Auditory Evoked Potential (AEP) in schizophrenia

This AEP study aims to investigate the characteristics of cerebral responsiveness in a large number of 181 schizophrenics compared with 200 normal controls. AEPs evoked by binaural click stimuli were recorded with 1024 msec of analysis time through the two derivations (3 CH: Cz→A1+2, 6 CH: Cz→T5). The differences between the two groups of each sex in latency and interpeak amplitude were estimated statistically. The statistically significant (P<0.01 or 0.05) results were obtained as follows. 1. The schizophrenic group of both sexes showed a significant latency prolongation, middle latency components, P 2, P 3, long latency components, especially for the most prominent negative peak N 4 and prominent positive peak P 5. 2. The schizophrenic group of both sexes showed a significant interpeak amplitude reduction including the most prominent negative peak N 4 and prominent positive peak P 5, but augmentation for N 2-P 3. 3. There were no significant differences in latency and amplitude of N 4, P 5 between unmedicated and medicated schizophrenics. A few components with significant differences in latencies and amplitudes between the subjects taking antipsychotics more than 600 mg, in chlorpromazine equivalent values, or not, coincides with those also between the epileptics and healthy subjects. Theses differences in the middle and long latency components confirmed regardless of schizphrenic subtypes, suggests the dysfunction in the primary and secondary cortex in schizphrenics

Somatosensory Evoked Potential (SEP) in schizophrenics

The differences between schizophrenics and healthy subjects in Somatosensory Evoked Potential (SEP) were studied with 174 schizophrenics (98 male and 76 female) and 200 healthy subjects (100 male and 100 female). SEPs evoked by electric stimuli to the right median nerve were recorded through the two derivations (monopolar : C3’→A1+2; bipolar: C3’→Cz), averaging 100 responses, with 1024 msec of analysis time. Individual SEPs were subjected to the component analysis, and the following statistically significant results were obtained. 1. In male schizophrenics, the peak latencies of SEP components were significantly longer in short-latency component, P1 (bipolar), compared with healthy subjects, and shorter in middle-latency component, P2. In female schizophrenics, those were longer in middle-latency components, N2, P3, N3 (monopolar), and N1, P3, N3 (bipolar). 2. The inter-peak amplitudes in schizophrenics of both sexes were significantly larger in middle-latency components without any changes in short-latency components. 3. A few components with significant differences in latencies and inter-peak amplitudes between the subjects taking neuroleptics more than 600 mg, in chlorpromazine equivalent values, or not, as well as between medicated and unmedicated subjects, coincided with those also between the schizophrenics and healthy subjects. Theses differences in SEPs confirmed in the present study, regardless of schizophrenic subtypes, suggest the dysfunction in somatosensory information processing in schizophrenics, and SEP abnormalities may serve as possible elctrophysiological indices for cognitive dysfunction in schizophrenics

Visual Evoked Potential (VEP) in schizophrenics

The differences between schizophrenics and healthy subjects in Visual evoked potential (VEP) were studied with 174 schizophrenics (98 male and 76 female) and 200 healthy subjects (100 male and 100 female). VEPs evoked by flash stimuli were recorded through the two derivations (monopolar: O1→A1+2; bipolar: O1→Cz), averaging 100 responses, with 1024 msec of analysis time. Individual VEPs were subjected to the component analysis, and the following statistically significant results were obtained. 1. In schizophrenics, the latencies in short-latency components were significantly longer in P2 (male, monopolar), N2, P3, N3 (male, bipolar) and N3 (female, monopolar). Those in middle-latency components were significantly shorter in P4~N5 (male, monopolar) and P6 (female). 2. The inter-peak amplitudes in short-latency components were significantly smaller in P3-N3 (male, mopolar), and larger in P1-N1, N1-P2, P2-N2 (male, bipolar). Those in middle-latency components were significantly smaller in N3-P4 (male, monopolar), and larger in N4-P5 (female, bipolar). 3. A few components with significant differences in latencies and interpeak amplitudes between the subjects taking neuroleptics more than 600 mg, in chlorpromazine equivalent values, or not, as well as between medicated and unmedicated subjects, coincided with those also between the schizophrenics and healthy subjects. Theses differences in VEPs confirmed in the present study, regardless of schizophrenic subtypes, suggest the dysfunction in visual information processing in schizophrenics, and VEP abnormalities may serve as possible elctrophysiological indices for cognitive dysfunction in schizophrenics

MEDICAL TREATMENT OF UNRUPTURED CEREBRAL ANEURYSMS

Background: Currently there are no pharmacological therapies for patients with unruptured cerebral aneurysms. Elsewhere we showed that the mineralocorticoid receptor antagonist eplerenone prevented the formation of cerebral aneurysms in our ovariectomized hypertensive aneurysm rat model. The current pilot study evaluated whether it can be used to prevent the growth and rupture of cerebral aneurysms in hypertensive patients. Methods: Between August 2011 and May 2014, we enrolled 82 patients with 90 aneurysms in an open-label uncontrolled clinical trial. All provided prior informed consent for inclusion in this study, and all were treated with eplerenone (25-100 mg/d). The primary end points of our study were the rupture and enlargement of the cerebral aneurysms. Results: Of the 82 patients, 80 (88 unruptured aneurysms) were followed for a mean of 21.3 months (153.4 aneurysm-years); 12 patients (15.0%) permanently discontinued taking the drug. One month after the start of eplerenone administration and throughout the follow-up period, eplerenone kept the blood pressure within the normal range. Most notably, no aneurysms smaller than 9 mm ruptured or enlarged. However, of 2 large thrombosed aneurysms, 1 enlarged and the other ruptured. The overall annual rupture rate was .65%; it was 13.16% for aneurysms larger than 10 mm; the overall annual rate for reaching the primary end points was 1.30%. Conclusion: Our observations suggest that eplerenone may help to prevent the growth and rupture of unruptured cerebral aneurysms smaller than 9 mm. To assess its potential long-term clinical benefits, large clinical trials are needed

Les normes, comment?

La description normalisée des ressources d’enseignement et d’apprentissage requiert l’utilisation d’outils d’implantation conformes aux conventions d’un standard ou d’une norme internationale et un réseau d’entraide et d’accompagnement

Arterial spin labeling灌流画像で得られる血管内高信号は内頚動脈の閉塞部位を予測する

Introduction Arterial spin labeling (ASL) involves perfusion imaging using the inverted magnetization of arterial water. If the arterial arrival times are longer than the post-labeling delay, labeled spins are visible on ASL images as bright, high intra-arterial signals (IASs); such signals were found within occluded vessels of patients with acute ischemic stroke. The identification of the occluded segment in the internal carotid artery (ICA) is crucial for endovascular treatment. We tested our hypothesis that high IASs on ASL images can predict the occluded segment. Methods Our study included 13 patients with acute ICA occlusion who had undergone angiographic and ASL studies within 48 h of onset. We retrospectively identified the high IAS on ASL images and angiograms and recorded the occluded segment and the number of high IAS-positive slices on ASL images. The ICA segments were classified as cervical (C1), petrous (C2), cavernous (C3), and supraclinoid (C4). Results Of seven patients with intracranial ICA occlusion, five demonstrated high IASs at C1–C2, suggesting that high IASs could identify stagnant flow proximal to the occluded segment. Among six patients with extracranial ICA occlusion, five presented with high IASs at C3–C4, suggesting that signals could identify the collateral flow via the ophthalmic artery. None had high IASs at C1–C2. The mean number of high IAS-positive slices was significantly higher in patients with intra- than extracranial ICA occlusion. Conclusion High IASs on ASL images can identify slow stagnant and collateral flow through the ophthalmic artery in patients with acute ICA occlusion and help to predict the occlusion site

Genome-Wide Association Study Confirming Association of HLA-DP with Protection against Chronic Hepatitis B and Viral Clearance in Japanese and Korean

Hepatitis B virus (HBV) infection can lead to serious liver diseases, including liver cirrhosis (LC) and hepatocellular carcinoma (HCC); however, about 85–90% of infected individuals become inactive carriers with sustained biochemical remission and very low risk of LC or HCC. To identify host genetic factors contributing to HBV clearance, we conducted genome-wide association studies (GWAS) and replication analysis using samples from HBV carriers and spontaneously HBV-resolved Japanese and Korean individuals. Association analysis in the Japanese and Korean data identified the HLA-DPA1 and HLA-DPB1 genes with Pmeta = 1.89×10−12 for rs3077 and Pmeta = 9.69×10−10 for rs9277542. We also found that the HLA-DPA1 and HLA-DPB1 genes were significantly associated with protective effects against chronic hepatitis B (CHB) in Japanese, Korean and other Asian populations, including Chinese and Thai individuals (Pmeta = 4.40×10−19 for rs3077 and Pmeta = 1.28×10−15 for rs9277542). These results suggest that the associations between the HLA-DP locus and the protective effects against persistent HBV infection and with clearance of HBV were replicated widely in East Asian populations; however, there are no reports of GWAS in Caucasian or African populations. Based on the GWAS in this study, there were no significant SNPs associated with HCC development. To clarify the pathogenesis of CHB and the mechanisms of HBV clearance, further studies are necessary, including functional analyses of the HLA-DP molecule

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362