Improving preoperative nTMS with a dual-task protocol:the contribution of Action Naming to language mapping

In order to perform safe brain tumor surgery that affects cognitive skills as little as possible, it is important to know exactly which brain areas around the tumor are hosting crucial skills, such as language. The non-invasive brain stimulation method of navigated Transcranial Magnetic Stimulation (nTMS) allows us to locate these areas even before surgery: We can probe small brain areas by applying the disrupting stimulation and having the patient perform a language task. Errors during the task suggest language involvement in this area. The neurosurgeon will then try to spare this area during resection. Until recently, only object naming in which the patient has to produce the name of a noun picture (e.g. This is a table) was used. This thesis explores the potential of employing an additional action naming task (e.g. The woman reads), that is linguistically more complex. First, we described the design of a standardized protocol, consisting of both Object Naming and Action Naming. Secondly, we applied it under nTMS in healthy participants to evaluate its usefulness in localizing language on the brain surface and the underlying network. Finally, we investigated its feasibility in brain tumor patients. Our results indicate that Action Naming is more successful than Object Naming in revealing language areas and networks. We provide evidence that clinicians should use both Object and Action Naming, because these tasks require partly different networks in the brain that both need to be preserved during surgery in order to avoid worsening of language after surgery

Infection of the metacarpal interosseus ligament within the metacarpal interosseus space as a complication of open fracture of the fourth metacarpal bone in 5 horses

Open splint bone fractures are at increased risk of osteomyelitis and/or sequestrum formation. Infection is not always restricted to bony structures but may also affect the surrounding ligamentous structures including the interosseous ligament. This case series describes 5 horses with infection of the metacarpal interosseus space, including the metacarpal interosseus ligament, as a complication of an open fracture of the fourth metacarpal bone. All described horses had been presented to the equine department, Vetsuisse Faculty, University of Zurich, between July 2017 and October 2021 and fulfilled the following criteria: radiographic diagnosis of an acute fracture of second metacarpal (MCII)/metatarsal bone (MTII) or the fourth metacarpal (MCIV)/metatarsal bone (MTIV); the fracture was classified as open because of a wound in the affected metacarpal/metatarsal region; the presence of radiographic signs of osteomyelitis in the interosseus metacarpal/ metatarsal space. Five horses fulfilled the inclusion criteria, and all had an open fracture of MCIV. Lameness at the walk varied from mild to severe. Wound secretion was present in 3 of the 5 horses. Radiography was done in all 5 cases and computed tomography was also used in 4 cases. Three different surgical treatments combined with antibiotics and nonsteroidal anti-inflammatory drugs were used: bone curettage, partial ostectomy and segmental ostectomy. All 5 cases made a complete recovery and returned to their intended use within 2.5 months to 2 years after surgery. In horses with persistent lameness and/or persistent wound secretion as a consequence of an open splint bone fracture, the adjacent metacarpal interosseus space should be assessed. Computed tomography appears superior to radiography for the presurgical staging of osteomyelitis because of its higher spatial and contrast resolution. The prognosis after extensive surgical and medical treatment appears to be good

Computed tomography of the abdomen in Saanen goats: II. liver, spleen, abomasum, and intestine

This study describes the results of computed tomography (CT) of the liver, spleen, abomasum, small intestine and large intestine in 30 healthy Saanen goats. CT examination and anatomical slice preparation postmortem were performed as described in the first communication. After subjective evaluation of the CT images, various variables including the length/size, volume and density of the liver, spleen and gallbladder, the wall thickness of the abomasum, small intestine and large intestine and the diameter of the intestine were measured. The liver, spleen, abomasum, small intestine and large intestine could be accurately visualised using CT

Eliciting verb inflection in the English language:The Verb and Noun Test (VAN) for Presurgical Language Mapping with navigated TMS and Intraoperative DES

Eliciting Verb Inflection in the English Language – The Verb and Noun Test (VAN) for Presurgical Language Mapping with navigated TMS and Interaoperative DES Ann-Katrin Ohlerth1, Antonio Valentin2, Keyoumars Ashkan3, Francesco Vergani3, Molood Sadat Safavi4, Frank Zanow4 & Roelien Bastiaanse1,5 1Center for Language and Cognition Groningen, the Netherlands 2Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Kings College London, UK 3Neurosurgical Department, King's College Hospital, London (UK) 4eemagine Medical Imaging Solutions GmbH, Berlin, Germany 5National Research University, Higher School of Economics, Moscow, Russian Federation Introduction: To ensure maximal removal of tumour in eloquent areas of the brain while preserving function, Direct Electrical Stimulation (DES) during awake brain surgery is the gold standard for intraoperative language mapping. To reduce the duration of the surgery and, thus, the stress for the patient, preoperative language mapping using navigated Transcranial Magnetic Stimulation (nTMS) can be beneficial (Tarapore, 2016). The method is, however, still not widely used in clinical practice. Reason for this could be the low predictive value of nTMS compared to DES mapping (Picht et al., 2013). In the recent years, advances have been made to further improve preoperative language mapping under nTMS. Parameters such as intensity, frequency, duration etc. of the stimulation, picture-presentation-time, inter-picture-interval of the stimuli etc. have been tested out and consensus has been reached that is used by the majority of centres (Krieg et al., 2017). However, the question of choice of task has not been further explored: whereas in the intraoperative situation, a variety of tasks is used and carefully chosen based on the individual’s characteristics, most centres only rely on one task, namely object naming, for preoperative mapping of language. It is known from stroke-induced aphasia research, that tasks involving only noun retrieval and production can hardly capture the individual’s language skills. The necessity of including verb tasks is evident (Bastiaanse, Wieling & Wolthuis, 2016). While some studies (Hauck et al., 2015, Hernandez-Pavon et al., 2014) have looked into the comparison of noun vs. verb tasks under nTMS, they neglected the actual contribution a verb task can have: the elicitation of the inflected form of a verb. However, while naming action in English, participants tend to use the progressive form of the verb (he is sleeping). This would diminish the morphological processes required for inflection, compared to inflection in tenses such as simple present and past (he sleeps/he slept). Therefore, adding a lead-in phrase with an adverb to the picture can help triggering tenses other than simple progressive (Daily, he sleeps). This has not been tested before regarding nTMS mapping. In this validation study, we established a reliable item list for both object and inflected action naming tasks for British English (BE) that uses lead-in phrases triggering one-word answers and that is feasible to use under nTMS parameters. We present a validated picture set with each 50 items for object naming and 50 for action naming with a high naming agreement. Methods: From a collection of around 400 available black-and-white drawings (Bastiaanse et al., 2016), the researchers chose 90 suitable pictures to elicit possible one-word targets in English. This preselection was shown to 5 BE native speakers with the instructions to name the object/action on the picture. Only pictures consistently named with one label were considered good depictions and chosen for the next step. Next, the remaining 80 object and 74 action stimuli were implemented in an experiment, following parameters commonly used in nTMS language mapping. Participants were instructed to name the pictures with the first word coming to their mind in one word. For the object naming task, they were asked to each time complete and read out the sentence “this is a…”, printed above. For the action naming task, elicitation of the progressive form of the verb was avoided, and instead the inflection of the verb in different tenses was triggered. For the first half of the stimuli, the participants were asked to complete and read out the sentence “Daily, he…”, triggering the the verb in simple present. In the second half, the printed lead-in phrase “Yesterday, he…” triggered the verb in simple past. The picture presentation time was 700ms for the objects and 1000ms for the actions with an inter picture interval of 2500ms comparable to conditions under TMS. After two practice items, the test began and was not further interrupted. Answers were recorded. The test took around 12 minutes. 28 native speakers of BE (15 female; age range: 23-65, age average: 40.91 with a wide range of educational background) took part in London, UK. Result Only items that were consistently named by at least 80% of the participants were selected for the final item list. 71 object stimuli and 50 action stimuli proofed to fulfill the criterion. To keep the lists even, another 21 objects were excluded. The final item lists consist of 100 items sorted by ascending values for Age of Acquisition of the words. All items are also matched for frequency, length in syllables, animacy (for objects); regularity, transitivity, number of arguments, instrumentality and name relatedness to a noun (for the actions). In the action naming paradigm, both subtests (present and past) have a balanced number for irregular vs. regular verbs. No difference was observed in the correct/incorrect naming of the irregular vs. regular verbs, neither within nor across tasks. Discussion: This validation study resulted in a reliable set of stimuli: we established two tasks that are capturing the linguistic abilities more adequate than a noun task alone could. The tasks are balanced for age of acquisition and frequency, as well as irregularity for the verbs. Moreover, all stimuli are controlled for linguistic factors, known to be impaired in clinical populations, and can, hence, be sorted participant-tailored. The inclusion of a lead-in phrase was necessary to trigger the inflected form of the verbs. While it makes the visual input more complex and the answer longer, it did not hinder the participants for completing the tasks correctly and in time. Even for the more complex pictures depicting less frequent actions, the picture presentation time has shown to be sufficient to recognize and name the target, yet short enough to be challenging and to stay as close as possible to the commonly used protocols. This proofs the paradigm to be feasible for usage under nTMS. The test will be made freely available for neurosurgical teams; it can be adapted to other languages. References: Bastiaanse, R., Wieling, M., & Wolthuis, N. (2016). The role of frequency in the retrieval of nouns and verbs in aphasia. Aphasiology, 30(11), 1221-1239. Krieg, S. M., Lioumis, P., Mäkelä, J. P., Wilenius, J., Karhu, J., Hannula, H., ... & Islam, M. (2017). Protocol for motor and language mapping by navigated TMS in patients and healthy volunteers; workshop report. Acta neurochirurgica, 159(7), 1187-1195. Hauck, T., Tanigawa, N., Probst, M., Wohlschlaeger, A., Ille, S., Sollmann, N., ... & Krieg, S. M. (2015). Task type affects location of language-positive cortical regions by repetitive navigated transcranial magnetic stimulation mapping. PLoS One, 10(4), e0125298. Hernandez-Pavon, J. C., Mäkelä, N., Lehtinen, H., Lioumis, P., & Mäkelä, J. P. (2014). Effects of navigated TMS on object and action naming. Frontiers in human neuroscience, 8, 660. Rofes A, De Witte E, Marie¨n P, Bastiaanse R (2012) The verb in sentence context test (VISC). Rijksuniversiteit Groningen, Groningen

Differences of morphological attributes between 62 proximal and distal subchondral cystic lesions of the proximal phalanx as determined by radiography and computed tomography

OBJECTIVE: To determine morphological characteristics of subchondral cystic lesions (SCLs) in the proximal phalanx (PP) of adult horses. SAMPLE: Radiographs and/or CT scans of PP from 46 horses. PROCEDURES: There were horses with a SCL in PP, which was diagnosed by radiography and/or computed tomography, included. Additional data (signalment, history, orthopedic examination) were collected retrospectively for each case. RESULTS: Forty-six horses met the required inclusion criteria, with a total of 62 SCLs. Forty-three SCLs (70.5%) were located in the proximal PP (group A). Forty-four percent of these were associated with short, incomplete fractures, while 30 of the proximal PP SCLs (69.7%) were found mid sagittal. Proximal SCLs mostly showed a blurred, irregular shape (62.8%) and long, as well as wide, but shallow shapes in CT. Eighteen SCLs (29.5%) were found in the distal PP, near the proximal interphalangeal joint (group B). In contrast to the described proximal SCLs, the distal SCLs were of circular or oval shape, well delineated (77.8%), and distinctly larger. Horses of group A were significantly older (mean age, 11.47 years) than horses of group B (mean age, 6.72 years). CLINICAL RELEVANCE: The distribution and morphological attributes of proximal PP SCLs as well as their association to subchondral bone lesions and short, incomplete proximal fractures indicate more recently developed lesions due to chronic stress factors, such as repetitive trauma to the cartilage and subchondral bone. In contrast, morphology and distribution of distal SCLs showed high accordance with developmental bone cysts originating from a failure of endochondral ossification

Correlation of Pretreatment Polarographically Measured Oxygen Pressures with Quantified Contrast-Enhanced Power Doppler Ultrasonography in Spontaneous Canine Tumors and their Impact on Outcome After Radiation Therapy

Purpose: : To evaluate the use of noninvasive quantified contrast-enhanced power Doppler ultrasonography as a surrogate in the estimation of tumor hypoxia measured by invasive pO2 histography in canine tumors. Material and Methods: : Data of pretreatment tumor oxygenation status, tumor vascularity and blood volume, and tumor response after radiation therapy was collected in 48 spontaneous malignant oral tumors (Table 1). Tumor oxygenation status was correlated to vascularity and blood volume, and influences on outcome after treatment were analyzed. Results: : Although vascularity and blood volume correlated moderately with median pO2 (r = 0.51 and 0.61; p = 0.001 and < 0.0001) and percentage of pO2 readings ≤ 2.5, 5, and 10 mmHg (r = -0.37 to -0.42; p < 0.01-0.03) for all tumors, they did not correlate within the different histology groups (p = 0.06-0.9). For all tumors, pretreatment oxygenation status, vascularity and blood volume were not found to be of prognostic value (Tables 2 and 3). Conclusion: : These analyses show that quantified contrast-enhanced power Doppler ultrasonography does not represent a noninvasive indirect method to assess tumor hypoxia measured by invasive pO2 histography. Both technologies were nonprognostic indicators in spontaneous malignant canine oral tumor

Non-surgical external jugular vein catheterization using an ear vein access in piglets

The objective of this study was to investigate the feasibility of external jugular vein catheterization through an ear vein in piglets. Forty-six sevoflurane-midazolam anaesthetized piglets were included. External jugular vein catheterization was conducted through the ear vein using the Seldinger technique. Part 1 (n = 27): optimal puncture site was based on the deltoid tuberosity as a landmark to reach the external jugular vein. The final position of the catheter was verified in 25 piglets using computer tomography. Catheterization time was recorded and patency of the catheter assessed by repeated blood sampling for up to 4 h. Part 2 (n = 19): ear vein catheterization was without taking into account any landmarks. Functionality for blood sampling was evaluated as described in part 1. Catheter advancement was possible in 25/27 and 18/19 piglets in parts 1 and 2, respectively. Median (range) time required for successful catheterization was 1.95 (1–10) min (n = 38). The deltoid tuberosity was a good landmark to reach the external jugular vein. But blood sampling was also possible through catheters ending slightly cranial to the external jugular vein. Despite successful catheter advancement, blood sampling was not possible from one catheter in each part of the study (total: two piglets). One of these catheters presented luminal damage, while the other one presented as normal after being removed from the animal. Summarizing, central vein catheterization through the ear vein was feasible in 93.5% and repeated blood sampling was possible in 89.1% of the piglets (n = 46)

Influence of Pretreatment Polarographically Measured Oxygenation Levels in Spontaneous Canine Tumors Treated with Radiation Therapy

Background and Purpose:: The level of hypoxia in primary tumors has been described to influence response to treatment. The aim of the present study was to investigate the impact of pretreatment oxygen level measurements in spontaneous canine tumors on treatment outcome. Materials and Methods:: Data of pretreatment tumor oxygenation status and local tumor response after primary radiation therapy in a group of spontaneously occurring tumors in dogs (n = 52) was collected. Radiation therapy was given with curative (14-17 × 3-3.5 Gy) or palliative intent (3 × 8 Gy or 4-5 × 6 Gy). Progression-free interval and overall survival were correlated to polarographically measured tumor oxygenation status. Results:: In the curatively irradiated group, tumors with median pO2 values ≤ 10 mmHg tended to have shorter median progression- free interval compared to better oxygenated tumors (246 vs. 739 days). The same trend could be shown for overall survival (330 vs. 745 days), indicating a cutoff value in this region. In the group treated with lower doses of radiation, the level of oxygen was no longer found to be of prognostic value; however, in this group hemoglobin had a significant impact on outcome. Conclusion:: In curatively irradiated spontaneous canine tumors, tumor hypoxia was found to be a prognostic indicator, independent of tumor histologies and volum

Computed tomographic findings in incisors and canine teeth with equine odontoclastic tooth resorption and hypercementosis: a retrospective study in 115 Warmblood horses

Computed tomography (CT) has become a routine method to examine the equine skull. Its clinical use for the diagnosis of diseases of the incisors and canine teeth has not been reported so far. The goal of this study was to study the prevalence and relationship of single CT features and equine odontoclastic tooth resorption and hypercementosis (EOTRH) in equine incisors and canine teeth. In this descriptive retrospective study, helical CT studies of 115 warmblood horses of the age of 5 years or older examined between 2007 and 2020 for reasons unrelated to the incisors and canine teeth were included. Resorption in the crown or root, hypercementosis, widening of the periodontal space, clubbing of the root, lysis of the lamina dura, an abnormal pulp cavity and fracture of the root were recorded in all incisors and canine teeth. The length of the pulp cavity and the labial and lingual/palatal length of the enamel and root was measured in each incisor and canine tooth. Additionally, the angulation was assessed in each incisor. The variable EOTRH was defined based on the presence of resorptive lesions, hypercementosis and clubbing. In result median age of the included horses was 12 years (range, 5-29 years). With regard to the investigated population of horses, 44.3% of all horses had normal incisors whereas 55.7% of the horses had mild EOTRH changes in one incisor at least. Regarding the canine teeth, 54.7% of the horses had normal canine teeth whereas 43.3% horses had mild EOTRH in one canine tooth at least. With regard to all investigated teeth, 868 teeth (53.0%) were classified as normal, whereas 769 incisors and canine teeth (47.0%) showed at least one abnormal CT criterion. Clubbing of the root and hypercementosis were most common (37.1% and 22.7%, respectively) and EOTRH was present in 27.1% of all teeth. Mild changes were more common than moderate or severe abnormalities. In the lower jaw, hypercementosis and widening of the periodontal space at the anatomical root and apex of the root was significantly more frequent (p = 0.004 and 0.02), whereas clubbing of the root was more common in the upper jaw (p = 0.009). In canine teeth, resorption in the anatomical crown and anatomical root, widening of the periodontal space, clubbing and lysis of the lamina dura were significantly more common whereas hypercementosis was more common in incisors (p < 0.001). Frequency of certain CT changes significantly increased from central to middle and corner incisors. Severity of all single CT criteria as well as prevalence and severity of EOTRH significantly increased with age (r = 0.08-0.56). Linear forward and backward multivariate regression analysis confirmed a significant association between prevalence and severity of EOTRH and age, changes of the pulp cavity, widening of the periodontal space at the anatomical root and incisor group (central, middle, corner) (p = 0.01 - < 0.001). In conclusion computed tomographic changes of the incisors and canine teeth are common and age-related in warmblood horses. Therefore, treatment of EOTRH should not be based on diagnostic imaging alone, but always in combination with a thorough clinical examination