Structural brain network abnormalities and the probability of seizure recurrence after epilepsy surgery

OBJECTIVE: We assessed preoperative structural brain networks and clinical characteristics of patients with drug-resistant temporal lobe epilepsy (TLE) to identify correlates of postsurgical seizure recurrences. METHODS: We examined data from 51 patients with TLE who underwent anterior temporal lobe resection (ATLR) and 29 healthy controls. For each patient, using the preoperative structural, diffusion, and postoperative structural MRI, we generated 2 networks: presurgery network and surgically spared network. Standardizing these networks with respect to controls, we determined the number of abnormal nodes before surgery and expected to be spared by surgery. We incorporated these 2 abnormality measures and 13 commonly acquired clinical data from each patient into a robust machine learning framework to estimate patient-specific chances of seizures persisting after surgery. RESULTS: Patients with more abnormal nodes had a lower chance of complete seizure freedom at 1 year and, even if seizure-free at 1 year, were more likely to relapse within 5 years. The number of abnormal nodes was greater and their locations more widespread in the surgically spared networks of patients with poor outcome than in patients with good outcome. We achieved an area under the curve of 0.84 ± 0.06 and specificity of 0.89 ± 0.09 in predicting unsuccessful seizure outcomes (International League Against Epilepsy [ILAE] 3–5) as opposed to complete seizure freedom (ILAE 1) at 1 year. Moreover, the model-predicted likelihood of seizure relapse was significantly correlated with the grade of surgical outcome at year 1 and associated with relapses up to 5 years after surgery. CONCLUSION: Node abnormality offers a personalized, noninvasive marker that can be combined with clinical data to better estimate the chances of seizure freedom at 1 year and subsequent relapse up to 5 years after ATLR. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that node abnormality predicts postsurgical seizure recurrence

A Negative Feedback Loop That Limits the Ectopic Activation of a Cell Type–Specific Sporulation Sigma Factor of Bacillus subtilis

Two highly similar RNA polymerase sigma subunits, σF and σG, govern the early and late phases of forespore-specific gene expression during spore differentiation in Bacillus subtilis. σF drives synthesis of σG but the latter only becomes active once engulfment of the forespore by the mother cell is completed, its levels rising quickly due to a positive feedback loop. The mechanisms that prevent premature or ectopic activation of σG while discriminating between σF and σG in the forespore are not fully comprehended. Here, we report that the substitution of an asparagine by a glutamic acid at position 45 of σG (N45E) strongly reduced binding by a previously characterized anti-sigma factor, CsfB (also known as Gin), in vitro, and increased the activity of σG in vivo. The N45E mutation caused the appearance of a sub-population of pre-divisional cells with strong activity of σG. CsfB is normally produced in the forespore, under σF control, but sigGN45E mutant cells also expressed csfB and did so in a σG-dependent manner, autonomously from σF. Thus, a negative feedback loop involving CsfB counteracts the positive feedback loop resulting from ectopic σG activity. N45 is invariant in the homologous position of σG orthologues, whereas its functional equivalent in σF proteins, E39, is highly conserved. While CsfB does not bind to wild-type σF, a E39N substitution in σF resulted in efficient binding of CsfB to σF. Moreover, under certain conditions, the E39N alteration strongly restrains the activity of σF in vivo, in a csfB-dependent manner, and the efficiency of sporulation. Therefore, a single amino residue, N45/E39, is sufficient for the ability of CsfB to discriminate between the two forespore-specific sigma factors in B. subtilis

The effect of dose on the antimalarial efficacy of artemether-lumefantrine: a systematic review and pooled analysis of individual patient data

Background: Artemether-lumefantrine is the most widely used artemisinin-based combination therapy for malaria, although treatment failures occur in some regions. We investigated the effect of dosing strategy on efficacy in a pooled analysis from trials done in a wide range of malaria-endemic settings. Methods: We searched PubMed for clinical trials that enrolled and treated patients with artemether-lumefantrine and were published from 1960 to December, 2012. We merged individual patient data from these trials by use of standardised methods. The primary endpoint was the PCR-adjusted risk of Plasmodium falciparum recrudescence by day 28. Secondary endpoints consisted of the PCR-adjusted risk of P falciparum recurrence by day 42, PCR-unadjusted risk of P falciparum recurrence by day 42, early parasite clearance, and gametocyte carriage. Risk factors for PCR-adjusted recrudescence were identified using Cox's regression model with frailty shared across the study sites. Findings: We included 61 studies done between January, 1998, and December, 2012, and included 14 327 patients in our analyses. The PCR-adjusted therapeutic efficacy was 97·6% (95% CI 97·4-97·9) at day 28 and 96·0% (95·6-96·5) at day 42. After controlling for age and parasitaemia, patients prescribed a higher dose of artemether had a lower risk of having parasitaemia on day 1 (adjusted odds ratio [OR] 0·92, 95% CI 0·86-0·99 for every 1 mg/kg increase in daily artemether dose; p=0·024), but not on day 2 (p=0·69) or day 3 (0·087). In Asia, children weighing 10-15 kg who received a total lumefantrine dose less than 60 mg/kg had the lowest PCR-adjusted efficacy (91·7%, 95% CI 86·5-96·9). In Africa, the risk of treatment failure was greatest in malnourished children aged 1-3 years (PCR-adjusted efficacy 94·3%, 95% CI 92·3-96·3). A higher artemether dose was associated with a lower gametocyte presence within 14 days of treatment (adjusted OR 0·92, 95% CI 0·85-0·99; p=0·037 for every 1 mg/kg increase in total artemether dose). Interpretation: The recommended dose of artemether-lumefantrine provides reliable efficacy in most patients with uncomplicated malaria. However, therapeutic efficacy was lowest in young children from Asia and young underweight children from Africa; a higher dose regimen should be assessed in these groups. Funding: Bill and Melinda Gates Foundation

Development of the self-modulation instability of a relativistic proton bunch in plasma

Self-modulation is a beam–plasma instability that is useful to drive large-amplitude wakefields with bunches much longer than the plasma skin depth. We present experimental results showing that, when increasing the ratio between the initial transverse size of the bunch and the plasma skin depth, the instability occurs later along the bunch, or not at all, over a fixed plasma length because the amplitude of the initial wakefields decreases. We show cases for which self-modulation does not develop, and we introduce a simple model discussing the conditions for which it would not occur after any plasma length. Changing bunch size and plasma electron density also changes the growth rate of the instability. We discuss the impact of these results on the design of a particle accelerator based on the self-modulation instability seeded by a relativistic ionization front, such as the future upgrade of the Advanced WAKefield Experiment

Simulation and experimental study of proton bunch self-modulation in plasma with linear density gradients

We present numerical simulations and experimental results of the self-modulation of a long proton bunch in a plasma with linear density gradients along the beam path. Simulation results agree with the experimental results reported [F. Braunmller, T. Nechaeva et al. (AWAKE Collaboration), Phys. Rev. Lett. 125, 264801 (2020)PRLTAO0031-900710.1103/PhysRevLett.125.264801]: with negative gradients, the charge of the modulated bunch is lower than with positive gradients. In addition, the bunch modulation frequency varies with gradient. Simulation results show that dephasing of the wakefields with respect to the relativistic protons along the plasma is the main cause for the loss of charge. The study of the modulation frequency reveals details about the evolution of the self-modulation process along the plasma. In particular for negative gradients, the modulation frequency across time-resolved images of the bunch indicates the position along the plasma where protons leave the wakefields. Simulations and experimental results are in excellent agreement

Experimental study of extended timescale dynamics of a plasma wakefield driven by a self-modulated proton bunch

Plasma wakefield dynamics over timescales up to 800 ps, approximately 100 plasma periods, are studied experimentally at the Advanced Wakefield Experiment (AWAKE). The development of the longitudinal wakefield amplitude driven by a self-modulated proton bunch is measured using the external injection of witness electrons that sample the fields. In simulation, resonant excitation of the wakefield causes plasma electron trajectory crossing, resulting in the development of a potential outside the plasma boundary as electrons are transversely ejected. Trends consistent with the presence of this potential are experimentally measured and their dependence on wakefield amplitude are studied via seed laser timing scans and electron injection delay scan

A simple and rapid chemiluminescence assay for on-site analysis of paraquat using a portable luminometer

Paraquat (N,N′-dimethyl-4,4′-bipyridinium dichloride) is one of the most widely used herbicides owing to its high efficacy and low environmental persistence. However, because paraquat has significant acute toxicity, fatalities are often caused by accidental or voluntary ingestion of paraquat. In consideration of the strong toxicity and fast-Acting property of paraquat, on-site analysis at accident scenes should be effective in facilitating immediate medical treatment. In this study, a simple and rapid chemiluminescence assay using a portable luminometer was developed for on-site analysis of paraquat. The proposed assay is based on luminol chemiluminescence detection of superoxide anion radical resulting from the redox reaction between paraquat and dithiothreitol. Intense chemiluminescence was observed after mixing of paraquat and dithiothreitol in the presence of luminol. Because the chemiluminescence intensity was proportional to the concentration of paraquat, a quantitative measurement of paraquat was possible. The calibration curve for standard paraquat solution was linear from 0.025 to 2.5 μM with the correlation coefficient of 0.992; the detection limit (blank + 3SD) was 22 nM. The proposed assay was applied to determine paraquat in beverage samples after a cation exchange clean-up procedure. Given that the portable luminometer used in this study is small and lightweight, the proposed assay should be useful for on-site analysis of paraquat