Historical perspectives in the assessment of cardiovascular structure and function

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Stonewall and Brickwall: Two Partially Redundant Determinants Required for the Maintenance of Female Germline in Drosophila

Proper specification of germline stem cells (GSCs) in Drosophila ovaries depends on niche derived non-autonomous signaling and cell autonomous components of transcriptional machinery. Stonewall (Stwl), a MADF-BESS family protein, is one of the cell intrinsic transcriptional regulators involved in the establishment and/or maintenance of GSC fate in Drosophila ovaries. Here we report identification and functional characterization of another member of the same protein family, CG3838/Brickwall (Brwl) with analogous functions. Loss of function alleles of brwl exhibit age dependent progressive degeneration of the developing ovarioles and loss of GSCs. Supporting the conclusion that the structural deterioration of mutant egg chambers is a result of apoptotic cell death, activated caspase levels are considerably elevated in brwl^- ovaries. Moreover, as in the case of stwl mutants, on several instances, loss of brwl activity results in fusion of egg chambers and misspecification of the oocyte. Importantly, brwl phenotypes can be partially rescued by germline specific over-expression of stwl arguing for overlapping yet distinct functional capabilities of the two proteins. Taken together with our phylogenetic analysis, these data suggest that brwl and stwl likely share a common MADF-BESS ancestor and they are expressed in overlapping spatiotemporal domains to ensure robust development of the female germline.

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Mac’s Ambulance Lift featured on Ford Transit Ambulance of the Future

AEV, Ferno Middle East and Al Tayer Ford design "Ambulance of the Future" for demo at Arab Health Exhibition and Congress in Dubai.

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A founder mutation MLC1 c.736delA associated with megalencephalic leukoencephalopathy with subcortical cysts‐1 in north Indian kindred

Clinical Genetics, EarlyView.


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Children and young people's understanding of inherited conditions and their attitudes towards genetic testing: A systematic review

Clinical Genetics, EarlyView.


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Ultrasound-Guided Shoulder Injection or Ultrasound Guides the Shoulder Injection?: Standard Versus State-of-the-Art

No abstract available

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Exploring the Use of Educational Material About Shoulder Dysfunction: A Quality Improvement Project in People With Amyotrophic Lateral Sclerosis

Shoulder pain is a common secondary complication of amyotrophic lateral sclerosis (ALS) that can contribute to functional decline and decreased participation in daily activities. The purpose of this study was to assess the effectiveness of an educational brochure aimed at improving knowledge regarding shoulder pain and dysfunction in people with ALS. Participants completed a preintervention survey with questions regarding their knowledge of how ALS may affect their shoulders. After completing the presurvey, they were mailed a brochure that described shoulder health and range of motion and stretching exercises. Four weeks after receiving the brochure, participants were then asked to determine the effectiveness of the educational materials in terms of impact on shoulder-related knowledge and self-efficacy with regard to prevention of shoulder pain and dysfunction. More than 50% of participants reported pain, decreased range of motion, or weakness in at least one shoulder since being diagnosed with ALS. All participants were interested in receiving educational materials, and all agreed that the brochure was easy to interpret and understand, with most (87%) reporting that it was helpful. Educational brochures are one strategy to improve awareness about shoulder health and to educate patients with ALS about exercises that may help reduce shoulder pain and dysfunction.

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Changes in Basic Movement Ability and Activities of Daily Living After Hip Fractures: Correlation Between Basic Movement Scale and Motor-Functional Independence Measure Scores

Objective The aim of this study was to examine the correlation between basic movement ability and activities of daily living (ADL) in elderly patients after hip fracture surgery and predict ADL outcomes from changes in basic movement ability. Design Fifty-four patients receiving rehabilitation after hip fracture surgery were collected prospectively. Ambulatory ability was evaluated using a Basic Movement Scale (BMS), and ADL was evaluated using the motor subscale of the Functional Independence Measure (motor-FIM). From the results of evaluating BMS and motor-FIM weekly, the important postoperative period to regain ADL was investigated. Results There was a close correlation between BMS and motor-FIM scores at each evaluation point (r = 0.971, P

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The Link Between Cerebrovascular Hemodynamics and Rehabilitation Outcomes After Aneurysmal Subarachnoid Hemorrhage

Objective The aim of the study was to assess the relation between cerebrovascular function early after aneurysmal subarachnoid hemorrhage onset and functional and rehabilitation outcomes. Design Observational cohort study of subarachnoid hemorrhage patients (n = 133) admitted to rehabilitation (n = 49), discharged home (n = 52), or died before discharge (n = 10). We obtained hemodynamic markers of cerebral autoregulatory function from blood flow velocities in the middle cerebral artery and arterial pressure waveforms, recorded daily on days 2–4 after symptom onset, and functional independence measure (FIM) scores and FIM efficiency for those admitted to acute rehabilitation. Results Compared to those discharged home, the range of pressures within which autoregulation is effective was lower in patients admitted to rehabilitation (4.6 [0.2] vs. 3.9 [0.2] mm Hg) and those who died (2.7 [0.4], P = 0.04). For those admitted to rehabilitation, autoregulatory range and the ability of cerebrovasculature to increase flow were related to discharge FIM score (R2 = 0.33 and 0.43, P

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Disability and Health Consequences of Traumatic Brain Injury: National Prevalence

Objective The aim of the study was to measure the prevalence of traumatic brain injury (TBI)-related disability and health status in the general population. Design The French National Survey, conducted in households and institutions, assessed 33,896 adults. Data included sequelae from TBI, impairments, current health conditions, and uses of health services. Analyses, adjusted for age and sex, compared subjects who declared sequelae from TBI (n = 479) with the remaining survey population (n = 33,287). Use of weighting factors ensured that results were representative of the national population. Results Prevalence of persistent sequelae from TBI in France was 704/100,000. Median time since injury was 14 yrs. For all Core Set items of the International Classification of Functioning, subjects with TBI reported more impairments than the control population: adjusted odds ratios from 1.7 (behavioral difficulties) to 8.6 (motor difficulties). Rates of cardiovascular, respiratory, musculoskeletal, digestive, urological, neurological, and psychiatric conditions were higher in the TBI population. Use of health services was greater, and women with TBI had higher rates of unmet health needs. Conclusions Persistent sequelae from TBI significantly affect health in the general population. Planning of post-TBI care should address the chronic needs of these persons.

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Feasibility of Early, Motor-Assisted Cycle Ergometry in Critically Ill Neurological Patients With Upper Limb Weakness and Variable Cognitive Status: A Case Series

Upper limb paresis, common in many neurological conditions, is a major contributor of long-term disability and decreased quality of life. Evidence shows that repetitive, bilateral arm movement improves upper limb coordination after neurological injury. However, it is difficult to integrate upper limb interventions into very early rehabilitation of critically ill neurological patients because of patient arousal and medical acuity. This report describes the safety and feasibility of bilateral upper limb cycling in critically ill neurological patients with bilateral or unilateral paresis. Patients were included in this pilot observational series if they used upper limb cycle ergometry with occupational therapy while in the neurocritical care unit between May and August 2016. Patient demographics, neurological function, and hemodynamic status were recorded precycling and postcycling. Cycling parameters including duration and active and/or passive cycling were collected. No significant changes in hemodynamic or respiratory status were noted postintervention. No adverse effects or safety events were noted. In this series, upper limb cycle ergometry was a safe and feasible intervention for early rehabilitation in critically ill patients in the neurocritical care unit. Future studies will prospectively measure the impact of early upper limb cycle ergometry on neurological recovery and functional outcome in this population.

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Immediate Effects of Simultaneous Application of Transcutaneous Electrical Nerve Stimulation and Ultrasound Phonophoresis on Active Myofascial Trigger Points: A Randomized Controlled Trial

Objective The aim of the study was to investigate the efficacy of phonophoresis with combined therapy on active myofascial trigger points. Participants One hundred participants with acute mechanical neck pain and at least one active myofascial trigger point in the upper trapezius were randomly assigned into four equal groups. Intervention Groups consisted of diclofenac phonophoresis with combined therapy, diclofenac phonophoresis, ultrasound (US) with coupling gel, and sham US and applied for 10 mins over myofascial trigger points. Measurements Measurements included pressure pain threshold and active cervical lateral flexion. Results There were statistically significant improvements in postintervention pressure pain threshold and range of motion values in treatment groups (P 0.05). Bonferroni correction test revealed that there was a significant difference between all the four groups in pressure pain threshold values (P 0.05) for range of motion. Conclusions Diclofenac phonophoresis with combined therapy, phonophoresis, and US were all effective in increasing pressure pain threshold values and range of motion. In addition, phonophoresis with combined therapy was shown to be superior over phonophoresis, and phonophoresis was superior over US in terms of reducing pain sensitivity. However, none of the treatment groups were found to be superior over the other in increasing range of motion.

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Diffusion Tensor Tractography for Decompressive Operation Decisions in Patients With Intracerebral Hemorrhage

No abstract available

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Priming With 1-Hz Repetitive Transcranial Magnetic Stimulation Over Contralesional Leg Motor Cortex Does Not Increase the Rate of Regaining Ambulation Within 3 Months of Stroke: A Randomized Controlled Trial

Background The potential benefits of repetitive transcranial magnetic stimulation (rTMS), applied either alone or as a combination treatment, on recovery of lower limbs after stroke have been insufficiently studied. Objective The aim of the study was to evaluate the effect of priming with 1-Hz repetitive transcranial magnetic stimulation over contralesional leg motor area with a double-cone coil before physical therapy on regaining ambulation. Methods Thirty-eight subacute stroke patients with significant leg disabilities were randomly assigned into the experimental group or control group to receive a 15-min real or sham 1-Hz repetitive transcranial magnetic stimulation, respectively, over the contralesional motor cortex representing the quadriceps muscle followed by 45-min physical therapy for 15 sessions for 3 wks. Functional measures, motor evoked potentials, and quality of life were assessed. Results There was no significant difference between experimental group and control group regarding the recovery in ambulation, balance, motor functions, and activity of daily living. No significant difference was found in other functional measures and the quality of life. Only the control group displayed significantly increased cortical excitability of the contralesional hemisphere after the intervention. Conclusions The present study found that insufficient evidence that contralesional priming with 1-Hz repetitive transcranial magnetic stimulation improves ambulatory and other motor functions among patients with a severe leg dysfunction in subacute stroke.

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Contralateral Involvement of Congenital Muscular Torticollis and Clavicular Fracture

Congenital muscular torticollis (CMT) is known to concur with some conditions such as developmental dysplasia of the hip or brachial plexus injury, which gives us some insights for pathogenesis of CMT. Although clavicular fracture is the most common fracture in newborns, little is known about concurrence of CMT and clavicular fracture. Our clinical experience led us to realize that concurrence of CMT and clavicular fracture tended to occur on the contralateral side for each other rather than the ipsilateral side. This study aimed to verify contralateral concurrence of CMT and clavicular fracture. This is a retrospective cohort study in a tertiary hospital, including 996 subjects with CMT. Concurrent clavicular fracture was found in 20 of 996 subjects with CMT, with the concurrence rate being 2.01%. Concurrent clavicular fracture and clavicular fracture occurred on the contralateral side for each other in 18 subjects (90%) rather than the ipsilateral side. This contralateral concurrence between side of CMT and clavicular fracture was significant (P = 0.001), with an odds ratio of 81 (P = 0.0032). Concurrent clavicular fracture and clavicular fracture seem to occur significantly more on the contralateral side for each other. Underlying mechanism for consistent contralateral concurrence needs to be verified in the near future.

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The Natural History of Idiopathic Scoliosis During Growth: A Meta-Analysis

Objective The aim of the study was to provide a meta-analysis of current literature concerning the natural history of idiopathic scoliosis during growth. Design A comprehensive search of Medline, Embase, And Scopus databases was conducted up to November 2016. Eligible works were prospective or retrospective studies that enrolled patients with infantile idiopathic scoliosis, juvenile idiopathic scoliosis, or adolescent idiopathic scoliosis, followed up without any treatment from the time of detection. A meta-analysis for proportion was performed. The following studies were grouped per diagnosis: infantile idiopathic scoliosis, juvenile idiopathic scoliosis, and adolescent idiopathic scoliosis. Results Of the 1797 citations screened, we assessed 61 full-text articles and included 13 of these (2301 participants). Three studies included infantile idiopathic scoliosis patients (347 participants), five studies included a mixed population of juvenile idiopathic scoliosis and adolescent idiopathic scoliosis (1330 participants), and five studies included adolescent idiopathic scoliosis patients only (624 participants). The random pooled estimated progression rate was 49% (95% confidence interval = 1%–97%) for infantile idiopathic scoliosis, 49% in a mixed group of patients affected by juvenile idiopathic scoliosis or adolescent idiopathic scoliosis (95% confidence interval = 19%–79%), and 42% in adolescent idiopathic scoliosis (95% confidence interval = 11%–73%). Conclusions During growth, idiopathic scoliosis tends to progress in a high percentage of cases. The progression rate varies according to the age at diagnosis, with infantile scoliosis being the most unpredictable. There are many confounders, such as age, Risser sign and baseline Cobb angles that were not consistent among studies, making the data very heterogeneous.

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Two Unique Cases of Ciprofloxacin-Associated Avulsion of Ligament and Tendon

Ciprofloxacin is recognized to have a deleterious relationship with tendons, particularly Achilles tendinopathy, which makes up most case reports. Tendinopathy seems to occur because of induction of collagen-degrading enzymes causing damage and ischemia of the poorly vascularized regions preventing repair. The focus on the relationship of ciprofloxacin and the Achilles tendon leaves patients on fluoroquinolones with non-Achilles tendinopathy symptoms at risk of misdiagnosis. There have not been any documented instances of ligament damage with ciprofloxacin administration in the literature, although ligament and tendon compositions are similar and should have similar susceptibility. This report includes two cases, one presenting with right lateral thumb pain and a medical history of gastroenteritis treated with ciprofloxacin. Physical examination showed swelling of the right metacarpophalangeal joint and ultrasound confirmed disruption of the radial collateral ligament at insertion on first metacarpal; the second case is of a woman presenting with right hip pain in setting of chronic recurrent diverticulitis treated with ciprofloxacin. She received work-up for lumbar disc disease and spondylosis. After standard therapy with pharmacotherapy and physical therapy for radiculopathy failed, magnetic resonance imaging was performed showing near complete avulsion of the right hamstring tendons from the ischial tuberosity.

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Effect of Stretching Combined With Ultrashort Wave Diathermy on Joint Function and Its Possible Mechanism in a Rabbit Knee Contracture Model

Objective The aim of this study was to investigate the therapeutic effect of stretching combined with ultrashort wave on joint contracture and explore its possible mechanism. Design Thirty-two rabbits underwent unilateral immobilization of a knee joint at full extension to cause joint contracture. At 6 wks after immobilization, the rabbits were randomly divided into the following four groups: natural recovery group, stretching treatment group, ultrashort wave treatment group, and combined treatment group. For comparison, eight control group animals of corresponding age were also examined. The effect of stretching and ultrashort wave treatment on joint contracture was assessed by measuring the joint range of motion, evaluating the collagen deposition of joint capsule and assessing the mRNA and protein levels for transforming growth factor β1 in the joint capsule. Results The combined treatment group led to the best recovery of joint function. The combined treatment with stretching and ultrashort wave was more effective than stretching or ultrashort wave treatment alone against the synovial thickening of suprapatellar joint capsule, the collagen deposition of anterior joint capsule, and the elevated expression of transforming growth factor β1 in the joint capsule. Conclusions Stretching combined with ultrashort wave treatment was effective in improving joint range of motion, reducing the biomechanical, histological, and molecular manifestations of joint capsule fibrosis in a rabbit model of extending joint contracture.

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Radial Extracorporeal Shock Wave Therapy in an Individual With Primary Trigeminal Neuralgia: A Case Report and Literature Review

A patient with primary trigeminal neuralgia exhibited pain relief without medication after radial extracorporeal shock wave therapy. The 52-yr-old woman had a 3-yr history of primary trigeminal neuralgia, involving the right maxillary division (V2) and the mandibular division (V3). She became refractory to carbamazepine and exhibited hepatic dysfunction. She hence received 3000 to 6000 impulses of craniofacial radial extracorporeal shock wave therapy to the region centered on the surface projection of the trigeminal ganglion and pain areas at 10 Hz; the intensity ranged from 1.4 to 4.5 bars twice per week for 8 wks. At baseline, and 1, 2, and 5 mos after treatment, the Barrow Neurological Institute scores were IV, IIIa, II, and II, and the visual analog scale scores were 8, 3, 1, and 1, respectively. No complications or adverse effects were observed. The hepatic function returned to normal after the discontinuation of carbamazepine. This case report demonstrates the feasibility of radial extracorporeal shock wave therapy for primary trigeminal neuralgia without complications or adverse effects with careful regulation of the therapy intensity.

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Does a Rehabilitation Program of Aerobic and Progressive Resisted Exercises Influence HIV-Induced Distal Neuropathic Pain?

Objective Distal symmetrical polyneuropathy is a common neurological sequela after HIV, which leads to neuropathic pain and functional limitations. Rehabilitation programs with exercises are used to augment pharmacological therapy to relieve pain but appropriate and effective exercises are unknown. This study explored the safety and effect of moderate-intensity aerobic exercises and progressive resisted exercises for HIV-induced distal symmetrical polyneuropathy neuropathic pain. Design A randomized pretest, posttest of 12 wks of aerobic exercise or progressive resisted exercise compared with a control. Outcome measures were assessed using the subjective periphery neuropathy, brief peripheral neuropathy screening, and numeric pain rating scale. Pain was assessed at baseline, 6 and 12 wks. Data between groups were compared using Kruskal-Wallis, Mann-Whitney U test, and within-groups Friedman and Wilcoxon signed rank tests. Results There were 136 participants (mean [SD] age = 36.79 [8.23] yrs) and the exercise groups completed the protocols without any adverse effects. Pain scores within and between aerobic exercise and progressive resisted exercise groups showed significant improvement (P 0.05). Conclusions This study supports a rehabilitation program of moderate-intensity aerobic exercise and progressive resisted exercise being safe and effective for reducing neuropathic pain and is beneficial with analgesics for HIV-induced distal symmetrical polyneuropathy.

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Response to the Letter to the Editor on “Point-of-Care Ultrasonography Findings and Care Use Among Patients Undergoing Ultrasound-Guided Shoulder Injections”

No abstract available

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Lactotripeptides Supplementations Alleviate the Decrease in Maximal Isometric Force After High-Intensity Eccentric Exercise: A Randomized, Placebo-Controlled, Double-Blind Clinical Trial

Objective The aim of the study was to investigate whether lactotripeptides supplementations alleviate the decrease in the maximal isometric force, an indirect marker of muscle damage, after eccentric exercise (ECC). Design Twenty-two young men performed 50 ECC of the elbow flexors using an isokinetic dynamometer. The subjects were randomly assigned to either the placebo or lactotripeptides group and were each given a 4.5 mg/d placebo or lactotripeptides thrice on the exercise day and the day after. Maximal isometric force and brachial arterial diameter were assessed before and 2 days after the ECC. Results The interaction of time and group on maximal isometric force was significant (P

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Heart-Shaped Sign: A Rare Stroke Syndrome

No abstract available

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Gender equality in Medicine: what do Gastroenterologists from Italy think of it?

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A longitudinal study of disc height narrowing and facet joint osteoarthritis at the thoracic and lumbar spine, evaluated by computed tomography: the framingham study

Prevalence and progression of disc height narrowing (DHN) and facet joint osteoarthritis (FJOA) in the thoracic and lumbar regions in non-clinical populations are not well-established.

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Late-presenting dural tear: incidence, risk factors, and associated complications

Unrecognized and inadequately repaired intraoperative durotomies may lead to cerebrospinal fluid leak, pseudomeningocele, and other complications. Few studies have investigated durotomy that is unrecognized intraoperatively and requires additional postoperative management (hereafter, late-presenting dural tear [LPDT]), though estimates of LPDT range from 0.6 – 8.3 per 1,000 spinal surgeries. These single-center studies are based on relatively small sample sizes for an event of this rarity, all with <10 patients experiencing LPDT.

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The influence of hand grip strength on surgical outcomes after surgery for degenerative lumbar spinal stenosis: a preliminary result

Although a number of prognostic factors have been demonstrated to be associated with surgical outcome of degenerative lumbar spinal stenosis (DLSS), no study has investigated the relation between hand grip strength (HGS) and treatment outcome of DLSS.

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Magnetic resonance imaging of the lumbar spine: determining clinical impact and potential harm from overuse

Lumbar spine MRI is frequently said to be "overused" in the evaluation of low-back pain, yet data concerning the extent of overuse and on potential harmful effects are lacking.

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Stand-alone lateral lumbar interbody fusion for the treatment of symptomatic adjacent segment degeneration following previous lumbar fusion

Revision posterior decompression and fusion for patients with symptomatic ASD is associated with significant morbidity and is technically challenging. The use of a stand-alone LLIF in patients with symptomatic ASD may avoid many of the complications associated with revision posterior surgery.

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ESO continues integration of FIREHOUSE Software®

Key milestones include tighter product integration with ESO EHR; infrastructure improvements, investment in customer service and support; high volume of sales opportunities.

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ESO launches surveillance form for overdose

Specialty Patient Form to help standardize definitions and data collection, highlight responder safety.

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Fla. county considers waiving ambulance fees for locals

Bay County commissioners are considering a policy that would still bill insurance companies, but not require locals to pay out-of-pocket fees

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Biophysical modeling of neural plasticity induced by transcranial magnetic stimulation

Publication date: June 2018
Source:Clinical Neurophysiology, Volume 129, Issue 6
Author(s): Marcus T. Wilson, Ben D. Fulcher, Park K. Fung, P.A. Robinson, Alex Fornito, Nigel C. Rogasch
Transcranial magnetic stimulation (TMS) is a widely used noninvasive brain stimulation method capable of inducing plastic reorganisation of cortical circuits in humans. Changes in neural activity following TMS are often attributed to synaptic plasticity via process of long-term potentiation and depression (LTP/LTD). However, the precise way in which synaptic processes such as LTP/LTD modulate the activity of large populations of neurons, as stimulated en masse by TMS, are unclear. The recent development of biophysical models, which incorporate the physiological properties of TMS-induced plasticity mathematically, provide an excellent framework for reconciling synaptic and macroscopic plasticity. This article overviews the TMS paradigms used to induce plasticity, and their limitations. It then describes the development of biophysically-based numerical models of the mechanisms underlying LTP/LTD on population-level neuronal activity, and the application of these models to TMS plasticity paradigms, including theta burst and paired associative stimulation. Finally, it outlines how modeling can complement experimental work to improve mechanistic understandings and optimize outcomes of TMS-induced plasticity.



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Investigating the effects of visual distractors on the performance of a motor imagery brain-computer interface

Publication date: June 2018
Source:Clinical Neurophysiology, Volume 129, Issue 6
Author(s): Zahra Emami, Tom Chau
ObjectivesBrain-computer interfaces (BCIs) allow users to operate a device or application by means of cognitive activity. This technology will ultimately be used in real-world environments which include the presence of distractors. The purpose of the study was to determine the effect of visual distractors on BCI performance.MethodsSixteen able-bodied participants underwent neurofeedback training to achieve motor imagery-guided BCI control in an online paradigm using electroencephalography (EEG) to measure neural signals. Participants then completed two sessions of the motor imagery EEG-BCI protocol in the presence of infrequent, small visual distractors. BCI performance was determined based on classification accuracy.ResultsThe presence of distractors was found to affect motor imagery-specific patterns in mu and beta power. However, the distractors did not significantly affect the BCI classification accuracy; across participants, the mean classification accuracy was 81.5 ± 14% for non-distractor trials, and 78.3 ± 17% for distractor trials.ConclusionThis minimal consequence suggests that the BCI was robust to distractor effects, despite motor imagery-related brain activity being attenuated amid distractors.SignificanceA BCI system that mitigates distraction-related effects may improve the ease of its use and ultimately facilitate the effective translation of the technology from the lab to the home.



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Neural and behavioral changes after the use of hearing aids

Publication date: June 2018
Source:Clinical Neurophysiology, Volume 129, Issue 6
Author(s): Hanin Karawani, Kimberly A. Jenkins, Samira Anderson
ObjectiveIndividuals with age-related hearing loss (ARHL) can restore some loss of the auditory function with the use of hearing aids (HAs). However, what remains unknown are the physiological mechanisms that underlie how the brain changes with exposure to amplified sounds though the use of HAs. We aimed to examine behavioral and physiological changes induced by HAs.MethodsThirty-five older-adults with moderate ARHL with no history of hearing aid use were fit with HAs tested in aided and unaided conditions, and divided into experimental and control groups. The experimental group used HAs during a period of six months. The control group did not use HAs during this period, but were given the opportunity to use them after the completion of the study. Both groups underwent testing protocols six months apart. Outcome measures included behavioral (speech-in-noise measures, self-assessment questionnaires) and electrophysiological brainstem recordings (frequency-following responses) to the speech syllable /ga/ in two quiet conditions and in six-talker babble noise.ResultsThe experimental group reported subjective benefits on self-assessment questionnaires. Significant physiological changes were observed in the experimental group, specifically a reduction in fundamental frequency magnitude, while no change was observed in controls, yielding a significant time × group interaction. Furthermore, peak latencies remained stable in the experimental group but were significantly delayed in the control group after six months. Significant correlations between behavioral and physiological changes were also observed.ConclusionsThe findings suggest that HAs may alter subcortical processing and offset neural timing delay; however, further investigation is needed to understand cortical changes and HA effects on cognitive processing.SignificanceThe findings of the current study provide evidence for clinicians that the use of HAs may prevent further loss of auditory function resulting from sensory deprivation.



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Oscillatory local field potentials of the nucleus accumbens and the anterior limb of the internal capsule in heroin addicts

Publication date: June 2018
Source:Clinical Neurophysiology, Volume 129, Issue 6
Author(s): Shunnan Ge, Xinyi Geng, Xuelian Wang, Nan Li, Lei Chen, Xinjing Zhang, Yongzhi Huang, Yang Li, Yukun Chen, Shouyan Wang, Guodong Gao
ObjectivesThe nucleus accumbens (NAc) is known to regulate the motivation and underlie addictive behaviors, and the anterior limb of the internal capsule (ALIC) is involved in several psychiatric disorders. Our study aimed to explore the functions of NAc and ALIC electrophysiologically.MethodsThe local field potentials (LFPs) of the NAc and ALIC were recorded from 7 heroin addicts treated with deep brain stimulation. Correlation analysis was made between LFP powers in various frequency bands and the subjects' neuropsychological test scores; coherence was calculated for the LFPs in NAc and ALIC.ResultsBoth the NAc and ALIC exhibited prominent theta and alpha frequency band activity in the LFP power spectra. Additionally, a distinct beta band peak was detected in the power spectra of ALIC LFPs, which may represent the activity of striatal bridge cells. There was a significant negative correlation between the power of the theta frequency band of ALIC LFPs and visual analogue scale (VAS) scores indicative of cravings (Spearman's ρ = −0.758, P = 0.002), and a significant positive correlation was found between the power of the alpha frequency band of NAc LFPs and subjects' scores on the Hamilton depression inventory (ρ = 0.727, P = 0.005). LFPs of the NAc and ALIC exhibited higher coherence values in the theta and alpha frequency bands.ConclusionsThe results suggest that theta power in the ALIC/dorsal striatum and alpha power in the NAc may be associated with drug cravings and depressive symptoms, respectively, in heroin addicts. For these subjects, the neural activities in the dorsal and ventral striatum were mainly coordinated within the low-frequency band.SignificanceThe study illustrates the neurophysiologic characteristics of heroin addiction and its comorbidities, providing a potential theoretical basis for optimizing deep brain stimulation (DBS) therapy.



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EMS in the warm zone: Tactical medicine inter-agency training

Considerations for planning interdisciplinary training and staging include properly equipping EMS providers and developing a common lexicon

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Parent-offspring cohabitation after weaning inhibits partner preference and alters central oxytocin and dopamine systems in adult mandarin vole

Abstract

In some mammals, offspring may live with their parents for a very long time after weaning, but little is known about the effect of post-weaning parent-offspring cohabitation on the behavioral and neurobiological development of offspring. Here, we explored the effect of this experience on partner preference in adult mandarin vole (Microtus mandarinus). Levels of central oxytocin (OT), tyrosine hydroxylase (TH), as well as OT receptor (OTR), dopamine D1-type and D2-type receptors (D1R and D2R) mRNA expression in the nucleus accumbens (NAcc) and medial amygdala (MeA) were also measured. Our data showed that post-weaning living with parents inhibited the preference to partner over an unfamiliar opposite-sex conspecific. Voles with this experience possessed more OT-but less TH-immunoreactive neurons as compared to the control. Additionally, males with this experience had less D2R and OTR mRNA expression in the NAcc than the control while females had less D2R mRNA expression in the NAcc, but more OTR mRNA expression in the MeA. These findings demonstrate that post-weaning parent-offspring cohabitation inhibits the partner preference formation at adulthood, and these changes may be associated with alterations in the levels of central OT and DA, and their receptor mRNA expression in specific brain regions.

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Disruptive behavior in the operating room: prevalence, consequences, prevention, and management

Purpose of review Disruptive workplace behavior can have serious consequences to clinicians, institutions, and patients. There is a range of disruptive behaviors, and the consequences are often underappreciated. The purpose of this manuscript is to review the definition, prevalence, consequences, prevention, and management of disruptive behavior in the operating room. Recent findings Although a small minority of operating room clinicians act disruptively, 98% of clinicians report having recently been exposed to disruptive behavior, with the average being 64 events per clinician per year. The causes include intrapersonal factors, workplace relationships, workplace logistics, and broader contextual factors. Disruptive behavior undermines patient care by decreasing individual and team clinical performance. It decreases clinician well being, sets a poor example for medical students who are susceptible to negative role models, and decreases hospital efficiency. The way that clinicians respond to disruptive behavior may either exacerbate or reduce the consequences of the behavior. In order to prevent disruptive behavior, the causes must be addressed. Institutions must have robust policies to deal with disruptive behavior and have preventive measures that include regular staff education. Whenever disruptive behavior does occur, it must be expeditiously addressed, which may include graded discipline. Summary Disruptive intraoperative behavior is prevalent and harms multiple parties in the operating room. Institutions require comprehensive measures to prevent the behavior and to mitigate consequences. Correspondence to Dr Eric Jacobsohn, MBChB, MHPE, FRCPC, AE215, Harry Medovy House – 671 William Avenue, Winnipeg, MB R3E 0Z2, Canada. Tel: +1 204 787 1518; e-mail: EJacobsohn@exchange.hsc.mb.ca Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Transjugular Intrahepatic Portosystemic Shunt Insertion for the Management of Portal Hypertension in Children

Objectives: To describe our 20-year experience with transjugular intrahepatic portosystemic shunt (TIPSS) procedures for children with resistant portal hypertension (PHTN). Methods: Retrospective review of all children that had a TIPSS performed at Birmingham Children's Hospital from 1st January 1995 - 1st January 2015. Results: 40 children underwent 42 attempted TIPSS for resistant PHTN with recurrent variceal bleeding (n = 35), refractory ascites (n = 4), and hypersplenism (n = 1). Median age at operation was 12 years (range, 7 months - 17 years). Thirty-four procedures were elective and 8 were emergency cases. TIPSS was established in 33 cases (79%). Median portal venous pressure reduction was 10mmHg. Variceal bleeding ceased in 27 (96%) and ascites improved in all. Clinical improvement following TIPSS enabled 7 children to be bridged to transplantation and 7 others to become suitable for transplantation. The 1-year and 5-year survival with TIPSS was 57% and 35%, respectively. Child-Pugh score C was an independent risk factor for adverse outcome (LR = 8.0; 95% CI 2.7 - 23.5; P = 0.001). There were 6 major complications: hepatic artery thrombosis and infarction (n = 1), hepatic artery pseudoaneurysm (n = 1), bile leak (n = 1), and hepatic encephalopathy (n = 3). Encephalopathy was resistant to medical treatment in 2 cases, necessitating staged closure in one. Ten patients (30%) required intervention to maintain TIPSS patency. The 1-year and 5-year freedom from reintervention was 71% and 55%, respectively. Conclusion: A TIPSS is highly successful in controlling symptoms in children with resistant PHTN and facilitating liver transplantation. However, it is technically demanding and not without risk. Patients must be appropriately selected and counselled. Address correspondence and reprint requests to Lauren Johansen, Liver Unit, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH (. e-mail: ljohansen@nhs.net). Received 15 December, 2017 Accepted 3 April, 2018 Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). Conflicts of Interest and Source of Funding: None declared © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Osteopontin Levels in Human Milk vary Across Countries and within Lactation Period: Data from a Multicenter Study

Objectives: Osteopontin (OPN) is a multifunctional protein expressed in many cell types, tissues and body fluids with the highest concentrations found in milk; significantly higher in human than in bovine milk. Intervention studies have indicated beneficial effects of supplementing infant formula with bovine OPN. In this multicenter study, we determined the OPN content in human milk samples from 629 Chinese, Danish, Japanese and Korean mothers. Methods: At each study site, milk samples were collected and analyzed for OPN and protein concentration using ELISA and infrared spectroscopy, respectively. Results: A total of 829 milk samples from 629 women were included. When delivering the first sample, mean maternal age was 31.4 years (SD 4.0), and median infant age was 13.4 weeks (IQR 4.6-17.9). The median OPN concentration varied across sites; from 99.7 mg/L in Danish, 182.5 mg/L in Japanese, 216.2 mg/L in Korean to 266.2 mg/L in Chinese mothers (p 

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Value of Serum Zinc in Diagnosing and Assessing Severity of Liver Disease in Children with Wilson Disease

Supplemental Digital Content is available in the text ABSTRACT Objectives: Wilson disease (WD) is a rare inborn error of copper metabolism with diverse manifestations. There has been no study of zinc (Zn), the copper's antagonist, in WD diagnosis and severity so far. Our aims were to evaluate serum Zn in WD and its correlation with the disease severity score (revised WD index). Although the ATP7B mutation analysis is highly accurate for WD diagnosis, it may not be readily available in a resource-limiting setting. We proposed a disease diagnostic score (Proposed WD diagnostic score) which incorporates serum Zn. Methods: Medical records of WD and non-WD children seen at King's College Hospital from 2005 to 2015 were reviewed for the selected parameters using the Proposed WD diagnostic score. Available serum Zn data in WD children before disease diagnosis and the calculated severity score were statistically analysed. Diagnostic values of the Proposed WD diagnostic score were evaluated. Results: Serum Zn level was significantly lower in 8 WD-acute liver failure (ALF) (5.8 [4.1–8.3] μmol/L) compared to 18 WD-non-ALF (13.5 [6.1–22.2] μmol/L) and 9 ALF from indeterminate cause (9.8 [7.0–12.1] μmol/L) (P 

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Anemia in Pediatric Inflammatory Bowel Disease

Objectives: Anemia is the most frequent extra-intestinal finding in Inflammatory Bowel Disease. The aim of this study is to determine the prevalence and types of anemia in pediatric patients with Inflammatory Bowel Disease at diagnosis and at approximately one year follow up. Methods: This is a retrospective chart review of patients diagnosed with Inflammatory Bowel Disease from 2005 to 2012, ages 1-18 years. Patients who had hemoglobin, hematocrit, mean corpuscular volume and iron indices obtained at the time of diagnosis and at approximately one year follow up were included in the study. The prevalence of anemia at the beginning and the end of the study was recorded. Using the soluble transferrin receptor index the type of anemia was determined. Results: At diagnosis, 67.31% of patients were anemic. Overall, 28.85% of patients had either Iron deficiency anemia or a combination of Iron deficiency anemia and anemia of chronic disease, while 38.46% had anemia of chronic disease alone. At follow up 20.51% were anemic. 15.38% had either iron deficiency anemia or a combination of iron deficiency anemia and anemia of chronic disease; 5.13% had anemia of chronic disease alone. The pattern of anemia and response to therapy differed among the inflammatory Bowel disease phenotypes Conclusion: Anemia is frequent in Inflammatory Bowel Disease. The prevalence was higher in Crohn's Disease. At one year, the prevalence of anemia decreased significantly, but persisted. Anemia of Chronic Disease predominated in CD. Iron Deficiency Anemia continued to be present in CD and UC. Address correspondence and reprint requests to Robert D. Baker, Digestive Diseases and Nutrition Center, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY 14222, Tel: +716 878 7793; fax: +716 888 3842;(e-mail: rbaker@upa.chob.edu). Received 14 August, 2017 Accepted 11 January, 2018 There was no outside funding for this research. Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Anaesthesia in High-Risk Patients

No abstract available

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Breathlessness amplifies amygdala responses during affective processing

Psychophysiology, EarlyView.


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