bluuebunny/crossref_metadata_2025 huggingface dataset:
Electrohydrodynamic spray applicator for homogenous application and reduced overspray of sunscreen
Authors: Schleusener Johannes , Schanzer Sabine , Wille Charlotte , Langen Valentin , Richter Heike , Lademann Jürgen , Meinke Martina C.
Published: July 2020

Background

The recommended amount of sunscreen by hand application (2 mg/cm2) is in reality not achieved, which decreases the homogeneity and thereby the effective sun protection factor (SPF).

Materials and Methods

The homogeneity of sunscreen applied by a newly developed spray applicator using an electrostatically charged aerosol, for which a hand rubbing of the formulation is not necessary, is evaluated. In vivo experiments were performed on the volar forearms of human volunteers using the spray applicator compared to the standardized hand application according to ISO 24444.

Results

The distribution homogeneity was assessed qualitatively using in vivo laser scanning microscopy and quantitatively by absorption spectroscopy after tape stripping and by the standard deviation of multiple spatially displaced reflectance measurements for non‐invasive SPF determination below the minimal erythemal dose, which showed a significantly higher homogeneity by 20.9% after spray application compared to hand application.

Conclusion

Non‐invasive SPF determination of multiple spatially displaced reflectance measurements was proven to be a suitable method for the non‐invasive determination of the sunscreen distribution homogeneity. Electrostatically charged spray application increased the sunscreen distribution homogeneity on the skin and can reduce the amount of overspray.
Large granular lymphocytosis in a cynomolgus macaque (Macacafascicularis) with a subclinical Trypanosomacruzi infection
Authors: Henderson Sally E. , Pfeiffer Sara C. , Novak Joseph , Peace Tracy A.
Published: July 2020

A 5.25‐year‐old cynomolgus macaque (Macaca fascicularis) was found to have a marked leukocytosis due to a lymphocytosis on routine quarantine laboratory data prior to inclusion in a preclinical research study. The majority of lymphocytes were characterized as intermediate to large with round to convoluted nuclei, coarse to clumped chromatin, rare prominent nucleoli, and moderate amounts of lightly basophilic cytoplasm that frequently contained small magenta granules and/or clear vacuoles. The animal had tested negative for several viruses and other etiologic agents found in nonhuman primates 1 week prior to shipment to the research facility. However, further evaluation of the blood smear revealed rare hemoflagellates, and later testing using real‐time PCR and ELISA was confirmatory for Trypanosoma cruzi (T cruzi). Trypanosoma cruzi is a zoonotic pathogen responsible for Chagas disease in people and can have negative consequences on study results when positive animals are inadvertently used for preclinical research. This case report describes a marked large granular lymphocytosis in an otherwise healthy macaque as the only indication of infection with T cruzi in an animal believed to be negative for the infection. Additionally, it highlights the diagnostic limitations of screening tests to rule out diseases in animals intended to be used in preclinical studies.
A pilot feasibility study of non‐cultured autologous skin cell suspension for healing diabetic foot ulcers
Authors: Rashid S. Tawqeer , Cavale Naveen , Bowling Frank L.
Published: July 2020

A prospective, single arm feasibility study was conducted to evaluate healing outcomes of DFUs treated with autologous skin cell suspension (ASCS) in combination with standard therapy. Wounds up to 100 cm2 in size that failed to heal with conventional therapy were included and wound healing, pain, exudate scores, Quality of Life, satisfaction scores, and safety outcomes were evaluated over a period of 26 weeks. Sixteen subjects were enrolled having a mean DFU duration of 60.4 weeks. All ulcers in this study had a positive healing trajectory, with a mean reepithelialization of 84.9% and 12.2 cm2 reduction in ulcer area. For ulcers that did not acquire a soft tissue infection post‐treatment, all either healed or achieved ≥95% reepithelialization including some with exposed tendon. Improvements were observed in all aspects of the health‐related Quality of Life questionnaire and subjects and clinicians were highly satisfied across all postoperative visits. This preliminary study suggests ASCS is a well‐tolerated and promising therapy for the treatment of DFUs as all ulcers evaluated experienced positive healing results regardless of size, depth, and wound duration. Future studies are warranted to investigate ASCS compared to standard of care for all diabetic foot ulcers, inclusive of the evaluation of treatment algorithms and combination products.
Laminar Convection in Circular Tubes With Developing Flow
Authors: Bennett T. D.
Published: July 2020

The combined entry problem for the simultaneous development of heat and momentum transfer in a circular tube has been resolved over an extended range of inverse Graetz number ZH≥10−6 and for a wide range of Prandtl numbers 0.1≤Pr≤500. For the historical range of ZH≥5×10−4 and 0.7≤Pr≤50, earlier studies are within 5% of the current benchmark calculations, but for the new extended range of conditions, the best authoritative sources were in error by as much as 33%. Four new correlations are proposed for the local and average Nusselt numbers, and for the constant temperature and constant heat flux wall condition, which are accurate to 2.2% for all values of inverse Graetz number and Pr≥0.5. In contrast, legacy correlations typically had a 10–20% error range when compared to the results of this work, with many exhibiting larger errors and only few achieving errors as low as 5–10%.
Local Heat Transfer Distributions Within a Rotating Pin-Finned Brake Disk
Authors: Atkins Michael D. , Kienhöfer Frank W. , Lu Tian Jian , Kim Tongbeum
Published: July 2020

This study presents local temperature and heat transfer coefficient distributions obtained experimentally on the internal surfaces of a rotating pin-finned brake rotor at realistic rotation speeds for braking (i.e., N = 100–300 rpm). To this end, the thermochromic liquid crystal technique in a rotating reference frame was employed. The results demonstrate that the bulk airflow within the ventilated channel of a rotating disk follows a predominantly backward sweeping inline-like path between the pin fins. Internal local heat transfer is distributed nonuniformly on both inboard and outboard surfaces, with twice higher average cooling from the outboard surface than the inboard surface: this possibly exacerbates the thermal stresses, which leads to thermal distortion of the rotor (i.e., coning).
Design-Based Doctoral Education in Bioengineering
Authors: Burke Alyssa K. R. , Wilson Sara E.
Published: July 2020

In order to meet the needs of industry, graduate schools should consider adding design-based programs to their curriculum. A majority of Ph.D. students in bio-engineering and biomedical engineering (BME) seek employment outside of academia, implying that these students will need to be able to leverage their dissertation research for other types of positions. Here, curriculum elements are examined from several graduate programs across the United States and a strategy is proposed that combines bio-engineering design-based research and education at the doctoral level. Ideally, a design-based Ph.D. includes: traditional engineering and scientific coursework, coursework focused on the design and commercialization process, industry and clinical experiences, and design-centric research. A design-based dissertation leverages the design process into specific aims that build on each other to complete a body of work. These aims can occur at different points in the design process and should include evaluation of the technology against user needs. It is possible to orient the in-depth research of a doctoral dissertation to the design of an innovative medical product that can be of a benefit to patients.
Piezoelectric stimulation by ultrasound facilitates chondrogenesis of mesenchymal stem cells
Authors: Chu Ya-Cherng , Lim Jormay , Hwang Wen-Hao , Lin Yu-Xuan , Wang Jaw-Lin
Published: July 2020

A cellular stimulation device utilizing an AT-cut quartz coverslip mounted on an ultrasonic live imaging chamber is developed to investigate the effect of piezoelectric stimulation. Two types of chambers deliver ultrasound at intensities ranging from 1 to 20 mW/cm2 to mesenchymal stem cells (MSCs) seeded on the quartz coverslip. The quartz coverslip imposes additionally localized electric charges as it vibrates with the stimulation. The device was applied to explore whether piezoelectric stimulation can facilitate chondrogenesis of MSCs. The results suggest piezoelectric stimulation drove clustering of MSCs and consequently facilitated chondrogenesis of MSCs without the use of differentiation media.
Relationships of the ultrasonic backscatter measurements with the bone mineral density and the microarchitectural parameters in bovine trabecular bone in vitro
Authors: Il Lee Kang
Published: July 2020

Relationships of the backscatter coefficient (BC), the apparent integrated backscatter (AIB), and the integrated reflection coefficient (IRC) with the bone mineral density (BMD) and the microarchitectural parameters were investigated in 28 bovine femoral trabecular bone samples. The BC was highly correlated with the BMD and the microarchitectural parameters (R = −0.66 to 0.71). In contrast, the AIB and the IRC exhibited high correlations with the BMD and the bone volume fraction (R = −0.68 to 0.77) and relatively lower correlations with the remaining microarchitectural parameters (R = −0.62 to 0.60). The multiple regression models yielded the adjusted squared correlation coefficients of 0.54–0.76.
Symptoms of Overtraining in Resistance Exercise: International Cross-Sectional Survey
Authors: Grandou Clementine , Wallace Lee , Coutts Aaron J. , Bell Lee , Impellizzeri Franco M.
Published: July 2020

Purpose: To provide details on the nature and symptomatic profile of training maladaptation in competitive resistance-based athletes to examine whether there are symptoms that may be used as prognostic indicators of overtraining. Identifying prognostic tools to assess for training maladaptation is essential for avoiding severe overtraining conditions. Methods: A Web-based survey was distributed to a cross-sectional convenience sample of competitive athletes involved in sports with a significant resistance-training component. The 46-item anonymous survey was distributed via industry experts and social media from July to August 2019. Results: The final sample included 605 responses (completion rate: 84%). About 71% of the respondents indicated that they had previously experienced an unexplained decrease in performance. Among those, the majority reported a performance decrement lasting 1 wk to 1 mo (43.8%). General feelings of fatigue were the most frequent self-reported symptom of maladaptation. Acute training maladaptation, lasting <1 mo, was also accompanied by symptoms of musculoskeletal aches and pain. In the majority of cases (92.5%), training maladaptation was accompanied by additional nontraining stressors. A greater proportion of the respondents with more severe maladaptation (>4 mo) were training to muscle failure. Conclusion: The results from this study support the multifactorial nature of training maladaptation. The multidimensional nature of fatigue and individual variability in symptomatic responses precludes definitive prognostic symptoms or differential diagnostic factors of functional/nonfunctional overreaching or the overtraining syndrome in resistance exercise.
The Clinically Approved Antifungal Drug Posaconazole Inhibits Human Cytomegalovirus Replication
Authors: Mercorelli Beatrice , Luganini Anna , Celegato Marta , Palù Giorgio , Gribaudo Giorgio , Lepesheva Galina I. , Loregian Arianna
Published: July 2020

Posaconazole (PCZ) is a clinically approved drug used predominantly for prophylaxis and salvage therapy of fungal infections. Here, we report its previously undescribed anti-human cytomegalovirus (HCMV) activity. By using antiviral assays, we demonstrated that PCZ, along with other azolic antifungals, has a broad anti-HCMV activity, being active against different strains, including low-passage-number clinical isolates and strains resistant to viral DNA polymerase inhibitors. Using a pharmacological approach, we identified the inhibition of human cytochrome P450 51 (hCYP51), or lanosterol 14α demethylase, a cellular target of posaconazole in infected cells, as a mechanism of anti-HCMV activity of the drug.
Multi-omic Directed Discovery of Cellulosomes, Polysaccharide Utilization Loci, and Lignocellulases from an Enriched Rumen Anaerobic Consortium
Authors: Tomazetto Geizecler , Pimentel Agnes C. , Wibberg Daniel , Dixon Neil , Squina Fabio M.
Published: July 2020

The lignocellulolytic ERAC displays a unique set of plant polysaccharide-degrading enzymes (with multimodular characteristics), cellulosomal complexes, and PULs. The MAGs described here represent an expansion of the genetic content of rumen bacterial genomes dedicated to plant polysaccharide degradation, therefore providing a valuable resource for the development of biocatalytic toolbox strategies to be applied to lignocellulose-based biorefineries.
Temperature-Induced Annual Variation in Microbial Community Changes and Resulting Metabolome Shifts in a Controlled Fermentation System
Authors: Wang Shilei , Xiong Wu , Wang Yuqiao , Nie Yao , Wu Qun , Xu Yan , Geisen Stefan
Published: July 2020

We used Chinese liquor fermentation as a model system to show that microbiome composition changes more dramatically across seasons than throughout the fermentation process within seasons. These changes translate to differences in the metabolome as the ultimate functional outcome of microbial activity, suggesting that temporal changes in microbiome composition are translating into functional changes. This result is striking as it suggests that microbial functioning, despite controlled conditions in the fermentors, fluctuates over season along with external temperature differences, which threatens a reproducible food taste. As such, we believe that our study provides a stepping-stone into novel taxonomy-functional studies that promote future work in other systems and that also is relevant in applied settings to better control surrounding conditions in food production.
Supplemental Material: Mesoproterozoic–Early Cretaceous provenance and paleogeographic evolution of the Northern Rocky Mountains: Insights from the detrital zircon record of the Bridger Range, Montana, USA
Authors: Ronemus Chance B. , al. et
Published: July 2020

Analytical techniques, data reduction methods, ICP-MS zircon U-Pb datasets, comparison of age-probability curves generated using PDPs and various KDE bandwidths, sample information, and NMF details and results.
Immunotherapy in pancreatic cancer and the importance of tumour testing
Authors: Ngo Phuong , Shanshal Mohamed , Rojan Adam
Published: July 2020

Advanced pancreatic cancer carries a poor prognosis and has traditionally been treated with chemotherapy. However, immunotherapy has made great strides in a subset of patients depending on mismatch repair/microsatellite status. We present a patient with locally advanced pancreatic cancer treated with neoadjuvant chemotherapy followed by surgery and additional adjuvant chemotherapy whose disease progressed while on adjuvant chemotherapy. Tumour testing showed a mismatch repair mutation and high microsatellite instability, making her eligible for treatment with immunotherapy. Germline genetic testing confirmed the clinical suspicion of Lynch syndrome. She has had isolated sites of progression treated with radiation but overall has been receiving immunotherapy for more than 3 years, highlighting the importance of tumour testing as it may allow for additional treatment options and improved survival.
Multidisciplinary, patient-centred approach to improving compliance with venous thromboembolism (VTE) prophylaxis in a district general hospital
Authors: Nana Melanie , Shute Cherry , Williams Rhys , Kokwaro Flora , Riddick Kathleen , Lane Helen
Published: July 2020

Hospital-acquired venous thromboembolism (VTE) accounts for an estimated 25 000 preventable deaths per annum in the UK and is associated with significant healthcare costs. The National Institute for Health and Care Excellence guidelines on the prevention of VTE in hospitalised patients highlight the clinical and cost-effectiveness of VTE prevention strategies. A multidisciplinary quality improvement team (MD QIT) based in a district general hospital sought to improve compliance with VTE prophylaxis prescription to greater than 85% of patients within a 3-month time frame. Quality improvement methodology was adopted over three cycles of the project. Interventions included the introduction of a ‘VTE sticker’ to prompt risk assessment; educational material for medical staff and allied healthcare professionals; and patient information raising the awareness of the importance of VTE prophylaxis. Implementation of these measures resulted in significant and sustained improvements in rates of risk assessment within 24 hours of admission to hospital from 51% compliance to 94% compliance after cycle 2 of the project. Improvements were also observed in medication dose adjustment for the patient weight from 69% to 100% compliance. Dose adjustments for renal function showed similar trends with compliance with guidelines improving from 80% to 100%. These results were then replicated in a different clinical environment. In conclusion, this project exemplifies the benefits of MD QITs in terms of producing sustainable and replicable improvements in clinical practice and in relation to meeting approved standards of care for VTE risk assessment and prescription. It has been demonstrated that the use of educational material in combination with a standardised risk assessment tool, the ‘VTE sticker’, significantly improved clinical practice in the context of a general medical environment.
Palliative versus hospice care in patients with cancer: a systematic review
Authors: Frasca Matthieu , Galvin Angeline , Raherison Chantal , Soubeyran Pierre , Burucoa Benoît , Bellera Carine , Mathoulin-Pelissier Simone
Published: July 2020

Background

Guidelines recommend an early access to specialised palliative medicine services for patients with cancer, but studies have reported a continued underuse. Palliative care facilities deliver early care, alongside antineoplastic treatments, whereas hospice care structures intervene lately, when cancer-modifying treatments stop.

Aim

This review identified factors associated with early and late interventions of specialised services, by considering the type of structures studied (palliative vs hospice care).

Design

We performed a systematic review, prospectively registered on PROSPERO (ID: CRD42018110063).

Data sources

We searched Medline and Scopus databases for population-based studies. Two independent reviewers extracted the data and assessed the study quality using Joanna Briggs Institute critical appraisal checklists.

Results

The 51 included articles performed 67 analyses. Most were based on retrospective cohorts and US populations. The median quality scores were 19/22 for cohorts and 15/16 for cross-sectional studies. Most analyses focused on hospice care (n=37). Older patients, men, people with haematological cancer or treated in small centres had less specialised interventions. Palliative and hospice facilities addressed different populations. Older patients received less palliative care but more hospice care. Patients with high-stage tumours had more palliative care while women and patients with a low comorbidity burden received more hospice care.

Conclusion

Main disparities concerned older patients, men and people with haematological cancer. We highlighted the challenges of early interventions for older patients and of late deliveries for men and highly comorbid patients. Additional data on non-American populations, outpatients and factors related to quality of life and socioeconomic status are needed.
Virtual visits in palliative care: about time or against the grain?
Authors: Hawkins Joseph Paul , Gannon Craig , Palfrey Jennifer
Published: July 2020

While the additional value from adding the option of virtual visits is not in question, numerous issues are raised around how to decide between face-to-face and virtual visits in individual cases and how best to set up such provision within an organisation. With only limited palliative care-specific literature and no time to set up and evaluate pilots, we had to get on and set up a prototype ‘virtual visits’ model, retro-fitting guidance and a supporting ethical framework. We looked at the issues spanning clinical, ethical and logistics domains; identifying areas of benefit as well as drawbacks, some specific to the rushed implementation because of COVID-19’s infective risks and the ‘rules’ of lockdown, but many are generic areas to help guide longer term service design. Unsurprisingly, it appears clear that a ‘one-size-fits-all’ mentality is a poor fit for the individualised needs of the heterogeneous palliative care population. Virtual visits have great potential even if they are not a panacea.
Image-based consensus molecular subtype (imCMS) classification of colorectal cancer
using deep learning
Authors: Sirinukunwattana Korsuk , Domingo Enric , Richman Susan D , Redmond Keara L , Blake Andrew , Verrill Clare , Leedham Simon J , Chatzipli Aikaterini , Hardy Claire , Whalley Celina M , Wu Chieh-hsi , Beggs Andrew D , McDermott Ultan , Dunne Philip D , Meade Angela , Walker Steven M , Murray Graeme I , Samuel Leslie , Seymour Matthew , Tomlinson Ian , Quirke Phil , Maughan Timothy , Rittscher Jens , Koelzer Viktor H
Published: July 2020

Objective

Complex phenotypes captured on histological slides represent the biological
processes at play in individual cancers, but the link to underlying molecular
classification has not been clarified or systematised. In colorectal cancer (CRC),
histological grading is a poor predictor of disease progression, and consensus
molecular subtypes (CMSs) cannot be distinguished without gene expression profiling.
We hypothesise that image analysis is a cost-effective tool to associate complex
features of tissue organisation with molecular and outcome data and to resolve
unclassifiable or heterogeneous cases. In this study, we present an image-based
approach to predict CRC CMS from standard H&E sections using deep
learning.

Design

Training and evaluation of a neural network were performed using a total of
n=1206 tissue sections with comprehensive multi-omic data from three independent
datasets (training on FOCUS trial, n=278 patients; test on rectal cancer biopsies,
GRAMPIAN cohort, n=144 patients; and The Cancer Genome Atlas (TCGA), n=430 patients).
Ground truth CMS calls were ascertained by matching random forest and single sample
predictions from CMS classifier.

Results

Image-based CMS (imCMS) accurately classified slides in unseen datasets from
TCGA (n=431 slides, AUC)=0.84) and rectal cancer biopsies (n=265 slides, AUC=0.85).
imCMS spatially resolved intratumoural heterogeneity and provided secondary calls
correlating with bioinformatic prediction from molecular data. imCMS classified
samples previously unclassifiable by RNA expression profiling, reproduced the expected
correlations with genomic and epigenetic alterations and showed similar prognostic
associations as transcriptomic CMS.

Conclusion

This study shows that a prediction of RNA expression classifiers can be made
from H&E images, opening the door to simple, cheap and reliable biological
stratification within routine workflows.
13 Using vision to understand dementia in Parkinson’s disease
Authors: Weil Rimona
Published: July 2020

Dr Rimona Weil is a Consultant Neurologist at the National Hospital for Neurology and Neurosurgery and a Clinician Scientist. She runs clinics that manage patients with Parkinson’s dementia and Dementia with Lewy Bodies. She studied medicine at Downing College, Cambridge and at UCL, and undertook a PhD in neuroscience at the Wellcome Trust Centre for Neuroimaging, UCL. She was awarded a post-doctoral UCL Excellence Fellowship in 2014 to study visual changes in Parkinson’s disease. Currently, she runs a Wellcome-funded longitudinal study on predictors of dementia in Parkinson’s disease, using neuroimaging, retinal and cognitive markers.

Dementia affects around half of all people with Parkinson’s disease by 10 years after diagnosis, but the timing and severity varies between individuals. Currently we lack methods to predict which patients with Parkinson’s disease will develop dementia, and we lack understanding of the anatomical structures that cause dementia in Parkinson’s disease.

We tested visual function in people with Parkinson’s disease, and found that poorer vision related to higher risk of dementia. We then used advanced neuroimaging techniques including measures of brain iron, and structural connectivity to reveal brain regions most vulnerable to degeneration in Parkinson’s disease. I will present recent visual and neuroimaging data that show that brain iron relates to degeneration in Parkinson’s disease and that the longest brain connections are most affected in patients at highest risk of Parkinson’s dementia.
16 Noninvasive deep brain stimulation via delivery of temporally interfering electric fields
Authors: Grossman Nir
Published: July 2020

Nir is a Lecturer (Assistant Professor) at Imperial College London and a founding fellow of the UK Dementia Research Institute (UK-DRI). The long-term goal of his research is to develop neuromodulatory interventions for neurodegenerative diseases by direct modulation of the underlying aberrant network activity. Nir received a BSc in Physics from the Israeli Institute of Technology (Technion), an MSc in Electromagnetic Engineering from the Technical University of Hamburg-Harburg, and a PhD in Neuroscience from Imperial College London. He then completed a postdoc training, as a Wellcome Trust Fellow, at the Massachusetts Institute of Technology (MIT) and Harvard University. Nir was recently awarded the prestige prize for Neuromodulation from the Science magazine for describing how temporal interfering of kHz electric fields can non-invasively stimulate focal neural structures deep in the brain.

Electrical brain stimulation is a key technique in research and clinical neuroscience studies, and also is in increasingly widespread use from a therapeutic standpoint. However, to date all methods of electrical stimulation of the brain either require surgery to implant an electrode at a defined site, or involve the application of non-focal electric fields to large fractions of the brain. We report a noninvasive strategy for electrically stimulating neurons at depth. By delivering to the brain multiple electric fields at frequencies too high to recruit neural firing, but which differ by a frequency within the dynamic range of neural firing, we can electrically stimulate neurons throughout a region where interference between the multiple fields results in a prominent electric field envelope modulated at the difference frequency. We validated this temporal interference (TI) concept via modeling and physics experiments, and verified that neurons in the living mouse brain could follow the electric field envelope. We demonstrate the utility of TI stimulation by stimulating neurons in the hippocampus of living mice without recruiting neurons of the overlying cortex. Finally, we show that by altering the currents delivered to a set of immobile electrodes, we can steerably evoke different motor patterns in living mice.
2 The association between obstructive sleep apnea severity and cognition in older people
Authors: Luo Yu-Jun , Lo Chen-Chen , Tsai Cheng-Yu , Lin Yin-Tzu , Hsu Hsin-Mei , Kuan Yi-Chun , Liu Wen-Te
Published: July 2020

Relationship between obstructive sleep apnea syndrome (OSAS) and dementia has been investigated in recent years. However, the effects of hypoxia during sleep timeon dementia remain unclear. The objective of this study is to associate the score of mini-mental state examination (MMSE) with OSAS. In this study, 67 patients whom were more than 50 years old and have been done for MMSE test and diagnosed with OSAS in sleep center in Taipei from 2015 to 2018. Four levels of OSAS severity were classified by the apnea and hypopnea index (AHI), according to the American Academy of Sleep Medicine (AASM) guideline. Subjects with MMSE scores above 25 and below 25 were served respectively as case group and control group. Logistic regression analyses were used to examine the associations. The average AHI were 28.48 times per hour for case group and 17.93 times per hour for control group. The AHI had a 1.03 fold higher odds ratio (95% CI=0.99 ~ 1.07, p=0.06) for lower score group compared with higher score group. The mean sleep efficiency were 57.8% in lower score group, while higher score group had an average sleep efficiency of 70.3%. Furthermore, sleep efficiency, total sleep time, the ratio of wake to total time in bed as well as the ratio of wake to sleep period time in case group were significant lower than the control group. We observe the associations between MMSE score and some parameters of polysomnography. The subjects with high severity OSAS, insufficient sleep efficacy, longer awake duration and shorter sleep duration could lead to cognitive impairment.
4 Delusional misidentification syndrome in basal forebrain lesion
Authors: Ting Simon Kang Seng , Hameed Shahul
Published: July 2020

Introduction

Delusional misidentification syndrome (DMS) is where a patient reduplicates or incorrectly identifies persons, places, objects or events due to false beliefs. DMS owning to brain lesions are heterogenous in locations, although it has been shown to be more commonly associated with lesions in the right frontal lobe areas. We describe a patient with basal forebrain lesion resulting in amnesia compounded with features of delusional misidentification and specific impairments in emotional perception.

Case Report

A 68-year-old man had undergone pituitary surgery for cyst removal, and had developed basal forebrain bleed postoperatively. Four month after, family members noted significant impairments in cognition, including delusional misidentification of his daughter and his house (feeling that his daughter is not his daughter and the house is not his house). Neurobehavioral examination showed Mini Mental State Exam score of 18/30, impaired visual and verbal memory, and executive function.

Comprehensive Affect Testing System (CATS) showed impaired emotional affect perception.

Discussion

Basal forebrain lesion typically produced amnestis syndrome. While DMS typically seen in right hemispheric or bifrontal lesion, its description in basal forebrain is uncommon. In this case, we demonstrated DMS from a basal forebrain lesion likely results from mismatch between factual retrieval and emotional processing, as basal forebrain lesion typically affects the neuroanatomy that processes and regulates memory, executive functions, and emotions. This case highlights the importance recognizing DMS in basal forebrain lesion and reaffirms the brain-behavior correlation underpinning DMS phenomenon.
21 Psychedelic treatment of functional neurological disorder – a systematic review
Authors: Butler Matthew , Seynaeve Mathieu , Nicholson Timothy R , Pick Susannah , Kanaan Richard A , Lees Andrew , Young Allan H , Rucker James
Published: July 2020

Aims

Functional neurological disorder (FND), formerly known as conversion disorder, causes a high burden of disability and distress, and is amongst the most commonly encountered conditions in neurology clinics and neuropsychiatry services, yet the therapeutic evidence base is limited. Research into psychedelics such as psilocybin and lysergic acid diethylamide (LSD) is currently being undertaken with significant renewed interest, and in recent studies psychedelics have shown promise in treating a range of psychiatric conditions. Modification of neural circuits associated with self-representation is thought to underlie some of this effect, and as some contemporary theories of FND focus on aberrant somatic self-representation, psychedelics may therefore represent an unexplored treatment option for FND. METHODS: We systematically reviewed studies involving the use of psychedelics in FND. Nine studies published between 1954 – 1967, with a total of 26 patients, were identified. Due to restriction of licencing of psychedelic drugs since this period, no modern studies were identified.

Results

LSD was the most commonly used psychedelic, with some studies also using psilocybin and/or mescaline. The number of therapeutic sessions of psychotherapy ± psychedelic substance administration ranged from one to 26, with descriptions of therapeutic methods used widely varying, and in some cases not described in any detail. Psychedelics were given either orally or intramuscularly, with doses of LSD ranging from 25 to 2,000 micrograms (mcg), and doses of psilocybin ranging from 3 to 15 milligrams (mg). Of those treated, 69% (n=18) were found to have made at least some recovery, with 23% (n=6) having completely recovered after psychedelic therapy. Adverse events were typically mild and transient.

Conclusions

Studies were generally of low quality, often lacking control groups and valid outcome measures. Despite this, the degree of improvement is considerable, even if the presumptive bias in favour of the treatment in the studies is taken into consideration. Furthermore, good therapeutic outcomes and lack of adverse events in modern open-label trials utilising psychedelic therapy for neuropsychiatric disorders is encouraging. Advances in the understanding of the neurobiology of FND, as well as further modern clinical research into the therapeutic utility of psychedelics, may help to determine whether psychedelics offer a feasible, safe and effective treatment for FND.
4 Psychedelics: therapeutic mechanisms
Authors: Carhart-Harris Robin
Published: July 2020

Robin Carhart-Harris moved to Imperial College London in 2008 after obtaining a PhD in Psychopharmacology from the University of Bristol and an MA in Psychoanalysis from Brunel University. At Imperial, he has designed and/or carried out brain imaging studies involving LSD, psilocybin, MDMA and DMT, plus a clinical trial of psilocybin for treatment-resistant depression, and an ongoing study comparing psilocybin with escitalopram for major depressive disorder. In 2019, he set-up the Centre for Psychedelic Research at Imperial and he also an honorary position with the University of Oxford.

The talk takes a multi-level approach to the question of how psychedelics work in the brain. Key themes include: the pharmacology of classic serotonergic psychedelics, what this tells us about the function and evolutionary purpose of the serotonin 2A receptor, the acute brain effects of psychedelics as determined by functional brain imaging, the entropic brain hypothesis, current evidence for psychedelic therapy, the ‘REBUS’ hierarchical predictive processing model of the action of psychedelics, and how this maps on to the phenomenology of the acute psychedelic experience and therapeutic outcomes.
23 Limbic neurochemical changes in patients with functional motor symptoms
Authors: Demartini Benedetta , Gambini Orsola , Uggetti Carla , Cariati Maurizio , Eng MarcelloCadioli , Goeta Diana , Marceglia Sara , Ferrucci Roberta , Priori Alberto
Published: July 2020

Objectives

To assess by magnetic resonance spectroscopy (MRS) the N-Acetyl- aspartate, myo-inositol, choline, sum of glutamate and glutamine (Glx), and creatine (Cr) content in the anterior cingulate cortex (ACC)/medial prefrontal cortex (mPFC) and in the occipital cortex (OCC) (control region) in patients with functional motor symptoms (FMS) and healthy controls, and to determine whether neurochemical limbic changes as estimated by MRS correlate with FMS-related motor symptom severity, alexithymia, anxiety, depression and quality of life.

Methods

This case-control study enrolled 10 patients with FMS and 10 healthy controls. Participants underwent MRS and were tested with the Mini Mental State Examination, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, 20- Item Toronto Alexithymia Scale and EuroQol 5D.

Results

In patients with FMS, MRS showed increased Glx/Cr in the ACC/mPFC but normal content in the control OCC. All the other metabolites tested were normal in both regions. The increased Glx/Cr content in the ACC/mPFC correlated with alexithymia, anxiety and severity of symptoms.

Conclusions

The abnormal limbic Glx increase could have a crucial pathophysiological role in FMS possibly by altering limbic-motor interactions, ultimately leading to abnormal movements.
25 Cerebellar cognitive affective syndrome – a case report of diagnosis and management using selective serotonin and norepinephrine reuptake inhibitors
Authors: Sridharan B , Liao YW
Published: July 2020

Objectives/aims

The objective of this case is to describe and report on a case of Cerebellar Cognitive Affective Syndrome (CCAS) which improved after the use of high dose venlafaxine therapy. To our knowledge, there are only a few case reports discussing on the effectiveness of various drug therapies in CCAS patients and none had reported on the use of Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRI).

Methods

We describe a 55-year-old male with a history of partially excised grade 1 left cerebellar haemangioblastoma in 2005 followed by Gamma Knife in 2006.

Unfortunately, he suffered a recurrence in 2018 requiring embolisation of the haemangioblastoma followed with surgery to resect the tumour. He presented to our specialist neuropsychiatric unit following episodes of new acute unprovoked behavioural changes after surgery. During these episodes, he would become verbally abusive, refuse to engage in any rehab activity, refuse any oral intake, become sexually disinhibited, and experience distressing hallucinations. On the neuropsychiatric ward, he continued to have episodes of severe emotional regulation difficulties. There were no obvious triggers identified and it was noted that the peaks and troughs in his behaviour lasted for a few days before self-resolving and did not follow any particular pattern. In between these episodes, the patient was pleasant, engaging in physiotherapy, and conversed normally with staff.

Results

He scored a total of 4 out of 10 on the CCAS-scale. A diagnosis of CCAS was concluded given the extensive history of cerebellar injury, nature of presenting complain, and his CCAS-scale score. He was started on high dose SNRI (Venlafaxine XL 150 mg BD). On repeating the CCAS-scale after being on SNRI for 4 months, his score was worse at 6 out of 10. However, we observed a decrease in the frequency, duration, and severity of behavioural change after commencement of SNRI. He benefited greatly from physiotherapy on the ward however despite our best efforts functional independence was not regained. He had to be transferred with the aid of 2 members of staff and mobilises with the aid of an electronic wheelchair.

Conclusions

CCAS is a complex disease and the management is yet to be agreed on by the neuropsychiatry community. Our case report illustrated the therapeutic benefit of venlafaxine in the treatment of severe emotional regulation difficulties associated with resection of a cerebellar haemangioblastoma. Furthermore, patients with cerebellar injuries should be managed in a multi-disciplinary manner with input from neurology, neuropsychiatry, neuropsychology, occupational therapist, and physiotherapist.
26 Can an automated assessment of language help distinguish between Functional Cognitive Disorder and early neurodegeneration?
Authors: O’Malley Ronan , Morris Lee-Anne , Longden Chloe , Turner Alex , Walker Traci , Venneri Annalena , Mirheidari Bahman , Christensen Heidi , Reuber Markus , Blackburn Daniel
Published: July 2020

Objectives/Aims

We used our automated cognitive assessment tool to explore whether responses to questions probing recent and remote memory could aid in distinguishing between patients with early neurodegenerative disorders and those with Functional Cognitive Disorders (FCD).

Hypotheses: pwFCD would have no significant differences in pause to speech ratio and measures of linguistic complexity compared to healthy controls. pwFCD would have significant differences in pause to speech ratio and measures of linguistic complexity compared to pwMCI and pwAD.

Methods

We recruited 15 participants with FCD, MCI and AD each as well as 15 healthy controls. Participants answered 12 questions posed by the ‘Digital Doctor’. Automatic processing of the audio-recorded answers involved automatic speech recognition including detecting length of pauses. Two questions probe recent memory, exploring knowledge of current affairs. Two probe remote memory, asking for autobiographical details.

We analysed the data using: Pause to speech time ratio. Moving average type token ratio (MATTR): An automated measure of vocabulary richness. Computerised propositional idea density rater (CPIDR): An automated measure of propositional idea density.

Results

There was a significant difference in the pause to speech ratio for recent memory questions for HC versus AD (P=0.0012) and MCI (p<0.0001) but also compared to those with FCD (p=0.0128). There was a significant difference in the pause to speech ratio for remote memory questions for HC vs AD (p=0.0008) and MCI (p=0.0049) but not FCD (p=0.0613). There was no significant difference between FCD v AD or FCD v MCI. The MATTR and CPIDR were similar across all groups but highest in HC and FMD.

Conclusions

This study rejects both hypotheses. However, the data supports the application of linguistic measures to recent and remote memory questions in distinguishing those with MCI & AD from HC’s. Further work will investigate the utility of incorporating additional measures of lexical and grammatical complexity (word frequency, sentence structure). Longitudinal study will provide insights into which features may predict stability in FCD and HC’s and progression from MCI to AD, supporting the system’s promise as a monitoring tool.
31 Measuring Initiation Impairments Post Brain Injury: Behavioural Initiation Rating Scale (BIRS)
Authors: Lam Joseph , Minioza Dennis , Tyagi Himanshu
Published: July 2020

Objectives

Behavioural Initiation is defined as the innate ability to trigger action. There is rich literature describing the high prevalence of motivational disorders and poor behavioural initiation during rehabilitation following acquired brain injury. This is not only due to their neurological conditions, but also that they might have spent many weeks in the wrong environment, with no stimulation other than receiving essential care. There is no established measure for behaviour initiation specific for a rehabilitation setting. This project aim to develop a tool that is sensitive to patients’ level of behavioural initiation, and support evidence-based decision making in formulating treatments in the Multi-Disciplinary Teams (MDT).

Methods

We proposed the 10-item nurse-rated Behavioural Initiation Rating Scale (BIRS). BIRS items were tailored to measure patient behaviour in day-to-day scenarios in inpatient rehabilitation. Included statements were shortlisted from a large pool of comments and observations from the MDT, and a review of literature on the topic. Following basic training with the nursing staff, we piloted a feasibility trial of BIRS for 4 weeks at an 18-bed Neurorehabilitation Unit. We arranged two focus-groups with MDT therapists and the nursing team, to reflect on the implementation of BIRS, and further refinement of scale items. Opinions from the focus-groups were used to revise the current version of BIRS.

Results

It takes less than 2 minutes to administer and score BIRS. BIRS appears to be sensitive to improvement in behavioural initiation, and in agreement with clinical impressions from MDT and feedback from carers. BIRS has been well-implemented into routine practice, and has resulted a cultural shift in the unit. We identified some levels of between-rating variation in using BIRS, which was addressed by clarifying the instruction manual and giving specific examples for the ambiguous items.

Secondary to our aim, the implementation of BIRS has improved the communication between nursing staff and therapists in delivering cohesive neurorehabilitation.

Conclusions

BIRS appears to be a promising tool to evaluate patient behavioural initiation in a rehabilitation setting. A multi-centre trial of BIRS is currently being planned to establish its psychometric properties.
32 An interesting case of a stroke involving the primary auditory cortex in a patient with paranoid schizophrenia
Authors: Tyagi Himanshu , Goodison William
Published: July 2020

Introduction

Auditory verbal hallucinations (AVH): the ‘subjective experience of hearing voices speaking in the absence of corresponding physical stimulation’ (Kompus et al 2013) are part of Schneider’s first rank symptoms. They are included in the American Psychiatric Association DSM-5 diagnostic criteria for Schizophrenia and can be difficult to treat in a proportion of patients with drug resistance in up to 25% of cases

Case

Our case is a 52 year old gentleman with a background of treatment resistant schizophrenia, who presented to hospital with a right sided hemiplegia and aphasia. He was diagnosed with a left middle cerebral artery territory stroke. A post CVA MRI showed ‘an extensive mature infarct in the left middle cerebral artery territory and encompassed the left superior temporal gyrus (STG) where the primary auditory cortex (PAC) is located’. He was known to a mental health team from 1989 and had eight inpatient psychiatric admissions, under section, with thought disorder and paranoid thoughts with aggressive behaviour endangering himself and the public.

Prior to the stroke he was treated with monthly Pipothiozine Depot Injections, however, these were missed post stroke; he remained untreated for his paranoid schizophrenia and no signs of distress or paranoia were identified by any of the treating staff. Due to his speech impairments, his mental state remained difficult to assess, however, in conjunction with speech and language colleagues the Neuropsychiatrist ascertained that there was no evidence of psychosis, beliefs or behaviours similar to his pre-morbid mental state.

Discussion

The human PAC is part of the temporal lobe and is the final target for afferent auditory signals. It is found bilaterally, specifically within the STG, occupying the dorsal and lateral surface of the STG and encompassing Heschl’s gyrus. There are several different hypotheses regarding the neural mechanisms behind auditory verbal hallucinations. Multiple studies have implicated the primary auditory cortex as being central to this process and functional imaging has shown the STG to be activated in patients with schizophrenia during hallucinations. The resolution of symptoms in this case supports the involvement of the PAC in AVH and could represent a target for future therapies.