Continuous synthesis of artificial speech sounds from human cortical surface recordings during silent speech production

Objective. Brain-computer interfaces can restore various forms of communication in paralyzed patients who have lost their ability to articulate intelligible speech. This study aimed to demonstrate the feasibility of closed-loop synthesis of artificial speech sounds from human cortical surface recordings during silent speech production.Approach. Ten participants with intractable epilepsy were temporarily implanted with intracranial electrode arrays over cortical surfaces. A decoding model that predicted audible outputs directly from patient-specific neural feature inputs was trained during overt word reading and immediately tested with overt, mimed and imagined word reading. Predicted outputs were later assessed objectively against corresponding voice recordings and subjectively through human perceptual judgments.Main results. Artificial speech sounds were successfully synthesized during overt and mimed utterances by two participants with some coverage of the precentral gyrus. About a third of these sounds were correctly identified by naïve listeners in two-alternative forced-choice tasks. A similar outcome could not be achieved during imagined utterances by any of the participants. However, neural feature contribution analyses suggested the presence of exploitable activation patterns during imagined speech in the postcentral gyrus and the superior temporal gyrus. In future work, a more comprehensive coverage of cortical surfaces, including posterior parts of the middle frontal gyrus and the inferior frontal gyrus, could improve synthesis performance during imagined speech.Significance.As the field of speech neuroprostheses is rapidly moving toward clinical trials, this study addressed important considerations about task instructions and brain coverage when conducting research on silent speech with non-target participants.

[Expression of GPNMB in renal eosinophilic tumors and its value in differential diagnosis]

Objective: To investigate the expression of glycoprotein non metastatic melanoma protein B (GPNMB) in renal eosinophilic tumors and to compare the value of GPNMB with CK20, CK7 and CD117 in the differential diagnosis of renal eosinophilic tumors. Methods: Traditional renal tumor eosinophil subtypes, including 22 cases of renal clear cell carcinoma eosinophil subtype (e-ccRCC), 19 cases of renal papillary cell carcinoma eosinophil subtype (e-papRCC), 17 cases of renal chromophobe cell carcinoma eosinophil subtype (e-chRCC), 12 cases of renal oncocytoma (RO) and emerging renal tumor types with eosinophil characteristics [3 cases of eosinophilic solid cystic renal cell carcinoma (ESC RCC), 3 cases of renal low-grade eosinophil tumor (LOT), 4 cases of fumarate hydratase-deficient renal cell carcinoma (FH-dRCC) and 5 cases of renal epithelioid angiomyolipoma (E-AML)], were collected at the Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2017 to March 2022. The expression of GPNMB, CK20, CK7 and CD117 was detected by immunohistochemistry and statistically analyzed. Results: GPNMB was expressed in all emerging renal tumor types with eosinophil characteristics (ESC RCC, LOT, FH-dRCC) and E-AML, while the expression rates in traditional renal eosinophil subtypes e-papRCC, e-chRCC, e-ccRCC and RO were very low or zero (1/19, 1/17, 0/22 and 0/12, respectively); the expression rate of CK7 in LOT (3/3), e-chRCC (15/17), e-ccRCC (4/22), e-papRCC (2/19), ESC RCC (0/3), RO (4/12), E-AML(1/5), and FH-dRCC (2/4) variedly; the expression of CK20 was different in ESC RCC (3/3), LOT(3/3), e-chRCC(1/17), RO(9/12), e-papRCC(4/19), FH-dRCC(1/4), e-ccRCC(0/22) and E-AML(0/5), and so did that of CD117 in e-ccRCC(2/22), e-papRCC(1/19), e-chRCC(16/17), RO(10/12), ESC RCC(0/3), LOT(1/3), E-AML(2/5) and FH-dRCC(1/4). GPNMB had 100% sensitivity and 97.1% specificity in distinguishing E-AML and emerging renal tumor types (such as ESC RCC, LOT, FH-dRCC) from traditional renal tumor types (such as e-ccRCC, e-papRCC, e-chRCC, RO),respectively. Compared with CK7, CK20 and CD117 antibodies, GPNMB was more effective in the differential diagnosis (P<0.05). Conclusion: As a new renal tumor marker, GPNMB can effectively distinguish E-AML and emerging renal tumor types with eosinophil characteristics such as ESC RCC, LOT, FH-dRCC from traditional renal tumor eosinophil subtypes such as e-ccRCC, e-papRCC, e-chRCC and RO, which is helpful for the differential diagnosis of renal eosinophilic tumors.

[Study on the correlation between PPG and HVPG in patients with portal hypertension]

Objective: To explore the correlation between portal vein pressure gradient (PPG) and hepatic vein pressure gradient (HVPG) in patients with portal hypertension (PHT). Methods: 752 cases with portal hypertension (PHT) who underwent transjugular intrahepatic portosystemic shunt (TIPS) and met the enrollment criteria between January 2016 to December 2019 were analyzed for hepatic vein, inferior vena cava and portal vein pressure. Paired t-test was used for analysis. Pearson correlation test was used to estimate correlation coefficient and coefficient of determination. P<0.05 were considered statistically significant. Results: Wedged hepatic vein pressure (WHVP), portal vein pressure (PVP), correlation coefficient, and coefficient of determination were 27.98±8.95 mmHg, 33.85±7.33 mmHg, 0.329 (P<0.001), and 0.108, respectively. HVPG, PPG,correlation coefficient, and coefficient of determination were 16.84±7.97 mmHg, 25.11±6.95 mmHg (P<0.001), 0.145, and 0.021 (P<0.001), respectively. The difference between HVPG and PPG was greater than 5 mmHg in 524 cases, accounting for 69.7%. The difference between HVPG and PPG was within 5 mmHg or basically equal in 228 cases, accounting for 30.3%. The correlation coefficient between free hepatic venous pressure (FHVP) and inferior vena cava pressure (IVCP) was 0.568 (P<0.001), and the coefficient of determination was 0.323. According to the presence or absence of hepatic venous collaterals after balloon occluded hepatic angiography, they were divided into two groups: 157 (20.9%) cases in the group with hepatic venous collaterals, and 595 (79.1%) cases in the group without hepatic venous collaterals. The parameters of the two groups were compared: WHVP (15.73±3.63) mmHg vs. (31.22±6.90) mmHg, P<0.001; PVP (31.69±8.70) mmHg vs. (34.42±6.81) mmHg, P<0.001; HVPG (7.18±4.40) mmHg vs. (19.40±6.62) mmHg, P<0.001; PPG (24.24±8.11) mmHg vs. (25.34±6.60) mmHg, P<0.001; free hepatic venous pressure (FHVP) (8.58±3.37) mmHg vs. (11.82±5.07) mmHg , P<0.001; inferior vena cava pressure (IVCP) (7.45±3.29) mmHg vs. (9.09±4.14) mmHg, P<0.001. Conclusion: The overall correlation is poor between HVPG and PPG. HVPG of most patients is not an accurate representation of PPG, and the former is lower than the latter. Hepatic venous collateral formation is one of the important reasons for the serious underestimation of HVPG values.

Wilms' tumor (WT1) (±KTS) variants decreases the progesterone secretion of bovine ovarian theca cells

Wilms' tumor gene WT1 encodes a nuclear transcriptional factor, which has been shown to regulate granulosa cell steroidogenesis in bovine; however, it is not known whether the functions of theca cells are regulated by WT1. Here, we determined the effects of this gene on theca cell proliferation, apoptosis, and steroidogenesis in vitro. In cultured bovine theca cells, the downregulation of WT1 increased the secretion of progesterone but had no effect on proliferation and apoptosis. WT1 includes the variants WT1(+KTS) and WT1(-KTS), which differ by 3 amino acids KTS (lysine, threonine, and serine). WT1(±KTS) upregulation increased the messenger RNA (mRNA) expression of STAR and CYP17A1 and decreased the progesterone secretion and CYP11A1 mRNA expression. In contrast to WT1(+KTS), WT1(-KTS) upregulation also decreased the mRNA expression of 3β-HSD. In both variants, WT1(-KTS) has more obvious effects. In conclusion, WT1 can decrease progesterone secretion, likely due in part to the inhibition of CYP11A1 and 3β-HSD.

Field evaporation and atom probe tomography of pure water tips

Measuring biological samples by atom probe tomography (APT) in their natural environment, i.e. aqueous solution, would take this analytical method, which is currently well established for metals, semi-conductive materials and non-metals, to a new level. It would give information about the 3D chemical structure of biological systems, which could enable unprecedented insights into biological systems and processes, such as virus protein interactions. For this future aim, we present as a first essential step the APT analysis of pure water (Milli-Q) which is the main component of biological systems. After Cryo-preparation, nanometric water tips are field evaporated with assistance by short laser pulses. The obtained data sets of several tens of millions of atoms reveal a complex evaporation behavior. Understanding the field evaporation process of water is fundamental for the measurement of more complex biological systems. For the identification of the individual signals in the mass spectrum, DFT calculations were performed to prove the stability of the detected molecules.

261 Prescribed burning of endophyte-infected tall fescue pastures: Effects on forage production, ergot alkaloid concentrations, and stand composition

Prescribed fire may be a non-chemical alternative for seedhead suppression in endophyte-infected tall fescue forage systems. A study was conducted to observe the effects of a single prescribed burn on seed head production, ergot alkaloid concentration, forage production, forage quality, and stand composition in K31 tall fescue plots (endophyte infection=96%). Treatments of an undisturbed control (CON), March mow (MOW), March burn (EARLY), and April burn (LATE) were randomly applied to 56 square meter plots with ten replicates per treatment. Plots were sampled for forage quality and ergot alkaloid concentrations monthly from May to October. Forage production and species composition was recorded in June and October. Fescue seedhead count was conducted in May. After June sampling, plots were clipped to a height of 10 cm and litter was removed to simulate spring grazing. CON had greater (P &lt; 0.01) total forage production in June than other treatments. MOW had greater (P &lt; 0.01) forage production (≤107 kg/ha) than EARLY and LATE in June. There was no effect (P = 0.30) of treatments on forage production in October. LATE burn reduced (month × trt; P = 0.02) ergovaline concentration in June but all treatments were above the established threshold (150 ppb) for fescue toxicosis. Fescue seed head frequency was decreased (P &lt; 0.01) by 50% in LATE plots. There was no treatment effect (P ≥ 0.22) on forb and non-fescue grass frequency in May, but warm season grass frequency was greater (P &lt; 0.01) in LATE plots in October. Crude protein in LATE was greater than other treatments in May and both LATE and CON were greater than other treatments in June (P &lt; 0.01). Neutral detergent fiber for LATE was less than other treatments in May and June (P &lt; 0.01). Under conditions of this experiment, prescribed fire decreased seed head count and ergot alkaloid concentration, with a modest reduction in forage production.

PSVII-7 Effects of alkali treatment on nutrient content and ergot alkaloid concentration in tall fescue silage

Addition of alkaline compounds at harvest may affect in vitro digestion and ergot alkaloid concentrations in endophyte-infected tall fescue silage. Silage (n = 60; 10 replications/treatment) was produced by filling vacuum-sealing plastic bags (35.5 cm by 27.9 cm) with 150 g of K31 tall fescue (DM basis; forage DM=76.9%; 96% endophyte infection rate) harvested in June. Alkalizing agents (CaO and NaOH) were solubilized in water (20% inclusion; wt/wt basis) and added to the forage at inclusion rates of 0%, 1%, 2%, 3%, 4%, and 5% on a dry matter basis. After ensiling for 42 d, forage samples were lyophilized and subsampled for proximate analysis and analysis of ergot alkaloids. A separate subsample was taken for in vitro total disappearance determination, and each sample was replicated in triplicate. Forage quality and digestibility values were calculated on an organic matter basis because organic matter linearly decreased (P &lt; 0.01) as alkali increased. Alkali increased pH linearly (P &lt; 0.01). Forage NDF decreased linearly (P &lt; 0.01) as greater amounts of alkali treatment were included. Crude protein did not differ (P = 0.41) among treatments. In vitro total disappearance (OM basis) increased linearly (P &lt; 0.01) as inclusion of alkali increased. Total ergot alkaloid concentration did not differ (P = 0.62) across treatments. Ergovaline concentration increased linearly (P &lt; 0.01) with increasing alkali inclusion, but remained below established threshold for toxicity in ruminants. Lactic acid concentration responded quadratically (P &lt; 0.01) with the lowest value corresponding to 3% alkali treatment. Acetic acid concentration increased quadratically (P &lt; 0.01) with the highest value occurring during the 1% alkali inclusion. Propionic acid concentration increased linearly (P = 0.02) as alkali inclusion increased. A quadratic effect (P &lt; 0.01) was observed for butyric acid concentration, with a decrease in butyrate above 1% alkali inclusion. Under conditions of this experiment, addition of alkalizing agents increased digestibility of baled tall fescue silage.

395 Effects of supplemental protein and yeast on fermentation of low quality forage in single-flow continuous culture fermenters

Various anecdotes suggest the combination of supplemental protein and yeast improve utilization of low-quality forage. Two studies were conducted to evaluate effects of a commercially available supplement containing protein and yeast on fermentation in single-flow continuous culture fermenters. In Exp. 1, Bermuda grass with no supplement (NCON1), dried distillers grains (PCON1), and two commercially available supplements Diamond V XP (DV1) or SweetPro 16 (SP1) were compared. In Exp. 2, K31 tall fescue with no supplement (NCON2), supplemental dried distillers grains (PCON2), and two commercially available supplements Diamond V XP (DV2) or SweetPro 16 (SP2) were compared. Twenty-four single flow fermenters (1470mL) were randomly assigned to treatments and fed twice daily for 8 d, 5 d of adaptation and 3 d of collection. In both experiments, digestibility of DM, OM, NDF, and ADF were not influenced by supplementation regardless of source (P &gt; 0.10). In Exp. 1, NH3-N concentration increased (P &lt; 0.01) for DV1 over both NCON1 and PCON1 and was greatest for SP1 (P &lt; 0.01). Greater amounts of NH3-N and microbial N were recovered from fermenter overflow when SP1 was supplemented (P &lt; 0.01). Crude protein (CP) degradation was also greatest for SP1; however, when supplement was included, regardless of source, CP degradation was increased over NCON1. Acetate, propionate, butyrate, and total VFA levels were similar (P &gt; 0.10) amongst NCON1, PCON1, and DV1 and greatest when SP1 was supplemented. In Exp. 2, fermenter NH3-N concentration was greatest for SP2 (P &lt; 0.01) and similar amongst NCON2, PCON2, and DV2 (P &gt; 0.01). No differences were detected (P &gt; 0.10) between treatments with respects to CP degradation. Total VFA concentrations increased over time regardless of treatment during the second study.

Tunable broadband terahertz polarizer using graphene-metal hybrid metasurface

We demonstrate an electrically tunable polarizer for terahertz (THz) frequency electromagnetic waves formed from a hybrid graphene-metal metasurface. Broadband (>3 THz) polarization-dependent modulation of THz transmission is demonstrated as a function of the graphene conductivity for various wire grid geometries, each tuned by gating using an overlaid ion gel. We show a strong enhancement of modulation (up to ∼17 times) compared to graphene wire grids in the frequency range of 0.2-2.5 THz upon introduction of the metallic elements. Theoretical calculations, considering both plasmonic coupling and Drude absorption, are in good agreement with our experimental findings.

Increasing the sensitivity of terahertz split ring resonator metamaterials for dielectric sensing by localized substrate etching

We demonstrate a significant enhancement in the sensitivity of split ring resonator terahertz metamaterial dielectric sensors by the introduction of etched trenches into their inductive-capacitive gap area, both through finite element simulations and in experiments performed using terahertz time-domain spectroscopy. The enhanced sensitivity is demonstrated by observation of an increased frequency shift in response to overlaid dielectric material of thicknesses up to 18 µm deposited on to the sensor surface. We show that sensitivity to the dielectric is enhanced by a factor of up to ∼2.7 times by the incorporation of locally etched trenches with a depth of ∼3.4 µm, for example, and discuss the effect of the etching on the electrical properties of the sensors. Our experimental findings are in good agreement with simulations of the sensors obtained using finite element methods.

Illness representations, pain and physical function in patients with rheumatic disorders: between- and within-person associations

OBJECTIVES

Rehabilitation for patients with rheumatic diseases improves both illness representations (IR) and clinical outcomes such as pain and physical functioning (PF). However, it is unclear whether IR may affect and, in turn, are affected by pain and PF. In this study, we examined both between-person associations and within-person associations between IR and pain/PF over time on three measurement occasions. Furthermore, cross-lagged relationships were examined.

DESIGN AND MAIN OUTCOME MEASURES

This secondary analysis is based on data from N = 186 patients with rheumatic diseases. Data on pain, PF and IR were assessed using self-report questionnaires at the beginning, the end and three months after a 3-week inpatient rehabilitation.

METHODS

To separate between- and within-person level, data were analysed using random-intercept cross-lagged panel models.

RESULTS

On both the between-person level (r = |0.21| - |0.44|) and the within-person level (r = |0.15| - |0.46|), pain and PF were related to cognitive and emotional IR. In addition, we found within-person bidirectional cross-lagged effects between emotional IR and PF.

CONCLUSION

IR show complex relationships with pain and PF. Improving PF might improve subsequent illness-related emotional distress and vice versa.

Upper stimulation threshold for retinal ganglion cell activation

OBJECTIVE

The existence of an upper threshold in electrically stimulated retinal ganglion cells (RGCs) is of interest because of its relevance to the development of visual prosthetic devices, which are designed to restore partial sight to blind patients. The upper threshold is defined as the stimulation level above which no action potentials (direct spikes) can be elicited in electrically stimulated retina.

APPROACH

We collected and analyzed in vitro recordings from rat RGCs in response to extracellular biphasic (anodic-cathodic) pulse stimulation of varying amplitudes and pulse durations. Such responses were also simulated using a multicompartment model.

MAIN RESULTS

We identified the individual cell variability in response to stimulation and the phenomenon known as upper threshold in all but one of the recorded cells (n  =  20/21). We found that the latencies of spike responses relative to stimulus amplitude had a characteristic U-shape. In silico, we showed that the upper threshold phenomenon was observed only in the soma. For all tested biphasic pulse durations, electrode positions, and pulse amplitudes above lower threshold, a propagating action potential was observed in the distal axon. For amplitudes above the somatic upper threshold, the axonal action potential back-propagated in the direction of the soma, but the soma's low level of hyperpolarization prevented action potential generation in the soma itself.

SIGNIFICANCE

An upper threshold observed in the soma does not prevent spike conductance in the axon.

Abstract P4-10-03: Racial variation in effects of gene expression profiling on chemotherapy use

Gene expression profile (GEP) testing in early hormone receptor-positive (HR+) breast cancer can inform adjuvant treatment decisions by providing refined estimates of prognosis and chemotherapy benefit. GEPs may also downshift chemotherapy use, potentially avoiding excess morbidity. Multiple studies have reported racial disparities in access to GEP testing. In this study, we examine the effect of race and GEP testing on chemotherapy utilization in early stage HR+ breast cancer.

From The University of North Carolina Cancer Information and Population Health Resource (CIPHR), a statewide linkage of cancer registry and administrative claims data, we studied all women eligible for GEP testing, including those with HR+, T1-2, N0 or N1 unilateral primary breast cancers diagnosed from 2005 to 2012. Separate analyses were performed for N0 and N1 patients. Patients were required to have breast surgery within 6 months of diagnosis and no chemotherapy prior to surgery. Use of GEP testing and chemotherapy treatment were defined from insurance claims, while race was defined using cancer registry data. Propensity score adjustment by standardized mortality ratio weighting (SMRW) was used to control for differences in measured patient characteristics between treatment groups in a non-randomized cohort. Propensity score models included age, race, diagnosis year, co-morbidity, and tumor features. Propensity weighted Poisson models were then used to calculate the adjusted risk of receiving chemotherapy. To investigate differential effects of covariates on chemotherapy across racial groups, we used race-stratified models in the N0 cohort. Due to small sample sizes, race-stratified models were not used for N1 patients.

The cohort included 11,958 women of whom 84.5% were non-Hispanic white (NHW), 12.9% black, and 2.6% other race/ethnicity. For stratified analyses, race was dichotomized to NHW versus non-white. In the N0 cohort (n=9,671), 11.5% of untested NHW women, 20.8% of tested NHW, 16.8% of untested non-whites, and 21.9% of tested non-whites received chemotherapy. In SMRW-adjusted models, GEP testing was associated with downshifts in chemotherapy for N0 patients (RR 0.79, 95% CI 0.72-0.86) and N1 patients (RR 0.46, 95% CI 0.40 - 0.54). In race-stratified analyses of N0 patients, use of GEP testing was associated with a decrease in chemotherapy of 19% among NHW women (RR 0.81, 95% CI 0.72 - 0.91) and 25% among non-white women (RR 0.75, 95% CI 0.57 - 0.99). Taxane-based regimens were most common, but a substantial portion of chemotherapy-treated patients (43%) received anthracycline-based regimens with or without a taxane.

We conclude that GEP testing was associated with decreases in chemotherapy use after propensity adjustment for patient and tumor factors, with greater reductions among non-white patients and node-positive patients. Possible explanations include over-treatment of black women in the absence of testing due to higher perceived risk, racial differences in provider recommendation or chemotherapy choice among tested women where benefit is uncertain, such as for intermediate recurrence scores. Further studies are underway to evaluate racial differences by recurrence score group and the effect of GEPs on racial disparities in outcome.

Citation Format: Reeder-Hayes KE, Meyer A-M, Baggett C, Roberts MC, Zhou X, Meng K, Wheeler SB. Racial variation in effects of gene expression profiling on chemotherapy use [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-03.

Single-molecule imaging reveals modulation of cell wall synthesis dynamics in live bacterial cells

The peptidoglycan cell wall is an integral organelle critical for bacterial cell shape and stability. Proper cell wall construction requires the interaction of synthesis enzymes and the cytoskeleton, but it is unclear how the activities of individual proteins are coordinated to preserve the morphology and integrity of the cell wall during growth. To elucidate this coordination, we used single-molecule imaging to follow the behaviours of the two major peptidoglycan synthases in live, elongating Escherichia coli cells and after perturbation. We observed heterogeneous localization dynamics of penicillin-binding protein (PBP) 1A, the synthase predominantly associated with cell wall elongation, with individual PBP1A molecules distributed between mobile and immobile populations. Perturbations to PBP1A activity, either directly through antibiotics or indirectly through PBP1A's interaction with its lipoprotein activator or other synthases, shifted the fraction of mobile molecules. Our results suggest that multiple levels of regulation control the activity of enzymes to coordinate peptidoglycan synthesis.

The bacterial cell wall is important for cell shape and stability, but how the activities of the biosynthetic machinery are coordinated are not clear. Here the authors use single-molecule imaging and chemical perturbations to determine factors that affect the localization dynamics of penicillin-binding proteins (PBP)1A and PBP1B.

Exploring the role of YAP signaling in CD4+ T cell biology

The adaptive immune system’s ability to defend against infections and destroy cancerous cells is highly dependent on T cell proliferation. A long-standing observation through in vitro and in vivo studies is that T cells cluster together during activation and subsequent proliferation. In contrast, the vast majority of other cell types turn off division machinery upon cell-cell contact. The highly conserved Hippo signaling pathway controls for cell size and number through proliferation and apoptosis, thereby making it essential for regulating organ size. At the core of the Hippo cascade is the transcription factor YAP. Upon activation, YAP translocates into the nucleus and binds with transcription enhancer factors (TEADs) to drive transcription of proliferation-related genes. While YAP signaling has been extensively studied in epithelial cells, its role in CD4+ T cell effector function and proliferation remains unexplored. Our data indicates that overall YAP protein levels rises during T cell activation. Interestingly, although YAP activation increases proliferation of epithelial cells, our data suggests that YAP is a negative regulator of cellular proliferation in CD4+ T cells. Upon YAP depletion and then restimulating T cells in vitro, we discovered that the T cells knocked down by YAP exhibited greater proliferation and produced more IL-2 than T cells transduced with control shRNA. In support of this surprising finding, expressing a constitutively active YAP with all five phosphorylation sites mutated (YAP 5SA) in T cells led to decreased proliferation of CD4+ T cells. These results hint at potentially novel functions of YAP and warrants further analysis into how YAP signaling affects T cell proliferation.

Ultrasound of the Hypoglossal Nerve in the Neck: Visualization and Initial Clinical Experience with Patients

BACKGROUND AND PURPOSE

The hypoglossal nerve, providing motor innervation for the tongue, can be affected in many diseases of the neck and skull base, leading to dysarthria, dysphagia, and ultimately atrophy of the tongue. We determined the feasibility of direct visualization of the hypoglossal nerve in the neck with ultrasound, testing this technique on healthy volunteers and evaluating it in clinical practice.

MATERIALS AND METHODS

The study consisted of 4 parts: first, ultrasound-guided perineural ink injections along the course of the hypoglossal nerve at 24 sides of 12 fresh, nonembalmed cadaver necks. Subsequently, the specimens were dissected to confirm the correct identification of the nerve. The second part was examination of healthy volunteers with ultrasound and measurement of cross-sectional areas for generating reference data. The third part was scanning of healthy volunteers by 2 resident physicians with little and intermediate experience in ultrasound. Fourth was examination with ultrasound of patients with motor symptoms of the tongue.

RESULTS

The hypoglossal nerve was correctly identified bilaterally in all cadaveric specimens (24/24) and all volunteers (33/33). The cross-sectional area ranged from 1.9 to 2.1 mm(2). The resident physicians were able to locate the nerve in 19 of 22 cases, demonstrating that locating the nerve is reproducible and feasible even with intermediate experience in ultrasound. Finally, alterations of the hypoglossal nerve in disease states could be depicted.

CONCLUSIONS

Direct, reliable, and reproducible visualization of the extracranial hypoglossal nerve with ultrasound is feasible.

[Acceptance of the Implementation of Standardised Patient Education Programmes by the Multidisciplinary Rehabilitation Team Using the Example of a Back School - A Qualitative Study]

AIM

The transfer of standardised patient education programmes into practice is a complex process with a multitude of influencing factors. Determinants relate among others to the organisation and individuals (e. g., practitioner, patient). Knowledge about individual factors regarding the trainers of patient education programmes in the German rehabilitation system is scarce. The aim of this study is to explore the acceptance of trainers concerning the implementation of a standardised back school and to derive facilitators and barriers to the implementation of patient education programmes.

METHODS

Semi-structured guideline-based interviews were conducted in 10 rehabilitation clinics. The sample consisted of 46 trainers (25 women): 11 physicians, 11 psychologists, 21 physio-/exercise therapists and 3 occupational therapists with a mean age of 41. The opinions of the trainers regarding the central components of back schools in general, their opinions about the new curriculum, their expectations on its implementation, anticipated difficulties with implementation and requests to the project team were explored as indicators for acceptance. The data were analysed with a multi-step qualitative content analysis.

RESULTS

6 main categories comprising 136 subcategories were created and 729 quotations coded. Regarding the central components that should be covered by back schools, back-friendly behaviour was addressed most often. Opinions regarding the new curriculum were mostly positive. Trainers' approval of content and methods was highlighted and the similarity with existing offers in the clinics as well as the structure of the programme were rated positively. The trainers expected an increased patient orientation and personal development as well as a common, coherent language and interdisciplinarity. Difficulties were anticipated regarding time and personnel as well as therapy and appointment planning and also regarding the motivation/acceptance of patients. A wish for communication, education of trainers and feedback was directed at the project team.

CONCLUSION

The study demonstrates high acceptance of programme implementation and central components of modern patient education programmes among trainers. The basis of individual facilitators and barriers has been investigated and might contribute to further development of implementation interventions. Communication and education considering those factors play a central role.

Genetic diversity and expression profiles of cysteine phytases in the sheep rumen during a feeding cycle

Cysteine phytase is the main phytate-degrading enzyme of ruminant animals. To explore the genetic diversity and dynamic expression profile of cysteine phytase in sheep rumen during a feeding cycle, four transcript (0, 4, 9 and 16 h after feeding) and one DNA (9 h after feeding) clone libraries were constructed, respectively. A total of 46 distinct gene fragments were identified, and most of these sequences had low identities (<60%) with known phytases. Great divergence was found in the constitution and abundance of genes at the genome and transcriptional levels, and the transcript data are more reliable to reflect the information of functional genes. Phylogenetic analysis indicated that the genes from uncultured bacteria instead of Firmicutes played the major phytate-degrading role. Further comparative analysis revealed the dynamic constitution of cysteine phytase genes in rumen at different time points.

SIGNIFICANCE AND IMPACT OF THE STUDY

Ruminal phytases, that are cysteine phytases, are novel in sequences and functions. Great divergence in the constitution and abundance of cysteine phytase genes at the genome and transcriptional levels suggested that transcript data are more reliable to reflect the information of functional genes. Phylogenetic and rarefaction analyses indicated that the cysteine phytase genes from uncultured bacteria instead of Firmicutes play the major phytate-degrading role in rumen, and their constitution is dynamic at different time points. This study provides a new insight into ruminal cysteine phytase genes and undermines their expression profiles over a whole feeding cycle.

Interleukin-37 ameliorates myocardial ischaemia/reperfusion injury in mice

Innate immune and inflammatory responses are involved in myocardial ischaemia/reperfusion (I/R) injury. Interleukin (IL)-37 is a newly identified member of the IL-1 family, and functions as a fundamental inhibitor of innate immunity and inflammation. However, its role in myocardial I/R injury remains unknown. I/R or sham operations were performed on male C57BL/6J mice. I/R mice received an injection of recombinant human IL-37 or vehicle, immediately before reperfusion. Compared with vehicle treatment, mice treated with IL-37 showed an obvious amelioration of the I/R injury, as demonstrated by reduced infarct size, decreased cardiac troponin T level and improved cardiac function. This protective effect was associated with the ability of IL-37 to suppress production of proinflammatory cytokines, chemokines and neutrophil infiltration, which together contributed to a decrease in cardiomyocyte apoptosis and reactive oxygen species (ROS) generation. In addition, we found that IL-37 inhibited the up-regulation of Toll-like receptor (TLR)-4 expression and nuclear factor kappa B (NF-kB) activation after I/R, while increasing the anti-inflammatory IL-10 level. Moreover, the administration of anti-IL-10R antibody abolished the protective effects of IL-37 in I/R injury. In-vitro experiments further demonstrated that IL-37 protected cardiomyocytes from apoptosis under I/R condition, and suppressed the migration ability of neutrophils towards the chemokine LIX. In conclusion, IL-37 plays a protective role against mouse myocardial I/R injury, offering a promising therapeutic medium for myocardial I/R injury.

[Development and short-term effects of a standardized patient education program for in-patient cardiologic rehabilitation]

BACKGROUND

Patient education is an essential part in the treatment of coronary heart disease in medical rehabilitation. In the German-speaking area, no standardized and evaluated patient education program for coronary heart disease is available so far. In this paper, we demonstrate the development of a quality assured patient education program based on a health-education program of the German statutory pension insurance scheme.

METHODS

In a multi-level approach, an existing program was modified concerning treatment evidence, practical guidelines, theories of health and illness behavior and quality criteria for patient education as well as clinical experience and thereafter manualized. In a formative evaluation, feasibility and patient acceptance of this modified program were assessed using evaluation questionnaires of patients and trainers. Afterwards, effects of the patient education program as compared to a traditional education program were assessed on a short-term (at discharge), medium-term (6-month follow-up) and long-term (12-month follow-up) basis in a multicenter quasi-experimental control group study of patients with coronary heart disease (n=434).

RESULTS

Results of the formative evaluation demonstrate an overall good acceptance and a good feasibility of the manualized program. Short-term results show a significant small treatment effect in the primary outcome variable patients' knowledge (p=0.001, η2 =0.028). Furthermore, small effects were also observed among some secondary outcomes, such as attitude towards medication, planning of physical activity, psychological quality of life and satisfaction with the education program.

CONCLUSION

A standardized education program for patients with coronary heart disease has been developed in a systematic process based on established quality standards. Depending on the outstanding medium and long-term effects, the program may be recommended for general use in medical rehabilitation. The manual provides the prerequisites allowing for a successful transfer into clinical practice.

[DGRW-update: patient education]

Patient education programmes, i. e. standardized, manualized, interactive group programmes aiming to increase self-management and empowerment, are a core element of medical rehabilitation for chronic conditions. In an update of the evidence of the effectiveness of patient education, its effectiveness was proven for a broad spectrum of chronic disorders, such as diabetes mellitus, chronic low back pain, rheumatoid arthritis, coronary heart disease, chronic heart failure, bronchial asthma, COPD, and cancer, as well as for the modification of health behaviours, such as diet and exercise. To sustain effects, aftercare interventions, such as support provided by phone, were found to be successful. Interventions targeted to particular patient groups according to gender, age, or migration background are also being developed more frequently. When evaluating educational interventions not only distal outcomes, such as quality of life and participation, should be used but also proximal outcomes such as self-management skills. A recent survey of patient education practice in medical rehabilitation revealed a continuing potential for optimization relative to manualization, evaluation and didactics. However, the dissemination of innovative programmes into rehabilitation routine presents a major challenge.

Therapeutic effects of anticoagulant agents on preeclampsia in a murine model induced by phosphatidylserine/phosphatidylcholine microvesicles

Preeclampsia (PE) is a placenta-mediated pregnancy complication that results in high maternal and neonatal mortality and morbidity worldwide. Currently, there is no satisfactory pharmacotherapeutic treatment to stop the PE progression. In this study, we investigated the therapeutic effects of anticoagulant agents, including annexin V, heparin, and a fusion protein of annexin V and hirudin (AND), in a murine PE model induced by intravenous injection of phosphatidylserine/phosphatidylcholine (PS/PC) microvesicles. Compared with the control pregnant animals, the pregnant mice injected with PS/PC presented PE-like symptoms, including elevated systolic blood pressure, proteinuria, and reduction of antithrombin III and blood platelets. However, the PE-like symptoms were significantly alleviated after the PS/PC-injected mice were treated with annexin V, AND, or heparin. Furthermore, fibrin deposition in the placentas in the anticoagulant treated mice was remarkably improved, compared with that in the mice injected with PS/PC alone. The data demonstrate that anticoagulants are effective to prevent the occurrence of PE in the murine model and also suggest that hypercoagulation in the placenta is a contributing factor in the pathogenesis of PE.

Endovascular procedures for cerebrovenous disorders

Cerebral venous anomalies may have a variety of clinical consequences. MR or CT venogram can assist the imaging diagnosis; yet, cerebral angiogram may be required to confirm or establish the correct diagnosis. Venous anomalies predisposing venous hypertension may be categorized into three major entities such as congenital variations, outflow obstruction, and increased blood flow. The degree of clinical presentations of venous hypertension depends upon the chronicity or acuteness. Venous hypertension may lead to venous congestion with edema, hemorrhage and encephalopathy. Endovascular therapeutic procedures may be employed to relieve venous congestion either from reducing blood flow or relieving obstruction. Those endovascular treatment options include embolization, thrombolysis and angioplastic stentings.

The host species affects the microbial community in the goat rumen

AIMS

This study was carried out to determine whether bacterial and ciliate populations in goat rumen vary significantly between different goat species living in the same environment.

METHODS AND RESULTS

Bacterial and ciliate communities in the rumen of three goat species were analysed at the molecular level using denaturing gradient gel electrophoresis. The microbial community varied considerably among goats living in the same environment. Interspecies variation in the bacterial population was noticeably greater than intraspecies variation. In contrast, there was considerable variation in the ciliate population among goats within the same species, and intraspecies similarities were no greater than those observed across species.

CONCLUSIONS

Because environmental factors and diets were identical for all goats, differences in bacterial populations reflect species-specific differences in rumen microbes.

SIGNIFICANCE AND IMPACT OF THE STUDY

Factors related to the host species have an important effect on determining the bacterial composition in the goat rumen.

[Rehabilitation need in sociomedical assessment--development and evaluation of an algorithm of decision-making]

For sociomedical assessment on application for medical rehabilitation by the German Statutory Pension Insurance no valid diagnostic assessment tools exist. In the present study two expert surveys and current guidelines were used to develop an algorithm of decision-making which is based on 13 criteria for rehabilitation need. The algorithm was evaluated in a prospective, longitudinal survey in the sociomedical services of five Bavarian Statutory Pension Insurance agencies on a sample of applicants with primary musculoskeletal disease (n=243). The medical experts rated the criteria after they had made their decision on the applications. To examine validity of the algorithm, concordance with the medical expert decisions and individual need for rehabilitation was analyzed. Respectively results of the algorithm were compared with data in course of the measure (rating by the clinician, patient questionnaire). Analyzing data, there is evidence for problems in rating the criteria by assessment on medical records; on average 9.2 (s=2.4) of 13 criteria could be rated. There is statistically significant concordance between decisions by the algorithm and sociomedical decisions based on assessment of medical records (kappa=0.37, p<0.001) or examination (kappa=0.71, p<0.001). Applications with positive recommendation by the algorithm have a significantly higher degree of subjective rehabilitation need (d=0.38). The results illustrate the need for measures to improve the basis of information by medical records. By reason of heterogeneity in practical application of criteria for rehabilitation need, operationalisation and explicit diagnostic algorithms are necessary to improve objectivity of making decisions.

Introduction of a disulfide bridge enhances the thermostability of a Streptomyces olivaceoviridis xylanase mutant

Substitution of the N-terminus of Streptomyces olivaceoviridis xylanase XYNB to generate mutant TB has been previously shown to increase the thermostability of the enzyme. To further improve the stability of this mutant, we introduced a disulfide bridge (C109-C153) into the TB mutant, generating TS. To assess the effect of the disulfide bridge in the wild-type enzyme, the S109C-N153C mutation was also introduced into XYNB, resulting in XS. The mutants were expressed in Pichia pastoris, the recombinant enzymes were purified, and the effect of temperature and pH on enzymatic activity was characterized. Introduction of the disulfide bridge (C109-C153) into XYNB (XS variant) and TB (TS variant) increased the thermostability up to 2.8-fold and 12.4-fold, respectively, relative to XYNB, after incubation at 70 degrees C, pH 6.0, for 20 min. In addition, a synergistic effect of the disulfide bridge and the N-terminus replacement was observed, which extended the half-life of XYNB from 3 to 150 min. Moreover, XS and TS displayed better resistance to acidic conditions compared with the respective enzymes that did not contain a disulfide bridge.

[Criteria for assessing the need for rehabilitation and for sanctioning refund claims -- Würzburg rating scale for sociomedical expertising on the need for rehabilitation and on the justification of refund demands on statutory insurance]

The essential criteria governing the assessment of the need for rehabilitation must be reviewed before making a sociomedical decision on claims to the German Statutory Pension Insurance (GRV) for refunding expenditure on rehabilitation. For an objective view of such a sociomedical decision, one must specify more clearly the fundamental assessment criteria. The study presented here was based on an exploratory analysis using a specific rating scale (the "Würzburg Checklist") for the various aspects of necessary rehabilitation according to sociomedical assessment of the medical records and medical examination of the patient. The aim of such an analysis is to pinpoint the various necessary decisions one by one before arriving at a final sociomedical expertise enabling the insurance body to decide to meet the cost of rehabilitating a particular patient. Three Bavarian Statutory Sickness Insurance bodies conducted medical random checks by selecting a sample of applicants with musculo-skeletal disease (n = 483) and examining the medical records and the results of a personal examination of the applicant by the medical expert. Completion of the rating scale was done after the experts had made their decision. The rating was subsequently repeated by the clinicians when the patient was admitted to the rehabilitation hospital. Although there were significant differences between these three groups of physicians in the evaluation of the applicants in respect of requirement criteria, it was not possible to identify any particular tendency to a verdict. Assessing the criteria according to the records is limited to some extent. Factor analysis yields five subscales in the rating list with good internal consistency: overall impediment, forecasting the ability to being motivated for rehabilitation, professional efficiency rating, psychosocial stress, risk factors. These subscales, while fairly consistent, are discriminatively valid in respect of rehabilitation recommendations by the sociomedical experts. The results of this survey are a first approach to the development of a practically relevant structural tool for sociomedical assessment.