Predictive value of early amplitude integrated electroencephalogram (aEEG) in sleep related problems in children with perinatal hypoxic-ischemia (HIE)

Background While great attention has been paid to motor and cognitive impairments in children with neonatal Hypoxic-Ischemic Encephalopathy (HIE), sleep related circadian rhythm problems, although commonly present, are often neglected. Subsequently, no early clinical indicators have been reported to correlate with sleep-related circadian dysfunction during development. Methods In this study, we first analyzed patterns of the amplitude integrated electroencephalogram (aEEG) in a cohort of newborns with various degrees of HIE. Next, during follow-ups, we collected information of sleep and circadian related problems in these patients and performed correlation analysis between aEEG parameters and different sleep/circadian disorders. Results A total of 101 neonates were included. Our results demonstrated that abnormal aEEG background pattern is significantly correlated with circadian rhythmic (r = 0.289, P = 0.01) and breathing issues during sleep (r = 0.237, P = 0.037). In contrast, the establishment of sleep–wake cycle (SWC) showed no correlation with sleep/circadian problems. Detailed analysis showed that summation of aEEG score, along with low base voltage (r = 0.272, P = 0.017 and r = -0.228, P = 0.048, respectively), correlates with sleep circadian problems. In contrast, background pattern (BP) score highly correlates with sleep breathing problem (r = 0.319, P = 0.004). Conclusion Abnormal neonatal aEEG pattern is correlated with circadian related sleep problems. Our study thus provides novel insights into predictive values of aEEG in sleep-related circadian problems in children with HIE.

Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in Taiwan

Background Endoscopic submucosal dissection (ESD) is gradually turning into the standard treatment for superficial esophageal squamous cell carcinoma (SESCC), however, the long-term outcomes have hardly ever been reported outside Japan. Method We consecutively recruited patients with SESCC who had received ESD treatment at E-Da Hospital. The demographics, pathological characteristics, and Lugol staining background pattern (type A or B: none or < 10 small Lugol-voiding lesions [LVLs]; type C or D: > 10 small or multiform LVLs) were collected, and then correlated to outcomes and survival. Results Total of 229 lesions were enrolled and the mean lesion size was 3.28 ± 1.69 (range 1–10) cm. 72% of the lesions had a type C-D Lugol staining background pattern. After ESD, the en bloc and R0 resection rates were 93.9% and 83.5%, respectively. Forty-nine subjects developed complications, including six (2.6%) with major bleeding, two (0.9%) with perforation, and 41 (17.9%) with strictures. Pathological staging showed that 19 cases had deep submucosal cancer invasion and subsequently received adjuvant therapies. During a mean follow-up period of 52.6 (range 3–146) months, 41 patients developed metachronous recurrence. The patients with a type C-D Lugol staining background pattern were associated with a higher risk of recurrence than those with few LVLs (log-rank P = 0.019). The 10-year survival rate was more than 90%, and only eight patients died of ESCC. Conclusion ESD has excellent long-term outcomes but a high risk of metachronous recurrence. The Lugol staining pattern over the background mucosa could offer the risk stratification of metachronous recurrence.

All Shades of Shrimp: Preferences of Colour Morphs of a Freshwater Shrimp Neocaridina davidi (Decapoda, Atyidae) for Substrata of Different Colouration

An ornamental freshwater shrimp, Neocaridina davidi, is popular as an aquarium hobby and, therefore, a potentially invasive species. There is a growing need for proper management of this species to determine not only their optimum breeding conditions, but also their ability to colonise novel environments. We tested habitat preferences of colour morphs (brown, red, white) of N. davidi for substratum colour (black, white, grey shades, red) and fine or coarse chess-board patterns to recognise their suitable captivity conditions and predict their distribution after potential release into nature. We conducted laboratory choice experiments (n = 8) with three individuals of the same morph exposed for two hours to a range of backgrounds. Shrimp preferred dark backgrounds over light ones irrespective of their own colouration and its match with the background colour. Moreover, the brown and red morphs, in contrast to the white morph, preferred the coarse background pattern over the finer pattern. This suggests that the presence of dark, uniform substrata (e.g., rocks, macrophytes) will favour N. davidi. Nevertheless, the polymorphism of the species has little effect on its total niche breadth, and thus its invasive potential.

Effect of Phenobarbitone on Amplitude-Integrated Electroencephalography in Neonates with Hypoxic-Ischemic Encephalopathy during Hypothermia

<b><i>Background:</i></b> Phenobarbitone induces suppression of cerebral electrical activity on amplitude-integrated electroencephalography (aEEG) in neonates with hypoxic-ischemic encephalopathy (HIE); however, its effect during therapeutic hypothermia (TH) has not been well characterized. <b><i>Objective:</i></b> To evaluate the effect of phenobarbitone on aEEG in neonates with HIE undergoing TH. <b><i>Methods:</i></b> Thirty-five neonates born at ≥35⁰ weeks gestational age (GA), who received phenobarbitone as first-line antiepileptic drug during TH for ≥ Sarnat stage II HIE with aEEG recordings were retrospectively studied. Background pattern, upper and lower margin voltages were characterized for a 30-min period before and 30–60 min after phenobarbitone administration. Primary outcome was presence of severely abnormal aEEG pattern after phenobarbitone administration. <b><i>Results:</i></b> Mean (±SD) GA and median birth weight were 38.2 ± 1.9 weeks and 3.1 (2.5–3.9) kg, respectively. Phenobarbitone (10–20 mg/kg), administered at median age 16.8 h, was associated with background pattern worsening in 19/29 (65.5%) cases. Severe background patterns were more prevalent in post- versus pre-phenobarbitone tracings (21/29 [72%] vs. 11/29 [38%]; <i>p</i> = 0.01). Presence of severe pattern versus either continuous normal voltage or discontinuous normal voltage pattern post-phenobarbitone, (20/25 [80%] vs. 3/8 [38%]; <i>p</i> = 0.036) was associated with death or moderate-to-severe injury on MRI brain. Median time to trace recovery, when measurable, was 4 h (45 min–72 h). <b><i>Conclusions:</i></b> Phenobarbitone induces significant suppression on aEEG in infants with HIE undergoing TH. Development of severe aEEG background patterns after phenobarbitone may unmask a population at greater risk of abnormal outcome.

EEG reactivity testing for prediction of good outcome in patients after cardiac arrest

ObjectiveTo determine the additional value of EEG reactivity (EEG-R) testing to EEG background pattern for prediction of good outcome in adult patients after cardiac arrest (CA).MethodsIn this post hoc analysis of a prospective cohort study, EEG-R was tested twice a day, using a strict protocol. Good outcome was defined as a Cerebral Performance Category score of 1–2 within 6 months. The additional value of EEG-R per EEG background pattern was evaluated using the diagnostic odds ratio (DOR). Prognostic value (sensitivity and specificity) of EEG-R was investigated in relation to time after CA, sedative medication, different stimuli, and repeated testing.ResultsBetween 12 and 24 hours after CA, data of 108 patients were available. Patients with a continuous (n = 64) or discontinuous (n = 19) normal voltage background pattern with reactivity were 3 and 8 times more likely to have a good outcome than without reactivity (continuous: DOR, 3.4; 95% confidence interval [CI], 0.97–12.0; p = 0.06; discontinuous: DOR, 8.0; 95% CI, 1.0–63.97; p = 0.0499). EEG-R was not observed in other background patterns within 24 hours after CA. In 119 patients with a normal voltage EEG background pattern, continuous or discontinuous, any time after CA, prognostic value was highest in sedated patients (sensitivity 81.3%, specificity 59.5%), irrespective of time after CA. EEG-R induced by handclapping and sternal rubbing, especially when combined, had highest prognostic value. Repeated EEG-R testing increased prognostic value.ConclusionEEG-R has additional value for prediction of good outcome in patients with discontinuous normal voltage EEG background pattern and possibly with continuous normal voltage. The best stimuli were clapping and sternal rubbing.

Leaving It Out

Chapter 23 shows how in the modernist era rhythm was no longer a stable background pattern, but became part of the overall acoustic texture of the poem—with short-form poetry the most powerful vehicle for rhythmic innovation. Poetry had, for most of English literary history, generally been held to be metrical—rhythmic in a consistent pattern. Ezra Pound helped shape modernist poetics, and the author focuses on the Poundian line of influence, with particular emphasis on the writing of the American poet Robert Creeley. While his verse is not “musical” in the tightly patterned sense of balladry, his precise and economical use of language encourages rhythmic innovations comparable to those of twentieth-century musical pioneers such as the composer Anton Webern or the bebop drummer Max Roach. The author argues that brevity and ellipsis are integral to a modernism best approached through the modernist dictum Dichten = condensare (to poetize is to condense).

An Observation and Experimental Evaluation of Image Spam Detection

In belonging to other supports duel beside researchers of image spam detections, unsolicited mail have newly developed the image based spam dodge to construct the investigation of e-mails’ content of text unsuccessful. To avoid signature based recognition, it involves in implanting the unsolicited text or message into an appendage image, which is frequently arbitrarily customized. Identifying image based spam emails tries out to be an motivating illustration of the problem text embedded in images were subjected to noise such as background pattern, color, font variations and imperfections in a font size so as to eliminate the chances of being identified as unsolicited e-mail by classification techniques. In this research paper we spring a exhaustive review and categorization of machine learning and classification systems suggested so far in contradiction of image based spam email, and make an empirical investigation and correlation of few of them on real, widely accessible data sets.

Hand Detection Using Cascade of Softmax Classifiers

Sliding-window based multiclass hand posture detections are often performed by detecting postures of each predefined category using an independent detector, which makes it lack efficiency and results in high postures confusion rates in real-time applications. To tackle such problems, in this work, an efficient cascade detector that integrates multiple softmax-based binary (SftB) models and a softmax-based multiclass (SftM) model is investigated to perform multiclass posture detection in parallel. The SftB models are used to distinguish the predefined postures from the background regions, and the SftM model is applied to discriminate among all the predefined hand posture categories. Another usage of the cascade structure is that it could effectively decompose the complexity of background pattern space and therefore improve the detection accuracy. In addition, to balance the detection accuracy and efficiency, the HOG features of increasing resolutions will be adopted by classifiers of increasing stage-levels in the cascade structure. The experiments are implemented under various scenarios with complicated background and challenging lightings. Results show the superiority of the proposed SftB classifiers over the traditional binary classifiers such as logistic regression, as well as the accuracy and efficiency improvements brought by the softmax-based cascade architecture compared with the noncascade multiclass softmax detectors.