Spatiotemporal Distribution and Environmental Drivers of Barley yellow dwarf virus and Vector Abundance in Kansas.

Several aphid species transmit barley yellow dwarf, a globally destructive disease caused by viruses that infect cereal grain crops. Data from >400 samples collected across Kansas wheat fields in 2014 and 2015 were used to develop spatiotemporal models predicting the extent to which landcover, temperature and precipitation affect spring aphid vector abundance and presence of individuals carrying Barley yellow dwarf virus (BYDV). The distribution of Rhopalosiphum padi abundance was not correlated with climate or landcover, but Sitobion avenae abundance was positively correlated with fall temperature and negatively correlated to spring temperature and precipitation. The abundance of Schizaphis graminum was negatively correlated with fall precipitation and winter temperature. The incidence of viruliferous (+BYDV) R. padi was positively correlated with fall precipitation but negatively correlated with winter precipitation. In contrast, the probability of +BYDV S. avenae was unaffected by precipitation but was positively correlated with fall temperatures and distance to forest or shrubland. R. padi and S. avenae were more prevalent at eastern sample sites where ground cover is more grassland than cropland, suggesting that grassland may provide over-summering sites for vectors and pose a risk as potential BYDV reservoirs. Nevertheless, land cover patterns were not strongly associated with differences in abundance or the probability that viruliferous aphids were present.

A randomized, controlled trial of surgery for temporal-lobe epilepsy.

BACKGROUND: Randomized trials of surgery for epilepsy have not been conducted, because of the difficulties involved in designing and implementing feasible studies. The lack of data supporting the therapeutic usefulness of surgery precludes making strong recommendations for patients with epilepsy. We conducted a randomized, controlled trial to assess the efficacy and safety of surgery for temporal-lobe epilepsy. METHODS: Eighty patients with temporal-lobe epilepsy were randomly assigned to surgery (40 patients) or treatment with antiepileptic drugs for one year (40 patients). Optimal medical therapy and primary outcomes were assessed by epileptologists who were unaware of the patients' treatment assignments. The primary outcome was freedom from seizures that impair awareness of self and surroundings. Secondary outcomes were the frequency and severity of seizures, the quality of life, disability, and death. RESULTS: At one year, the cumulative proportion of patients who were free of seizures impairing awareness was 58 percent in the surgical group and 8 percent in the medical group (P<0.001). The patients in the surgical group had fewer seizures impairing awareness and a significantly better quality of life (P<0.001 for both comparisons) than the patients in the medical group. Four patients (10 percent) had adverse effects of surgery. One patient in the medical group died. CONCLUSIONS: In temporal-lobe epilepsy, surgery is superior to prolonged medical therapy. Randomized trials of surgery for epilepsy are feasible and appear to yield precise estimates of treatment effects.

Does the intracarotid amobarbital procedure predict global amnesia after temporal lobectomy?

PURPOSE: The intracarotid amobarbital procedure (IAP) is widely used to help predict who might be at risk for postoperative amnesia after unilateral temporal lobectomy for intractable seizures. We describe the memory outcome in 10 patients who underwent standard temporal lobectomy, including mesial temporal structures, despite failing the memory portion of the IAP after injections both ipsilateral and contralateral to the resected seizure focus. METHODS: Data for seven of the study subjects were obtained through a retrospective review of patients assessed on a surgical epilepsy unit during a 15-year period who failed the Montreal Neurological Institute IAP memory protocol after both ipsilateral and contralateral injections and subsequently underwent unilateral temporal lobectomy. More recently, we have studied temporal lobectomy patients who failed the Medical College of Georgia memory protocol after both ipsilateral and contralateral injections (n = 3). Preoperative and postoperative memory test scores were compared, and data regarding seizure outcome and self-perception of postoperative memory were collected. RESULTS: At follow-up, none of the patients presented with a pattern indicative of a global amnesia, and 80% demonstrated >90% improvement in their seizure disorder or were seizure-free. CONCLUSIONS: These findings indicate that bilateral memory failure on the IAP does not preclude the removal of an epileptogenic temporal lobe or a successful surgical outcome. In addition, the findings raise questions regarding the validity of the IAP and the possibility that memory may be reorganized in patients with a long history of temporal lobe epilepsy.

Communication and mental preparation issues for the epilepsy surgery patient.

This paper reviews the importance of adequate communication between the treatment team and the patient and family in epilepsy surgery. Ensuring that patient and family adequately understand the diagnosis, natural history, management alternatives and the risks and outcomes of surgery is a challenge for each epilepsy team. Guidelines as to process and content from the authors' experience and the participants in the workshop are presented.

Surgical pitfalls, their consequences, transient complications.

The methodology of this paper is based entirely on the experiential backgrounds of the authors. It outlines those factors which have become recognized as potentially important issues to patients who are considering recommendations of surgical treatment for their intractable epilepsy. Thus, on the one hand, it includes the important generic aspects of Informed Consent, while on the other hand there must be a very comprehensive and, when the operation is to be carried out under local anesthesia, a very detailed explanation of the preparation and the sequential steps in the surgical procedure. This should also entail a brief description of the roles of the various "team" members during the operative procedure. There are well-recognized complications associated with the various surgical procedures for the treatment of epilepsy. Further, there are predictable deficits following some of these procedures, some of which might be permanent and some of which may be transient. These pitfalls are briefly discussed.

Malignant transformation of a dysembryoplastic neuroepithelial tumor. Case report.

A 29-year-old man presented in 1984 with a recent onset of partial seizures marked by speech arrest. Electroencephalography identified a left frontotemporal dysrhythmia. Computerized tomography (CT) scanning revealed a superficial hypodense nonenhancing lesion in the midleft frontal convexity, with some remodeling of the overlying skull. The patient was transferred to the London Health Sciences Centre for subtotal resection of what was diagnosed as a "fibrillary astrocytoma (microcystic)." He received no chemotherapy or radiation therapy and remained well for 11 years. The patient presented again in late 1995 with progressive seizure activity. Both CT and magnetic resonance imaging demonstrated a recurrent enhancing partly cystic lesion. A Grade IV astrocytoma was resected, and within the malignant tumor was a superficial area reminiscent of a dysembryoplastic neuroepithelial tumor (DNT). Data on the lesion that had been resected in 1984 were reviewed, and in retrospect the lesion was identified as a DNT of the complex form. It was bordered by cortical dysplasia and contained glial nodules, in addition to the specific glioneuronal element. The glial nodules were significant for moderate pleomorphism and rare mitotic figures. The Ki67 labeling index averaged 0.3% in the glial nodules and up to 4% focally. Cells were rarely Ki67 positive within the glioneuronal component. This case is the first documented example of malignant transformation of a DNT. It serves as a warning of the potential for malignant transformation in this entity, which has been traditionally accepted as benign. This warning may be especially warranted when confronted with complex forms of DNT. The completeness of resection in the benign state is of paramount importance.

Arctic and Antarctic exploration including the contributions of physicians and effects of disease in the polar regions.

A history of Arctic and Antarctic exploration, whether to find a Northwest Passage, North Pole, or South Pole, is a story of triumph and tribulation. The hardship experienced by polar explorers in the last 1000 years permeates the tales of achievement. Physicians and surgeons have played prominent roles in all major polar explorations. No significant Arctic voyage, particularly in the last 300 years, was made without a member of the party trained in the management of medical emergencies and in basic surgery. During times of health, surgeons functioned as the voyage naturalists with expertise in biology, botany, zoology, and the writing of scientific catalogs. Spurred by our interest and fascination with the history of polar exploration, we reviewed the roles of physicians and natural scientists in Arctic and Antarctic adventures.

Networking for career planning.

Formal networking approaches should be prepared for meticulously. If you waste your contact's time waffling around a subject, you may find that the person is not so willing to talk with you another time. Have your questions ready, be as specific as you can, and be businesslike. And remember, no one can wave a magic wand and have a solution to all your queries. You should not expect anything from informal networking situations--if you do, you will give out unconscious signals that might put people off. Just enjoy yourself, meet new people, share ideas and thoughts, and maybe you will be able to help them or they will be able to help you in the future. Your career is in your own hands--but others are often willing to lend a hand.