Frequency domain EEG source localization of ictal epileptiform activity in patients with partial complex epilepsy of temporal lobe origin

The aim of this study was to investigate whether EEG source localization in the frequency domain, using the FFT dipole approximation (Lehmann, D. and Michel, C.M. Electroenceph. clin. Neurophysiol., 1990, 76: 271-276), would be useful for quantifying the frequency content of epileptic seizure activity. Between one and 7 extracranially recorded seizures were analyzed in each of 7 patients with mesolimbic epilepsy, who were seizure-free after temporal lobe resection. The full scalp frequency spectrum for the first 4 s after seizure onset, as well as for subsequent periods, was determined. Power peaks in the spectra were identified, and an instant dipole fit was performed for the frequencies corresponding to these peaks. Ictal frequencies, ranging between 3.5 and 8.5 Hz, showed a variable degree of stability over time in the different patients. For a particular frequency, dipole results were similar during the different phases of seizure development. In patients with more than one prominent frequency, dipole results for the different frequencies were similar. Dipole results were also similar between patients. We conclude that dipole localization of dominant frequencies, as obtained from full scalp FFT analysis, gives quite reproducible results for seizures originating in the mesial temporal area. The method may become a useful tool for the pre-surgical identification of patients with mesolimbic epilepsy

Necrotizing soft tissue infections - a multicentre, prospective observational study (INFECT) : Protocol and statistical analysis plan

Background: The INFECT project aims to advance our understanding of the pathophysiological mechanisms in necrotizing soft tissue infections (NSTIs). The INFECT observational study is part of the INFECT project with the aim of studying the clinical profile of patients with NSTIs and correlating these to patient-important outcomes. With this protocol and statistical analysis plan we describe the methods used to obtain data and the details of the planned analyses. Methods: The INFECT study is a multicentre, prospective observational cohort study. Patients with NSTIs are enrolled in five Scandinavian hospitals, which are all referral centres for NSTIs. The primary outcomes are the descriptive variables of the patients. Secondary outcomes include identification of factors associated with 90-day mortality and amputation; associations between affected body part, maximum skin defect and Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score and 90-day mortality; 90-day mortality in patients with and without acute kidney injury (AKI) and LRINEC score of six and above or below six; and association between affected body part at arrival and microbiological findings. Exploratory outcomes include univariate analyses of baseline characteristics associations with 90-day mortality. The statistical analyses will be conducted in accordance with the predefined statistical analysis plan. Conclusion: Necrotizing soft tissue infections result in severe morbidity and mortality. The INFECT study will be the largest prospective study in patients with NSTIs to date and will provide important data for clinicians, researchers and policy makers on the characteristics and outcomes of these patients.</p

Space-oriented segmentation and 3-dimensional source reconstruction of ictal EEG patterns

OBJECTIVES: Characterization of the EEG pattern during the early phase of a seizure is crucial for identifying the epileptic focus. The purpose of the present investigation was to evaluate a method that divides ictal EEG activity into segments of relatively constant surface voltage distribution, and to provide a 3-dimensional localization of the activity during the different segments. METHODS: For each timepoint the electrical voltage distribution on the scalp (the voltage map) was determined from the digitized EEG recording. Through a spatial cluster analysis time sequences where the maps did not change much (segments) were identified, and a 3-dimensional source reconstruction of the activity corresponding to the different mean maps was performed using a distributed linear inverse solution algorithm. RESULTS: Segments dominating early in seizure development were identified, and source reconstruction of the EEG activity corresponding to the maps of these segments yielded results which were consistent with the results from invasive recordings. In some cases a sequence of consecutive segments was obtained, which might reflect ictal propagation. CONCLUSIONS: Segmentation of ictal EEG with subsequent 3-dimensional source reconstruction is a useful method to non-invasively determine the initiation and perhaps also the spread of epileptiform activity in patients with epileptic seizures

Modelling CO formation in the turbulent interstellar medium

We present results from high-resolution three-dimensional simulations of turbulent interstellar gas that self-consistently follow its coupled thermal, chemical and dynamical evolution, with a particular focus on the formation and destruction of H2 and CO. We quantify the formation timescales for H2 and CO in physical conditions corresponding to those found in nearby giant molecular clouds, and show that both species form rapidly, with chemical timescales that are comparable to the dynamical timescale of the gas. We also investigate the spatial distributions of H2 and CO, and how they relate to the underlying gas distribution. We show that H2 is a good tracer of the gas distribution, but that the relationship between CO abundance and gas density is more complex. The CO abundance is not well-correlated with either the gas number density n or the visual extinction A_V: both have a large influence on the CO abundance, but the inhomogeneous nature of the density field produced by the turbulence means that n and A_V are only poorly correlated. There is a large scatter in A_V, and hence CO abundance, for gas with any particular density, and similarly a large scatter in density and CO abundance for gas with any particular visual extinction. This will have important consequences for the interpretation of the CO emission observed from real molecular clouds. Finally, we also examine the temperature structure of the simulated gas. We show that the molecular gas is not isothermal. Most of it has a temperature in the range of 10--20 K, but there is also a significant fraction of warmer gas, located in low-extinction regions where photoelectric heating remains effective.Comment: 37 pages, 15 figures; minor revisions, matches version accepted by MNRA

Diabetes and necrotizing soft tissue infections—A prospective observational cohort study : Statistical analysis plan

Background: Necrotizing soft tissue infections (NSTIs) are rare but carry a high morbidity and mortality. The multicenter INFECT project aims to improve the understanding of the pathogenesis, clinical characteristics, diagnosis, and prognosis of NSTIs. This article describes the study outline and statistical analyses that will be used. Methods: Within the framework of INFECT project, patients with NSTI at 5 Scandinavian hospitals are enrolled in a prospective observational cohort study. The goal is to evaluate outcome and characteristics for patients with NSTI and diabetes compared to patients with NSTI without diabetes. The primary outcome is mortality at 90 days after inclusion. Secondary outcomes include days alive and out of ICU and hospital, SAPS II, SOFA score, infectious etiology, amputation, affected body area, and renal replacement therapy. Comparison in mortality between patients with diabetes type 1 and 2 as well as between insulin-treated and non-insulin–treated diabetes patients will be made. Clinical data for diabetic patients with NSTI will be reported. Conclusion: The study will provide important data on patients with NSTI and diabetes.</p

Postprandial differences in the plasma metabolome of healthy Finnish subjects after intake of a sourdough fermented endosperm rye bread versus white wheat bread

<p>Abstract</p> <p>Background</p> <p>The mechanism behind the lowered postprandial insulin demand observed after rye bread intake compared to wheat bread is unknown. The aim of this study was to use the metabolomics approach to identify potential metabolites related to amino acid metabolism involved in this mechanism.</p> <p>Methods</p> <p>A sourdough fermented endosperm rye bread (RB) and a standard white wheat bread (WB) as a reference were served in random order to 16 healthy subjects. Test bread portions contained 50 g available carbohydrate. <it>In vitro </it>hydrolysis of starch and protein were performed for both test breads. Blood samples for measuring glucose and insulin concentrations were drawn over 4 h and gastric emptying rate (GER) was measured. Changes in the plasma metabolome were investigated by applying a comprehensive two-dimensional gas chromatography coupled to time-of-flight mass spectrometry metabolomics platform (GC×GC-TOF-MS).</p> <p>Results</p> <p>Plasma insulin response to RB was lower than to WB at 30 min (P = 0.004), 45 min (P = 0.002) and 60 min (P < 0.001) after bread intake, and plasma glucose response was significantly higher at time point 90 min after RB than WB intake (P = 0.045). The starch hydrolysis rate was higher for RB than WB, contrary to the <it>in vitro </it>protein digestibility. There were no differences in GER between breads. From 255 metabolites identified by the metabolomics platform, 26 showed significant postprandial relative changes after 30 minutes of bread intake (p and q values < 0.05). Among them, there were changes in essential amino acids (phenylalanine, methionine, tyrosine and glutamic acid), metabolites involved in the tricarboxylic acid cycle (alpha-ketoglutaric, pyruvic acid and citric acid) and several organic acids. Interestingly, the levels of two compounds involved in the tryptophan metabolism (picolinic acid, ribitol) significantly changed depending on the different bread intake.</p> <p>Conclusions</p> <p>A single meal of a low fibre sourdough rye bread producing low postprandial insulin response brings in several changes in plasma amino acids and their metabolites and some of these might have properties beneficial for health.</p