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Is there a Return of Looking after Intricate High-need, High-cost People?
Patient 1 was not able to have further RTX treatments due to an allergic reaction when receiving the second dose. Rituximab treatment resulted in sustained remission and full recovery of anterior pituitary function in Patients 1 and 2, with complete resolution of pituitary enlargement. By contrast, Patient 3 only showed a symptomatic response following RTX treatment, but pituitary enlargement and hypofunction persisted. Conclusion Rituximab treatment for IgG4-related hypophysitis resulted in sustained remission in 2 patients treated early in the disease process but only achieved partial response in a patient with chronic disease, suggesting that early therapeutic intervention may be crucial in order to avoid irreversible changes.The ketogenic diet, which has become an increasingly popular diet, severely restricts carbohydrate intake to shunt metabolism towards fatty acid oxidation and production of ketones as a fuel source. There have been many studies illustrating the positive effects of a ketogenic diet in weight loss and other benefits; however, the long-term effects and potential adverse events of a ketogenic diet have not been well studied or documented in literature. There are a few case reports of ketogenic diet resulting in hypoglycemia. We report a case of hypoglycemia with a blood glucose of 39 mg/dL and ketosis in a 69-year-old woman who strictly followed a ketogenic diet for nearly one year. She presented with malaise, sugar cravings, and mental fogginess, and after intake of alcoholic beverages, was admitted to the hospital with hypoglycemia. She had elevated beta-hydroxybutyrate, and low insulin and C-peptide, all consistent with a starvation ketosis. This case illustrates that adherence to a ketogenic diet for a prolonged period of time, in combination with alcohol intake, can disrupt normal glucose homeostatic mechanisms and result in a significant degree of hypoglycemia. Cerdulatinib This pattern of hypoglycemia may not present with classic symptoms, most likely partly due to effects of the ketogenic diet on brain function. This case provides insight that supports the need to counsel patients about alcohol intake while on the ketogenic diet. More information is needed on long-term complications of the ketogenic diet on glucose homeostasis in the body as well as in the brain.Network neuroscience applied to epilepsy holds promise to map pathological networks, localize seizure generators, and inform targeted interventions to control seizures. However, incomplete sampling of the epileptic brain because of sparse placement of intracranial electrodes may affect model results. In this study, we evaluate the sensitivity of several published network measures to incomplete spatial sampling and propose an algorithm using network subsampling to determine confidence in model results. We retrospectively evaluated intracranial EEG data from 28 patients implanted with grid, strip, and depth electrodes during evaluation for epilepsy surgery. We recalculated global and local network metrics after randomly and systematically removing subsets of intracranial EEG electrode contacts. We found that sensitivity to incomplete sampling varied significantly across network metrics. This sensitivity was largely independent of whether seizure onset zone contacts were targeted or spared from removal. We present an algorithm using random subsampling to compute patient-specific confidence intervals for network localizations. Our findings highlight the difference in robustness between commonly used network metrics and provide tools to assess confidence in intracranial network localization. We present these techniques as an important step toward translating personalized network models of seizures into rigorous, quantitative approaches to invasive therapy.The contribution of structural connectivity to functional brain states remains poorly understood. We present a mathematical and computational study suited to assess the structure-function issue, treating a system of Jansen-Rit neural mass nodes with heterogeneous structural connections estimated from diffusion MRI data provided by the Human Connectome Project. Via direct simulations we determine the similarity of functional (inferred from correlated activity between nodes) and structural connectivity matrices under variation of the parameters controlling single-node dynamics, highlighting a nontrivial structure-function relationship in regimes that support limit cycle oscillations. To determine their relationship, we firstly calculate network instabilities giving rise to oscillations, and the so-called 'false bifurcations' (for which a significant qualitative change in the orbit is observed, without a change of stability) occurring beyond this onset. We highlight that functional connectivity (FC) is inherited robustly from structure when node dynamics are poised near a Hopf bifurcation, whilst near false bifurcations, and structure only weakly influences FC. Secondly, we develop a weakly coupled oscillator description to analyse oscillatory phase-locked states and, furthermore, show how the modular structure of FC matrices can be predicted via linear stability analysis. This study thereby emphasises the substantial role that local dynamics can have in shaping large-scale functional brain states.Large-scale patterns of spontaneous whole-brain activity seen in resting-state functional magnetic resonance imaging (rs-fMRI) are in part believed to arise from neural populations interacting through the structural network (Honey, Kötter, Breakspear, & Sporns, 2007). Generative models that simulate this network activity, called brain network models (BNM), are able to reproduce global averaged properties of empirical rs-fMRI activity such as functional connectivity (FC) but perform poorly in reproducing unique trajectories and state transitions that are observed over the span of minutes in whole-brain data (Cabral, Kringelbach, & Deco, 2017; Kashyap & Keilholz, 2019). The manuscript demonstrates that by using recurrent neural networks, it can fit the BNM in a novel way to the rs-fMRI data and predict large amounts of variance between subsequent measures of rs-fMRI data. Simulated data also contain unique repeating trajectories observed in rs-fMRI, called quasiperiodic patterns (QPP), that span 20 s and complex state transitions observed using k-means analysis on windowed FC matrices (Allen et al.
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