Managing psychogenic pseudosyncope: Facts and experiences

Psychogenic pseudosyncope (PPS) is a common cause of apparent transient loss of conscious­ness (TLOC) with a dramatic impact on the quality of life. This review aims to give an overview of the definition, incidence, etiology, diagnosis, treatment, and prognosis of PPS based on a combination of literature data and personal experience. The limited literature on the subject suggests that PPS is relatively common but insufficiently recognized. PPS is probably similar to psychogenic nonepiteptic seizures (PNES), in which a long delay to diagnosis worsens the prognosis. A detailed history is of paramount importance for the diagnosis. The key feature in the history of patients with PPS is the occurrence of frequent, long attacks of apparent TLOC with closed eyes. The diagnosis is certain when a typical event is recorded during a tilt-table test with simultaneous blood pressure (BP), heart rate and video-electroencephalographic re­cordings. Home video and BP recording during an attack can be very useful. The diagnosis should be communicated to the patient in a way that is clear, understandable and does not cause offense. Although treatment options have not been investigated formally, the literature on PNES suggests that cognitive behavioral therapy is beneficial

The tail of the contact force distribution in static granular materials

We numerically study the distribution P(f) of contact forces in frictionless bead packs, by averaging over the ensemble of all possible force network configurations. We resort to umbrella sampling to resolve the asymptotic decay of P(f) for large f, and determine P(f) down to values of order 10^{-45} for ordered and disordered systems in two and three dimensions. Our findings unambiguously show that, in the ensemble approach, the force distributions decay much faster than exponentially: P(f) ~ exp(-f^{\alpha}), with alpha \approx 2.0 for 2D systems, and alpha \approx 1.7 for 3D systems.Comment: 4 pages, 4 figures, submitted to Phys. Rev.

Demonstration of asymmetric electron conduction in pseudosymmetrical photosynthetic reaction centre proteins in an electrical circuit

Photosynthetic reaction centres show promise for biomolecular electronics as nanoscale solar-powered batteries and molecular diodes that are amenable to atomic-level re-engineering. In this work the mechanism of electron conduction across the highly tractable Rhodobacter sphaeroides reaction centre is characterized by conductive atomic force micro-scopy. We find, using engineered proteins of known structure, that only one of the two cofactor wires connecting the positive and negative termini of this reaction centre is capable of conducting unidirectional current under a suitably oriented bias, irrespective of the magnitude of the bias or the applied force at the tunnelling junction. This behaviour, strong functional asymmetry in a largely symmetrical protein–cofactor matrix, recapitulates the strong functional asymmetry characteristic of natural photochemical charge separation, but it is surprising given that the stimulus for electron flow is simply an externally applied bias. Reasons for the electrical resistance displayed by the so-called B-wire of cofactors are explored

Ensemble Theory for Force Networks in Hyperstatic Granular Matter

An ensemble approach for force networks in static granular packings is developed. The framework is based on the separation of packing and force scales, together with an a-priori flat measure in the force phase space under the constraints that the contact forces are repulsive and balance on every particle. In this paper we will give a general formulation of this force network ensemble, and derive the general expression for the force distribution $P(f)$. For small regular packings these probability densities are obtained in closed form, while for larger packings we present a systematic numerical analysis. Since technically the problem can be written as a non-invertible matrix problem (where the matrix is determined by the contact geometry), we study what happens if we perturb the packing matrix or replace it by a random matrix. The resulting $P(f)$'s differ significantly from those of normal packings, which touches upon the deep question of how network statistics is related to the underlying network structure. Overall, the ensemble formulation opens up a new perspective on force networks that is analytically accessible, and which may find applications beyond granular matter.Comment: 17 pages, 17 figure

Not All Scale-Free Networks Are Born Equal: The Role of the Seed Graph in PPI Network Evolution

The (asymptotic) degree distributions of the best-known “scale-free” network models are all similar and are independent of the seed graph used; hence, it has been tempting to assume that networks generated by these models are generally similar. In this paper, we observe that several key topological features of such networks depend heavily on the specific model and the seed graph used. Furthermore, we show that starting with the “right” seed graph (typically a dense subgraph of the protein–protein interaction network analyzed), the duplication model captures many topological features of publicly available protein–protein interaction networks very well

Transcranial magnetic stimulation-evoked electroencephalography responses as biomarkers for epilepsy: A review of study design and outcomes

Transcranial magnetic stimulation (TMS) with electroencephalography (EEG), that is TMS-EEG, may assist in managing epilepsy. We systematically reviewed the quality of reporting and findings in TMS-EEG studies on people with epilepsy and healthy controls, and on healthy individuals taking anti-seizure medication. We searched the Cochrane Library, Embase, PubMed and Web of Science databases for original TMS-EEG studies comparing people with epilepsy and healthy controls, and healthy subjects before and after taking anti-seizure medication. Studies should involve quantitative analyses of TMS-evoked EEG responses. We evaluated the reporting of study population characteristics and TMS-EEG protocols (TMS sessions and equipment, TMS trials and EEG protocol), assessed the variation between protocols, and recorded the main TMS-EEG findings. We identified 20 articles reporting 14 unique study populations and TMS methodologies. The median reporting rate for the group of people with epilepsy parameters was 3.5/7 studies and for the TMS parameters was 13/14 studies. TMS protocols varied between studies. Fifteen out of 28 anti-seizure medication trials in total were evaluated with time-domain analyses of single-pulse TMS-EEG data. Anti-seizure medication significantly increased N45, and decreased N100 and P180 component amplitudes but in marginal numbers (N45: 8/15, N100: 7/15, P180: 6/15). Eight articles compared people with epilepsy and controls using different analyses, thus limiting comparability. The reporting quality and methodological uniformity between studies evaluating TMS-EEG as an epilepsy biomarker is poor. The inconsistent findings question the validity of TMS-EEG as an epilepsy biomarker. To demonstrate TMS-EEG clinical applicability, methodology and reporting standards are required

The paleobiogeographical significance of the Silurian and Devonian trilobites of Japan

Six major groups of trilobites from the Silurian and Devonian of Japan are evaluated for their paleobiogeographical signature. Silurian illaenids and scutelluids show four generic-level and at least two species-level links with the Australian segment of the Gondwana paleocontinent; encrinurids also indicate two generic-level links with Australia and also the South China paleocontinent; whilst Devonian phacopids, and possibly proetids, suggest at least two generic-level links with the North China paleocontinent. These different patterns may reflect the fragmentary biostratigraphical record of Japanese trilobites, but they also appear to reflect paleoenvironmental parameters associated with lithofacies, and paleoecology. Thus, Japanese assemblages of proetids and phacopids occurring in deep-water clastic lithofacies have counterparts in similar settings in North China, and Japanese scutelluids and illaenids are strongly associated with shallow marine carbonate lithofacies that are similar to those of their occurrences in Australia. Japanese encrinurids occur in carbonate rocks indicative of shallow marine settings in the Kurosegawa Terrane, and they demonstrate a consistent paleobiogeographical affinity with Australia and South China. Larval ecology cannot be directly assessed for Japanese trilobite groups. However, proetids have consistently been shown to have planktonic protaspides, whereas illaenids, scutelluids, and encrinurids have benthic protaspides. Planktonic protaspides would have a greater propensity for distribution in ocean currents than benthic ones, and therefore may be of more limited paleobiogeographical utility. The combined data from the six different groups indicates that the complex paleobiogeographical patterns of the Japanese trilobite assemblages need to be interpreted with caution, and similarity of taxa does not necessarily denote paleogeographical proximity to other regions

Genetic risk factors for ischaemic stroke and its subtypes (the METASTROKE Collaboration): a meta-analysis of genome-wide association studies

<p>Background - Various genome-wide association studies (GWAS) have been done in ischaemic stroke, identifying a few loci associated with the disease, but sample sizes have been 3500 cases or less. We established the METASTROKE collaboration with the aim of validating associations from previous GWAS and identifying novel genetic associations through meta-analysis of GWAS datasets for ischaemic stroke and its subtypes.</p> <p>Methods - We meta-analysed data from 15 ischaemic stroke cohorts with a total of 12 389 individuals with ischaemic stroke and 62 004 controls, all of European ancestry. For the associations reaching genome-wide significance in METASTROKE, we did a further analysis, conditioning on the lead single nucleotide polymorphism in every associated region. Replication of novel suggestive signals was done in 13 347 cases and 29 083 controls.</p> <p>Findings - We verified previous associations for cardioembolic stroke near PITX2 (p=2·8×10−16) and ZFHX3 (p=2·28×10−8), and for large-vessel stroke at a 9p21 locus (p=3·32×10−5) and HDAC9 (p=2·03×10−12). Additionally, we verified that all associations were subtype specific. Conditional analysis in the three regions for which the associations reached genome-wide significance (PITX2, ZFHX3, and HDAC9) indicated that all the signal in each region could be attributed to one risk haplotype. We also identified 12 potentially novel loci at p<5×10−6. However, we were unable to replicate any of these novel associations in the replication cohort.</p> <p>Interpretation - Our results show that, although genetic variants can be detected in patients with ischaemic stroke when compared with controls, all associations we were able to confirm are specific to a stroke subtype. This finding has two implications. First, to maximise success of genetic studies in ischaemic stroke, detailed stroke subtyping is required. Second, different genetic pathophysiological mechanisms seem to be associated with different stroke subtypes.</p&gt