Seizure outcome after switching antiepileptic drugs: A matched, prospective study.

OBJECTIVE: Outcomes after changing antiepileptic drugs (AEDs) have largely been studied in single cohort series. We recently reported the first study to examine this question in a controlled manner. Here we expand on these results by using a matched, prospective methodology applied to both uncontrolled and well-controlled patients taking any AED. METHODS: We reviewed all outpatient notes over a 9-month period and identified patients with focal epilepsy who were on monotherapy. We classified those who switched AEDs as case patients, with those remaining on the same drug serving as controls. We matched cases with controls for seizure status (seizure-free in the preceding 6 months or not), current AED, and number of failed AEDs. We subsequently assessed outcome 6 months later. RESULTS: Seizure-free patients who switched drug (n = 12) had a 16.7% rate of seizure recurrence at 6 months, compared to 2.8% among controls remaining on the same drug (n = 36, p = 0.11). There was a 37% remission rate among uncontrolled patients who switched drug compared to 55.6% among controls (n = 27 per group, p = 0.18). Uncontrolled patients who had previously tried more than one AED were somewhat less likely to enter remission (p = 0.057). Neither AED mechanism of action nor change in dosage impacted outcome. SIGNIFICANCE: Herein we provide further estimation of the modest risk (~14%) associated with switching AEDs in patients in remission compared to being maintained on the same regimen. Uncontrolled patients were no more likely to enter remission after a drug switch than they were after remaining on the same drug, suggesting that spontaneous changes in disease state, and not drug response, underlie remission in this population

The Multiphase Intracluster Medium in Galaxy Groups Probed by the Lyman Alpha Forest

The case is made that the intracluster medium (ICM) in spiral-rich galaxy groups today probably has undergone much slower evolution than that in elliptical-rich groups and clusters. The environments of proto-clusters and proto-groups at z > 2 are likely similar to spiral-rich group environments at lower redshift. Therefore, like the ICM in spiral-rich groups today, the ICM in proto-groups and proto-clusters at z > 2 is predicted to be significantly multiphased. The QSO Lyman alpha forest in the vicinity of galaxies is an effective probe of the ICM at a wide range of redshift. Two recent observations of Lyman alpha absorption around galaxies by Adelberger et al. and by Pascarelle et al are reconciled, and it is shown that observations support the multiphase ICM scenario. Galaxy redshifts must be very accurate for such studies to succeed. This scenario can also explain the lower metallicity and lower hot gas fraction in groups.Comment: 4 pages, 1 figure, replaced with the version after proo

Squares of primes and powers of 2, II

We prove that the density of integers ≡2 (mod 24), which can be represented as the sum of two squares of primes and k powers of 4, tends to 1 as k→∞ in the sequence k≡0 (mod 3). Consequently, there exists a positive integer k0 such that every large integer ≡4 (mod 24) is the sum of four squares of primes and k0 powers of 4postprin

In situ observation of shrinking and swelling of normal and compression Chinese fir wood at the tissue, cell and cell wall level

The shrinking and swelling of wood due to moisture changes are intrinsic material properties that control and limit the use of wood in many applications. Herein, hygroscopic deformations of normal and compression wood of Chinese fir (Cunninghamia lanceolata [Lamb.] Hook.) were measured during desorption and absorption processes. The dimensional changes were observed in situ by an environmental scanning electron microscope and analyzed at different hierarchical levels (tissue, cell and cell wall). The relationship between moisture variation and hygroscopic deformation was measured. During initial desorption periods from 95 to 90 or 75% RH, an expansion of the lumen and a shrinkage of the cell wall were observed, revealing a non-uniform and directional deformation of single wood cells. The variation of shrinking or swelling at different hierarchical levels (tissue, cell and cell wall) indicates that the hygroscopic middle lamella plays a role in the deformation at the tissue level. Higher microfibril angles and helical cavities on the cell wall in compression wood correlate with a lower shrinking/swelling ratio. Normal wood showed a more pronounced swelling hysteresis than compression wood, while the sorption hysteresis was almost the same for both wood types. This finding is helpful to elucidate effects of micro- and ultrastructure on sorption. The present findings suggest that the sophisticated system of wood has the abilities to adjust the hygroscopic deformations by fine-tuning its hierarchical structures