Optimising EEG-fMRI for Localisation of Focal Epilepsy in Children

BACKGROUND: Early surgical intervention in children with drug resistant epilepsy has benefits but requires using tolerable and minimally invasive tests. EEG-fMRI studies have demonstrated good sensitivity for the localization of epileptic focus but a poor yield although the reasons for this have not been systematically addressed. While adults EEG-fMRI studies are performed in the "resting state"; children are commonly sedated however, this has associated risks and potential confounds. In this study, we assessed the impact of the following factors on the tolerability and results of EEG-fMRI in children: viewing a movie inside the scanner; movement; occurrence of interictal epileptiform discharges (IED); scan duration and design efficiency. This work's motivation is to optimize EEG-fMRI parameters to make this test widely available to paediatric population. METHODS: Forty-six children with focal epilepsy and 20 controls (6-18) underwent EEG-fMRI. For two 10 minutes sessions subjects were told to lie still with eyes closed, as it is classically performed in adult studies ("rest sessions"), for another two sessions, subjects watched a child friendly stimulation i.e. movie ("movie sessions"). IED were mapped with EEG-fMRI for each session and across sessions. The resulting maps were classified as concordant/discordant with the presumed epileptogenic focus for each subject. FINDINGS: Movement increased with scan duration, but the movie reduced movement by ~40% when played within the first 20 minutes. There was no effect of movie on the occurrence of IED, nor in the concordance of the test. Ability of EEG-fMRI to map the epileptogenic region was similar for the 20 and 40 minute scan durations. Design efficiency was predictive of concordance. CONCLUSIONS: A child friendly natural stimulus improves the tolerability of EEG-fMRI and reduces in-scanner movement without having an effect on IED occurrence and quality of EEG-fMRI maps. This allowed us to scan children as young as 6 and obtain localising information without sedation. Our data suggest that ~20 minutes is the optimal length of scanning for EEG-fMRI studies in children with frequent IED. The efficiency of the fMRI design derived from spontaneous IED generation is an important factor for producing concordant results

Libraries and open society; Popper, Soros and digital information

This paper examines the role of libraries and information services, in promoting the ‘open society’ espoused by Karl Popper and George Soros. After a brief discussion of the nature of an ‘open society’, the paper covers the role played by provision of knowledge and information, of new technology, particularly the Internet, and of critical thinking and digital literacy in the development of this form of society. Conclusions are drawn for the role of libraries and librarians, with seven general principles suggested: • provision of access to a wide variety of sources without ‘negative’ restriction or censorship • provision of ‘positive’ guidance on sources, based on open and objective criteria • a recognition that a ‘free flow of information’ though essential, is not sufficient • a recognition that provision of factual information, while valuable, is not enough • a need for a specific concern for the effect of new ICTs, and the Internet in particular • promotion of critical thinking and digital literacy • a need for explicit consideration of the ethical values of librarie

Combined EEG-fMRI and ESI improves localisation of paediatric focal epilepsy

OBJECTIVE: Surgical treatment in epilepsy is effective if the epileptogenic zone (EZ) can be correctly localized and characterized. Here we use simultaneous Electroencephalography-functional MRI (EEG-fMRI) data to derive EEG-fMRI and Electrical Source Imaging (ESI) maps. Their yield and their individual and combined ability to 1) localize the epileptogenic zone and 2) predict seizure outcome was then evaluated. METHODS: Fifty-three children with drug-resistant epilepsy underwent EEG-fMRI. Interictal discharges were mapped using both EEG-fMRI haemodynamic responses and Electrical Source Imaging (ESI). A single localization was derived from each individual test (EEG-fMRI global maxima (GM)/ESI maxima) and from the combination of both maps (EEG-fMRI/ESI spatial intersection). To determine the localisation accuracy and its predictive performance the individual and combined test localisations were compared to the presumed EZ and to the postsurgical outcome. RESULTS: Fifty-two/53 patients had significant maps; 47/53 for EEG-fMRI; 44/53 for ESI; 34/53 had both. The epileptogenic zone was well characterised in 29 patients; 26 had an EEG-fMRI GM localisation which was correct in 11; 22 patients had ESI localisation which was correct in 17; 12 patients had combined EEG-fMRI and ESI which was correct in 11. Seizure outcome following resection was correctly predicted by EEG-fMRI GM in 8/20 patients, by the ESI maxima in 13/16. The combined EEG-fMRI/ESI region entirely predicted outcome in 9/9 patients including 3 with no lesion visible on MRI. INTERPRETATION: EEG-fMRI combined with ESI provides a simple unbiased localisation that may predict surgery better than each individual test including in MRI-negative patients

Combined EEG-fMRI and ESI improves localisation of paediatric focal epilepsy

OBJECTIVE: Surgical treatment in epilepsy is effective if the epileptogenic zone (EZ) can be correctly localized and characterized. Here we use simultaneous Electroencephalography-functional MRI (EEG-fMRI) data to derive EEG-fMRI and Electrical Source Imaging (ESI) maps. Their yield and their individual and combined ability to 1) localize the epileptogenic zone and 2) predict seizure outcome was then evaluated. METHODS: Fifty-three children with drug-resistant epilepsy underwent EEG-fMRI. Interictal discharges were mapped using both EEG-fMRI haemodynamic responses and Electrical Source Imaging (ESI). A single localization was derived from each individual test (EEG-fMRI global maxima (GM)/ESI maxima) and from the combination of both maps (EEG-fMRI/ESI spatial intersection). To determine the localisation accuracy and its predictive performance the individual and combined test localisations were compared to the presumed EZ and to the postsurgical outcome. RESULTS: Fifty-two/53 patients had significant maps; 47/53 for EEG-fMRI; 44/53 for ESI; 34/53 had both. The epileptogenic zone was well characterised in 29 patients; 26 had an EEG-fMRI GM localisation which was correct in 11; 22 patients had ESI localisation which was correct in 17; 12 patients had combined EEG-fMRI and ESI which was correct in 11. Seizure outcome following resection was correctly predicted by EEG-fMRI GM in 8/20 patients, by the ESI maxima in 13/16. The combined EEG-fMRI/ESI region entirely predicted outcome in 9/9 patients including 3 with no lesion visible on MRI. INTERPRETATION: EEG-fMRI combined with ESI provides a simple unbiased localisation that may predict surgery better than each individual test including in MRI-negative patients

Surgical outcomes for colon and rectal cancer over a decade: results from a consecutive monocentric experience in 902 unselected patients

<p>Abstract</p> <p>Background</p> <p>This study evaluates the surgical morbidity and long-term outcome of colorectal cancer surgery in an unselected group of patients treated over the period 1994–2003.</p> <p>Methods</p> <p>A consecutive series of 902 primary colorectal cancer patients (489 M, 413 F; mean age: 63 years ± 11 years, range: 24–88 years) was evaluated and prospectively followed in a university hospital (mean follow-up 36 ± 24 months; range: 3–108 months). Perioperative mortality, morbidity, overall survival, curative resection rates, recurrence rates were analysed.</p> <p>Results</p> <p>Of the total, 476 colorectal cancers were localized to the colon (CC, 53%), 406 to the rectum (RC, 45%), 12 (1%) were multicentric, and 8 were identified as part of HNPCC (1%). Combining all tumours, there were 186 cancers (20.6%) defined as UICC stage I, 235 (26.1%) stage II, 270 (29.9%) stage III and 187 (20.6%) stage IV cases. Twenty-four (2.7%) cases were of undetermined stage. Postoperative complications occurred in 38% of the total group (37.8% of CC cases, 37.2% of the RC group, 66.7% of the synchronous cancer patients and 50% of those with HNPCC, p = 0.19) Mortality rate was 0.8%, (1.3% for colon cancer, 0% for rectal cancer; p = 0.023). Multivisceral resection was performed in 14.3% of cases. Disease-free survival in cases resected for cure was 73% at 5-years and 72% at 8 years. The 5- and 8-year overall survival rates were 71% and 61% respectively (total cases). At 5-year analysis, overall survival rates are 97% for stage I disease, 87% for stage II, 73% for stage III and 22% for stage IV respectively (p < 0.0001). The 5-year overall survival rates showed a marked difference in R0, R1+R2 and non resected patients (82%, 35% and 0% respectively, p < 0.0001). On multivariate analysis, resection for cure and stage at presentation but not tumour site (colon vs. rectum) were independent variables for overall survival (p < 0.0001).</p> <p>Conclusion</p> <p>A prospective, uniform follow-up policy used in a single institution over the last decade provides evidence of quality assurance in colorectal cancer surgery with high rates of resection for cure where only stage at presentation functions as an independent variable for cancer-related outcome.</p

Nitroxide-Mediated Polymerization of Styrene Initiated from the Surface of Laponite Clay Platelets

International audienc

Nitroxide-Mediated Polymerization of Styrene Initiated from the Surface of Laponite Clay Platelets

International audienc

Hydrocarbons and oxidized organic compounds in hydrothermal fluids from Rainbow and Lost City ultramafic-hosted vents

The first building blocks of life could be produced in ultramafic-hosted hydrothermal systems considering the large amounts of hydrogen and methane generated by serpentinisation and Fischer-Tropsch-Type synthesis, respectively, in those systems. The purpose of this study was to detect and characterise organic molecules in hydrothermal fluids from ultramafic-hosted hydrothermal systems in the Mid-Atlantic Ridge (MAR) region. During the EXOMAR cruise 2005, fluids from the Rainbow (36 degrees 14'N) and the Lost City (30 degrees N) hydrothermal fields were collected and treated by Stir Bar Sorptive Extraction (SBSE) and Solid Phase Extraction (SPE). The extracts were analysed by Thermal Desorption-Gas Chromatography-Mass Spectrometry (TD-GC-MS) and GC-MS, respectively. Compared to nearby deep seawater, hydrothermal fluids were clearly enriched in organic compounds, with a more diverse spectrum of molecules. We observed a very similar range of organic compounds in fluids from both sites, with a dominance of aliphatic hydrocarbons (C9-C14), aromatic compounds (C6-C16) and carboxylic acids (C8-C18). The occurrence of these compounds is supported by other field studies on serpentinites and sulfide deposits. Literature on thermodynamic data and experimental work has suggested the possible abiogenic origin of hydrocarbons and organic acids. In addition, it has been shown elsewhere that catalytic reactions producing hydrocarbons likely occur at both Lost City and Rainbow hydrothermal fields as suggested by the evolution of delta C-13 with increasing C number for methane, ethane, propane and butane. In order to investigate the origin of the organic molecules in the fluids, compound-specific carbon isotope ratio measurements were performed on n-alkanes and carboxylic acids, for which the delta C-13 values were in the range of -46 to -20 parts per thousand (vs. V-PDB). These preliminary data did not allow conclusive support or rejection of an abiogenic origin of the compounds. Indeed, predicting delta C-13 signatures in hydrothermal systems is likely to be complicated, due to differences in source delta C-13 signatures (i.e., of the C building blocks), and a variety of, mostly unknown. fractionation steps which may occur along the synthesis pathways. in addition, even though a fraction of the compounds detected in the fluids is likely abiotically produced, a dominance of biogenic sources and/or processes might hide their characteristic signature. (C) 2008 Elsevier B.V. All rights reserved.status: publishe

Hydrocarbons and oxidized organic compounds in hydrothermal fluids from Rainbow and Lost City ultramafic-hosted vents

The first building blocks of life could be produced in ultramafic-hosted hydrothermal systems considering the large amounts of hydrogen and methane generated by serpentinisation and Fischer–Tropsch-Type synthesis, respectively, in those systems. The purpose of this study was to detect and characterise organic molecules in hydrothermal fluids from ultramafic-hosted hydrothermal systems in the Mid-Atlantic Ridge (MAR) region. During the EXOMAR cruise 2005, fluids from the Rainbow (36°14′N) and the Lost City (30°N) hydrothermal fields were collected and treated by Stir Bar Sorptive Extraction (SBSE) and Solid Phase Extraction (SPE). The extracts were analysed by Thermal Desorption–Gas Chromatography–Mass Spectrometry (TD–GC–MS) and GC–MS, respectively. Compared to nearby deep seawater, hydrothermal fluids were clearly enriched in organic compounds, with a more diverse spectrum of molecules. We observed a very similar range of organic compounds in fluids from both sites, with a dominance of aliphatic hydrocarbons (C9–C14), aromatic compounds (C6–C16) and carboxylic acids (C8–C18). The occurrence of these compounds is supported by other field studies on serpentinites and sulfide deposits. Literature on thermodynamic data and experimental work has suggested the possible abiogenic origin of hydrocarbons and organic acids. In addition, it has been shown elsewhere that catalytic reactions producing hydrocarbons likely occur at both Lost City and Rainbow hydrothermal fields as suggested by the evolution of δ13C with increasing C number for methane, ethane, propane and butane. In order to investigate the origin of the organic molecules in the fluids, compound-specific carbon isotope ratio measurements were performed on n-alkanes and carboxylic acids, for which the δ13C values were in the range of − 46 to − 20‰ (vs. V-PDB). These preliminary data did not allow conclusive support or rejection of an abiogenic origin of the compounds. Indeed, predicting δ13C signatures in hydrothermal systems is likely to be complicated, due to differences in source δ13C signatures (i.e., of the C building blocks), and a variety of, mostly unknown, fractionation steps which may occur along the synthesis pathways. In addition, even though a fraction of the compounds detected in the fluids is likely abiotically produced, a dominance of biogenic sources and/or processes might hide their characteristic signature.