Cognitive dysfunction and associated neuroimaging biomarkers in antiphospholipid syndrome: a systematic review

OBJECTIVES: Cognitive dysfunction is common in patients with antiphospholipid antibodies (aPL) (including primary antiphospholipid syndrome (APS) or APS associated with systemic lupus erythematosus (SLE)). Neuroimaging biomarkers may contribute to our understanding of mechanisms of cognitive dysfunction in these cohorts. This review aimed to investigate: (1) the prevalence of cognitive dysfunction in studies including neuroimaging biomarkers; and (2) associations between cognition and neuroimaging biomarkers in patients with APS/aPL. METHODS: We conducted a systematic search of electronic databases PubMed, Science Direct, Scopus and PsycINFO and included studies with descriptions of neuroimaging findings, cognitive dysfunction, or both, in patients with aPL positivity (lupus anticoagulant, IgG and IgM anticardiolipin and anti-β2 glycoprotein-I antibodies). RESULTS: Of 120 search results we included 20 eligible studies (6 APS, 4 SLE with APS/aPL and 10 neuropsychiatric SLE (NPSLE)). We identified a medium risk of bias in 6/11 (54%) of cohort studies and 44% of case-control studies, as well as marked heterogeneity in cognitive assessment batteries, APS and aPL definitions and neuroimaging modalities and protocols. The prevalence of cognitive dysfunction ranged between 11% and 60.5%. Structural MRI was the most common imaging modality, reporting cognitive dysfunction to be associated with white matter hyperintensities, ischaemic lesions and cortical atrophy (4 with cerebral atrophy, 2 with white matter hyperintensities, and 2 with cerebral infarcts). CONCLUSION: Our findings confirm that cognitive impairment is commonly found in patients with aPL (including APS, SLE and NPSLE). The risk of bias, and heterogeneity in cognitive and neuroimaging biomarkers reported does not allow for definitive

Inhibition of food intake in obese subjects by peptide YY3-36

Background: The gut hormone fragment peptide YY3-36 (PYY) reduces appetite and food intake when infused into subjects of normal weight. In common with the adipocyte hormone leptin, PYY reduces food intake by modulating appetite circuits in the hypothalamus. However, in obesity there is a marked resistance to the action of leptin, which greatly limits its therapeutic effectiveness. We investigated whether obese subjects were also resistant to the anorectic effects of PYY.Methods: We compared the effects of PYY infusion on appetite and food intake in 12 obese and 12 lean subjects in a double-blind, placebo-controlled, crossover study. The plasma levels of PYY, ghrelin, leptin, and insulin were also determined.Results: Caloric intake during a buffet lunch offered two hours after the infusion of PYY was decreased by 30 percent in the obese subjects (P<0.001) and 31 percent in the lean subjects (P<0.001). PYY infusion also caused a significant decrease in the cumulative 24-hour caloric intake in both obese and lean subjects. PYY infusion reduced plasma levels of the appetite-stimulatory hormone ghrelin. Endogenous fasting and postprandial levels of PYY were significantly lower in obese subjects (the mean [+/-SE] fasting PYY levels were 10.2+/-0.7 pmol per liter in the obese group and 16.9+/-0.8 pmol per liter in the lean group, P<0.001). Furthermore, the fasting PYY levels correlated negatively with the body-mass index (r=-0.84, P<0.001).Conclusions: We found that obese subjects were not resistant to the anorectic effects of PYY. Endogenous PYY levels were low in the obese subjects, suggesting that PYY deficiency may contribute to the pathogenesis of obesity

Impacts of Unattended Train Operations (UTO) on Productivity and Efficiency in Metropolitan Railways

Urban metro subway systems (metros) around the world are choosing increasing levels of automation for new and existing lines: the global length of metro lines capable of unattended train operation (UTO) is predicted to triple in the next 10 years. Despite significant investment in this technology, empirical evidence for the financial and service quality impacts of UTO in metros remains scarce. This study used questionnaires and semistructured interviews with the Community of Metros and Nova Group benchmarking groups to assemble emerging evidence of how automation affected costs, staffing, service capacity, and reliability. The results from an analysis of data from 23 lines suggested that UTO could reduce staff numbers by 30% to 70%, with the amount of wage cost reduction depending on whether staff on UTO lines were paid more. On the basis of the experience of seven metros, the capital costs of lines capable of UTO were higher, but the internal rate of return had been estimated by two metros at 10% to 15%. Automated lines were capable of operating at the highest service frequencies of up to 42 trains per hour, and the limited available data suggested that automated lines were more reliable. The findings indicated that UTO was a means to a more flexible and reliable operating model that could increase metro productivity and efficiency. The study identified important work needed to understand the impacts of UTO and identify where statistical analyses would add value once sufficiently large data sets became available

Cerebral venous thrombosis: a practical guide

All neurologists need to be able to recognise and treat cerebral venous thrombosis (CVT). It is difficult to diagnose, partly due to its relative rarity, its multiple and various clinical manifestations (different from ‘conventional’ stroke, and often mimicking other acute neurological conditions), and because it is often challenging to obtain and interpret optimal and timely brain imaging. Although CVT can result in death or permanent disability, it generally has a favourable prognosis if diagnosed and treated early. Neurologists involved in stroke care therefore also need to be aware of the treatments for CVT (with varying degrees of supporting evidence): the mainstay is prompt anticoagulation but patients who deteriorate despite treatment can be considered for endovascular procedures (endovascular thrombolysis or thrombectomy) or neurosurgery (decompressive craniotomy). This review summarises current knowledge on the risk factors, diagnosis, treatment and prognosis of CVT in adults, and highlights some areas for future research

Musical preferences are linked to cognitive styles

Why do we like the music we do? Research has shown that musical preferences and personality are linked, yet little is known about other influences on preferences such as cognitive styles. To address this gap, we investigated how individual differences in musical preferences are explained by the empathizing-systemizing (E-S) theory. Study 1 examined the links between empathy and musical preferences across four samples. By reporting their preferential reactions to musical stimuli, samples 1 and 2 (Ns = 2,178 and 891) indicated their preferences for music from 26 different genres, and samples 3 and 4 (Ns = 747 and 320) indicated their preferences for music from only a single genre (rock or jazz). Results across samples showed that empathy levels are linked to preferences even within genres and account for significant proportions of variance in preferences over and above personality traits for various music-preference dimensions. Study 2 (N = 353) replicated and extended these findings by investigating how musical preferences are differentiated by E-S cognitive styles (i.e., 'brain types'). Those who are type E (bias towards empathizing) preferred music on the Mellow dimension (R&B/soul, adult contemporary, soft rock genres) compared to type S (bias towards systemizing) who preferred music on the Intense dimension (punk, heavy metal, and hard rock). Analyses of fine-grained psychological and sonic attributes in the music revealed that type E individuals preferred music that featured low arousal (gentle, warm, and sensual attributes), negative valence (depressing and sad), and emotional depth (poetic, relaxing, and thoughtful), while type S preferred music that featured high arousal (strong, tense, and thrilling), and aspects of positive valence (animated) and cerebral depth (complexity). The application of these findings for clinicians, interventions, and those on the autism spectrum (largely type S or extreme type S) are discussed.This work was supported by the Medical Research Council

Novel Characteristics of Valveless Pumping

This study investigates the occurrence of valveless pumping in a fluidfilled system consisting of two open tanks connected by an elastic tube. We show that directional flow can be achieved by introducing a periodic pinching applied at an asymmetrical location along the tube, and that the flow direction depends on the pumping frequency. We propose a relation between wave propagation velocity, tube length, and resonance frequencies associated with shifts in the pumping direction using numerical simulations. The eigenfrequencies of the system are estimated from the linearized system, and we show that these eigenfrequencies constitute the resonance frequencies and the horizontal slope frequencies of the system; 'horizontal slope frequency' being a new concept. A simple model is suggested, explaining the effect of the gravity driven part of the oscillation observed in response to the tank and tube diameter changes. Results are partly compared with experimental findings.Art. no. 22450

Further insights into the operation of the Chinese number system: Competing effects of Arabic and Mandarin number formats

Here we report the results of a speeded relative quantity task with Chinese participants. On each trial a single numeral (the probe) was presented and the instructions were to respond as to whether it signified a quantity less than or greater than five (the standard). In separate blocks of trials, the numerals were either presented in Mandarin or in Arabic number formats. In addition to the standard influence of numerical distance, a significant predictor of performance was the degree of physical similarity between the probe and the standard as depicted in Mandarin. Additionally, competing effects of physical similarity, defined in terms of the Arabic number format, were also found. Critically the size of these different effects of physical similarity varied systematically across individuals such that larger effects of one compensated for smaller effects of the other. It is argued that the data favor accounts of processing that assume that different number formats access different format-specific representations of quantities. Moreover, for Chinese participants the default is to translate numerals into a Mandarin format prior to accessing quantity information. The efficacy of this translation process is itself influenced by a competing tendency to carry out a translation into Arabic format

A generalizability study of the medical judgment vignettes interview to assess students' noncognitive attributes for medical school

<p>Abstract</p> <p>Background</p> <p>Although the reliability of admission interviews has been improved through the use of objective and structured approaches, there still remains the issue of identifying and measuring relevant attributes or noncognitive domains of interest. In this present study, we use generalizability theory to determine the estimated variance associated with participants, judges and stations from a semi-structured, Medical Judgment Vignettes interview used as part of an initiative to improve the reliability and content validity of the interview process used in the selection of students for medical school.</p> <p>Methods</p> <p>A three station, Medical Judgment Vignettes interview was conducted with 29 participants and scored independently by two judges on a well-defined 5-point rubric. Generalizability Theory provides a method for estimating the variability of a number of facets. In the present study each judge (<it>j</it>) rated each participant (<it>p</it>) on all three Medical Judgment Vignette stations (<it>s</it>). A two-facet crossed designed generalizability study was used to determine the optimal number of stations and judges to achieve a 0.80 reliability coefficient.</p> <p>Results</p> <p>The results of the generalizability analysis showed that a three station, two judge Medical Judgment Vignettes interview results in a G coefficient of 0.70. As shown by the adjusted <it>Eρ</it>²scores, since interviewer variability is negligible, increasing the number of judges from two to three does not improve the generalizability coefficient. Increasing the number of stations, however, does have a substantial influence on the overall dependability of this measurement. In a decision study analysis, increasing the number of stations to six with a single judge at each station results in a G coefficient of 0.81.</p> <p>Conclusion</p> <p>The Medical Judgment Vignettes interview provides a reliable approach to the assessment of candidates' noncognitive attributes for medical school. The high inter-rater reliability is attributed to the greater objectivity achieved through the used of the semi-structured interview format and clearly defined scoring rubric created for each of the judgment vignettes. Despite the relatively high generalizability coefficient obtained for only three stations, future research should further explore the reliability, and equally importantly, the validity of the vignettes with a large group of candidates applying for medical school.</p