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• Stereotactic brain biopsy is to perform manual aspiration tissue biopsy through a cannula using a syringe under stereotactic guidance to provide a histological confirmation. Excessive vacuum aspiration increases the risk of haemorrhage. Manual aspiration relies on surgeon's experience while minimum vacuum pressure is unknown. • It is the first study measuring the vacuum pressure at brain tumour biopsy in vivo. A vacuum pressure of 40 to 66 kPas is safe and adequate for biopsy of various types of tumours with heterogenous elastographic characters. A 3-cc syringe is able to generate this range of vacuum pressure. • And it is also the first report about the correlation with Strain ratio of US-elastography to the vacuum pressure. Ultrasonographic elastography may be a real-time guide for the minimum vacuum pressure required for biopsy. Stereotactic brain biopsy is to perform the manual aspiration tissue biopsy using a cannula on a syringe under stereotactic guidance to provide histological confirmation. Excessive vacuum aspiration increases the risk of haemorrhage. Manual aspiration relies on the surgeon's experience while the minimum vacuum pressure is unknown. 1. To assess the aspiration vacuum pressure range in cannula brain tumour biopsy; 2. To understand the correlation of ultrasound elastography data with the aspiration pressure. This prospective study has recruited 10 patients for stereotactic brain tumour biopsy. With the use of ultrasound elastography, strain ratio of the lesion was assessed in real time before biopsy. Vacuum aspiration pressures were recorded using a T-connector pressure sensor during the stereotactic biopsy. A total of 11 biopsies were taken from 10 patients, including a bilateral biopsy for a patient with bifrontal lesions. The diagnostic yield was 100% in all the 10 patients with no symptomatic haemorrhage (but 2 subclinical haemorrhages in CT scan) nor infection. The vacuum pressures ranged from 40.34 to 65.61 kPa and the strain-ratio ranged from 0.405 to 2.74. Strain ratio of the lesion at the lower range required a lower range of aspiration pressure, whereas lesions of Strain ratio over 0.45 required a higher range of aspiration pressure. A vacuum pressure of 40 to 66 kPas is safe and adequate for biopsy of various types of tumours with heterogenous elastographic characters. Ultrasonographic elastography may be a real-time guide for the minimum vacuum pressure required for biopsy. [ABSTRACT FROM AUTHOR]

Highlights • Control by stimuli signaling future reinforcer availability is often weaker in more certain environments. • We examined whether this was the case when reinforcer availability changed over time. • Across conditions, we varied the certainty of the next-reinforcer location at a particular time. • Stimuli strongly controlled behavior and environmental contingencies exerted weak control. • Control by stimuli and by the environment may depend on global, not local, environmental certainty. Abstract Several studies suggest that the degree of control by reinforcer ratios (environment tracking) and by exteroceptive stimuli that signal future reinforcer availability (signal following) depends on environmental certainty: As reinforcers become more likely at one location, environmental contingencies exert stronger control and exteroceptive stimuli exert weaker control. This research has not yet been extended to environments in which reinforcer availability changes across time, even though such changes are present in most natural environments. Thus, in the present experiment, we examined environment tracking and signal following in a concurrent schedule in which the reinforcer ratio reversed to its reciprocal 30 s after a reinforcer delivery and keylight-color stimuli signaled the likely or definite time or location of the next reinforcer. Across conditions, we manipulated environmental certainty by varying the probability of reinforcer deliveries on the locally richer key. This made the location of future reinforcers at a particular time more or less certain, but did not change the overall reinforcer ratio. Changes in local environmental certainty had little to no effect on environment tracking and signal following; in all conditions, keylight-color stimuli strongly controlled choice and reinforcer ratios exerted weak control. The present findings suggest that the extent of environment tracking and signal following is primarily determined by global, not local, environmental certainty. [ABSTRACT FROM AUTHOR]

Highlights • We studied stimulus generalization of response patterns in a multiple peak procedure. • Two training stimuli differentially signaled an FI 5-s and FI 20-s schedule. • Response-rate patterns to one training stimulus generalized nearly exclusively. • This research provides a strong starting point for future studies of generalization under FI schedules. • A thorough understanding of generalization under FI schedules requires analyzing a range of dependent variables. Abstract Stimulus generalization is typically assessed by analyzing overall response rates. Studies of generalization of response-rate patterns across time are less common, despite the ubiquitous nature of time and the strong temporal control over behavior in the natural world. Thus, we investigated generalization of response-rate patterns across time using a multiple peak procedure in pigeons. The frequency (fast or slow) at which the color of a keylight changed signaled a fixed-interval (FI) 5-s or 20-s schedule, counterbalanced across subjects. In peak trials, the frequency of keylight-color changes was varied. For the fast and slow training stimuli, response rates in peak trials were controlled by the arranged FI schedule value; they increased as the arranged reinforcer time approached, and decreased thereafter. Response-rate patterns to all test stimuli were similar to response-rate patterns to the slow training stimulus for all subjects. Thus, overall, strong generalization from the slow training stimulus to all test stimuli was evident, whereas there was little to no generalization from the fast training stimulus. These findings extend past research examining generalization of temporally controlled response-rate patterns, and provide a useful starting point for future investigations of generalization of fixed-interval responding. A thorough understanding of generalization processes requires analysis of dependent variables other than overall response rates, especially when responding is likely to be temporally controlled. [ABSTRACT FROM AUTHOR]

In concurrent schedules with a changeover delay (COD), choice often strongly favours the just-reinforced alternative immediately after a reinforcer delivery. These ‘preference pulses’ may be caused by a change in reinforcer availability created by the COD, and/or because the COD decreases the overall probability of switching. We investigated which explanation better accounts for preference pulses by arranging concurrent schedules that allowed us to separate the COD’s effects on reinforcer availability from its effects on the probability of switching. When the reinforcer ratio was 1:1, pulses were inconsistently accompanied by changes in reinforcer availability, but consistently accompanied by longer visits. These pulses appeared to be related only to the decreased probability of switching caused by the COD, providing the first evidence of pulses after reinforcers caused by the probability of switching alone. When the reinforcer ratio was 1:5 or 5:1; preference pulses were accompanied by changes in reinforcer availability and by longer visits. These pulses appeared to be related to the COD’s effects on reinforcer availability, although a small portion appeared to be related to low probability of switching. These findings suggest that the COD affects preference pulses by both decreasing the probability of switching and creating a change in reinforcer availability. [ABSTRACT FROM AUTHOR]

Chronic subdural haematoma (CSDH) is a common neurosurgical condition and is more prevalent in the ageing population. Studies have suggested that placement of subdural drains after burr-hole drainage was associated with lower recurrence rates. However, a considerable proportion of surgeons remained unconvinced of the effectiveness of drain placement and concerns exist with the potential complications this additional manoeuvre entails such as infection or bleeding. The aim of the present study is to evaluate the impact of subdural drain on CSDH recurrence and its safety. This is a multicentre observational study. Data of consecutive patients with burr-hole drainage performed for CSDH in three hospitals in Hong Kong during a four-year period from January 2008 to December 2011 were prospectively collected and retrospectively analysed. The primary outcome was symptomatic recurrence requiring re-operation. Secondary outcomes included the modified Rankin scales (mRS), morbidity and mortality at six months. A total of 302 patients were identified. The recurrence rate was 8.72% (13/149) with drain placement versus 16.3% (25/153) with no drain (Odds Ratio = 0.489, 95%CI 0.240–0.998; p = 0.0463). Local wound infection, subdural empyema, acute subdural haematoma and other complications had no significant difference. Six-month mRS, 30-day mortality and six-month mortality were comparable in both groups. In conclusion, the use of subdural drain significantly reduced recurrence with no significant increase in complications. [ABSTRACT FROM AUTHOR]

When short-term memory is assessed in the delayed matching-to-sample (DMTS) procedure, performance is better when cues signal larger reinforcer magnitudes or higher reinforcer probabilities for correct responding. Previous studies demonstrating signaled-magnitude or signaled-probability effects presented cues for a prolonged period during the sample stimulus and/or retention interval. The present study asked whether a signaled-probability effect would occur with brief post-sample cues that signaled the presence or absence of reinforcement. Five pigeons responded in a DMTS task in which sample stimuli were sometimes followed by a 0.5-s cue signaling that reinforcers would either be available or not available in the current trial, and the retention interval varied from 0.5 s to 20 s. A reliable signaled-probability effect was found when reinforcers were arranged independently and for all correct responses, whereas a smaller, less systematic effect was found when reinforcers were arranged dependently and probabilistically. These findings highlight the importance of reinforcement contingencies and contingency discriminability in remembering, and add to the evidence showing that cues signaling differential reinforcement in DMTS may affect processes during the retention interval and comparison phase, rather than attention to the sample stimulus. • We investigated how brief cues signaling the presence or absence of reinforcers affect memory performance. • Cues were presented for 0.5 s after the sample in a delayed matching-to-sample procedure. • In reinforced trials, reinforcers were arranged with p =.5 (Expt 1) or for all correct responses (Expt 2). • Accuracy was lower when cues signaled reinforcer absence in Expt 2. This effect was smaller and less systematic in Expt 1. • These findings highlight the role of discriminated reinforcement contingencies in remembering. [ABSTRACT FROM AUTHOR]

Summary Objectives This study examined long term swallowing outcomes of a cohort of head and neck cancer (HNC) patients identified at high risk of experiencing significant side effects from cancer treatment and were provided with a proactive PEG. Material and Methods Ninety-five HNC patients receiving definitive or adjuvant radiotherapy +/− chemotherapy were identified for proactive PEG placement using validated guidelines and followed for up to 3 years. Functional swallowing status was recorded at regular time points and data were collected on PEG use and duration in situ. Results Mean duration of enteral feeding was 125 days. PEGs remained in situ for approximately 7 months. PEG removal was achieved by 52% by 6 months and 86% by 1 year. Only 3 (3%) remained PEG dependent at 3 years. Over half (55%) had resumed a full non-texture modified diet by PEG removal. Conclusion Proactive PEG placement did not lead to high proportion of long term tube dependence in this high risk group and the majority achieved good swallowing outcomes. [ABSTRACT FROM AUTHOR]

Craniectomy is a life-saving procedure. Subsequent cranioplasty with autologous skull bone has a bone resorption rate from 4% to 22.8% and an infection rate from 3.3% to 26%. There are concerns with their viability and the potential microbial contamination as they were explanted for a long period of time. Eighteen cranial bone flaps stored at Prince of Wales Hospital Skull Bone Bank during the period from June 2011 to March 2016 were identified. Ethics approval was obtained. Bone chips and deep bone swabs were collected for osteoblast culture and microbial culture. Skull Bone Bank was kept at −80 °C under strict aseptic technique during the study period. The storage period ranged from 4 months to 55 months. For the osteoblast culture, all eighteen bone flaps had no viable osteoblast growth. For the bacterial culture, five had positive bacteria growth (27.8%). Three were Pasteurella multocida and two were Methicillin-resistant Staphylococcus aureus . The mean duration of storage of the infected bone flap was 32.9 months (±15.1 months) versus 19.9 months (±17.9 months) of those bone flaps with no bacterial growth ( p = 0.1716). The mean size of the infected versus non-infected bone flaps was 117.7 cm 2 (±44.96 cm 2 ) versus 76.8 cm 2 (±50.24 cm 2 ) respectively ( p = 0.1318). Although in this study statistical significance was not reached, it was postulated that infected bone flaps tended to be larger in size and had a longer duration of storage. In conclusion, cryostored skull bone flaps beyond four months showed no viable osteoblasts. Bacterial contamination rate of bone flaps was 27.8% in this study. [ABSTRACT FROM AUTHOR]

We recently found that initial-link stimuli signaling trial outcomes (signals) in a concurrent-chains procedure exerted imperfect control during initial and terminal links. Here, we conducted a follow-up experiment to investigate further such imperfect control. Five pigeons worked on a concurrent-chains procedure in which one alternative led to a terminal link ending in a smaller-sooner reinforcer delivery, and the other in a larger-later reinforcer. During initial links of some trials, compound stimuli (signals) signaled the trial outcome. We assessed control by signal dimensions in Conflicting trials, in which the dimensions signaled conflicting outcomes. Unlike our previous experiment, signals remained present during terminal links. During initial links, preference favored the signaled key in Signaled trials, and the key signaled by the dimension exerting stronger control in Conflicting trials, suggesting strong signal control. Initial-link choice also depended on trial outcomes; preference was overall biased towards the smaller-sooner key. Terminal-link responding was primarily controlled by the key peck producing terminal-link entry, although some weak signal control was also evident. Thus, signal control during initial and terminal links was enhanced, and control by key-peck location during terminal links persisted, when signals remained present during terminal links. This suggests that our previous findings were partly related to temporal separation between signals and trial outcomes, and to history effects producing strong control by key-peck location. • We investigated how temporal separation between stimuli and outcomes affects stimulus control. • Pigeons responded for differentially signaled, delayed outcomes in a concurrent-chains procedure. • Behavior was controlled by the signals, and by key-peck location. • Signal control was stronger when the signals remained present until the outcome. • Interoceptive cues such as key-peck location may help bridge the gap between stimuli and future outcomes. [ABSTRACT FROM AUTHOR]

• Stimuli signaling reinforcement reduce responding on one alternative of a concurrent schedule. • We asked how signal reliability affects choice between signaled and unsignaled alternatives. • Signal reliability changed responding on the signaled alternative, but not the unsignaled alternative. • These results are consistent with matching theories, but not with research showing changes in responding on both alternatives. • Response competition and local reinforcer rates may modulate effects of signaled reinforcement in concurrent schedules. When reinforcer availability on one alternative of a concurrent schedule is signaled by a discriminative stimulus, responding on that alternative decreases. We investigated how the correlation between signal presentation and reinforcement (signal reliability) affects choice between signaled and unsignaled alternatives. Six pigeons responded in a concurrent schedule, in which reinforcers on one alternative were signaled by a key-color change. Across conditions, the probability of reinforcement following signal presentation varied (the probability in its absence was the complement). As signal reliability increased, response rates and latencies following signal onset on the signaled alternative decreased, whereas responding on the unsignaled alternative remained unchanged. Because the signal did not alter overall reinforcer rates, these findings are consistent with matching theories and research suggesting that responding on one alternative of a concurrent schedule depends on reinforcer, but not response, rates on other alternatives. However, these findings are inconsistent with others demonstrating concomitant changes in responding on signaled and unsignaled alternatives. We consider whether a response-competition account of concurrent performance can explain these discrepancies, and suggest avenues for future studies to investigate the mechanisms underlying effects of signaled reinforcement in concurrent schedules. [ABSTRACT FROM AUTHOR]

This study aims to identify independent factors associated with cervical spinal injuries in head-injured patients. The extent of injuries to other body parts was assessed by the Abbreviated Injury Scale (AIS) and was included in the analysis. Consecutive head-injured patients admitted via the emergency department from January 1, 2014 to December 31, 2016 were retrospectively reviewed. The inclusion criteria were head-injured patients with an Abbreviated Injury Scale (AIS) score ≥2 (i.e., head injuries with intracranial hematoma or skull fracture). Patients with minor head injuries with only scalp abrasions or superficial lacerations without significant intracranial injuries (i.e., head injury AIS score = 1) were excluded. The primary outcome was to identify independent predictors associated with cervical spinal injuries in these head-injured patients. Univariate and multivariable analyses were conducted. A total of 1105 patients were identified. Of these patients, 11.2% (n = 124) had cervical spinal injuries. Univariate and multivariable analyses identified male gender (P = 0.006), the presence of thoracic injury (including rib fracture, hemothorax, or pneumothorax) (P = 0.010), and hypotension with systolic blood pressure <90 mm Hg on admission (P = 0.009) as independent predictors for cervical spinal injury in head-injured patients. This study showed that about 1 in 10 patients with significant head injury had cervical spine injury, usually associated with fracture or dislocation. Male gender, the presence of thoracic injury, and hypotension on admission were independent risk factors associated with cervical spinal injuries. [ABSTRACT FROM AUTHOR]

Background: The timing of definitive aneurysm treatment (coiling or clipping) in acute aneurysm subarachnoid hemorrhage was a subject of controversy. Although most vascular neurosurgeons agreed on early aneurysm treatment (within the first 72 hours), whether ultra-early aneurysm treatment (within the first 24 hours) was beneficial remained debatable. We aimed to investigate whether ultra-early aneurysm treatment is associated with better neurological outcome in all patients or only good-grade patients or only poor-grade patients. Methods: Two-hundred and seventy-six (84%) patients had hemorrhage onset time and aneurysm treatment time available for analysis. Values of P < 0.05 were taken as statistically significant, and P values between 0.05 and 0.10 were considered to be a trend. Results: For the 96 poor-grade (World Federation of Neurological Surgeons grading scale 4 to 5) patients, there was a significant association between Short Form-36 mental scores and ultra-early aneurysm treatment (50 ± 10 vs. 46 ± 10, P = 0.019) and a trend toward association between ultra-early surgery and favorable neurological outcome (odds ratio 2.4 [95% confidence interval 1.0 to 6.0], P = 0.062). A reduction in clinical rebleeding (12% vs. 22%, P = 0.168) was observed in patients undergoing ultra-early aneurysm treatment. Conclusions: Aneurysm treatment performed within the 24-hour window may be associated with a better outcome and halve the clinical rebleeding risk in poor-grade aneurysmal subarachnoid hemorrhage patients. [Copyright &y& Elsevier]

Metformin, an anti-hyperglycemic drug, has been known to have antitumor properties for around 15 years. Although there are a number of reports attributing the antitumor function of metformin to its impact on energy homeostasis and oxygen re-distribution in tumor microenvironment, detailed mechanisms remain largely unknown. In the past several years, there is an increasing number of publications indicating that metformin can affect various immunological components including lymphocytes, macrophages, cytokines and several key immunological molecules in both human and animal studies. These interesting results appear to be in line with emerging data that suggest associations between immune responses and energy homeostasis/oxygen re-distribution, which may explain effective impacts of metformin on immunotherapies against autoimmune diseases as well as cancers. This review article is to analyse and discuss recent development in the above areas with aim to justify metformin as a new adjuvant for immunotherapy against human cancers. We hope that our summary will help to optimize the application of metformin for various types of human cancers. [ABSTRACT FROM AUTHOR]

The discovery of a new series of selective S1P 1 agonists is described. This series of piperazinyl-oxadiazole derivatives was rapidly optimized starting from high-throughput screening hit 1 to afford potent and selective lead compound 10d . Further SAR studies showed that 10d was converted to the active phosphate metabolite 29 in vivo. Oral administration of compound 10d to rats was shown to induce lymphopenia at 3 mg/kg. [ABSTRACT FROM AUTHOR]

Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are two common betacoronaviruses, which are still causing transmission among the human population worldwide. The major difference between the two coronaviruses is that MERS-CoV is now causing sporadic transmission worldwide, whereas SARS-CoV-2 is causing a pandemic outbreak globally. Currently, different guidelines and reports have highlighted several diagnostic methods and approaches which could be used to screen and confirm MERS-CoV and SARS-CoV-2 infections. These methods include clinical evaluation, laboratory diagnosis (nucleic acid-based test, protein-based test, or viral culture), and radiological diagnosis. With the presence of these different diagnostic approaches, it could cause a dilemma to the clinicians and diagnostic laboratories in selecting the best diagnostic strategies to confirm MERS-CoV and SARS-CoV-2 infections. Therefore, this review aims to provide an up-to-date comparison of the advantages and limitations of different diagnostic approaches in detecting MERS-CoV and SARS-CoV-2 infections. This review could provide insights for clinicians and scientists in detecting MERS-CoV and SARS-CoV-2 infections to help combat the transmission of these coronaviruses. [ABSTRACT FROM AUTHOR]