Effect of prior general anesthesia or sedation and antiseizure drugs on the diagnostic utility of wireless video electroencephalography in dogs

Background Ambulatory wireless video electroencephalography (AEEG) is the method of choice to discriminate epileptic seizures from other nonepileptic episodes. However, the influence of prior general anesthesia (GA), sedation, or antiseizure drug (ASD) on the diagnostic ability of AEEG is unknown. Hypothesis/Objectives The use of sedation/GA or ASD treatment before AEEG recording may affect the diagnostic ability of AEEG and the time to first abnormality on AEEG. Animals A total of 108 client-owned dogs undergoing ambulatory AEEG for paroxysmal episodes. Methods Retrospective cohort study. Proportions of diagnostic AEEG and time to first abnormality were compared between dogs that received sedation/GA or neither for instrumentation as well as dogs receiving at least 1 ASD and untreated dogs. Results Ambulatory EEG was diagnostic in 60.2% of all dogs including 49% of the sedation/GA dogs and 68% of dogs that received neither (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.02-5.00;P= .05). The AEEG was diagnostic in 51% of dogs receiving at least 1 ASD and 66% of untreated dogs (OR, 1.95; 95% CI, 0.9-4.3;P= .11). No difference was found in time to first abnormality between sedation/GA or neither or ASD-treated or untreated dogs (P= .1 andP= .3 respectively). Ninety-five percent of dogs had at least 1 abnormality within 277 minutes. Conclusion and Clinical Importance Sedation/GA and concurrent ASD administration were not identified as confounding factors for decreasing AEEG diagnostic capability nor did they delay the time to first abnormality. A 4-hour minimal recording period is recommended.Peer reviewe

Seizure frequency discrepancy between subjective and objective ictal electroencephalography data in dogs

Background Many studies of epilepsy in veterinary medicine use subjective data (eg, caregiver-derived histories) to determine seizure frequency. Conversely, in people, objective data from electroencephalography (EEG) are mainly used to diagnose epilepsy, measure seizure frequency and evaluate efficacy of antiseizure drugs. These EEG data minimize the possibility of the underreporting of seizures, a known phenomenon in human epileptology. Objective To evaluate the correlation between reported seizure frequency and EEG frequency of ictal paroxysmal discharges (PDs) and to determine whether seizure underreporting phenomenon exists in veterinary epileptology. Animals Thirty-three ambulatory video-EEG recordings in dogs showing >= 1 ictal PD, excluding dogs with status epilepticus. Methods Retrospective observational study. Ictal PDs were counted manually over the entire recording to obtain the frequency of EEG seizures. Caregiver-reported seizure frequency from the medical record was categorized into weekly, daily, hourly, and per minute seizure groupings. The Spearman rank test was used for correlation analysis. Results The coefficient value (r(s)) comparing reported seizure to EEG-confirmed ictal PD frequencies was 0.39 (95% confidence interval [CI] = 0.048-0.64, P = .03). Other r(s) values comparing history against various seizure types were: 0.36 for motor seizures and 0.37 for nonmotor (absence) seizures. Conclusions and Clinical Importance A weak correlation was found between the frequency of reported seizures from caregivers (subjective data) and ictal PDs on EEG (objective data). Subjective data may not be reliable enough to determine true seizure frequency given the discrepancy with EEG-confirmed seizure frequency. Confirmation of the seizure underreporting phenomenon in dogs by prospective study should be carried out.Peer reviewe

Haemophilus ducreyi Cutaneous Ulcer Strains Are Nearly Identical to Class I Genital Ulcer Strains

BACKGROUND: Although cutaneous ulcers (CU) in the tropics is frequently attributed to Treponema pallidum subspecies pertenue, the causative agent of yaws, Haemophilus ducreyi has emerged as a major cause of CU in yaws-endemic regions of the South Pacific islands and Africa. H. ducreyi is generally susceptible to macrolides, but CU strains persist after mass drug administration of azithromycin for yaws or trachoma. H. ducreyi also causes genital ulcers (GU) and was thought to be exclusively transmitted by microabrasions that occur during sex. In human volunteers, the GU strain 35000HP does not infect intact skin; wounds are required to initiate infection. These data led to several questions: Are CU strains a new variant of H. ducreyi or did they evolve from GU strains? Do CU strains contain additional genes that could allow them to infect intact skin? Are CU strains susceptible to azithromycin? METHODOLOGY/PRINCIPAL FINDINGS: To address these questions, we performed whole-genome sequencing and antibiotic susceptibility testing of 5 CU strains obtained from Samoa and Vanuatu and 9 archived class I and class II GU strains. Except for single nucleotide polymorphisms, the CU strains were genetically almost identical to the class I strain 35000HP and had no additional genetic content. Phylogenetic analysis showed that class I and class II strains formed two separate clusters and CU strains evolved from class I strains. Class I strains diverged from class II strains ~1.95 million years ago (mya) and CU strains diverged from the class I strain 35000HP ~0.18 mya. CU and GU strains evolved under similar selection pressures. Like 35000HP, the CU strains were highly susceptible to antibiotics, including azithromycin. CONCLUSIONS/SIGNIFICANCE: These data suggest that CU strains are derivatives of class I strains that were not recognized until recently. These findings require confirmation by analysis of CU strains from other regions

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Internet-delivered cognitive-behavioral treatment for adolescents with chronic pain and their parents: a randomized controlled multicenter trial

Internet-delivered interventions are emerging as a strategy to address barriers to care for individuals with chronic pain. This is the first large multicenter randomized controlled trial of Internet-delivered cognitive-behavioral therapy (CBT) for pediatric chronic pain. Participants included were 273 adolescents (205 females and 68 males), aged 11 to 17 years with mixed chronic pain conditions and their parents, who were randomly assigned in a parallel-group design to Internet-delivered CBT (n = 138) or Internet-delivered Education (n = 135). Assessments were completed before treatment, immediately after treatment, and at 6-month follow-up. All data collection and procedures took place online. The primary analysis used linear growth models. Results demonstrated significantly greater reduction on the primary outcome of activity limitations from baseline to 6-month follow-up for Internet CBT compared with Internet education (b = −1.13, P = 0.03). On secondary outcomes, significant beneficial effects of Internet CBT were found on sleep quality (b = 0.14, P = 0.04), on reducing parent miscarried helping (b = −2.66, P = 0.007) and protective behaviors (b = −0.19, P = 0.001), and on treatment satisfaction ( P values < 0.05). On exploratory outcomes, benefits of Internet CBT were found for parent-perceived impact (ie, reductions in depression, anxiety, self-blame about their adolescent’s pain, and improvement in parent behavioral responses to pain). In conclusion, our Internet-delivered CBT intervention produced a number of beneficial effects on adolescent and parent outcomes, and could ultimately lead to wide dissemination of evidence-based psychological pain treatment for youth and their families

<i>H</i>. <i>ducreyi</i> strains selected for the study and their genome sequencing statistics.

<p>^aThe description NZS is defined as a strain isolated in New Zealand from a patient who had acquired disease in Samoa; NZV, from a patient who had acquired disease in Vanuatu.</p><p>Unk, unknown</p><p><i>H</i>. <i>ducreyi</i> strains selected for the study and their genome sequencing statistics.</p

Circular visualization of multiple alignment of the CU and GU strains using Blast Ring Image Generator.

<p>The draft genomes of the CU and GU strains were mapped to 35000HP using nucleotide BLAST. The innermost ring showing the genomic positions represents the reference genome 35000HP. For clarity, each ring representing each strain is indicated by a different color. Positions covered by nucleotide BLAST are indicated as solid color, while positions not covered by nucleotide BLAST are indicated as white spaces. The gene coordinates of potential large-scale deletions are indicated.</p

Antimicrobial susceptibility of the CU and GU strains (minimal inhibitory concentrations, μg/ml).

<p>B- <i>blaTEM-1B</i>; TB- <i>tet(B)</i>; T32- <i>tet(32)</i>; TM- <i>tet(M)</i></p><p>AMX- amoxicillin; PEN- penicillin; AMC- amoxicillin and clavulanate; DOX- doxycycline; CIP- ciprofloxacin; AZT- azithromycin; ERY- erythromycin; CRO- ceftriaxone</p><p>Antimicrobial susceptibility of the CU and GU strains (minimal inhibitory concentrations, μg/ml).</p

Distribution of putative SNPs in the CU, class I and class II GU strains of <i>H</i>. <i>ducreyi</i> relative to 35000HP.

<p>SNPs were identified using DNASTAR Lasergene program and 35000HP as a reference. The SNPs in CU genomes were manually verified for accuracy.</p><p>Distribution of putative SNPs in the CU, class I and class II GU strains of <i>H</i>. <i>ducreyi</i> relative to 35000HP.</p

Whole-genome heat map showing the pairwise genome conservation distances of the CU and GU strains.

<p>The genome conservation distances were calculated using ProgressiveMauve; the distance matrix was plotted as an heat map using CIMminer with heat map clustering methods. Dendrograms across the top and left of the heat map show the relationship of genomes based on genome conservation. The strain names are indicated to the right and bottom of the heat map. Distance values range from 0.0000 to 0.1207, which are depicted by the gradient of colors ranging from dark blue (lowest distance value indicating high similarity between genomes) to red (highest distance value indicating low similarity between genomes).</p