Long-Term Outcome of Repetitive Transcranial Magnetic Stimulation in a Large Cohort of Patients With Cocaine-Use Disorder: An Observational Study

Background: Cocaine is a psychostimulant drug used as performance enhancer throughout history. The prolonged use of cocaine is associated with addiction and a broad range of cognitive deficits. Currently, there are no medications proven to be effective for cocaine-use disorder (CocUD). Previous preliminary clinical work suggests some benefit from repetitive transcranial magnetic stimulation (rTMS) stimulating the prefrontal cortex (PFC), involved in inhibitory cognitive control, decision-making and attention. All published studies to date have been limited by small sample sizes and short follow-up times. Methods: This is a retrospective observational study of 284 outpatients (of whom 268 were men) meeting DSM-5 criteria for CocUD. At treatment entry, most were using cocaine every day or several times per week. All patients underwent 3 months of rTMS and were followed for up to 2 years, 8 months. Self-report, reports by family or significant others and regular urine screens were used to assess drug use. Results: Median time to the first lapse (resumption of cocaine use) since the beginning of treatment was 91 days. For most patients, TMS was re-administered weekly, then monthly, throughout follow-up. The decrease in frequency of rTMS sessions was not accompanied by an increase in lapses to cocaine use. Mean frequency of cocaine use was <1·0 day/month (median 0), while serious rTMS-related adverse events were infrequent, consistent with published reports from smaller studies. Conclusions: This is the first follow-up study to show that rTMS treatment is accompanied by long-lasting reductions in cocaine use in a large cohort

Serum levels and removal by haemodialysis and haemodiafiltration of tryptophan-derived uremic toxins in ESKD patients

Tryptophan is an essential dietary amino acid that originates uremic toxins that contribute to end-stage kidney disease (ESKD) patient outcomes. We evaluated serum levels and removal during haemodialysis and haemodiafiltration of tryptophan and tryptophan-derived uremic toxins, indoxyl sulfate (IS) and indole acetic acid (IAA), in ESKD patients in different dialysis treatment settings. This prospective multicentre study in four European dialysis centres enrolled 78 patients with ESKD. Blood and spent dialysate samples obtained during dialysis were analysed with high-performance liquid chromatography to assess uremic solutes, their reduction ratio (RR) and total removed solute (TRS). Mean free serum tryptophan and IS concentrations increased, and concentration of IAA decreased over pre-dialysis levels (67%, 49%, -0.8%, respectively) during the first hour of dialysis. While mean serum total urea, IS and IAA concentrations decreased during dialysis (-72%, -39%, -43%, respectively), serum tryptophan levels increased, resulting in negative RR (-8%) towards the end of the dialysis session (p < 0.001), despite remarkable Trp losses in dialysate. RR and TRS values based on serum (total, free) and dialysate solute concentrations were lower for conventional low-flux dialysis (p < 0.001). High-efficiency haemodiafiltration resulted in 80% higher Trp losses than conventional low-flux dialysis, despite similar neutral Trp RR values. In conclusion, serum Trp concentrations and RR behave differently from uremic solutes IS, IAA and urea and Trp RR did not reflect dialysis Trp losses. Conventional low-flux dialysis may not adequately clear Trp-related uremic toxins while high efficiency haemodiafiltration increased Trp losses

Thermal Effect on TL Response of Single Doped LiF+NaF:RE Polycrystalline Phosphors

In this work, the sintering and annealing effects on the thermoluminescent (TL) behavior of undoped and rare earth (RE)-doped LiF+NaF powder samples (RE = Ce3+, Eu3+, Lu3+ or Tl+, at 0.5 mol%) was analyzed by evaluating the sensitivity to gamma radiation and TL response of the material. The polycrystalline samples were obtained by solid state reaction at 1000°C. The samples were irradiated in a Gammacell-3000 Elan irradiator loaded with 137Cs sources. The glow curves of the LiF+NaF doped with lutetium or thallium show an intense glow peak at about 175°C and 135°C, respectively. When the phosphor was doped with cerium or europium the glow curves were complex in their structure, with TL peaks observed at 155°C and 165°C, respectively. The linear dose-response was between 10 and 50 Gy for cerium, europium or lutetium doped LiF+NaF samples, while for the thallium doped and undoped samples such intervals were 10-100 Gy and 10-500 Gy, respectively. Because the shape of the glow curves were complex, the analysis was carried out in (i) samples without a sintering treatment where the TL response was found insensitive to pre-irradiation annealing treatment, and (ii) sintered samples (300, 350, 400 or 500 °C), in this last case the TL response was dependent on the annealing temperature (100-400 °C), finally (iii) the kinetics parameters of the glow curves were analyzed by assuming a general order kinetics model. The observed glow curves and TL characteristics of the LiF+NaF:RE phosphor make attractive this material to be useful in gamma dose dosimetry

Observation of a topologically protected state in a magnetic domain wall stabilized by a ferromagnetic chemical barrier

The precise control and stabilization of magnetic domain walls is key for the development of the next generation magnetic nano-devices. Among the multitude of magnetic configurations of a magnetic domain wall, topologically protected states are of particular interest due to their intrinsic stability. In this work, using XMCD-PEEM, we have observed a topologically protected magnetic domain wall in a ferromagnetic cylindrical nanowire. Its structure is stabilized by periodic sharp alterations of the chemical composition in the nanowire. The large stability of this topologically protected domain wall contrasts with the mobility of other non-protected and non-chiral states also present in the same nanowire. The micromagnetic simulations show the structure and the conditions required to find the topologically protected state. These results are relevant for the design of future spintronic devices such as domain wall based RF oscillators or magnetic memories

The impact of a large object with Jupiter in July 2009

On 2009 July 19, we observed a single, large impact on Jupiter at a planetocentric latitude of 55^{\circ}S. This and the Shoemaker-Levy 9 (SL9) impacts on Jupiter in 1994 are the only planetary-scale impacts ever observed. The 2009 impact had an entry trajectory opposite and with a lower incidence angle than that of SL9. Comparison of the initial aerosol cloud debris properties, spanning 4,800 km east-west and 2,500 km north-south, with those produced by the SL9 fragments, and dynamical calculations of pre-impact orbit, indicate that the impactor was most probably an icy body with a size of 0.5-1 km. The collision rate of events of this magnitude may be five to ten times more frequent than previously thought. The search for unpredicted impacts, such as the current one, could be best performed in 890-nm and K (2.03-2.36 {\mu}m) filters in strong gaseous absorption, where the high-altitude aerosols are more reflective than Jupiter's primary cloud.Comment: 15 pages, 5 figure

Outbreak Of NDM-1-producing Klebsiella Pneumoniae In A Neonatal Unit In Colombia

Six multiresistant, NDM-1-producing Klebsiella pneumoniae strains were recovered from an outbreak that affected six neonatal patients in a Colombian hospital. Molecular analysis showed that all of the isolates harbored the blaNDM-1, qnrA, and intI1 genes and were clonally related. Multilocus sequence typing showed that the isolates belonged to a new sequence type (ST1043) that was different from the sequence types that had previously been reported. This is the first report of NDM-1-producing isolates in South America

Leprosy Associated with Atypical Cutaneous Leishmaniasis in Nicaragua and Honduras

In Central America, few cases of leprosy have been reported, but the disease may be unrecognized. Diagnosis is based on clinical criteria and histology. Preliminary field work in Nicaragua and Honduras found patients, including many children, with skin lesions clinically suggestive of atypical cutaneous leishmaniasis or indeterminate leprosy. Histology could not distinguish these diseases although acid-fast organisms were visible in a few biopsies. Lesions healed after standard antimicrobial therapy for leprosy. In the present study, patients, family members, and other community members were skin-tested and provided nasal swabs and blood samples. Biopsies were taken from a subgroup of patients with clinical signs of infection. Two laboratories analyzed samples, using local in-house techniques. Mycobacterium leprae, Leishmania spp. and Leishmania infantum were detected using polymerase chain reactions. Mycobacterium leprae DNA was detected in blood samples and nasal swabs, including some cases where leprosy was not clinically suspected. Leishmania spp. were also detected in blood and nasal swabs. Most biopsies contained Leishmania DNA and coinfection of Leishmania spp. with M. leprae occurred in 33% of cases. Mycobacterium leprae DNA was also detected and sequenced from Nicaraguan and Honduran environmental samples. In conclusion, leprosy and leishmaniasis are present in both regions, and leprosy appears to be widespread. The nature of any relationship between these two pathogens and the epidemiology of these infections need to be elucidated