Effects of hypothermia during propofol anesthesia on learning and memory ability and hippocampal apoptosis in neonatal rats

Abstract

Objective

At present, the harm of hypothermia to the central nervous system has received a great attention from scholars. The present study aimed to investigate the effects of hypothermia on learning and memory abilities and hippocampal apoptosis in neonatal rats and the role of p-ERK and p-CREB in anesthesia.

Methods

In this study, 60 Sprague Dawley newborn rats (age 7-day-old) were randomly divided into 3 groups (n = 20), including Control Group (Group C), Anesthesia Group (Group A), and Anesthesia Hypothermia Group (Group AH). Group C was intraperitoneally injected with 0.1 ml saline, and rectal temperature was maintained in the range of 38–39 °C; Group A was intraperitoneally injected with 25 mg/kg of propofol (0.1 ml), the 1/2 initial dose was added per each period of 20 min, anesthesia was maintained for 2 h, and rectal temperature was kept in the range of 38–39 °C. The anesthesia mode and duration of Group AH were as same as Group A, room temperature was set to 23 °C, which caused body's temperature naturally dropped down. After the anesthesia recovered, each group randomly involved five rats for analyzing by Western blot to detect the expression level of p-ERK and p-CREB, and other five rates were also analyzed by flow cytometry assay to detect hippocampal apoptosis rate. The remaining 10 rats in each group were kept up to 30 days for conducting the Morris water maze test, five rats were tested for detecting the expression level of p-ERK and p-CREB, as well as hippocampal apoptosis rate in each group.

Results

Compared with Group C and Group A, the rectal temperature of Group AH was decreased significantly (P < 0.05); At the age of 7 days, compared with Group C and Group A, apoptosis rate of hippocampal tissue in Group AH was increased (P < 0.05), the expression level of p-ERK and p-CREB proteins in Group AH was significantly reduced (P < 0.05), and there were no significant differences between Group C and Group A. At the age of 36 days, there were no significant differences in the results of behavioral test, apoptotic rates, and expression level of the proteins.

Conclusion

Our findings suggest that hypothermia during anesthesia can increase the apoptosis rate in the hippocampus of neonatal rats, whose mechanism may be related to the downward adjustment of p-ERK and p-CREB. However, it has no obvious influence on the long-term learning and memory abilities.

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On Loneliness: Where Politics, Medicine, Psychology, and Society Meet

No abstract available

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Short-Term Effects of Normocapnic Hyperpnea and Exercise Training in Patients With Chronic Obstructive Pulmonary Disease: A Pilot Study

Objective The aim of the study was to evaluate the short-term physiologic effects of respiratory muscle training with normocapnic hyperpnea added to standard exercise training on respiratory muscle endurance/strength and exercise tolerance in patients with chronic obstructive pulmonary disease. Design The study used a randomized controlled trial. Patients referred for rehabilitation were randomly assigned to 20 sessions (twice daily 5 d/wk) of either normocapnic hyperpnea (group 1, n = 12) or sham maneuvers (group 2, n = 10) in addition to individualized cycle training and abdominal, upper, and lower limb muscle exercise. At baseline and end of study, patients underwent evaluation of respiratory muscle endurance, maximum voluntary ventilation, maximal inspiratory, and expiratory pressures, and 6-min walking distance. Results After training, a significant improvement was found only for group 1 in respiratory muscle endurance time (by 654 [481] secs versus 149 [216] secs for group 2, P = 0.0108) and maximal inspiratory (group 1: from 81.2 [21.9] cmH2O to 107.6 [23.0] cmH2O, P = 0.018 versus group 2: from 75.4 [13.8] cmH2O to 81.3 [18.9] cmH2O, P = 0.139). The difference between groups for 6-min walking distance, maximum voluntary ventilation, and expiratory pressures was not significant. Conclusions Short-term normocapnic hyperpnea training added to standard exercise, compared with exercise training alone, improves respiratory muscle endurance and strength but not exercise tolerance in patients with chronic obstructive pulmonary disease.

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Physical Medicine and Rehabilitation Role on Notalgia Paresthetica: Case Report and Treatment Review

Notalgia paresthetica is a rarely reported T2–T6 sensory neuropathy whose etiology and treatment are not fully established. Although it is believed to be common in dermatological practice, it remains underrecognized, underdiagnosed, and therefore underreported. This case-report provides a physical medicine and rehabilitation perspective on notalgia paresthetica diagnosis and treatment. This article presents a case report of a 39-yr-old woman with pain, pruritus, and a hyperpigmented area in the right dorsal infra scapular region. The diagnosis of notalgia paresthetica was established. She was successfully treated with topical anesthetics, postural corrective exercises, scapular muscle strengthening, and pectoral muscle stretching. In this context, different treatment options were reviewed. A small set of pharmacological and nonpharmacological techniques were identified. Several of these modalities belong to the physical medicine and rehabilitation field of action.

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Onabotulinum Toxin A Injections Into the Salivary Glands for Spinal Muscle Atrophy Type I: A Prospective Case Series of 4 Patients

Objective The aim of the study was to investigate the safety and efficacy of onabotulinum toxin A injection to the salivary glands under ultrasound guidance for the treatment of sialorrhea in patients with spinal muscular atrophy type I. Design Prospective case series with four patients with spinal muscular atrophy type I who received onabotulinum toxin A injection to parotid and submandibular glands for sialorrhea as part of clinical care. All four patients received validated surveys for measuring drooling, including objective measures of number of bib changes, and number of mouth wipes before injection and 4–6 wks after injection. Research was limited to survey completion. Scales included the Drooling Severity and Frequency Scale and the Drooling Impact Scale as well as a new scale used in our clinic, the Posterior Drooling Scales looking at coughing/choking and number of aspiration pneumonias. Results There were no adverse events. All four patients showed clinically significant improvements. The improvement in drooling using the Drooling Impact Scale was statistically significant (paired t test, t = 3.243, P = 0.048). All patients improved with number of mouth wipes. Conclusion Ultrasound-guided onabotulinum toxin A injections to the salivary glands may be a safe and effective method of decreasing drooling in patients with spinal muscular atrophy type I.

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Co-morbidities Associated With Early Mortality in Adults With Spina Bifida

Objective The aims of this quality improvement project were to identify secondary conditions and medical co-morbidities in adult patients with spina bifida and to determine which factors were associated with an earlier age of death. Design Retrospective chart review of 487 patients who attended the University of Pittsburgh Medical Center Adult Spina Bifida Clinic between August 1, 2005, and June 6, 2017, was conducted. Results Of 487 patients who had received care at the University of Pittsburgh Medical Center Adult Spina Bifida Clinic, 48 were deceased. The most commonly reported causes of death included infection, respiratory failure, renal failure, shunt malfunction, and metastatic cancer. Underlying co-morbidities and secondary conditions included hydrocephalus, Chiari II malformation, tethered cord, scoliosis, and abnormal renal function. In deceased patients, earlier age of death was significantly associated with myelomeningocele subtype and the presence of hydrocephalus and Chiari II malformation. Conclusions Clinicians treating individuals with spina bifida should be aware of the potential for earlier mortality in individuals with myelomeningocele, hydrocephalus, and Chiari II malformation, especially with regard to infection, respiratory failure, renal failure, shunt malfunction, and cancer. To Claim CME Credits Complete the self-assessment activity and evaluation online at https://ift.tt/1l80W45 CME Objectives Upon completion of this article, the reader should be able to: (1) Discuss the importance of recognizing co-morbidities in adult individuals with spina bifida; (2) Describe secondary conditions and medical co-morbidities associated with spina bifida; and (3) Identify which conditions are associated with earlier age of death in adult individuals with spina bifida. Level Advanced Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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Improvement During Inpatient Rehabilitation Among Older Adults With Guillain-Barré Syndrome, Multiple Sclerosis, Parkinson Disease, and Stroke

Objective The aim of the study was to quantify the improvement in independence experienced by patients with the following diagnoses: Guillain-Barré syndrome, multiple sclerosis, Parkinson disease, and stroke after inpatient rehabilitation. Design Subjects who were admitted to inpatient rehabilitation hospitals in 2012–2013 with an incident diagnosis of the following: Guillain-Barré syndrome (n = 1079), multiple sclerosis (n = 1438), Parkinson disease (n = 11,834), or stroke (n = 131,313), were included. The main outcome measure was improvement in Functional Independence Measure scores on self-care, mobility, and cognition during inpatient rehabilitation. We estimated percent improvement from a linear mixed-effects model adjusted for patients' age, sex, race/ethnicity, comorbidity count, diagnostic group (Guillain-Barré syndrome, multiple sclerosis, Parkinson disease, and stroke), and admission score. Results All patient diagnostic groups receiving inpatient rehabilitation improved across all three domains. The largest adjusted percent improvements were observed in the mobility domain and the smallest in the cognition domain for all groups. Percent improvement in mobility ranged from 84.9% (multiple sclerosis) to 144.0% (Guillain-Barré syndrome), self-care from 49.5% (multiple sclerosis) to 84.1% (Guillain-Barré syndrome), and cognition from 34.0% (Parkinson disease) to 51.7% (Guillain-Barré syndrome). Patients with Guillain-Barré syndrome demonstrated the greatest percent improvement across all three domains. Conclusions Patients with Guillain-Barré syndrome, multiple sclerosis, Parkinson disease, and stroke should improve during inpatient rehabilitation but anticipated outcomes for patients with Guillain-Barré syndrome should be even higher.

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Influencing Health Behavior Change Related to Musculoskeletal Conditions: The Need to Expand the Evidence Base and the Case for Multitheory Model

No abstract available

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The Effect of Stabilization Exercises on Pain, Disability, and Pelvic Floor Muscle Function in Postpartum Lumbopelvic Pain: A Randomized Controlled Trial

Objective The effect of stabilization exercises on pain, disability, and pelvic floor muscle function in postpartum lumbopelvic pain. Design This is a single-blind, randomized controlled trial. Setting This study was performed at the physiotherapy clinic, Zahedan University of Medical Science, from January to November 2017. Participants Thirty-six multiparous women with persistent postpartum lumbopelvic pain were recruited at least 3 mos after delivery. Interventions Subjects in the training group (n = 18) received electrotherapy modalities and specific stabilizing exercises. The control group (n = 18) received only electrotherapy modalities. Main Outcome Measures Pain, disability, and bladder base displacement (at rest and pelvic floor muscles contraction) were measured through visual analog scale, Oswestry Disability Index questionnaires, and transabdominal ultrasound imaging respectively at baseline and after 6 wks of intervention. Results Between-groups comparison showed significant improvement in pain, disability, and bladder base displacement in the training group (P

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Ultrasonographic Findings in a Latissimus Dorsi Injury in a Beach Volleyball Player

No abstract available

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Relation Between Memory Impairment and the Fornix Injury in Patients With Mild Traumatic Brain Injury: A Diffusion Tensor Tractography Study

Objective We investigated the relation between memory impairment and the fornix injury in patients with mild traumatic brain injury, using diffusion tensor tractography. Design Eighty-six chronic patients with mild traumatic brain injury and 50 normal control subjects were recruited. Fractional anisotropy and fiber volume were measured for each reconstructed fornix. The patients were classified according to the following three types: type A (47 patients), intact integrity of both fornical crura; type B (27 patients), showed a discontinuation in either fornical crus; and type C (12 patients), discontinuations in both fornical crura. The Memory Assessment Scale was used for evaluation of memory function. Results Fractional anisotropy and fiber volume showed weak positive correlations with global memory of Memory Assessment Scale, respectively (r = 0.303, P = 0.006; r = 0.271, P = 0.014). Significant difference in the global memory of Memory Assessment Scale was observed between type A and B and between type A and C without difference between type B and C (P

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State of the States: Growing PhysiatryAssociation of Academic Physiatrists Position Statement Addressing Academic Physiatry and Physical Medicine and Rehabilitation Growth

The growth of physiatry in the United States is dependent on academic exposure at both the undergraduate and graduate medical education levels. Undergraduate medical education provides students with knowledge of physiatry, as well as proper understanding of human function, medical rehabilitation treatments, and of physiatrists as consultants. Graduate medical education contributes more directly to the total number of practicing physiatrists. This article presents disparities in medical student exposure to physiatry, physical medicine and rehabilitation residency positions, the number of practicing physiatrists, and physical medicine and rehabilitation–relevant patient care needs, by state. In the model, these disparities are highlighted to provide guidance and expose gaps/opportunities for targeted physiatric growth.

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Association of Admission Functional Status and Assistive Device Provision for Veterans Poststroke: A Retrospective Study

Objectives The aims of the study were (a) to provide knowledge about the provision of assistive devices in practice and (b) to describe the challenges of standardizing device provision. Design This is a retrospective study using Department of Veteran Affairs National Prosthetic Patient Database and other administrative databases. The cohort included all veterans treated by the Veterans Health Administration for stroke during fiscal years 2007–2008. Descriptive methods were used to analyze data with emphasis on inspecting relationships between device provision and motor and cognitive function using Functional Independence Measure scores. Results A total of 8374 veterans treated for stroke and receiving at least one assistive device are included. Individuals who received standard or caregiver controlled wheelchairs tended to be older, and those who received ultralight or caregiver controlled wheelchairs had a higher proportion of Hispanics than the overall cohort. Veterans who received any type of wheelchair had lower motor, cognitive, and total functioning scores than the cohort as a whole. Veterans who received canes had the highest functioning. Veteran patients who received patient lifts and beds had lower cognitive scores compared with the overall cohort. Conclusions Functional status can provide some objectivity to the largely subjective assistive device provision decision-making process; however, many other factors must be considered simultaneously, complicating efforts to standardize provision.

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Retraction: Sato et al. Am J Phys Med Rehabil 2005;84:692–8

No abstract available

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Efficacy of Compression Gloves in the Rehabilitation of Distal Radius Fractures: Randomized Controlled Study

Objective The aim of this study was to examine the outcomes of wearing made-to-measure compression gloves after distal radius fracture. Design In a randomized controlled trial, adults who were about 6 wks post distal radius fracture were recruited and divided into a comparison control group (n = 15), who received standard rehabilitation twice a week for half an hour, and an intervention group (n = 17), who additionally used compression gloves. All treatments were conducted at a single rehabilitation clinic. Outcomes assessed were wrist and finger range of motion, grip strength, swelling, pain, and activities of daily living (using the Patient Rating Wrist Evaluation). The intervention group underwent additional objective dynamic assessments of range of motion with and without the gloves. Results The intervention group demonstrated reduced swelling, pain, and analgesic use; increased wrist range of motion; better scores for specific hand functions; and greater participation in activities of daily living compared with the comparison group. Conclusion This randomized controlled trial shows that using compression gloves during the rehabilitation phase after distal radius fracture improves daily functioning and reduces adverse symptoms. These improvements, which are important in their own right, are also expected to aid in preventing the development of chronic conditions and disability. Evidence Level II Un-blinded prospective comparative study.

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Letter to the Editor About the Article "Aquatic Exercises in the Treatment of Low Back Pain: A Systematic Review of the Literature and Meta-Analysis of Eight Studies"

No abstract available

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Bone Marrow Fat Physiology in Relation to Skeletal Metabolism and Cardiometabolic Disease Risk in Children With Cerebral Palsy

Individuals with cerebral palsy exhibit neuromuscular complications and low physical activity levels. Adults with cerebral palsy exhibit a high prevalence of chronic diseases, which is associated with musculoskeletal deficits. Children with cerebral palsy have poor musculoskeletal accretion accompanied by excess bone marrow fat, which may lead to weaker bones. Mechanistic studies to determine the role of bone marrow fat on skeletal growth and maintenance and how it relates to systemic energy metabolism among individuals with cerebral palsy are lacking. In this review, we highlight the skeletal status in children with cerebral palsy and analyze the existing literature on the interactions among bone marrow fat, skeletal health, and cardiometabolic disease risk in the general population. Clinically vital questions are proposed, including the following: (1) Is the bone marrow fat in children with cerebral palsy metabolically distinct from typically developing children in terms of its lipid and inflammatory composition? (2) Does the bone marrow fat suppress skeletal acquisition? (3) Or, does it accelerate chronic disease development in children with cerebral palsy? (4) If so, what are the mechanisms? In conclusion, although inadequate mechanical loading may initiate poor skeletal development, subsequent expansion of bone marrow fat may further impede skeletal acquisition and increase cardiometabolic disease risk in those with cerebral palsy.

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Reversible Visual Field Defect After Isolated Intraventricular Hemorrhage

No abstract available

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Evidence-Based Physiatry: Pediatric Neuromuscular Rehabilitation in the Era of Precision Medicine

No abstract available

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Respiratory Synkinesis Seen in the Biceps Brachii Muscle Resulting From Meningitis 20 Years Ago

No abstract available

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Abstracts of the XXXIX Congress of the Spanish Society of Physiological Sciences (SECF), 18-21 September 2018, Cádiz, Spain

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Roles of inflammation, neurogenic inflammation, and neuroinflammation in pain

Abstract

Inflammation is the body's response to injury and infection, involving a complex biological response of the somatosensory, immune, autonomic, and vascular systems. Inflammatory mediators such as prostaglandin, proinflammatory cytokines, and chemokines induce pain via direct activation of nociceptors, the primary sensory neurons that detect noxious stimuli. Neurogenic inflammation is triggered by nerve activation and results in neuropeptide release and rapid plasma extravasation and edema, contributing to pain conditions such as headache. Neuroinflammation is a localized inflammation in the peripheral nervous system (PNS) and central nervous system (CNS). A characteristic feature of neuroinflammation is the activation of glial cells in dorsal root ganglia, spinal cord, and brain which leads to the production of proinflammatory cytokines and chemokines in the PNS and CNS that drives peripheral sensitization and central sensitization. Here, we discuss the distinct roles of inflammation, neurogenic inflammation, and neuroinflammation in the regulation of different types of pain conditions, with a special focus on neuroinflammation in postoperative pain and opioid-induced hyperalgesia.

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Reply

No abstract available

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Use of Blood Biomarkers in the Assessment of Sports-Related Concussion—A Systematic Review in the Context of Their Biological Significance

Objectives: To critically review current knowledge on the positive and negative predictive value of blood biomarkers for concussion; to illustrate the clinical and biological contexts that help evaluate the use of these markers in sport-related traumatic brain injuries (TBIs). Methods: This systematic review was performed in accordance with PRISMA guidelines. We reviewed the measurement, clinical utility, endpoint, and biological significance of blood biomarkers in concussion. Results: A total of 4352 publications were identified. Twenty-six articles relating to blood biomarkers were included in the review. Four common blood biomarkers, namely S100B, tau, neuron-specific enolase (NSE), and glial fibrillary acidic protein (GFAP), were examined. Overall, the studies showed S100B measurement and use, either acutely or at several time points, can distinguish injured from noninjured patients with an uncertain degree of utility in predicting mortality. At present, S100B has largely become an acceptable biomarker of TBI; however, studies have begun to highlight the need to incorporate clinical symptoms instead of S100B concentration in isolation on the basis of inconsistent results and lack of specificity across published studies. Further research is needed to evaluate and validate the use of tau, NSE, and GFAP as a diagnostic aid in the management of concussion and TBI. Conclusions: At present, blood biomarkers have only a limited role in the evaluation and management of concussion. Although several biomarkers of brain injury have been identified, continued research is required. S100B holds promise as the most clinically useful diagnostic biomarker. Blood biomarkers, in combination with other clinical data, such as head computed tomography, would maximize the diagnostic accuracy. The methodological limitations evident in blood biomarker research results in the need for the clinical utility of blood biomarker use in concussion to be further explored.

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Effects of Intravenous Cold Saline on Hyperthermic Athletes Representative of Large Football Players and Small Endurance Runners

Objective: To evaluate the cooling effects of intravenous (IV) cold normal (0.9%) saline on hyperthermic athletes. Design: Randomized crossover study design. Setting: Controlled research laboratory. Participants: Twelve male participants who were representative of a collegiate cross-country (6) and American football (6) population. Interventions: Participants underwent body composition analysis using a BodPod. They were placed in an environmentally controlled chamber and brought to a Tc of 39.5°C with dynamic exercise. When temperatures were reached, they were treated with either 2 L of cold saline (CS) (4°C) or intravenous room temperature (22°C) saline (RS) over a ∼30-minute period. Tre was measured with a rectal temperature probe every minute during the treatment period. Main Outcome Measures: Total ΔTre (ending Tre − starting Tre) and cooling rate (total change in Tre/time) were measured for each condition, and body composition variables calculated included body surface area (BSA), BSA-to-mass ratio (BSA/mass), lean body mass, and body fat percentage (%BF) (P

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Risks of Exertional Rhabdomyolysis With Blood Flow–Restricted Training: Beyond the Case Report

No abstract available

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Effects of 12-Week Resistance Exercise on Electroencephalogram Patterns and Cognitive Function in the Elderly With Mild Cognitive Impairment: A Randomized Controlled Trial

Objective: To investigate the effects of a 12-week resistance exercise program with an elastic band on electroencephalogram (EEG) patterns and cognitive function in elderly patients with mild cognitive impairment (MCI). Design: Randomized controlled trial. Setting: Community center. Participants: Twenty-two subjects with MCI and 25 healthy volunteer subjects were randomly assigned to 1 of 4 groups: subjects with MCI who undertook the exercise program (MCI-EX; n = 10), an MCI control group (MCI-Con; n = 12), a healthy volunteer exercise group (NG-EX; n = 12), and a healthy volunteer control group (NG-Con; n = 13). Intervention: The exercise group engaged in a 15-repetition maximum (15RM; 65% of 1RM) resistance exercise program for 12 weeks. Main Outcome Measures: Electroencephalograms, neuropsychological tests, and Senior Fitness Test. Results: The 12-week 15RM (65% of 1RM) resistance exercise program significantly improved variables related to the physical fitness of the elderly subjects. Furthermore, for the EEG test, the MCI and NG groups showed significant differences at baseline in relative beta waves on electrodes Fp1 (P

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Reactive Osteochondromatous Lesion of the Femoral Neck in a Highly Active Preadolescent Patient: Is This the Pathogenesis of a Cam Deformity?

Abstract: Here, we present a rare case of a preadolescent boy with a prominent bony bump on the femoral neck. The main histological feature was concordant with a reactive osteochondromatous lesion possibly induced by repetitive microtrauma, probably because of overtraining as a soccer goalkeeper. The nature of this pathological change is consistent with the growth of a cam deformity. Especially in the preadolescent age group, we should note that repetitive use of the same joint kinematics may induce a prominent cam deformity.

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Postexercise Hypotension as a Predictor for Long-Term Training-Induced Blood Pressure Reduction: A Large-Scale Randomized Controlled Trial

Objective: To investigate the correlation between acute exercise effects and chronic training effects on blood pressure (BP). Design: Randomized, controlled training study focusing on the optimization of preventive effects of physical training. Setting: The study was performed in a university department. Participants: One hundred twenty-seven healthy, untrained subjects. Intervention: Subjects were divided into 4 groups: interval endurance training (IET) (n = 26, 4 × 4 min at 95% maximal heart rate), continuous endurance training (CET) (n = 23, 45 minutes at 60% heart rate reserve), strength endurance training (SET) (n = 40, 8 machine-based exercises, each 2 x 15 repetitions at the 20 repetition maximum), and control (CON) (n = 38). In the 3 training groups, subjects trained 3 times a week for 6 months, the CON group was asked to retain their sedentary lifestyle. Main Outcome Measures: The acute exercise effect on BP was defined as the change of BP after an exhaustive stage test, compared with baseline. The chronic training effect on BP was determined as the change of resting BP after the 6-month training period. Results: For CET, a significant correlation between acute and chronic effects on systolic (r = 0.66, P = 0.001) and diastolic (r = 0.66, P = 0.001) BP was observed. For SET, a significant correlation (r = 0.45, P = 0.007) was found only for diastolic BP. No significant correlations were found for IET. Conclusions: It can be assumed that postexercise hypotension is an easy-to-use predictor for the efficacy of CET to reduce BP, and may be a valuable tool for physicians to individualize prescribed training schedules for patients to reduce cardiovascular risk. Trial Registration: www.clinicaltrials.gov; ID: NCT01263522.

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Reply

No abstract available

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TRest as a New Diagnostic Variable for Chronic Exertional Compartment Syndrome of the Forearm: A Prospective Cohort Analysis of 124 Athletes

Objectives: To measure the accuracy of currently used intracompartmental pressure (ICP) diagnostic variables for forearm chronic exertional compartment syndrome (CECS) and a new ICP diagnostic variable, TRest, the recovery time between the maximum ICP and return to resting pressure. Design: Retrospective cohort. Level evidence IV. Setting: University-affiliated tertiary hospital. Participants: Patients with suspected forearm CECS, 1990 to 2014. Interventions: All patients underwent physical examination and exertional stress test, preceded and followed by measuring ICP in all suspicious CECS. Surgery was proposed when indicated. Minimum follow-up was 18 months. Final diagnosis was established at the final follow-up. Main Outcome Measures: Intracompartmental pressure measurements: PRest (baseline/pre-exercise pressure), P1 min (pressure 1 minute after exercise), P5 min (pressure 5 minutes after exercise), and TRest. Patients rated their pain and completed Quick-DASH in all follow-ups. Patients ultimately were classified into 4 groups (true positives, true negatives, false positives, and false negatives) for each ICP measurement relative to the final diagnosis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: A total of 124 male athletes were diagnosed with CECS, 27 bilateral. Accuracy with standard ICP diagnostic variables was lower (sensitivity 73.5%, specificity 84.2%, positive predictive value 97%, and negative predictive value 31.4%) than with TRest (SN 100%, SP 94.7%, PPV 99.3%, and NPV 100%); 23% of patients would have been missed following the standard ICP diagnostic criteria. Conclusions: Diagnostic thresholds for current standard ICP measurements should be lowered. TRest, a new measure, might be more accurate.

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Strengths, Limitations, and Geographical Discrepancies in the Eligibility Criteria for Sport Participation in Young Patients With Congenital Heart Disease

Objective: Benefits of physical activity has been shown in children with congenital heart disease (CHD). In several forms of CHD, the risk of sudden death remains a major concern both for parents and clinicians, who in turn will have to consider the risk–benefit ratio of sport participation versus restriction. Data source: A literature search was performed within the National Library of Medicine using the keywords: Sport, CHD, and Eligibility. The search was further refined by adding the keywords: Children, Adult, and Criteria. Main Results: Fifteen published studies evaluating sport eligibility criteria in CHD were included. Seven documents from various scientific societies have been published in the past decade but which of them should be adopted remains unclear. Our research highlighted accuracy and consistency of the latest documents; however, differences have emerged between the US and European recommendations. Eligibility criteria were consistent between countries for simple congenital heart defects, whereas there are discrepancies for borderline conditions including moderate valvular lesions and mild or moderate residual defects after CHD repair. Furthermore, some of the more severe defects were not evaluated. Multiple recommendations have been made for the same CHD, and cut-off values used to define disease severity have varied. Published eligibility criteria have mainly focused on competitive sports. Little attention was paid to recreational activities, and the psychosocial consequences of activity restriction were seldom evaluated. Conclusions: Comprehensive consensus recommendations for sport eligibility evaluating all CHD types and stages of repair are needed. These should include competitive and recreational activities, use standardized classifications to grade disease severity, and address the consequences of restriction.

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Shoulder Injuries in Canoeing and Kayaking

Objective: We report the largest case series of shoulder injuries among paddlers so far to establish common mechanisms and patterns of injury. We also discuss how these injuries were managed and report the proportion of paddlers that return to paddlesport. Design: Case series. Setting: Upper Limb Unit, Wrightington Hospital, United Kingdom. Manchester Arm Clinic, United Kingdom. Patients: Fifty-seven shoulder injuries to professional and recreational paddlers were reviewed at a mean follow-up time of 55 months from the first consultation. The patient cohort had a mean age of 36 years and consisted of 56% males. Assessment of Risk Factors: Sex, mechanism of injury, acute/nonacute injury, and level of sport participation. Main Outcome Measures: Patient data were analyzed with regards to Constant score, QuickDASH score, and VAS satisfaction score before and after treatment. Results: The most common mechanism of injury was a capsize which accounted for 15 (26%) injuries. Ten injuries caused by a capsize were labral tears all of which needed surgery. A significant improvement in patient outcome scores was noted. Patients were able to return to a high level of paddling such as 3 slalom paddlers who returned to international competition; one of whom had bilateral surgery. Conclusions: Paddlers most commonly injure their shoulder when preventing a capsize, during a capsize or while rolling. The paddles strokes performed at these times often require paddlers to place their shoulder in a dangerous abducted and externally rotated position. We believe this is one of the commonest causes of serious shoulder injuries to paddlers.

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Syncope Episodes and Blood Flow Restriction Training

Abstract: The combination of low-load resistance training [or more recently, neuromuscular electrical stimulation (NMES)] with a moderate local blood flow restriction (BFR) is becoming a widespread training and rehabilitation method. Scientific data indicate the overall safety of BFR, at least in healthy young people. However, it has been associated with side effects, usually minor, and further research is warranted regarding the safety and efficacy of this technique, especially in clinical populations. We found 3 syncope/presyncopal episodes among 21 healthy people (9 men), all occurring in men and during familiarization sessions (in which BFR was applied alone) but not thereafter (BFR sessions combined with NMES): 1 subject experienced a brief syncope and 2 other subjects exhibited presyncopal symptoms (sweating, lightheadedness, and pallor). Our cases are evidence that cardiovascular complications may emerge during BFR. Caution is thus needed in the application of BFR, and gentle familiarization with this training modality is also recommended.

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Preparticipation Sports Physicals: A Comparison of Single Provider and Station-Based Models

Background: Preparticipation physical examinations (PPEs) are required for children and adolescents before sports participation to identify at-risk athletes. These evaluations can be completed in a traditional office-based setting or in a station-based format. It is unclear if one format is superior to the other in identifying at-risk athletes. Methods: We performed a retrospective chart review of children and adolescents between the ages 10 and 18 years who received their PPE in our office or in a station-based setting in a local high school between the years 2009 and 2015. Results: We reviewed 2934 PPEs total, 1136 in the office-based format and 1798 in the station-based setting. A similar proportion of athletes were excluded or required further evaluation before participation in the office compared with the station-based setting (4.84% vs 5.67%). No statistically significant associations were seen between site of PPE or athlete sex and rate of clearance. There was, however, a statistically significant association between PPE site and reason for exclusion (P = 0.0456) with higher rates of exclusion for vision-related issues in the station-based setting and higher rates of exclusion for musculoskeletal or cardiopulmonary reasons in the office-based setting. Conclusion: When conducted by the same examiners, the office-based and team-based PPE excluded or referred equal number of athletes, although the reason for further evaluation does differ based on setting.

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In Response to: Hamstring-and-Lower-Back Flexibility in Male Amateur Soccer Players

No abstract available

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Decreased Average Power of the Hip External Muscles as a Predictive Parameter for Lower Extremity Injury in Women: A Prospective Study

Objective: To prospectively identify hip strength associated risk factors contributing to the development of lower extremity (LE) injury. Design: Data were prospectively collected on healthy female physical education students. Setting: This study was conducted in the institution of the University of Ghent. Participants: Eighty-nine female physical education students aged 19.53 ± 1.07 years. Assessment of Risk Factors: Testing included isokinetic hip strength measurements of abductors, adductors, internal rotators, and external rotators (ERs). Main Outcome Measures: Follow-up of the participants was assessed using a weekly online questionnaire and a 3-month retrospective control questionnaire. Lower extremity injury was diagnosed by an experienced medical doctor. Cox regression was used to identify the potential risk factors for the development of an LE injury. Results: Thirty-four participants were diagnosed with an LE injury during follow-up. This study identified that decreased average power (AP) (P = 0.031) on concentric ER strength was found to be a significant risk factor for LE injury. No other hip strength parameters were found to be significant contributors to the development of LE injury. Conclusions: Decreased AP of the hip ER muscles was identified as a significant predictor for LE injury, whereas no hip abduction weakness or peak torque parameters were found to be predictive. Because controlling LE extremity movements is an important function of the hip muscles, they might be more challenged in a dynamic measure such as AP than in a point measure such as peak torque. Concentric AP of hip ER muscles can therefore be seen as an interesting factor to include in LE injury screening protocols.

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In Response to: Googling Concussion Care

No abstract available

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Self-Reported Physical Activity Level in Student Athletes at Preparticipation Physical Evaluations

Objective: Quantify physical activity in healthy student athletes. Design: Cross-sectional survey. Setting: Five Central Ohio schools during mass preparticipation physicals. Participants: Three hundred sixty-five children between the ages 10 and 18 years. Independent Variables: Days per week of moderate to vigorous physical activity (MVPA), minutes per day of MVPA, and number of activities. Main Outcome Measures: Minutes per week of MVPA. Results: One hundred eighty high school and 177 middle school subjects responded to the survey. There were 198 male and 162 female respondents. Mean age recorded 14.2 ± 1.7 years. There were no differences in activity volume based on sex. Mean minutes per week of MVPA reported 316.0 ± 231.0. High school subjects reported fewer activities than middle school cohort 2.7 ± 1.2 versus 3.2 ± 1.5 (P

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Reply

No abstract available

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Effectiveness of golimumab in ulcerative colitis: A review of the real world evidence

Biologics against tumor necrosis factor (anti-TNF) have dramatically changed the management of moderate-to-severe ulcerative colitis (UC). In pivotal clinical trials, golimumab showed efficacy as induction and maintenance therapy in anti-TNF naïve UC patients. However, confirmatory data on effectiveness in the real world setting are needed.

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Frequency and risk factors for liver disease following pancreatitis: A population-based cohort study

Both liver disease (LD) and pancreatitis pose substantial burdens. There have been no general population-based studies on frequency of LD after an episode of pancreatitis. The aim of this study was to investigate the occurrence of LD in a population-based cohort of patients following pancreatitis.

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Deep learning-based preoperative predictive analytics for patient-reported outcomes following lumbar diskectomy: Feasibility of center-specific modelling

There is considerable variability in patient-reported outcome measures (PROM) following surgery for lumbar disk herniation (LDH). Individualized prediction tools that are derived from center- or even surgeon-specific data could provide valuable insights for shared decision-making.

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Effectiveness of golimumab in ulcerative colitis: A review of the real world evidence

Biologics against tumor necrosis factor (anti-TNF) have dramatically changed the management of moderate-to-severe ulcerative colitis (UC). In pivotal clinical trials, golimumab showed efficacy as induction and maintenance therapy in anti-TNF naïve UC patients. However, confirmatory data on effectiveness in the real world setting are needed.

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Frequency and risk factors for liver disease following pancreatitis: A population-based cohort study

Both liver disease (LD) and pancreatitis pose substantial burdens. There have been no general population-based studies on frequency of LD after an episode of pancreatitis. The aim of this study was to investigate the occurrence of LD in a population-based cohort of patients following pancreatitis.

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Predicting prognosis in patients with first-episode psychosis using auditory P300: A 1-year follow-up study

Early intervention from the first episode is well known to be essential for favorable outcomes in patients with schizophrenia. Previous studies have shown that a shorter duration of untreated psychosis (DUP) is associated with better symptomatic and functional outcomes (Perkins et al., 2005). The DUP seems to affect quality of life, social functioning and cognitive function throughout the course of the illness and often throughout the patient's life (Ito et al., 2015). In this respect, appropriate management of patients during their first episode of psychosis for the purpose of preventing illness progression and recurrent episodes has been a great interest (McGorry et al., 2008, Sommer et al., 2016).

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Electroencephalogram Dynamics during General Anesthesia Predict the Later Incidence and Duration of Burst-suppression During Cardiopulmonary Bypass

Electroencephalogram (EEG) burst-suppression consists of quasi-periodic alternations between isoelectricity and brief bursts of electrical activity such as spikes, sharp waves, or slow waves (Young, 2000, Akeju et al., 2017). It reflects a brain state of relative cortical quiescence that is not observed during normal behavioral states of wake or sleep(Young, 2000, Brown et al., 2010, Akeju et al., 2017). Instead, it is closely associated with cortical pathologies such as diffuse anoxic brain injury, hypothermia and Ohtahara syndrome(Young, 2000, Brown et al., 2010, Akeju et al., 2017).

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Detecting Abnormal Electroencephalograms Using Deep Convolutional Networks

Electroencephalography (EEG) can be used to detect the abnormal patterns of brain electrical activity present in a broad range of neurological and medication conditions. For example, EEGs of patients with epilepsy often exhibit characteristic "epileptiform" discharges (epileptic spikes or sharp-waves) (Schomer and Da Silva 2012). Lesions, such as strokes or hemorrhages, can result in asymmetry across left and right hemispheres (Agius Anastasi et al. 2017; Jordan 2004; van Putten 2007). Patients with depressed levels of consciousness exhibit generalized slowing of EEG rhythms or burst suppression patterns (Young 2000; Kaplan 2004; Schomer and Da Silva 2012) Metabolic encephalopathy from acute liver failure can cause abnormalities such as triphasic waves (Boulanger et al.

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Satisfaction With Care Coordination for Families of Children With Disabilities

Children with disabilities have significant health care needs, and receipt of care coordinator services may reduce caregiver burdens. The present study assessed caregivers' experience and satisfaction with care coordination.

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Pain Relief in the Palm of Your Hand: Harnessing Mobile Health to Manage Pediatric Pain

Summary

The development and implementation of mobile health (mHealth) interventions provide an opportunity for more optimal management of pediatric pain in the home setting. Leveraging the popularity, mobility, and technological capabilities of digital mobile devices may reduce pediatric pain. Several mHealth applications have already been developed that target the reduction of acute and chronic pediatric pain by digitally delivering intervention strategies in an engaging manner, accumulating pain assessment data, facilitating patient provider communication, and providing interactive training. Although several mHealth programs have begun to make strides in the management of pediatric pain, there are still many more possibilities for improvement as greater development and adoption of mHealth practices is on the horizon. Recommendations are provided that advocate for continued advancement of pediatric pain mHealth implementation with an emphasis on robust scientific evaluation, a structured approach to development and design elements that enhance engagement. Increased awareness about the positive influence of mHealth along with the encouragement of researchers and healthcare providers to promote and develop mHealth programs has the potential to transform pediatric pain management. This merger of evidence‐based pain management strategies and digital technology positions pediatric mHealth to have a profound impact by effectively augmenting standard of care and benefiting healthcare providers, parents, and especially children in need.

This article is protected by copyright. All rights reserved.

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Sempermed announces five Nitrile Examination Gloves tested and approved to provide protection against fentanyl exposure

CLEARWATER, FL — Sempermed, one of the world's leading manufacturers and suppliers of hand protection, is pleased to announce that fentanyl permeation testing has been conducted on five Sempermed glove brands, and they have all passed. The five brands are: SemperCare® Nitrile, SemperForce® Nitrile, StarMed® Ultra Nitrile, Tender Touch® Nitrile and SemperShield®...

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Three versus five lumbar paravertebral injections for inguinal hernia repair in the elderly: a randomized double-blind clinical trial

Abstract

Purpose

The objective of the study was to compare three nerve stimulator-guided paravertebral injections versus five injections for elderly patients undergoing inguinal hernia repair in terms of the amount of intraoperative fentanyl and propofol consumption and conversion to general anesthesia. The secondary objective was postoperative pain.

Methods

A prospective, randomized, double-blind clinical trial was performed. 200 elderly patients undergoing unilateral herniorrhaphy were randomized into two groups. Group III received three PVB injections from T₁₂ to L₂ and placebo at T₁₁ and L₃. Group V received five PVB injections from T₁₁ to L₃.

Results

The mean intraoperative fentanyl and propofol consumption were significantly lower in group V (4.9 ± 7.2 µg versus 20.0 ± 12.9 µg and 5.7 ± 11.6 mg versus 34.6 ± 22.9 mg, respectively, p value < 0.0001). Five patients (5.0%) in group III had failed block and were converted to general anesthesia (p value = 0.024). Group V had significantly lower pain scores compared to group III during the first three postoperative days (p value < 0.0001).

Conclusion

The five PVB injection technique is more suitable as a sole anesthetic technique for elderly patients undergoing herniorrhaphy, since it required less intraoperative supplemental analgesia and provided lower postoperative pain scores compared to the three PVB injection technique.

Trial registration

Clinicaltrials.gov identifier: NCT02537860.

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Risk of Rebleeding After Hemostasis for Peptic Ulcer

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Protease Activated Receptor-2 Induces Immune Activation and Visceral Hypersensitivity in Post-infectious Irritable Bowel Syndrome Mice

Abstract

Background

The role of protease activated receptor-2 (PAR-2) in the pathogenesis of abdominal pain in irritable bowel syndrome (IBS) is not well defined.

Aims

To investigate the role of PAR-2-mediated visceral hypersensitivity in a post-infectious IBS (PI-IBS) mouse model.

Methods

T. spiralis-infected PI-IBS mouse model was used. Fecal serine protease activity and intestinal mast cells were evaluated. Intestinal permeability was assessed by urine lactulose/mannitol ratio, and colonic expressions of PAR-2 and tight junction (TJ) proteins were examined by Western blot. Intestinal immune profile was assessed by measuring Th (T helper) 1/Th2 cytokine expression. Visceral sensitivity was evaluated by abdominal withdrawal reflex in response to colorectal distention.

Results

Colonic PAR-2 expression as well as fecal serine protease activity and intestinal mast cell counts were elevated in PI-IBS compared to the control mice. Decreased colonic TJ proteins expression, increased lactulose/mannitol ratio, elevated colonic Th1/Th2 cytokine ratio, and visceral hypersensitivity were observed in PI-IBS compared to the control mice. Administration of PAR-2 agonist in control mice demonstrated similar changes observed in PI-IBS mice, while PAR-2 antagonist normalized the increased intestinal permeability and reduced visceral hypersensitivity observed in PI-IBS mice.

Conclusions

PAR-2 activation increases intestinal permeability leading to immune activation and visceral hypersensitivity in PI-IBS mouse model.

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Endocrine regulation of gut function – a role for glucagon‐like peptide‐1 in the pathophysiology of irritable bowel syndrome

New Findings

Pathophysiological changes linked to Irritable Bowel Syndrome (IBS) include stress and immune activation, changes in gastrointestinal microbial and bile acids profiles and sensitisation of extrinsic and intrinsic gut neurons. This review explores the potential role for L‐cells in these pathophysiological changes. L‐cells, which secrete glucagon‐like peptide‐1 (GLP‐1) in response to nutrients, microbial factors, bile acids and short‐chain fatty acids, may sense IBS‐related changes in the luminal environment. Glucagon‐like peptide 1 can act as a hormone, a paracrine factor or a neuromodulatory factor and through its actions on central or peripheral neurons, may play a role in gastrointestinal dysfunction.

Abstract

The prevalent and debilitating functional bowel disorder Irritable Bowel Syndrome (IBS), is characterized by symptoms which include abdominal pain, bloating, diarrhoea and/or constipation. The heterogeneity of IBS underscores a complex multifactorial pathophysiology, which is not completely understood, but involves dysfunction of the bidirectional signalling axis between the brain and the gut. This axis incorporates efferent and afferent branches of the autonomic nervous system, circulating endocrine hormones and immune factors, local paracrine and neurocrine factors and microbial metabolites. L‐cells, which are electrically excitable biosensors embedded in the gastrointestinal epithelium, secrete glucagon‐like peptide‐1 (GLP‐1) in response to nutrients in the small intestine. However, they appear to function differently more distally in the gastrointestinal tract, where they are activated by luminal factors including short‐chain fatty acids, bile acids and microbial metabolic products, all of which are altered in IBS patients. GLP‐1 can also interact with the hypothalamic‐pituitary‐adrenal stress axis and immune system, both of which are activated in IBS. Given that a GLP‐1 mimetic has been found to alleviate acute pain symptoms in IBS patients, GLP‐1 may be important in the manifestation of IBS symptoms. This review assessed the current knowledge on the role of GLP‐1 in IBS pathophysiology and its potential role as a signal transducer in the microbiome–gut‐brain signalling axis.

This article is protected by copyright. All rights reserved

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Intraperitoneal abscess formation spreading to the liver after endoscopic ultrasound-guided fine-needle aspiration for abdominal lymphadenopathy

Abstract

A 75-year-old woman was admitted to our hospital because of anemia and appetite loss. She had rheumatoid arthritis and was taking 1 mg of prednisolone and 150 mg of peficitinib orally. She was detected with lymphadenopathy, 18 mm in diameter, around the common hepatic artery with abdominal ultrasonography and abdominal computed tomography. Upper gastrointestinal endoscopy, colonoscopy, and chest computed tomography did not show any evidence of malignant disease. Using endoscopic ultrasound-guided fine-needle aspiration, the lymphadenopathy was punctured through the stomach. She was discharged 4 days after endoscopic ultrasound-guided fine needle aspiration. However, 3 days following discharge, she developed fever and was admitted again 14 days after the endoscopic ultrasound-guided fine-needle aspiration. Abdominal ultrasonography revealed that, at the site of the lymphadenopathy where the endoscopic ultrasound-guided fine-needle aspiration was performed, an intraperitoneal abscess was formed and spreading to the lateral segment of the liver, penetrating the hepatic capsule. Antibiotics failed to improve her condition. Percutaneous transhepatic abscess aspiration was performed 4 days following admission. Thereafter, her condition improved, and she was discharged 10 days after the transhepatic abscess aspiration. It should be noted that intraperitoneal abscess formation in the puncture can occur after ultrasound-guided fine-needle aspiration. Particularly in immunosuppressed patients such as our case, attention may be needed more than those with normal immune function.

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PIWI-interacting RNAs: small RNAs with big functions

PIWI-interacting RNAs: small RNAs with big functions

PIWI-interacting RNAs: small RNAs with big functions, Published online: 16 November 2018; doi:10.1038/s41576-018-0073-3

PIWI-interacting RNAs (piRNAs) have numerous crucial biological roles, particularly transposon silencing in the germ line. In this Review, the authors describe our latest understanding of piRNA biogenesis and functions across diverse species, highlighting how, despite the universal importance of transposon control, different species have evolved intriguingly distinct mechanistic routes to achieve this.

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The oracle of inDelphi predicts Cas9 repair outcomes

The oracle of inDelphi predicts Cas9 repair outcomes

The oracle of inDelphi predicts Cas9 repair outcomes, Published online: 16 November 2018; doi:10.1038/s41576-018-0077-z

A study in Nature shows the feasibility of using the CRISPR–Cas9 system for efficient and precise genotypic correction of pathogenic mutations without a donor template.

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Nonhuman biota dose rate estimation from liquid effluent releases during normal operations of light water reactors using the LADTAP II computer code

Publication date: Available online 16 November 2018

Source: Journal of Environmental Radioactivity

Author(s): Sunita Kamboj

Abstract

The LADTAP II computer code was used to estimate the dose rates to seven nonhuman biota (fish, algae, invertebrate, muskrat, raccoon, heron, and duck) from liquid effluent releases during the normal operations of new light water reactor facilities in the United States. The estimated dose rates to nonhuman biota depended on the nuclear power plant design but were orders of magnitude less than the 'derived consideration reference levels' (DCRL) in International Commission on Radiological Protection (ICRP) Publication 108. The estimated dose rates were at least three orders of magnitude lower than the guideline values identified by the International Atomic Energy Agency (IAEA) and the National Council on Radiation Protection and Measurements to cause observable changes in populations of biota. Radionuclides that contributed most of the dose rates for seven nonhuman biota depended on the nuclear power plant design. The differences in the estimated dose rates to seven nonhuman biota calculated from the default bioaccumulation factors used in the LADTAP II computer code and the dose rates calculated from the concentration ratios of radionuclides in the IAEA Technical Report Series (TRS) wildlife handbook were less than one order of magnitude for most default biota in LADTAP. The concentration ratios for some radionuclides in liquid effluent releases from nuclear power plant designs that contributed more than 5% of the internal dose rates for invertebrates (P, and Ru) and algae (La and Pr) were not available in the IAEA TRS wildlife handbook.

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High-Dose Infliximab Rescue Therapy for Hospitalized Acute Severe Ulcerative Colitis Does Not Improve Colectomy-Free Survival

Abstract

Background and Objective

Optimization strategies with infliximab (IFX) are increasingly used as rescue therapy for steroid refractory acute severe ulcerative colitis (ASUC). We aim to determine if intensified IFX induction improves colectomy rate and identifies outcome predictors.

Methods

Hospitalized adult patients who received IFX for ASUC between 2010 and 2016 were identified. We compared standard inductions (5 mg/kg) vs high-dose induction (10 mg/kg) with 3-month colectomy rate as primary outcome.

Results

Seventy-two patients (62.5% male, median age 38.5) were identified. Thirty-seven patients (51.3%) received 5 mg/kg IFX and 35 received 10 mg/kg. Baseline clinical, biochemical and endoscopic parameters were well matched between these two groups. 10 mg/kg was more likely to be used by clinicians from 2014 onwards (p < 0.001). Three-month colectomy rate was 9.7%; which was not significantly different between the standard (5.4%) and high-dose (14.3%) IFX induction (p = 0.205). CRP ≥ 60 (OR 10.9 [95% CI 1.23–96.50], p = 0.032), hemoglobin ≤ 90 g/L (OR 15.6 [95% CI 2.61–92.66], p = 0.036) and albumin < 30 g/L (OR 9.4 [95% CI 1.06–83.13], p = 0.044) were associated with increased risk of colectomy at 3 months in univariate regression analysis.

Conclusion

Use of high-dose infliximab rescue therapy did not improve 3-month colectomy-free survival in this cohort. Tailored use in high-risk patients may be beneficial although further validation is required.

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Successful direct-acting antiviral treatment of three patients with genotype 2/1 recombinant hepatitis C virus

Abstract

There have been a few reports on the treatment of patients infected with recombinant hepatitis C virus (HCV) genotype 2/1 strains with direct-acting antivirals (DAAs). We experienced three patients, with genotype 2/1 recombinant HCV, treated with DAAs successfully. The first, a 39-year-old man, was infected with recombinant HCV genotype 2a/1b, a rare variant. The sequence of the relapsed virus showed chimeric HCV 2a/1b with the recombinant breakpoint found at nucleotide +49 from the start of the NS3 region. Sofosbuvir plus ribavirin, a regimen recommended for HCV genotype 2, did not lead to a sustained viral response (SVR). Retreatment with grazoprevir plus elbasvir resulted in an SVR. The second case, a 70-year-old woman, was infected with recombinant HCV genotype 2b/1b. DAA therapy with sofosbuvir plus ledipasvir resulted in an SVR. The third case, a 48-year-old woman, was also infected with recombinant HCV genotype 2b/1b. DAA therapy with daclatasvir plus asunaprevir resulted in an SVR. The baseline sequences of the viruses from both the second and third cases showed chimeric HCV 2b/1b with the recombinant breakpoint found at nucleotide +10 from the NS3 start. We report three cases with 2/1 chimeras and discuss the prevalence and response to therapy.

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The oracle of inDelphi predicts Cas9 repair outcomes

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Optimized Deep Neural Network Architecture for Robust Detection of Epileptic Seizures using EEG Signals

Publication date: Available online 15 November 2018

Source: Clinical Neurophysiology

Author(s): Ramy Hussein, Hamid Palangi, Rabab K. Ward, Z. Jane Wang

Abstract

Objective

Automatic detection of epileptic seizures based on deep learning methods received much attention last year. However, the potential of deep neural networks in seizure detection has not been fully exploited in terms of the optimal design of the model architecture and the detection power of the time-series brain data. In this work, a deep neural network architecture is introduced to learn the temporal dependencies in Electroencephalogram (EEG) data for robust detection of epileptic seizures.

Methods

A deep Long Short-Term Memory (LSTM) network is first used to learn the high-level representations of different EEG patterns. Then, a Fully Connected (FC) layer is adopted to extract the most robust EEG features relevant to epileptic seizures. Finally, these features are supplied to a softmax layer to output predicted labels.

Results

The results on a benchmark clinical dataset reveal the prevalence of the proposed approach over the baseline techniques; achieving 100% classification accuracy, 100% sensitivity, and 100% specificity. Our approach is additionally shown to be robust in noisy and real-life conditions. It maintains high detection performance in the existence of common EEG artifacts (muscle activities and eye movement) as well as background noise.

Conclusions

We demonstrate the clinical feasibility of our seizure detection approach achieving superior performance over the cutting-edge techniques in terms of seizure detection performance and robustness.

Significance

Our seizure detection approach can contribute to accurate and robust detection of epileptic seizures in ideal and real-life situations.

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PIWI-interacting RNAs: small RNAs with big functions

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Intensity expectation modifies gustatory evoked potentials to sweet taste: Evidence of bidirectional assimilation in early perceptual processing

Abstract

Expectations can affect subjective sensory and hedonic ratings of tastes, but it is unclear whether they also shape sensory experience at a perceptual level. The neural correlates of the taste‐expectancy relationship were explored through EEG analysis. Using a trial‐by‐trial cueing paradigm, lingual delivery of 0.05 M or 0.3 M sucrose solutions was preceded by congruent or incongruent visual cues designed to promote anticipation of either a low‐sweet or high‐sweet solution. When participants were cued to expect low‐sweet, but received high‐sweet (incongruent cue), intensity ratings for high‐sweet decreased. Likewise, expectation of high‐sweet increased intensity ratings of low‐sweet solutions. Taste‐dependent, right central‐parietal gustatory ERPs were detected, with greater P1 (associated with greater right insula activation) and P2 peak amplitudes for high‐sweet tastes. Valid cue‐taste pairings led to specific reduced right‐lateralized N400 responses (associated with an attenuation in right insula activation) compared with invalid cue‐taste pairings. Finally, P1 amplitudes following invalidly cued low‐sweet tastes closely matched those generated by expected high‐sweet tastes, and P1 amplitudes for invalidly cued high‐sweet tastes resembled those generated by low‐sweet tastes. We conclude that, as well as modifying subjective ratings toward the anticipated intensity level, expectations affect cortical activity in a top‐down manner to induce bidirectional assimilation in the early perceptual processing of sweet taste and modulate N400 ERP components not previously associated with gustatory stimulation.

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Hypomania and depression associated with distinct neural activity for immediate and future rewards

Abstract

Bipolar spectrum and unipolar depressive disorders have been associated with distinct and opposite profiles of reward‐related neural activity. These opposite profiles may reflect a differential preexisting vulnerability for both types of disorders. In support, recent ERP studies find that, following reward feedback, a larger reward positivity (RewP) is associated with greater vulnerability for bipolar spectrum disorders, whereas a smaller RewP is associated with greater vulnerability for depression. However, prior studies have investigated only immediate rewards and have not examined dimensions of both bipolar disorder and unipolar depression within the same sample. The present study is the first to investigate feedback‐related ERP correlates of proneness to hypomania and unipolar depressive tendencies within the same sample and to expand our scope to include future rewards. Participants completed a modified time estimation task where the same monetary reward was available immediately or at one of five different future dates. Results revealed proneness to hypomania and unipolar depressive tendencies were related to an elevated and blunted RewP, respectively, but only following immediate rewards (i.e., today). Following rewards in the distant future (e.g., 8 months), proneness to hypomania and depressive tendencies were associated with elevated and blunted amplitudes for the P3, respectively, a subsequent ERP component reflecting motivational salience during extended feedback processing. Furthermore, these opposing profiles were independent of, and significantly different from, one another. These results suggest that feedback‐related ERPs following immediate and future rewards are candidate biomarkers that can physiologically separate vulnerability for bipolar spectrum from unipolar depressive disorders.

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Differential modulations of reward expectation on implicit facial emotion processing: ERP evidence

Abstract

Implicit emotional processing refers to the preferential processing of emotional content even if it is task irrelevant. Given that motivation enhances executive control by biasing attentional resources toward target stimuli, here we investigated the effects of reward expectation on implicit facial emotional processing in two experiments using ERPs. A precue signaling additional monetary reward for fast and accurate response for the upcoming trial (incentive condition; relative to a cue indicating no such additional reward, i.e., nonincentive condition) was followed by the presentation of a happy, angry, or neutral face. Participants had to determine the gender of the face in Experiment 1 and decide whether a number superimposed on the face was even or odd in Experiment 2. In both experiments, incentive cues elicited larger P3 and contingent negative variation responses, and the targets following incentive cues elicited more positive‐going ERPs (200–700 ms), compared with the nonincentive condition. Importantly, the N2 responses (200–280 ms) to the target exhibited differential patterns of Reward × Emotion interaction: relative to the nonincentive condition, the N2 amplitude differences between emotional (i.e., happy and/or angry) and neutral faces increased in the incentive condition in Experiment 1, but diminished in Experiment 2. These results indicate that reward expectation can differentially modulate implicit processing of facial expressions, with increased sensitivity to emotions when the processing of whole faces is required, but with reduced sensitivity when the processing of faces is distractive. This study enriches the evidence for interactions between reward‐related executive control and implicit emotional processing.

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