Stability effects on results of diffusion tensor imaging analysis by reduction of the number of gradient directions due to motion artifacts: an application to presymptomatic Huntington's disease.

In diffusion tensor imaging (DTI), an improvement in the signal-to-noise ratio (SNR) of the fractional anisotropy (FA) maps can be obtained when the number of recorded gradient directions (GD) is increased. Vice versa, elimination of motion-corrupted or noisy GD leads to a more accurate characterization of the diffusion tensor. We previously suggest a slice-wise method for artifact detection in FA maps. This current study applies this approach to a cohort of 18 premanifest Huntington's disease (pHD) subjects and 23 controls. By 2-D voxelwise statistical comparison of original FA-maps and FA-maps with a reduced number of GD, the effect of eliminating GD that were affected by motion was demonstrated.We present an evaluation metric that allows to test if the computed FA-maps (with a reduced number of GD) still reflect a "true" FA-map, as defined by simulations in the control sample. Furthermore, we investigated if omitting data volumes affected by motion in the pHD cohort could lead to an increased SNR in the resulting FA-maps.A high agreement between original FA maps (with all GD) and corrected FA maps (i.e. without GD corrupted by motion) were observed even for numbers of eliminated GD up to 13. Even in one data set in which 46 GD had to be eliminated, the results showed a moderate agreement

Canonical wave packets in quantum cosmology

We discuss the construction of wave packets resulting from the solutions of a class of Wheeler-DeWitt equations in Robertson-Walker type cosmologies, for arbitrary curvature. We show that there always exists a ``canonical initial slope" for a given initial wave function, which optimizes some desirable properties of the resulting wave packet, most importantly good classical-quantum correspondence. This can be properly denoted as a canonical wave packet. We introduce a general method for finding these canonical initial slopes which is generalization of our earlier work.Comment: 19 pages, 8 figure

Advantages and Disadvantages of Health Care Accreditation Mod­els

Background: This systematic review seeks to define the general advantages and disadvantagesof accreditation programs to assist in choosing the most appropriate approach.Method: Systematic search of SID, Ovid Medline & PubMed databases was conducted by thekeywords of accreditation, hospital, medical practice, clinic, accreditation models, health careand Persian meanings. From 2379 initial articles, 83 articles met the full inclusion criteria.From initial analysis, 23 attributes were identified which appeared to define advantages anddisadvantages of different accreditation approaches and the available systems were comparedon these.Results: Six systems were identified in the international literature including the JCAHO fromUSA, the Canadian program of CCHSA, and the accreditation programs of UK, Australia,New Zealand and France. The main distinguishing attributes among them were: qualityimprovement, patient and staff safety, improving health services integration, public’s confidence,effectiveness and efficiency of health services, innovation, influence global standards,information management, breadth of activity, history, effective relationship with stakeholders,agreement with AGIL attributes and independence from government.Conclusion: Based on 23 attributes of comprehensive accreditation systems we have definedfrom a systematic review, the JCAHO accreditation program of USA and then CCHSA ofCanada offered the most comprehensive systems with the least disadvantages. Other programssuch as the ACHS of Australia, ANAES of France, QHNZ of New Zealand and UK accreditationprograms were fairly comparable according to these criteria. However the decision forany country or health system should be based on an assessment weighing up their specificobjectives and needs

Draft genome sequences of two unclassified bacteria, Hydrogenophaga sp. strains IBVHS1 and IBVHS2, isolated from environmental samples

We report here the draft genome sequences of Hydrogenophaga sp. strains IBVHS1 and IBVHS2, two bacteria assembled from the metagenomes of surface samples from freshwater lakes. The genomes are >95% complete and may represent new species within the Hydrogenophaga genus, indicating a larger diversity than currently identified

Spatiotemporal Organization of Electromechanical Phase Singularities during High-Frequency Cardiac Arrhythmias

Ventricular fibrillation (VF) is a lifethreatening electromechanical dysfunction of the heart associated with complex spatiotemporal dynamics of electrical excitation and mechanical contraction of the heart muscle. It has been hypothesized that VF is driven by three-dimensional (3D) rotating electrical scroll waves, which can be characterized by filament-like electrical phase singularities (EPS). Recently, it was shown that rotating excitation waves during VF are associated with rotating waves of mechanical deformation. 3D mechanical scroll waves and mechanical filaments describing their rotational core were observed in the ventricles by using high-resolution ultrasound. The findings suggest that the spatiotemporal organization of cardiac fibrillation may be assessed from waves of mechanical deformation. However, the complex relationship between excitation and mechanical waves during VF is currently not understood. Here, we study the fundamental nature of mechanical phase singularities (MPS), their spatiotemporal organization and relation with EPS. We demonstrate the existence of two fundamental types of MPS: "paired singularities", which are co-localized with EPS, and "unpaired singularities", which can form independently. We show that the unpaired singularities emerge due to the anisotropy of the active force field, generated by fiber anisotropy in cardiac tissue, and the non-locality of elastic interactions, which jointly induce strong spatiotemporal inhomogeneities in the strain fields. The inhomogeneities lead to the breakup of deformation waves and create MPS, even in the absence of EPS, which are typically associated with excitation wave break. We exploit these insights to develop an approach to discriminate paired and unpaired MPS. Our findings provide a fundamental understanding of the complex spatiotemporal organization of electromechanical waves in the heart.Comment: 23 pager, 17 figure

Functional compensation of motor function in pre-symptomatic Huntington's disease

Involuntary choreiform movements are a clinical hallmark of Huntington's disease. Studies in clinically affected patients suggest a shift of motor activations to parietal cortices in response to progressive neurodegeneration. Here, we studied pre-symptomatic gene carriers to examine the compensatory mechanisms that underlie the phenomenon of retained motor function in the presence of degenerative change. Fifteen pre-symptomatic gene carriers and 12 matched controls performed button presses paced by a metronome at either 0.5 or 2 Hz with four fingers of the right hand whilst being scanned with functional magnetic resonance imaging. Subjects pressed buttons either in the order of a previously learnt 10-item finger sequence, from left to right, or kept still. Error rates ranged from 2% to 7% in the pre-symptomatic gene carriers and from 0.5% to 4% in controls, depending on the condition. No significant difference in task performance was found between groups for any of the conditions. Activations in the supplementary motor area (SMA) and superior parietal lobe differed with gene status. Compared with healthy controls, gene carriers showed greater activations of left caudal SMA with all movement conditions. Activations correlated with increasing speed of movement were greater the closer the gene carriers were to estimated clinical diagnosis, defined by the onset of unequivocal motor signs. Activations associated with increased movement complexity (i.e. with the pre-learnt 10-item sequence) decreased in the rostral SMA with nearing diagnostic onset. The left superior parietal lobe showed reduced activation with increased movement complexity in gene carriers compared with controls, and in the right superior parietal lobe showed greater activations with all but the most demanding movements. We identified a complex pattern of motor compensation in pre-symptomatic gene carriers. The results show that preclinical compensation goes beyond a simple shift of activity from premotor to parietal regions involving multiple compensatory mechanisms in executive and cognitive motor areas. Critically, the pattern of motor compensation is flexible depending on the actual task demands on motor contro

An ITPR1 gene deletion causes SCA15 and 16; a genetic, clinical and radiological description

Spinocerebellar ataxia (SCA) 15/16 is an autosomal dominantly inherited, almost pure cerebellar ataxia, which shows slow or no progression. (It has been designated variably SCA15 and SCA 16; we refer to it here as SCA15/16 to avoid confusion). Deletions in the inositol 1, 4, 5-triphosphate receptor 1 (ITPR1) on chromosome 3 have been shown to cause SCA15/16 in six families worldwide to date, with one further Japanese family identified as having an ITPR1 point mutation. We present a previously unreported SCA15/16 kindred. We describe the clinical phenotype of the family in detail; affected subjects display a remarkably slow, almost pure cerebellar syndrome. We also present genetic analyses for all subjects and longitudinal MRI data for one affected subject. Genetic analysis shows a deletion of 346,487bp in ITPR1 (the second largest ITPR1 deletion reported to date), suggesting SCA15 is due to a loss of ITPR1 function, and western blotting of lymphoblastoid cell line protein confirms reduced ITPR1 protein levels. Serial MRIs show progressive midline cerebellar atrophy with mild inferior parietal and temporal cortical volume loss in the absence of clinical disease progression. We believe that genetic testing for SCA15/16 should become a routine DNA screen available in all Neurogenetics clinics, which is likely to lead to an increased rate of the diagnosis. Familiarity with the phenotype is therefore important for all neurologists

Progressive genetic aberrations detected by comparative genomic hybridization in squamous cell cervical cancer

Genetic changes orchestrated by human papillomaviruses are the most important known factors in carcinogenesis of the uterine cervix. However, it is clear that additional genetic events are necessary for tumour progression. We have used comparative genomic hybridization to document non-random chromosomal gains and losses within a subset of 37 cervical carcinomas matched for clinical stage Ib, but with different lymph node status. There were significantly more chromosomal changes in the primary tumours when the lymph nodes were positive for metastases. The most frequent copy number alterations were loss of 3p, 11q, 6q and 10q and gain of 3q. The smallest areas of loss and gain on chromosome 3 were 3p14–22 and 3q24–26. The study identifies progressive DNA copy number changes associated with early-stage invasive cervical cancers with and without lymph node metastases, a factor of potential prognostic and therapeutic value. © 2000 Cancer Research Campaign http://www.bjcancer.co

Genetic aberrations detected by comparative genomic hybridisation in vulvar cancers

Squamous cell carcinoma of the vulva is a disease of significant clinical importance, which arises in the presence or absence of human papillomavirus. We used comparative genomic hybridisation to document non-random chromosomal gains and losses within human papillomavirus positive and negative vulvar cancers. Gain of 3q was significantly more common in human papillomavirus-positive cancers compared to human papillomavirus-negative cancers. The smallest area of gain was 3q22–25, a chromosome region which is frequently gained in other human papillomavirus-related cancers. Chromosome 8q was more commonly gained in human papillomavirus-negative compared to human papillomavirus-positive cancers. 8q21 was the smallest region of gain, which has been identified in other, non-human papillomavirus-related cancers. Chromosome arms 3p and 11q were lost in both categories of vulvar cancer. This study has demonstrated chromosome locations important in the development of vulvar squamous cell carcinoma. Additionally, taken together with previous studies of human papillomavirus-positive cancers of other anogenital sites, the data indicate that one or more oncogenes important in the development and progression of human papillomavirus-induced carcinomas are located on 3q. The different genetic changes seen in human papillomavirus-positive and negative vulvar squamous cell carcinomas support the clinicopathological data indicating that these are different cancer types

Altered brain mechanisms of emotion processing in pre-manifest Huntington's disease

Huntington's disease is an inherited neurodegenerative disease that causes motor, cognitive and psychiatric impairment, including an early decline in ability to recognize emotional states in others. The pathophysiology underlying the earliest manifestations of the disease is not fully understood; the objective of our study was to clarify this. We used functional magnetic resonance imaging to investigate changes in brain mechanisms of emotion recognition in pre-manifest carriers of the abnormal Huntington's disease gene (subjects with pre-manifest Huntington's disease): 16 subjects with pre-manifest Huntington's disease and 14 control subjects underwent 1.5 tesla magnetic resonance scanning while viewing pictures of facial expressions from the Ekman and Friesen series. Disgust, anger and happiness were chosen as emotions of interest. Disgust is the emotion in which recognition deficits have most commonly been detected in Huntington's disease; anger is the emotion in which impaired recognition was detected in the largest behavioural study of emotion recognition in pre-manifest Huntington's disease to date; and happiness is a positive emotion to contrast with disgust and anger. Ekman facial expressions were also used to quantify emotion recognition accuracy outside the scanner and structural magnetic resonance imaging with voxel-based morphometry was used to assess the relationship between emotion recognition accuracy and regional grey matter volume. Emotion processing in pre-manifest Huntington's disease was associated with reduced neural activity for all three emotions in partially separable functional networks. Furthermore, the Huntington's disease-associated modulation of disgust and happiness processing was negatively correlated with genetic markers of pre-manifest disease progression in distributed, largely extrastriatal networks. The modulated disgust network included insulae, cingulate cortices, pre- and postcentral gyri, precunei, cunei, bilateral putamena, right pallidum, right thalamus, cerebellum, middle frontal, middle occipital, right superior and left inferior temporal gyri, and left superior parietal lobule. The modulated happiness network included postcentral gyri, left caudate, right cingulate cortex, right superior and inferior parietal lobules, and right superior frontal, middle temporal, middle occipital and precentral gyri. These effects were not driven merely by striatal dysfunction. We did not find equivalent associations between brain structure and emotion recognition, and the pre-manifest Huntington's disease cohort did not have a behavioural deficit in out-of-scanner emotion recognition relative to controls. In addition, we found increased neural activity in the pre-manifest subjects in response to all three emotions in frontal regions, predominantly in the middle frontal gyri. Overall, these findings suggest that pathophysiological effects of Huntington's disease may precede the development of overt clinical symptoms and detectable cerebral atroph