressive effect of this therapy on regulatory T-cell levels in peripheral blood. Currently, assays for regulatory T-cell activity are used to further support this hypothesis.

Effects of stop-signal probability in the stop-signal paradigm: the N2/P3 complex further validated

The aim of this study was to examine the effects of frequency of occurrence of stop signals in the stop-signal paradigm. Presenting stop signals less frequently resulted in faster reaction times to the go stimulus and a lower probability of inhibition. Also, go stimuli elicited larger and somewhat earlier P3 responses when stop signals occurred less frequently. Since the amplitude effect was more pronounced on trials when go signals were followed by fast than slow reactions, it probably reflected a stronger set to produce fast responses. N2 and P3 components to stop signals were observed to be larger and of longer latency when stop signals occurred less frequently. The amplitude enhancement of these N2 and P3 components were more pronounced for unsuccessful than for successful stop-signal trials. Moreover, the successfully inhibited stop trials elicited a frontocentral P3 whereas unsuccessfully inhibited stop trials elicited a more posterior P3 that resembled the classical P3b. P3 amplitude in the unsuccessfully inhibited condition also differed between waveforms synchronized with the stop signal and waveforms synchronized with response onset whereas N2 amplitude did not. Taken together these findings suggest that N2 reflected a greater significance of failed inhibitions after low probability stop signals while P3 reflected continued processing of the erroneous response after response execution.

A flow cytometric method to detect apoptosis-related protein expression in minimal residual disease in acute myeloid leukemia

Minimal residual disease (MRD) cells are thought to be responsible for the persistence and relapse of acute myeloid leukemia (AML). Flow cytometric MRD detection by the establishment of a leukemia-associated phenotype (LAP) at diagnosis can be used in 80% of AML patients, allowing detection and functional characterization of MRD in follow-up bone marrow. One of the mechanisms contributing to inefficient chemotherapy is apoptosis resistance. Measuring apoptosis parameters in MRD cells will help to unravel the importance of apoptosis resistance in AML. We therefore developed a four-color flow cytometry method that enables establishment of apoptosis-related protein expression such as Bcl-2, Bcl-x(L), Mcl-1 and Bax at diagnosis and in MRD. Firstly, validation of this assay using Western blot analysis in five leukemia cell lines showed a significant correlation (R=0.70: P<0.0001). Secondly, the influence of the permeabilization procedure on LAP expression was investigated in 38 AML samples at diagnosis and in 42 MRD samples. Quantification of the frequency of LAP+ cells with and without permeabilization showed no significant differences (diagnosis: P= 0.57, follow-up: P= 0.43). The flow cytometric protocol thus enables analysis of apoptosis-related proteins at different stages of the disease, which will lead to a better understanding of the role of apoptosis resistance in the emergence of MRD in AML.

Neuroelectrical signs of selective attention to color in boys with attention-deficit hyperactivity disorder

In order to gain insight into the functional and macroanatomical loci of visual selective processing deficits that may be basic to attention-deficit hyperactivity disorder (ADHD), the present study examined multi-channel event-related potentials (ERPs) recorded from 7- to 11-year-old boys clinically diagnosed as having ADHD (n=24) and age-matched healthy control boys (n=24) while they performed a visual (color) selective attention task. The spatio-temporal dynamics of several ERP components related to attention to color were characterized using topographic profile analysis, topographic mapping of the ERP and associated scalp current density distributions, and spatio-temporal source potential modeling. Boys with ADHD showed a lower target hit rate, a higher false-alarm rate, and a lower perceptual sensitivity than controls. Also, whereas color attention induced in the ERPs from controls a characteristic early frontally maximal selection positivity (FSP), ADHD boys displayed little or no FSP. Similarly, ADHD boys manifested P3b amplitude decrements that were partially lateralized (i.e., maximal at left temporal scalp locations) as well as affected by maturation. These results indicate that ADHD boys suffer from deficits at both relatively early (sensory) and late (semantic) levels of visual selective information processing. The data also support the hypothesis that the visual selective processing deficits observed in the ADHD boys originate from deficits in the strength of activation of a neural network comprising prefrontal and occipito-temporal brain regions. This network seems to be actively engaged during attention to color and may contain the major intracerebral generating sources of the associated scalp-recorded ERP components.

Nonspatial intermodal selective attention is mediated by sensory brain areas: evidence from event-related potentials

The present study focuses on the question of whether inter- and intramodal forms of attention are reflected in activation of the same or different brain areas. ERPs were recorded while subjects were presented a random sequence of visual and auditory stimuli. They were instructed to attend to nonspatial attributes of either auditory or visual stimuli and to detect occasional target stimuli within the attended channel. An occipital selection negativity was found for intramodal attention to visual stimuli. Visual intermodal attention was also manifested in a similar negativity. A symmetrical dipole pair in the medial inferior occipital areas could account for the intramodal effects. Dipole pairs for the intermodal attention effect had a slightly more posterior location compared to the dipole pair for the intramodal effect. Auditory intermodal attention was manifested in an early enhanced negativity overlapping with the N1 and P2 components, which was localized using a symmetrical dipole pair in the lateral auditory cortex. The onset of the intramodal attention effect was somewhat later (around 200 ms), and was reflected in a frontal processing negativity. The present results indicate that intra- and intermodal forms of attention were indeed similar for visual stimuli. Auditory data suggest the involvement of multiple brain areas.

Error-related brain potentials are differentially related to awareness of response errors: evidence from an antisaccade task

The error negativity (Ne/ERN) and error positivity (Pe) are two components of the event-related brain potential (ERP) that are associated with action monitoring and error detection. To investigate the relation between error processing and conscious self-monitoring of behavior, the present experiment examined whether an Ne and Pe are observed after response errors of which participants are unaware. Ne and Pe measures, behavioral accuracy, and trial-to-trial subjective accuracy judgments were obtained from participants performing an antisaccade task, which elicits many unperceived, incorrect reflex-like saccades. Consistent with previous research, subjectively unperceived saccade errors were almost always immediately corrected, and were associated with faster correction times and smaller saccade sizes than perceived errors. Importantly, irrespective of whether the participant was aware of the error or not, erroneous saccades were followed by a sizable Ne. In contrast, the Pe was much more pronounced for perceived than for unperceived errors. Unperceived errors were characterized by the absence of posterror slowing. These and other results are consistent with the view that the Ne and Pe reflect the activity of two separate error monitoring processes, of which only the later process, reflected by the Pe, is associated with conscious error recognition and remedial action.

On the utility of P3 amplitude as a measure of processing capacity

The present review focuses on the utility of the amplitude of P3 of as a measure of processing capacity and mental workload. The paper starts with a brief outline of the conceptual framework underlying the relationship between P3 amplitude and task demands, and the cognitive task manipulations that determine demands on capacity. P3 amplitude results are then discussed on the basis of an extensive review of the relevant literature. It is concluded that although it has often been assumed that P3 amplitude depends on the capacity for processing task relevant stimuli, the utility of P3 amplitude as a sensitive and diagnostic measure of processing capacity remains limited. The major factor that prompts this conclusion is that the two principal task variables that have been used to manipulate capacity allocation, namely task difficulty and task emphasis, have opposite effects on the amplitude of P3. I suggest that this is because, in many tasks, an increase in difficulty transforms the structure or actual content of the flow of information in the processing systems, thereby interfering with the very processes that underlie P3 generation. Finally, in an attempt to theoretically integrate the results of the reviewed studies, it is proposed that P3 amplitude reflects activation of elements in a event-categorization network that is controlled by the joint operation of attention and working memory.