Extended Course Research Articles

Contemporary Practice Patterns for Radiotherapy of Bone Metastases: Preliminary Analysis of Prospective Data from a Statewide Consortium Focusing on Extended Fractionation

National guidelines recommend various effective dose and fractionation schemes for palliative radiotherapy (RT) of bone metastases, including noninferior outcomes with single fraction regimens. For Choosing Wisely, ASTRO advocated against use of extended fractionation schemes with greater than 10 fractions. We previously reported a retrospective assessment of heterogeneity in RT management of bone metastases. Herein, we sought to prospectively analyze current practice patterns of palliative RT in the treatment of bone metastases in diverse clinical settings. Specifically, we investigated possible predictors of extended treatment courses. Within a statewide radiation oncology quality consortium, patients were consecutively enrolled between March 2018 and February 2019 in both academic and non-academic facilities. Data on patient characteristics, provider and facility characteristics, dose and fractionation schedules, treatment planning and delivery techniques and image guidance were collected. Multivariable binary logistic regression was employed to assess use of extended fractionation (>10 fractions) RT. A total of 444 consecutive patients were enrolled by 24 treating facilities. The median case volume per center was 15 (range, 1-55), with a total of 608 plans from 411 patients available for analysis. The median number of plans per patient was 1 (range, 1-4). The most commonly employed dose and fractionation schedules were 3 Gy x 10 fractions (54%), 4 Gy x 5 fractions (14%), and 8 Gy x 1 fraction (11%). A minority of plans (5%) used extended fractionation. IMRT was utilized for 9% of plans, while cone beam CT image guidance was used in 14% of cases. A majority of plans (64%) were designed for uncomplicated osseous metastatic lesions. For uncomplicated lesions 13% of plans were prescribed 8 Gy x 1 fraction, while 5% were prescribed greater than 10 fractions. The only significant predictor of use of extended fractionation was type of treatment facility with academic centers significantly less likely to use more than 10 fractions per plan (OR=0.16, 95% CI: 0.04-0.72, p<0.02). This is our initial analysis of contemporary practice patterns of palliative RT for bone metastases using prospective data recently collected from our statewide consortium. Within a large, consecutively enrolled patient cohort, we demonstrate that palliative RT for management of bone metastases remains diverse. Resource-intensive treatments including image guidance and extended fractionation exist, with type of treatment facility significantly predicting use of extended fractionation. Taken together, these preliminary results support our ongoing collection of the prospective data needed to more clearly understand the barriers to high value RT approaches in this setting.

Infection Rates After Microlaryngeal and Open Phonosurgery: The Role of Postoperative Antibiotics.

Although it is known that the airway has bacterial contamination that seeds the surgical site during microlaryngeal surgery, literature on the use of postoperative antibiotics is lacking. We performed a retrospective analysis of open phonosurgical and phonomicrosurgical cases at a single institution to assess whether use of postoperative antibiotics impacts the incidence of surgical site infections (SSI). In this retrospective cohort study, we reviewed 228 phonomicrosurgery and 53 open phonosurgery cases performed for benign diseases. Surgeries were performed by two laryngologists between February 2016 and August 2018. The surgeons differ in their postoperative antibiotic regimens: no antibiotics versus a 5- to 7-day postoperative course. Data collected include demographics, medical comorbidities, type of benign laryngeal disease, and surgical procedure. The primary outcome measure was postoperative infection, defined as the patient requiring a new prescription for antibiotics, an extended course of antibiotics, or any mention of infection at follow-up/emergency visits within the first month postoperatively. The overall rate of SSI was 3.1% and 0% for phonomicrosurgery and open phonosurgery cases, respectively. For phonomicrosurgery, there was no difference in the rate of SSI for patients who received or did not receive antibiotics perioperatively: 2.9% versus 3.2% (P = 0.99). Similarly, there was no difference in the infection rate for open phonosurgical cases. Infection rates after endoscopic and open phonosurgery are low. In this study, we found no evidence to suggest a protective effect associated with postoperative use of antibiotics. 4 Laryngoscope, 130:1128-1131, 2020.

Prophylactic antibiotics in head and neck free flap surgery: A novel protocol put to the test.

Recent evidence supports the use of ampicillin-sulbactam as a favored choice for antibiotic prophylaxis following head and neck free flap reconstructive surgery. However, there is a paucity of evidence guiding the optimal duration of antibiotic prophylaxis. The aim of this study is to compare the infection rates of short courses of ampicillin-sulbactam versus extended courses of various antibiotics in head and neck free flap reconstructive surgery. This is a retrospective cohort study conducted from 2012 to 2017 at a tertiary academic center on 266 consecutive patients undergoing head and neck surgery with free flap reconstruction. The primary outcome measure was the rate of any infection within 30 days of surgery. There were 149 patients who received antibiotic prophylaxis for an extended duration of at least seven days. 117 patients received a short course of antibiotics defined as 24 h for non-radiated patients and 72 h for radiated patients. Postoperative infections occurred in 45.9% of patients, of which 92.6% occurred at surgical sites. There was no significant difference in terms of postoperative infection rate between patients receiving an extended duration of antibiotics versus a short duration (p = 0.80). This held true for subgroups of surgical site infections (p = 0.38) and distant infections (p = 0.59 for pneumonia and p = 0.76 for UTI). Risk factors for infections were identified as hypothyroidism (p = 0.047) and clean contaminated wound classification (p = 0.0002). Shorter duration of ampicillin-sulbactam prophylaxis in free flap reconstruction of head and neck defects does not negatively affect postoperative infection rates. Level 2b.

Surgical Care Improvement Project Recommendations Versus Extended Course of Antibiotics in Tissue Expander Breast Reconstruction

Surgical Care Improvement Project Recommendations Versus Extended Course of Antibiotics in Tissue Expander Breast Reconstruction

How much can patients expect to improve with six weeks of deep TMS for OCD?

Introduction Deep TMS with the H7 coil over the dmPFC/ACC was recently approved for the treatment of obsessive compulsive disorder (OCD) by the FDA based on a twenty-nine-treatment-six-week sham-controlled study. Objective Quantify the improvement patients and clinicians can expect from their initial six-weeks of treatment. Methods The current analysis (n = 68) combined data from two groups of patients: – patients from the multi-center study who received active dTMS (n = 42) – an open label sample (n = 26). All patients were assessed on a weekly basis with Yale Brown Obsessive Compulsive Scale (YBOCS). Results The YBOCS score decreased significantly by 8.6 ± 0.8 which represents a 30.1% reduction from baseline through week 6 of treatment (P Conclusions Six weeks of dTMS treatment for OCD resulted in both statistically and clinically significant improvement. Notably, in eight out of nine patients who were treated for more than twenty-nine treatments, their scores improved. Patients with higher baseline severity are less likely to achieve response within 6 weeks and may benefit from longer treatment. Similarly, responders may reach remission with extended treatment courses.

Benefits and Adverse Events Associated With Extended Antibiotic Use in Total Knee Arthroplasty Periprosthetic Joint Infection.

Total knee arthroplasty (TKA) periprosthetic joint infection (PJI) can be managed with debridement, antibiotic therapy, and implant retention (DAIR). Oral antibiotics can be used after DAIR for an extended time period to improve outcomes. The objective of this study was to compare DAIR failure rates and adverse events between an initial course of intravenous antibiotic therapy and the addition of extended treatment with oral antibiotics. A multicenter observational study of patients diagnosed with a TKA PJI who underwent DAIR was performed. The primary outcome of interest was the failure rate derived from the survival time between the DAIR procedure and future treatment failure. One hundred eight patients met inclusion criteria; 47% (n = 51) received an extended course of oral antibiotics. These patients had a statistically significant lower failure rate compared to those who received only intravenous antibiotics (hazard ratio, 2.47; P = .009). Multivariable analysis demonstrated that extended antibiotics independently predicted treatment success, controlling for other variables. There was no significant difference in failure rates between an extended course of oral antibiotics less or more than 12 months (P = .23). No significant difference in the rates of adverse events was observed between patients who received an initial course of antibiotics alone and those who received a combination of initial and extended antibiotic therapy (P = .59). Extending therapy with oral antibiotics had superior infection-free survival for TKA PJI managed with DAIR. There was no increase in adverse events, demonstrating safety. After 1 year, there appears to be no significant benefit associated with continued antibiotic therapy.

A Versatile Protocol for Studying Anterior Cruciate Ligament Reconstruction in a Rabbit Model.

Anterior cruciate ligament (ACL) injuries are frequent, as >200,000 injuries occur in the United States alone each year. Owing to the risks for associated meniscus and cartilage damage, ACL injuries are a significant source of both orthopedic care and research. Given the extended recovery course after ACL injury, which often lasts 1-2 years, and is associated with limited participation in sports and activities of daily living for patients, there is a critical need for the evolution of new and improved methods for ACL repair. Subsequently, animal models of ACL reconstruction (ACLR) play a key role in the development and initial trialing of novel ACL interventions. This article provides a clear operative description and associated illustrations for a validated, institutional animal care and use committee, and veterinarian approved and facile model of ACLR to serve researchers investigating ACLR.

Azithromycin vs erythromycin for the management of preterm premature rupture of membranes

Preterm premature rupture of membranes complicates 2-3% of pregnancies. Many institutions have advocated for the use of azithromycin instead of erythromycin. This is secondary to national shortages of erythromycin, ease of administration, better side effect profile, and decreased cost of azithromycin as compared with erythromycin. The objective of the study was to evaluate whether there are differences in the latency from preterm premature rupture of membranes to delivery in patients treated with different dosing regimens of azithromycin vs erythromycin. This is a multicenter, retrospective cohort of women with singleton pregnancies with confirmed rupture of membranes between 230 and 336 weeks from January 2010 to June 2015. Patients were excluded if there was a contraindication to expectant management of preterm premature rupture of membranes. Patients received 1 of 4 antibiotic regimens: (1) azithromycin 1000 mg per os once (azithromycin 1 day group); (2) azithromycin 500 mg per os once, followed by azithromycin 250 mg per os daily for 4 days (azithromycin 5 day group); (3) azithromycin 500 mg intravenously for 2 days, followed by azithromycin 500 mg per os daily for 5 days (azithromycin 7 day group); or (4) erythromycin intravenously for 2 days followed by erythromycin per os for 5 days (erythromycin group). The choice of macrolide was based on institutional policy and/or availability of antibiotics at the time of admission. In addition, all patients received ampicillin intravenously for 2 days followed by amoxicillin per os for 5 days. Primary outcome was latency from diagnosis of rupture of membranes to delivery. Secondary outcomes included clinical and histopathological chorioamnionitis and neonatal outcomes. Four hundred fifty-three patients who met inclusion criteria were identified. Seventy-eight patients received azithromycin for 1 day, 191 patients received azithromycin for 5 days, 52 patients received azithromycin for 7 days, and 132 patients received erythromycin. Women who received the 5 day regimen were younger and less likely to be non-African American, have hypertension, have sexually transmitted infection, or experienced substance abuse. There was no statistical difference in median latency time of azithromycin 1 day (4.9 days, 95% confidence interval, 3.3-6.4), azithromycin 5 days (5.0, 95% confidence interval, 3.9-6.1), or azithromycin 7 days (4.9 days, 95% confidence interval, 2.8-7.0) when compared with erythromycin (5.1 days, 95% confidence interval, 3.9-6.4) after adjusting for demographic variables (P= .99). Clinical chorioamnionitis was not different between groups in the adjusted model. Respiratory distress syndrome was increased in the azithromycin 5 day group vs azithromycin 1 day vs erythromycin (44% vs. 29% and 29%, P= .005, respectively). There was no difference in latency to delivery, incidence of chorioamnionitis, or neonatal outcomes when comparing different dosing regimens of the azithromycin with erythromycin, with the exception of respiratory distress syndrome being more common in the 5 day azithromycin group. Azithromycin could be considered as an alternative to erythromycin in the expectant management of preterm premature rupture of membranes if erythromycin is unavailable or contraindicated. There appears to be no additional benefit to an extended course of azithromycin beyond the single-day dosing, but final recommendations on dosing strategies should rely on clinical trials.

How much can patients expect to improve with six weeks of deep TMS for OCD?

Introduction Deep TMS with the H7 coil over the dmPFC/ACC was recently approved for the treatment of obsessive compulsive disorder (OCD) by the FDA based on a twenty-nine-treatment-six-week sham-controlled study. Objective Quantify the improvement patients and clinicians can expect from their initial six-weeks of treatment. Methods The current analysis (n = 68) combined data from two groups of patients: – patients from the multi-center study who received active dTMS (n = 42) – an open label sample (n = 26). All patients were assessed on a weekly basis with Yale Brown Obsessive Compulsive Scale (YBOCS). Results The YBOCS score decreased significantly by 8.6 ± 0.8 which represents a 30.1% reduction from baseline through week 6 of treatment (P Conclusions Six weeks of dTMS treatment for OCD resulted in both statistically and clinically significant improvement. Notably, in eight out of nine patients who were treated for more than twenty-nine treatments, their scores improved. Patients with higher baseline severity are less likely to achieve response within 6 weeks and may benefit from longer treatment. Similarly, responders may reach remission with extended treatment courses.

Short Letrozole Therapy Vs Extended (Long) Letrozole Therapy for Induction of Ovulation in Women with Polycystic Ovary Syndrome

Background: polycystic ovary syndrome (PCOS) is the major cause of anovulatory infertility. Letrozole and other aromatase inhibitors (AIs) have been introduced as a new treatment option could challenge clomiphene citrate (CC) for ovulation induction in this group. Objective: to compare the efficacy of short vs extended courses of letrozole therapy for ovulation induction in PCOS women. Patients and Methods: this is prospective randomized comparative study done on 60 patients attended El-Hussein Hospital and previously diagnosed as having PCOS, based on the revised Rotterdam criteria (2003). Patients were divided randomly into 2 treatment groups, group I, short letrozole therapy (30 patients, received 5mg of letrozole from 1st to 5th day of menstrual bleeding) and group II, long letrozole therapy (30 patients, received 2.5mg of letrozole from 1st to 10th day of menstrual bleeding). All patients of both groups monitored by trans-vaginal ultrasound on day 10 of the cycles. HCG injection (5,000 IU IM) was given when at least one follicle measured ≥ 18mm. Intercourse were advised for 24-36h after HCG injection. Serum HCG and trans-vaginal ultrasound were done 2 weeks after HCG injection in the absence of menstruation for diagnosis of pregnancy. Results: in long letrozole therapy, total number of follicles, mean number of mature follicles, endometrial thickness, percentage of patients ovulated after treatment, occurrence of pregnancy were greater when compared to results of short letrozole therapy. Conclusion: long letrozole therapy can produce more mature follicles and subsequently more pregnancies than short letrozole therapy.

Short-Term Steroid Regimen for Adult Steroid-Sensitive Minimal Change Disease

Background: In pediatric patients with steroid-sensitive nephrotic syndrome, recent trials have revealed that a 2-month, short-term steroid regimen is not inferior to an extended steroid course. However, the optimal duration of initial steroid therapy for adult steroid-sensitive minimal change disease (MCD) remains unclear. Objectives: The aim of present study was to evaluate the effectiveness of a 2-month, short-term steroid regimen in the treatment of adult steroid-sensitive MCD patients. Method: This was a prospective observational study. Adult patients with steroid-sensitive MCD (n = 35) who were initiated on a short-term steroid regimen between January 2015 and June 2016 were included. The details of the regimen are as follows: (1) prednisolone was administered at an initial dose of 0.8–1.0 mg/kg/day and continued for 4–6 weeks and (2) dosage was reduced to 0.5–0.6 mg/kg/alternate day and continued for 4 weeks. Control patients (n = 140), who were treated using conventional steroid administration, were selected from our previous adult MCD cohort. All patients fulfilled the following criteria: biopsy-proven MCD, age ≥20 years, first episode of nephrotic syndrome, and attainment of complete remission within 4 weeks. The following parameters of patients who received short-term treatment regimen and control patients were compared: any relapse and frequent relapse, adverse events caused by steroid treatment and cumulative steroid dose. Results: Throughout the observation period (median: 17.3 months), 24 (68.6%) patients in the short-term group developed at least one relapse. The short-term regimen showed earlier occurrence of any relapse than the conventional regimen (adjusted hazard ratio [aHR] 2.45; 95% CI 1.51–3.97; p < 0.001), but there was no difference in frequent relapse (aHR 1.31; 95% CI 0.43–3.99; p = 0.63). None of the patients showed any symptoms of adrenal insufficiency after discontinuation of corticosteroids. The cumulative steroid dose during the observational period was significantly lower in the short-term group than in the conventional group. Conclusions: The short-term steroid regimen may represent an effective treatment option that ensures lower steroid exposure when treating adult steroid-sensitive MCD patients.

Academic literacy for science: a starting point for recurriculation

English for Specific Purposes courses are taught at many universities around the world and also play a critical role in the South African context. There is limited transparency and therefore little agreement regarding what the curricula of such courses should include. The aim of this study was to start a conversation about which academic abilities are essential for academic success by describing and evaluating the proposed outcomes of two academic literacy (AL) courses for science students at a South African university. The courses were examined by comparing the abilities addressed in each course to an extensive checklist of general AL abilities. The four year programme course was found to cover most of these AL abilities sufficiently, but the weight of several features warranted reassessment. The three-year programme course addressed fewer of these AL abilities and the weighting of several AL abilities also needed to be reassessed. The findings suggest that the four-year extended programme course curriculum offers the better AL foundation as it appears to be more successful in sufficiently addressing a variety of AL abilities. Should the learning outcomes of the two programmes be more closely aligned, students from both programmes entering second year would be equally prepared. However, it would seem that both courses would benefit from further analysis, for example feedback from various stakeholders, and consequent recurriculation. Keywords: English for science and technology, English for specific purposes, academic literacy, curriculum development

Prioritizing Reflection and Integrative Learning in First-Year Seminar Courses

First-Year Seminar (FYS) or First-Year Experience (FYE) courses help college students transition to college, learn valuable academic skills, and create successful habits. This research analyzes the benefit of reorganizing FYS curriculum around reflection and integrative learning, by comparing students who participated in this redesigned curriculum with those who participated in a skills-based, extended orientation first-year seminar course. The two groups were compared on several measures, including perception about the utility of reflective and integrative thinking, first year retention, and first year GPA. Our findings suggest that prioritizing reflection and integrative learning in a FYS seminar is beneficial.

The attitudes, behaviors, and knowledge of healthcare professionals towards the diagnosis, treatment, and prevention of bacterial meningitis in Turkey

ABSTRACTIntroduction: Bacterial meningitis is one of the leading causes of morbidity and mortality among children and adults. Better understanding of the seroepidemiology of meningitis is critical for both the selection and implementation of an effective meningitis vaccine for the national immunization program. Because physicians play a crucial role in the implementation of this vaccine, the aim of this study was to evaluate the attitudes, behaviors, and knowledge of healthcare professionals in Turkey regarding the diagnosis, treatment and prevention of bacterial meningitis, especially pneumococcal and meningococcal meningitis.Methods: This study used a cross-sectional electronic survey with a national convenience sample of 339 physicians (171 pediatric age specialists [PAS] and 168 adult patient specialists [APS]) in Turkey. A web-based questionnaire which consisted 28 questions about the definition, diagnosis, and treatment of bacterial as well as knowledge and/or attitudes about meningococcal vaccines, was designed.Results: Approximately 72.9% (n = 247) of the respondents followed a patient with meningitis in the last year. A 49.5% of participants preferred to perform computerized cranial tomography (CCT) for suspected meningitis cases before lumbar puncture (LP) at 75–100% frequency (27.5% PAS; 72% APS, p < .01). In addition 27.1% of the respondents reported using a routine steroid as an adjunctive treatment (19% PAS; 35% APS, p < .01). For meningococcal meningitis, 72.5% of the participants preferred to use third-generation cephalosporins (63.1% PAS; 82.1% APS, p < .05). For pneumococcal meningitis, approximately 50% of the participants preferred to use a third-generation cephalosporin plus glycopeptide (41.5% PAS; 58.9% APS, p < .05). While 32.7% of the sample preferred to administer a 7-day course of antibiotics for meningococcal meningitis, 40.9% preferred a course of 14 days or more. For pneumococcal meningitis, 88.4% of the sample preferred a 10–14 day course of antibiotics. In addition, 67% of the PAS group and 50% (p < .001) of the APS group thought that a conjugated meningococcal vaccine should be a part of the National Immunization Program. The top five groups recommended for routine immunization included all children, asplenia/splenectomy patients, immunodeficient patients, those who planned to travel to endemic areas, including Hajj, and military personnel.Conclusion: In this large convenient sample of physicians in Turkey, we showed that there are heterogenous approaches to the diagnosis and treatment of bacterial meningitis, also differences between pediatricians and non-pediatricians regarding their beliefs and attitudes, which may be due to differences in the epidemiology and clinical presentation between children and adults. We observed appropriate but unnecessary extended courses of antibiotics for meningitis. Most of the participants thought that children are a vulnerable risk group that should potentially be immunized and that meningococcal vaccines should be included in the National Immunization Program. Our results imply that more awareness is needed regarding diagnosis, treatment, and further recommendations for meningitis at the country level in Turkey.

The role of skin testing and extended antibiotic courses in assessment of children with penicillin allergy: An Australian experience.

To determine if skin testing (ST) in addition to extended oral provocation challenge (OPC) is necessary for beta-lactam allergy verification in an Australian paediatric population. This was a retrospective study (176 children) that undertook assessments for beta-lactam allergy from 2006 to 2015 at a tertiary paediatric hospital. Patients either underwent direct OPC without ST or ST plus challenge if ST was negative. The analysis included children with a history of varying rash types/severity as well as angioedema and reported anaphylaxis. A direct OPC was undertaken in 73 children. Three children reacted with one anaphylaxis. A total of 103 children underwent ST, with 13 children (12.6%) reacting. Of the 90 who subsequently proceeded to OPC, 4 reacted. A total of 132 children were given an extended oral course of the culprit antibiotic, to which 6 children reacted. A direct OPC with the culprit drug in Australian children can be safely performed, avoiding resource-intensive and painful ST. Our data demonstrate that a prior history of anaphylaxis does not necessarily predict IgE-mediated allergy, as detected by positive immediate ST or reactions to oral challenge. Such history should not detract from efforts to assess these children for antibiotic allergy. We suggest that extended courses of at least 5 days are important in paediatric antibiotic de-labelling as six children (4.5% of those who were prescribed the extended course) reacted in our study and even developed symptoms late in the extended course, from days 2 to 6.

Cutaneous Botryomycosis and Staphylococcus aureus: Diagnosis, Management, and a Systemic Literature Review

We present a case and provide a review of the literature of all confirmed cases of cutaneous botryomycosis due to Staphylococcus aureus between January 1, 1990 and January 31, 2018. Cutaneous botryomycosis occurs in diverse age groups and more frequently in men. Immunodeficiency increases risk for botryomycosis. Preceding trauma commonly occurs, and after bacterial inoculation, patients develop a variety of chronic skin lesions. Culture and biopsy of lesions aid in diagnosis. Pathology usually displays the Splendore-Hoeppli reaction. Culture confirms the identity of the bacterium and provides antimicrobial sensitivities to guide therapy. Antimicrobial therapy should be maintained until lesions resolve; surgery may be needed. Botryomycosis is a rare chronic granulomatous condition that affects the skin and the viscera and is easily misdiagnosed. Treatment is not standardized yet typically requires extended courses of systemic antibiotics. Adjunctive surgery may be required in the presence of a heavy disease burden.

A systematic review of levetiracetam versus phenytoin in the prevention of late post-traumatic seizures and survey of UK neurosurgical prescribing practice of antiepileptic medication in acute traumatic brain injury

Background: Guidelines recommend 1 week of prophylactic phenytoin for post-traumatic seizures (PTS). Levetiracetam is gaining popularity as an alternative with a superior side-effect profile and may be suitable for extended use. We performed a systematic review comparing the efficacy of levetiracetam and phenytoin in reducing the incidence of late PTS. The secondary objectives were to compare their effects on the Extended Glasgow Outcome Scale (GOS-E) and length of stay. We also aimed to survey current prophylaxis prescribing practices.Methods: A systematic review was performed using Medline, Pubmed, Embase and Cochrane. Trials and observational studies comparing the efficacy of phenytoin and levetiracetam in the prevention of late PTS were included. A survey assessing prescribing practices was e-mailed to all consultant members of the Society of British Neurological Surgeons (n = 249) in March 2013.Results: One randomised controlled trial (RCT) (52 patients) and a cohort study (19 patients) met our criteria. Neither found a significant difference in the incidence of late PTS or length of hospital stay, although the RCT showed an improvement in the GOS-E with levetiracetam. Of the 249 consultants included in the survey, 55 responded (22.1%). Prophylaxis was prescribed by 32 consultants (58%), of whom 21 (65.6%) chose phenytoin, 7 (21.9%) chose levetiracetam, 3 (9.4%) chose valproate and 1 (3%) chose ‘other’. Half indicated they would prescribe prophylaxis for 1 week, the remainder opting for extended use.Conclusion: While our review found no evidence of a difference in late seizure incidence, there is evidence of improved long-term outcomes with levetiracetam. Neither study used an extended course of levetiracetam or continuous electroencephalography. Further research which accounts for these factors is required for the development of guidelines which take levetiracetam into account. Our survey showed a lack of awareness of the potential harms of extended phenytoin use and a move towards levetiracetam.

Repetitive Neonatal Erythropoietin and Melatonin Combinatorial Treatment Provides Sustained Repair of Functional Deficits in a Rat Model of Cerebral Palsy.

Cerebral palsy (CP) is the leading cause of motor impairment for children worldwide and results from perinatal brain injury (PBI). To test novel therapeutics to mitigate deficits from PBI, we developed a rat model of extreme preterm birth (<28 weeks of gestation) that mimics dual intrauterine injury from placental underperfusion and chorioamnionitis. We hypothesized that a sustained postnatal treatment regimen that combines the endogenous neuroreparative agents erythropoietin (EPO) and melatonin (MLT) would mitigate molecular, sensorimotor, and cognitive abnormalities in adults rats following prenatal injury. On embryonic day 18 (E18), a laparotomy was performed in pregnant Sprague–Dawley rats. Uterine artery occlusion was performed for 60 min to induce placental insufficiency via transient systemic hypoxia-ischemia, followed by intra-amniotic injections of lipopolysaccharide, and laparotomy closure. On postnatal day 1 (P1), approximately equivalent to 30 weeks of gestation, injured rats were randomized to an extended EPO + MLT treatment regimen, or vehicle (sterile saline) from P1 to P10. Behavioral assays were performed along an extended developmental time course (n = 6–29). Open field testing shows injured rats exhibit hypermobility and disinhibition and that combined neonatal EPO + MLT treatment repairs disinhibition in injured rats, while EPO alone does not. Furthermore, EPO + MLT normalizes hindlimb deficits, including reduced paw area and paw pressure at peak stance, and elevated percent shared stance after prenatal injury. Injured rats had fewer social interactions than shams, and EPO + MLT normalized social drive. Touchscreen operant chamber testing of visual discrimination and reversal shows that EPO + MLT at least partially normalizes theses complex cognitive tasks. Together, these data indicate EPO + MLT can potentially repair multiple sensorimotor, cognitive, and behavioral realms following PBI, using highly translatable and sophisticated developmental testing platforms.

Young Adults with Autism Spectrum Disorder Show Early Atypical Neural Activity during Emotional Face Processing.

Social cognition is impaired in autism spectrum disorder (ASD). The ability to perceive and interpret affect is integral to successful social functioning and has an extended developmental course. However, the neural mechanisms underlying emotional face processing in ASD are unclear. Using magnetoencephalography (MEG), the present study explored neural activation during implicit emotional face processing in young adults with and without ASD. Twenty-six young adults with ASD and 26 healthy controls were recruited. Participants indicated the location of a scrambled pattern (target) that was presented alongside a happy or angry face. Emotion-related activation sources for each emotion were estimated using the Empirical Bayes Beamformer (pcorr ≤ 0.001) in Statistical Parametric Mapping 12 (SPM12). Emotional faces elicited elevated fusiform, amygdala and anterior insula and reduced anterior cingulate cortex (ACC) activity in adults with ASD relative to controls. Within group comparisons revealed that angry vs. happy faces elicited distinct neural activity in typically developing adults; there was no distinction in young adults with ASD. Our data suggest difficulties in affect processing in ASD reflect atypical recruitment of traditional emotional processing areas. These early differences may contribute to difficulties in deriving social reward from faces, ascribing salience to faces, and an immature threat processing system, which collectively could result in deficits in emotional face processing.

The Application of Autonomous Learning in PAD Class under Informatization Teaching Background for University English Extended Courses

Based on the informatization teaching background and the PAD Class teaching paradigm (Presentation-Assimilation-Discussion), this paper aims to carry a research of a reform and practice for the university English extended courses. This paper summarized the informatization teaching, PAD Class teaching paradigm and autonomous learning, showing the autonomous learning teaching design under PAD Class teaching paradigm for university English extended courses, so as to discuss the course design under this teaching paradigm. With the use of the informational technology, the PAD Class teaching paradigm being in accordance with the students learning psychology, could help mobilize the enthusiasm of the students’ autonomous study activity, which could better carry out the teaching activities.