Are you sure? The relationship between response certainty and performance in visual detection using a perimetry-style task.

Conventional psychophysical methods ignore the degree of confidence associated with each response. We compared the psychometric function for detection with that for "absolute certainty" in a perimetry-style task, to explore how knowledge of response certainty might aid the estimation of detection thresholds. Five healthy subjects performed a temporal 2-AFC detection task, indicating on each trial whether they were "absolutely certain." The method of constant stimuli was used to characterize the shape of the two psychometric functions. Four eccentricities spanning central and peripheral vision were tested. Where possible, conditions approximated those of the Humphrey Field Analyzer (spot size, duration, background luminance, test locations). Based on the empirical data, adaptive runs (ZEST) were simulated to predict the likely improvement in efficiency obtained by collecting certainty information. Compared to detection, threshold for certainty was 0.5 to 1.0 dB worse, and slope was indistinguishable across all eccentricities tested. A simple two-stage model explained the threshold difference; under this model, psychometric functions for detection and for certainty-given-detection are the same. Exploiting this equivalence is predicted to reduce the number of trials required to achieve a given level of accuracy by approximately 30% to 40%. The chances of detecting a spot and the chances of certainty-given-detection were approximately the same in young, healthy subjects. This means, for example, that a spot detected at threshold was labeled as "certainly" detected approximately half the time. The collection of certainty information could be used to improve the efficiency of estimation of detection thresholds.

Colonoscopy Leading to the Diagnosis of AL Amyloidosis in the Gastrointestinal Tract Mimicking an Acute Ulcerative Colitis Flare.

The 2 most common types of amyloidosis are light chain (AL) and reactive (AA). AL is associated with plasma cell dyscrasias; reactive (AA) is associated with chronic inflammatory conditions. A few cases have described AL amyloidosis mimicking colitis. However, endoscopic findings leading to the diagnosis of AL amyloidosis are rare. We report a 77-year-old woman with a medical history of ulcerative colitis who presented with recurrent nonbloody watery diarrhea. Colonoscopy revealed features suspicious for amyloidosis. Bone marrow biopsy showed multiple myeloma and AL amyloidosis. This case demonstrates the importance of generating a broad differential and the pivotal role of endoscopic findings in diagnosing uncommon diseases.

Demographic heterogeneity and the dynamics of open populations.

Individuals vary in their phenotype and propensity for growth and survival, but the demographic consequences of this remain poorly understood. We extend previous theoretical work on benthic marine populations and formulate a new model to evaluate how demographic heterogeneity among newly settled reef fish affects population stability. We simulated settlement, growth, and mortality of a small reef fish, the common triplefin (Forsterygion lapillurn) in an open "subpopulation" using a delay-differential equation model framework. We modeled demographic heterogeneity with a discrete number of "quality" types, motivated by our previous empirical observations: individuals were either "high quality" (immigrants from nearby subpopulations) or "low quality" (immigrants from distant subpopulations); in our model, quality influences how quickly individuals develop at a given competitor density. Our results demonstrate how demographic heterogeneity and juvenile competition interact to qualitatively alter the effects of settlement on population stability. Specifically, our model suggests that a mixture of quality types can stabilize the equilibrium even when equal settlement of either type alone would result in an unstable equilibrium. These results highlight the importance of among-individual variation in a metapopulation context, and suggest that in systems where dispersal influences individual quality, connectivity may serve to stabilize local populations.

Posterior reversible encephalopathy syndrome in Guillain-Barré syndrome.

Autonomic dysfunction is a well-known complication of Guillain-Barré syndrome (GBS) and may manifest as hemodynamic fluctuations. Posterior reversible encephalopathy syndrome (PRES) is commonly associated with acute hypertension, but is rarely reported to occur in association with GBS. We describe a patient with GBS who developed PRES in the setting of autonomic dysfunction and review the clinical features of all 12 previously reported patients with co-occurrence of GBS and PRES. Almost all cases have occurred in women over the age of 55, raising the possibility of increased sensitivity to dysautonomia in this patient group.

ATF3 expression improves motor function in the ALS mouse model by promoting motor neuron survival and retaining muscle innervation.

ALS is a fatal neurodegenerative disease characterized by a progressive loss of motor neurons and atrophy of distal axon terminals in muscle, resulting in loss of motor function. Motor end plates denervated by axonal retraction of dying motor neurons are partially reinnervated by remaining viable motor neurons; however, this axonal sprouting is insufficient to compensate for motor neuron loss. Activating transcription factor 3 (ATF3) promotes neuronal survival and axonal growth. Here, we reveal that forced expression of ATF3 in motor neurons of transgenic SOD1(G93A) ALS mice delays neuromuscular junction denervation by inducing axonal sprouting and enhancing motor neuron viability. Maintenance of neuromuscular junction innervation during the course of the disease in ATF3/SOD1(G93A) mice is associated with a substantial delay in muscle atrophy and improved motor performance. Although disease onset and mortality are delayed, disease duration is not affected. This study shows that adaptive axonal growth-promoting mechanisms can substantially improve motor function in ALS and importantly, that augmenting viability of the motor neuron soma and maintaining functional neuromuscular junction connections are both essential elements in therapy for motor neuron disease in the SOD1(G93A) mice. Accordingly, effective protection of optimal motor neuron function requires restitution of multiple dysregulated cellular pathways.

Protection from UV-induced skin carcinogenesis by genetic inhibition of the ataxia telangiectasia and Rad3-related (ATR) kinase.

Multiple human epidemiologic studies link caffeinated (but not decaffeinated) beverage intake with significant decreases in several types of cancer, including highly prevalent UV-associated skin carcinomas. The mechanism by which caffeine protects against skin cancer is unknown. Ataxia telangiectasia and Rad3-related (ATR) is a replication checkpoint kinase activated by DNA stresses and is one of several targets of caffeine. Suppression of ATR, or its downstream target checkpoint kinase 1 (Chk1), selectively sensitizes DNA-damaged and malignant cells to apoptosis. Agents that target this pathway are currently in clinical trials. Conversely, inhibition of other DNA damage response pathways, such as ataxia telangiectasia mutated (ATM) and BRCA1, promotes cancer. To determine the effect of replication checkpoint inhibition on carcinogenesis, we generated transgenic mice with diminished ATR function in skin and crossed them into a UV-sensitive background, Xpc(-/-). Unlike caffeine, this genetic approach was selective and had no effect on ATM activation. These transgenic mice were viable and showed no histological abnormalities in skin. Primary keratinocytes from these mice had diminished UV-induced Chk1 phosphorylation and twofold augmentation of apoptosis after UV exposure (P = 0.006). With chronic UV treatment, transgenic mice remained tumor-free for significantly longer (P = 0.003) and had 69% fewer tumors at the end of observation of the full cohort (P = 0.019), compared with littermate controls with the same genetic background. This study suggests that inhibition of replication checkpoint function can suppress skin carcinogenesis and supports ATR inhibition as the relevant mechanism for the protective effect of caffeinated beverage intake in human epidemiologic studies.

The influence of natural variation at the foraging gene on thermotolerance in adult Drosophila in a narrow temperature range.

Poikilothermic organisms such as insects have mechanisms to protect neural function under high temperature stress. Natural variation at the foraging (for) locus of the fruit fly, Drosophila melanogaster, encoding a cGMP-dependent protein kinase (PKG), influences neural thermotolerance in Drosophila larvae. The current study re-examines thermotolerance of adult flies to account for inconsistencies in the documented role of for during hyperthermia. We found that adult for (R) (rover) flies with high PKG activity were incapacitated faster under hyperthermic conditions of 39°C compared to their lower PKG activity counterparts for (s) and for (s2) (sitters), but not at higher temperatures. This indicates that lowered PKG activity promotes tolerance to heat stress, and that the for gene influences thermotolerance for a narrow range of temperatures in adult flies.

T lymphocytes potentiate endogenous neuroprotective inflammation in a mouse model of ALS.

Amyotrophic Lateral Sclerosis (ALS) is an adult-onset, progressive, motor neuron degenerative disease, in which the role of inflammation is not well established. Innate and adaptive immunity were investigated in the CNS of the Superoxide Dismutase 1 (SOD1)(G93A) transgenic mouse model of ALS. CD4+ and CD8+ T cells infiltrated SOD1(G93A) spinal cords during disease progression. Cell-specific flow cytometry and gene expression profiling showed significant phenotypic changes in microglia, including dendritic cell receptor acquisition, and expression of genes linked to neuroprotection, cholesterol metabolism and tissue remodeling. Microglia dramatically up-regulated IGF-1 and down-regulated IL-6 expression. When mutant SOD1 mice were bred onto a TCRbeta deficient background, disease progression was significantly accelerated at the symptomatic stage. In addition, microglia reactivity and IGF-1 levels were reduced in spinal cords of SOD1(G93A) (TCRbeta-/-) mice. These results indicate that T cells play an endogenous neuroprotective role in ALS by modulating a beneficial inflammatory response to neuronal injury.

Neonatal neuronal circuitry shows hyperexcitable disturbance in a mouse model of the adult-onset neurodegenerative disease amyotrophic lateral sclerosis.

Distinguishing the primary from secondary effects and compensatory mechanisms is of crucial importance in understanding adult-onset neurodegenerative diseases such as amyotrophic lateral sclerosis (ALS). Transgenic mice that overexpress the G93A mutation of the human Cu-Zn superoxide dismutase 1 gene (hSOD1(G93A) mice) are a commonly used animal model of ALS. Whole-cell patch-clamp recordings from neurons in acute slice preparations from neonatal wild-type and hSOD1(G93A) mice were made to characterize functional changes in neuronal activity. Hypoglossal motoneurons (HMs) in postnatal day 4 (P4)-P10 hSOD1(G93A) mice displayed hyperexcitability, increased persistent Na(+) current (PC(Na)), and enhanced frequency of spontaneous excitatory and inhibitory transmission, compared with wild-type mice. These functional changes in neuronal activity are the earliest yet reported for the hSOD1(G93A) mouse, and are present 2-3 months before motoneuron degeneration and clinical symptoms appear in these mice. Changes in neuronal activity were not restricted to motoneurons: superior colliculus interneurons also displayed hyperexcitability and synaptic changes (P10-P12). Furthermore, in vivo viral-mediated GFP (green fluorescent protein) overexpression in hSOD1(G93A) HMs revealed precocious dendritic remodeling, and behavioral assays revealed transient neonatal neuromotor deficits compared with controls. These findings underscore the widespread and early onset of abnormal neural activity in this mouse model of the adult neurodegenerative disease ALS, and suggest that suppression of PC(Na) and hyperexcitability early in life might be one way to mitigate or prevent cell death in the adult CNS.

Acupuncture increases nocturnal melatonin secretion and reduces insomnia and anxiety: a preliminary report.

The response to acupuncture of 18 anxious adult subjects who complained of insomnia was assessed in an open prepost clinical trial study. Five weeks of acupuncture treatment was associated with a significant (p = 0.002) nocturnal increase in endogenous melatonin secretion (as measured in urine) and significant improvements in polysomnographic measures of sleep onset latency (p = 0.003), arousal index (p = 0.001), total sleep time (p = 0.001), and sleep efficiency (p = 0.002). Significant reductions in state (p = 0.049) and trait (p = 0.004) anxiety scores were also found. These objective findings are consistent with clinical reports of acupuncture's relaxant effects. Acupuncture treatment may be of value for some categories of anxious patients with insomnia.