Πέμπτη, 10 Μαρτίου 2016

1. A meta-analysis of the cortical silent period in epilepsies

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Publication date: April 2016
Source:Clinical Neurophysiology, Volume 127, Issue 4
Author(s): F. Giovannelli, A. Borgheresi, L. Tramacere, S. Colon, E. Sirabella, M.P. Viggiano, G. Zaccara, M. Cincotta
The cortical silent period (CSP) following transcranial magnetic stimulation reflects GABAB-mediated inhibition in the primary motor cortex (M1), and could contribute to understand the pathophysiological substrates of epilepsies. Increased CSP duration has been reported in idiopathic generalized epilepsy (IGE) and in partial epilepsy (PE) involving the M1, although other studies yielded discordant findings. In this meta-analysis we systematically assessed the consistency of CSP changes in untreated epileptic patients. We searched for controlled studies evaluating the CSP in drug-naïve or drug-free patients with IGE or PE. The mean difference between CSP duration obtained in patients and controls was calculated. Fourteen studies (267 patients and 234 controls) were included. A significant mean difference was found, with longer CSP in patients than in controls. The difference was still greater if IGE patients only were analyzed. CSP modifications did not depend from differences in motor threshold between patients and controls. Meta-analysis confirms CSP modifications in epilepsies, with enhancement of this cortical inhibitory measure in most IGE patients. This provides a rationale for investigations aiming to verify the hypotheses that increased CSP reflects compensatory neural phenomena counteracting transition from the interictal to ictal state, and that CSP variability reflects the pathophysiological heterogeneity of epileptic syndromes.



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3. Evaluation of long term cognitive risks associated with the presence of seizure during acute disseminated encephalomyelitis

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Publication date: April 2016
Source:Clinical Neurophysiology, Volume 127, Issue 4
Author(s): L. Santangelo, E. Cainelli, M. Nosadini, S. Sartori, M. Sole, A. Suppiej
A small percentage of paediatric acute disseminated encephalomyelitis (ADEM) presents with seizures. The association of epileptic activity with demyelination could represent an increased risk for long-lasting cognitive sequelae; however, this risk has not yet been explored in the literature. Objective of this study was to compare long-term neuropsychological outcomes among children and adolescents with history of ADEM with or without seizures. A neuropsychological evaluation (explored areas: general intelligence, language, attention, memory, visuo-motor skills and executive functions) was administered to 20 children and adolescents with history of ADEM (12 boys; mean age at ADEM onset 6.5years (DS 4.23), mean age at follow-up 13.8years (DS 5.65) and mean length of follow-up 6.8years (DS 3.7). Multichannel-EEG recordings during hospitalization for ADEM were evaluated by a neurophysiologist trained in the identification of epileptic activity. 4/20 patients had EEG confirmed seizures. Neuropsychological scores of patients with and without seizures were compared using the Mann–Whitney test. No significant differences were found among children with and without seizures, in none of the cognitive domains explored. In conclusion, the presence of seizures during ADEM does not appear to represent a risk factor for developing long-term cognitive impairment.



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Legal explanation, arguments for fire engine transport of sick child

Sometimes a split-second decision opens a can of worms. And sometimes a split-second decision smashes that can of worms open with a sledge hammer. EMS providers know that there's no time to wonder which it will be; sometimes the can just needs to be opened.

Such was the case in Fredericksburg, Virginia when Capt. James Kelley and his crew arrived to find a toddler unresponsive after an alleged seizure and, rather than wait for the ambulance, transported the child in the fire engine to the hospital — three minutes away.

Kelley and his crew are credited with saving the child's life. In return and paradoxically, he and Sgt. Virgil Bloom were suspended and subsequently reinstated for violating the policy that prohibits transporting patients in non-transport vehicles.

Our decisions open that can of worms
Many years ago, I wrote about doing what's right versus doing what's allowed in EMS. I pointed out that, "…for every action there are consequences, sometimes positive, sometimes negative but always consequences. You have to sleep at night and you have to look yourself in the eye every day. If you can sleep at all, what do you dream? When you look at yourself, who do you see? Finally, ask yourself a simple question … What consequences are you prepared to face and how willing are you to face them?"

The case at hand demonstrates my point exactly. Kelley and his crew were faced with what they believed to be a life-determining situation and they responded as most of us would; by choosing life. As an EMS provider, I commend them.

The law, on the other hand, cannot readily see the penumbra; the spaces or colors in between black and white. By design, the law sees fact for fact and compares facts to laws as written. The law is intended to be blind — that sword cuts both ways.

Malum in Se: Wrong or evil in itself
The law sees some things as being wrong because by their very nature they are wrong; murder, rape, robbery, etc. This case is obviously not that.

Malum Prohibitum: Wrong because it is prohibited
On the other hand, the law also recognizes that some things are considered wrong because the book says so; those things are frequently subject to change as society matures. In the not-so-distant past, interracial marriage was illegal and it was legal to smoke on an airplane. Society has deemed both of those laws worthy of change.

Presently, it is simply Malum Prohibitum for an EMS provider to transport a patient in a vehicle not designated as a patient transport vehicle and there is no room for interpretation. Someday, maybe even as a result of cases like this, society will bend and the rules will change. Until then, the laws are what they are.

Arguing in favor of the paradox
Emergency responders are exactly that: emergency responders. They are tasked with the very difficult job of assessing situations, assessing patients and making split-second decisions about how best to manage everything.

In most cases, the law recognizes how challenging it is and affords some leeway.

This crew arrived to a situation they reasonably believed to require action more immediate than waiting an unknown length of time for an ambulance. It does not really matter whether they were right; it is only necessary that their conclusion be reasonable.

I was not there and I have no reason to doubt them. In fact, we as a community of professionals and as a society must [be able to] trust that they made the best, most rational, most reasonable decision under the circumstances. If we can't, then the whole system collapses under the weight of uncertainty.

The child was transported successfully and without incident. Moreover, they are credited with saving the child's life. I don't have any context for what that means, so I must accept it at face value.

The simplest argument in favor is this: In EMS, you do what you gotta do!

And, I agree.

Arguing against the paradox
Laws, rules, policies, protocols and procedures are all created and implemented to protect patients as well as providers. They are created with an understanding that EMS is dynamic and that we have not come close to seeing everything there is to see or knowing everything there is to know.

The rules of EMS are established — those that established them would say — after careful consideration, analysis and research. Policies are effectively written in the blood of those who came before and violating those policies, even with a happy outcome, is more dangerous to society than not.

Policy and protocol understand that resources don't always arrive at the same time and that, quite often, transport resources are delayed. The system is designed to manage that reality by having first responders who can initiate care in anticipation of the subsequent arrival of more advanced and or transport resources.

In this case, the law would argue that the fire engine lacked proper restraints and the equipment necessary to manage a radical change in the patient's condition. The patient could have been harmed just as easily as helped under countless predictable and unpredictable scenarios during the brief transport. The fact that there was no bad outcome is irrelevant, but the potential harm is enough.

The law says that the system only works when all of the pieces and parts function as intended.

And, I agree.

Conclusion
Both angles of the paradox can be true at the same time.

On the record, as an attorney who defends EMS providers, I say that providers can only find true safety, security and protection within the confines of policy, protocol and procedure as intended; those changes and improvements in thinking and practice must be codified before they are implemented; policies are intended to benefit patients above all and they should be followed with great faith and integrity.

Off the record, not as an attorney, but as an EMS provider, I say this: Consider the consequences and how willing you are to face them … then, do what you gotta do knowing there will be a price to be paid.

To Kelley and Bloom, I say this: Kudos!

If this was in California, I would defend you for free.



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5. Psychophysiological responsivity and conscious appraisal of affective stimuli in non-organic syncope

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Publication date: April 2016
Source:Clinical Neurophysiology, Volume 127, Issue 4
Author(s): D. Crivelli, G. Lecci, B. Nelli, P.L. Baldi, M. Balconi
Transient losses of consciousness and muscular tone that characterize syncope are due to a sudden decrease of blood flow to the brain. Nevertheless, in part of patients reporting syncope episodes, the classic diagnostic process does not lead to a proper organic etiology – e.g. neutrally mediated or cardiac. Psychological non-organic factors like emotional dysregulation or anxiety mechanisms might act as triggers for those clinical manifestations. Given the link between affective experience and sympathetic-parasympathetic autonomic system, this research aims at investigating the hypothesis of a psychogenic etiopathogenesis and at sketching a clearer picture of affective responses in syncope. Control (healthy volunteers) and clinical (syncope patients with no organic etiology) groups were presented with arousing affective visual stimuli and assessed by psychometric tests. In order to explore both automatic and conscious processing of affective information, we recorded participants' psychophysiological responses (autonomic and EEG) and subjective appraisal ratings (valence and arousal). The comparison of psychometric, electrophysiological and autonomic data across patients and control subjects showed anomalous response profiles, with partially incongruent autonomic automatic psychophysiological responses and conscious appraisal ratings. While the dysregulation of psychophysiological responsivity might characterize syncope profiles, the complexity of clinical pictures suggest that different non-organic syncope subtypes may exist.



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Legal explanation, arguments for fire engine transport of sick child

Sometimes a split-second decision opens a can of worms. And sometimes a split-second decision smashes that can of worms open with a sledge hammer. EMS providers know that there's no time to wonder which it will be; sometimes the can just needs to be opened.

Such was the case in Fredericksburg, Virginia when Capt. James Kelley and his crew arrived to find a toddler unresponsive after an alleged seizure and, rather than wait for the ambulance, transported the child in the fire engine to the hospital — three minutes away.

Kelley and his crew are credited with saving the child's life. In return and paradoxically, he and Sgt. Virgil Bloom were suspended and subsequently reinstated for violating the policy that prohibits transporting patients in non-transport vehicles.

Our decisions open that can of worms
Many years ago, I wrote about doing what's right versus doing what's allowed in EMS. I pointed out that, "…for every action there are consequences, sometimes positive, sometimes negative but always consequences. You have to sleep at night and you have to look yourself in the eye every day. If you can sleep at all, what do you dream" When you look at yourself, who do you see" Finally, ask yourself a simple question … What consequences are you prepared to face and how willing are you to face them""

The case at hand demonstrates my point exactly. Kelley and his crew were faced with what they believed to be a life-determining situation and they responded as most of us would; by choosing life. As an EMS provider, I commend them.

The law, on the other hand, cannot readily see the penumbra; the spaces or colors in between black and white. By design, the law sees fact for fact and compares facts to laws as written. The law is intended to be blind — that sword cuts both ways.

Malum in Se: Wrong or evil in itself
The law sees some things as being wrong because by their very nature they are wrong; murder, rape, robbery, etc. This case is obviously not that.

Malum Prohibitum: Wrong because it is prohibited
On the other hand, the law also recognizes that some things are considered wrong because the book says so; those things are frequently subject to change as society matures. In the not-so-distant past, interracial marriage was illegal and it was legal to smoke on an airplane. Society has deemed both of those laws worthy of change.

Presently, it is simply Malum Prohibitum for an EMS provider to transport a patient in a vehicle not designated as a patient transport vehicle and there is no room for interpretation. Someday, maybe even as a result of cases like this, society will bend and the rules will change. Until then, the laws are what they are.

Arguing in favor of the paradox
Emergency responders are exactly that: emergency responders. They are tasked with the very difficult job of assessing situations, assessing patients and making split-second decisions about how best to manage everything.

In most cases, the law recognizes how challenging it is and affords some leeway.

This crew arrived to a situation they reasonably believed to require action more immediate than waiting an unknown length of time for an ambulance. It does not really matter whether they were right; it is only necessary that their conclusion be reasonable.

I was not there and I have no reason to doubt them. In fact, we as a community of professionals and as a society must [be able to] trust that they made the best, most rational, most reasonable decision under the circumstances. If we can't, then the whole system collapses under the weight of uncertainty.

The child was transported successfully and without incident. Moreover, they are credited with saving the child's life. I don't have any context for what that means, so I must accept it at face value.

The simplest argument in favor is this: In EMS, you do what you gotta do!

And, I agree.

Arguing against the paradox
Laws, rules, policies, protocols and procedures are all created and implemented to protect patients as well as providers. They are created with an understanding that EMS is dynamic and that we have not come close to seeing everything there is to see or knowing everything there is to know.

The rules of EMS are established — those that established them would say — after careful consideration, analysis and research. Policies are effectively written in the blood of those who came before and violating those policies, even with a happy outcome, is more dangerous to society than not.

Policy and protocol understand that resources don't always arrive at the same time and that, quite often, transport resources are delayed. The system is designed to manage that reality by having first responders who can initiate care in anticipation of the subsequent arrival of more advanced and or transport resources.

In this case, the law would argue that the fire engine lacked proper restraints and the equipment necessary to manage a radical change in the patient's condition. The patient could have been harmed just as easily as helped under countless predictable and unpredictable scenarios during the brief transport. The fact that there was no bad outcome is irrelevant, but the potential harm is enough.

The law says that the system only works when all of the pieces and parts function as intended.

And, I agree.

Conclusion
Both angles of the paradox can be true at the same time.

On the record, as an attorney who defends EMS providers, I say that providers can only find true safety, security and protection within the confines of policy, protocol and procedure as intended; those changes and improvements in thinking and practice must be codified before they are implemented; policies are intended to benefit patients above all and they should be followed with great faith and integrity.

Off the record, not as an attorney, but as an EMS provider, I say this: Consider the consequences and how willing you are to face them … then, do what you gotta do knowing there will be a price to be paid.

To Kelley and Bloom, I say this: Kudos!

If this was in California, I would defend you for free.



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7. EEG characteristics in “eyes open” vs “eyes closed” conditions: Small world network architecture in healthy aging and age-related brain degeneration

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Publication date: April 2016
Source:Clinical Neurophysiology, Volume 127, Issue 4
Author(s): F. Miraglia, F. Vecchio, P.M. Rossini
Applying graph theory, we investigated how cortical sources small worldness (SW) of resting EEG in eyes-closed/open (EC/EO) differs in mild cognitive impairment (MCI) and Alzheimer's disease (AD) subjects respect to normal elderly (Nold). EEGs were recorded in 30 Nold, 30 MCI, 30 AD during EC and EO. Undirected and weighted cortical brain network was built to evaluate graph core measures. eLORETA lagged linear connectivity was used to weight the network. In Nold, EO condition presented more random network (higher SW) in alpha bands and more regular organization (lower SW) in beta2 and gamma bands. In MCI, SW trend was the same, except for delta and theta bands with more ordered organization. AD showed similar trend of Nold, but with less fluctuations between the conditions. Furthermore, in both conditions, MCI SW architecture presented midway properties between AD and Nold. In low frequencies, Nold showed more random network organization, while SW parameter displayed a more ordered architecture with disease progression. Small world properties had different patterns in pathological aging in open eyes, with different trends in EEG frequency bands. Graph theory provides an excellent tool to characterize neuronal network capacities from coupling parameters of time-varying signals.



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9. “Validation of the new portable recording system BluNet for identifying patients with Respiratory Sleep Disorders”

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Publication date: April 2016
Source:Clinical Neurophysiology, Volume 127, Issue 4
Author(s): I. Roma, T. Atzori, A. Vettori, F. Gigliotti, B. Binazzi, V. Roma, A. Grippo
This study was designed to evaluate the diagnostic and technical accuracy of the new portable recording device BluNet. BluNet has innovative features that introduce a new generation of devices: modularity, communication with the iPad/iPhone world, ease in data exchange (European Data Format file), impressive small sizes and weight, use of wireless transmission (Bluetooth "Low Energy" 4.0). The validation was done by comparing N=10 recordings in patients with clinical suspicion of Respiratory Sleep Disorders. We performed simultaneous polygraphic recordings with BluNet and with the main reference portable PSG device, Embletta GOLD. The PSG data acquired during the night were: air flow through a nasal cannula, chest and abdomen movements via inductive belts, oxygen saturation, and heart rate via saturimeter. The recordings were analysed manually by a blinded investigator. The AHI obtained by the BluNet device are closely correlated to that obtained by Embletta (Pearson correlation, r= 0.988); the correlation between oxygen desaturation index by BluNet and the one by Embletta was also strong (r= 0.943). Similar diagnostic sensitivity in detecting OSA was found with the two portable devices. We concluded that BluNet is clinically applicable, technically reliable, and sensitive for the diagnostics of Respiratory Sleep Disorders.



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Behavioral Rehearsal for Analogue Fidelity: Feasibility in a State-Funded Children’s Mental Health Initiative

Abstract

A substantial number of evidence-based treatments (EBTs) are available, but are delivered infrequently in public mental health. To improve the quality of care, some states and systems have focused on EBT training; however, these efforts have rarely included objective measurement of clinician fidelity because of feasibility issues. The primary goal of the current study was evaluating the feasibility of the behavioral rehearsal (BR) method to assess "analogue fidelity" in a children's mental health quality improvement initiative. Results indicated low—but representative—clinician participation. Participants demonstrated greatest improvement at post-training with maintenance or decreases at 6-months (post-consultation). Implications for future use of BR are discussed.



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11. Visual electrophysiology revealed the diagnosis in an unusual case of bilateral blindness at the multiple sclerosis center. A case of bilateral chronic optic neuropathy related to inverted papilloma of paranasal sinuses

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Publication date: April 2016
Source:Clinical Neurophysiology, Volume 127, Issue 4
Author(s): S. Silipo, M. Calabrese, I. Juergenson, Mc. Tozzi, S. Monaco, L. Bertolasi
The afferent visual pathway can be evaluated by the neurophysiologist using full-field ERG, transient or stationary P-ERG and pattern VEP. We report a case of a 65 year-old man which was admitted to the Multiple Sclerosis Center because of chronic bilateral blindness where the visual electrophysiology gave important clues for an unexpected diagnosis. Recurrent episodes of subacute vision loss, without improvement after steroid therapy, led the patient to blindness in the right eye at age 45. Ten years later he developed a progressive loss of visual acuity on the contralateral eye. Ophthalmological examinations disclosed also recurrent episodes of left anterior uveitis lately complicated by cataract. However the visual acuity on the left eye didn't improve after phacoemulsification. Brain and spinal MRI were normal as well as CSF examination and anti NMO antibodies. Rheumatological screening revealed only a positivity to HLA B27. The visual electrophysiology was consistent for bilateral chronic optic neuropathy without involvement of the retina or features of Leber disease or glaucoma. A tailored MRI of the orbits and CT scan of the face disclosed a butterfly-like inverted papilloma of paranasal sinuses which destroyed the wall of both optic canals. The patient underwent surgical treatment.



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13. Optical coherence tomography and multifocal visual evoked potential clinical usefulness in identifying visual pathway involvement

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Publication date: April 2016
Source:Clinical Neurophysiology, Volume 127, Issue 4
Author(s): S. Guerrieri, G. Di Maggio, F. Vitali, R. Santangelo, S. Medaglini, L. Moiola, U. Del Carro, V. Martinelli, G. Comi, L. Leocani
Full-field visual evoked potentials (ff-VEP) are fundamental in neurological practice, for defining the nature of visual disturbances. We explored whether, in case of normal ff-VEP and suspected organic visual pathway involvement, multifocal visual evoked potentials (mf-VEP) and optical coherence tomography (OCT) can be useful in the diagnostic workup. Observational case reports on 3 patients presenting with visual disturbances. Two had relapsing optic neuritis (ON) and visual acuity (VA) loss, with normal or non-significant ff-VEP outside acute clinical episodes. In both cases OCT showed a retinal nerve fiber layer (RNFL) thickness reduction, allowing visual pathway damage identification. The third, with meningioma involving left optic nerve, complained of blurred vision in the nasal field of the left eye as confirmed by computerized perimetry (CP). While ff-VEP showed normal latency and non-significant amplitude reduction in the left eye, mf-VEP showed important amplitude reduction in the lower visual field of the left eye. OCT scan confirmed axonal damage showing left RNFL thinning. Sometimes ff-VEP fails in identifying abnormalities in patients with pathologic processes involving the visual pathway, particularly in cases with axonal or sectorial optic nerve involvement. We suggest the importance of a multimodal evaluation, including OCT and mf-VEP.



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15. Scalp somatosensory evoked potentials recordings after human subthalamic and pedunculopontine tegmental nucleus stimulation

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Publication date: April 2016
Source:Clinical Neurophysiology, Volume 127, Issue 4
Author(s): A. Insola, P. Mazzone, M. Valeriani
The study aimed to investigate the pathways activated by deep brain stimulation (DBS). Four patients, suffering from parkinson disease (PD), underwent DBS electrode implant in the pedunculopontine (PPTg) nucleus (2 patients) and in the Subthalamic (STN) nucleus (2 patients) for neuromodulation. Somatosensory evoked potentials (SEPs) were recorded from the scalp to either median nerve or DBS electrode stimulation. The PPTg stimulation evoked a parietal negative and a frontal positive response at a latency of 3 ms, corresponding to the N20 and P20 potentials to median nerve stimulation, respectively. The STN stimulation evoked a negative potential at a latency of 6ms in both the parietal and frontal electrodes. Our findings show that the electrical stimulation of the PPTg electrode contacts activate an oligosynaptic (probably lemniscal) pathway, while the scalp responses to STN stimulation are mediated by a polysynaptic pathway.



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A study on the correlation between soil radon potential and average indoor radon potential in Canadian cities

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Publication date: Available online 9 March 2016
Source:Journal of Environmental Radioactivity
Author(s): Jing Chen, Ken L. Ford
Exposure to indoor radon is identified as the main source of natural radiation exposure to the population. Since radon in homes originates mainly from soil gas radon, it is of public interest to study the correlation between radon in soil and radon indoors in different geographic locations. From 2007 to 2010, a total of 1070 sites were surveyed for soil gas radon and soil permeability. Among the sites surveyed, 430 sites were in 14 cities where indoor radon information is available from residential radon and thoron surveys conducted in recent years. It is observed that indoor radon potential (percentage of homes above 200 Bq m−3; range from 1.5% to 42%) correlates reasonably well with soil radon potential (SRP: an index proportional to soil gas radon concentration and soil permeability; average SRP ranged from 8 to 26). In five cities where in-situ soil permeability was measured at more than 20 sites, a strong correlation (R2 = 0.68 for linear regression and R2 = 0.81 for non-linear regression) was observed between indoor radon potential and soil radon potential. This summary report shows that soil gas radon measurement is a practical and useful predictor of indoor radon potential in a geographic area, and may be useful for making decisions around prioritizing activities to manage population exposure and future land-use planning.



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25. Çocuk ve Ergen Ruh Sağlığı ve Hastalıkları Kongresi Bildirileri

2016-03-10T09-04-57Z
Source: Çocuk ve Gençlik Ruh Sağlığı Dergisi / Turkish Journal of Child and Adolescent Mental Health
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Imaging of topiramate induced myopic shift and choroidal effusion by ultrasonographic biomicroscopy: a case report [Topiramat kullanımına bağlı gelişen miyopik kayma ve koroidal efüzyonun ultrason biyomikroskopi ile gösterilmesi: olgu sunumu]

2016-03-10T06-08-42Z
Source: Medicine Science | International Medical Journal
Akin Cakır, Eyup Duzgun, Onat Yilmaz, Serkan Demir, Yildiray Yildirim.
In this case report, we discuss a 22-year-old female patient with diagnosis of migraine who developed high myopia and choroidal effusion after 7 days of treatment with topiramate. The anterior chamber parameters that induced myopia and choroidal effusion were demonstrated by using ultrasonic biomicroscopy. We aimed to augment the knowledge of the neurologists, psychiatrists and ophthalmologists about the plausible complications of topiramate treatment. The patients under topiramate theraphy must be warned about terminating treatment and consulting to an ophthalmologist immediately when visual symptoms emerged.


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Movement distributions of stroke survivors exhibit distinct patterns that evolve with training

While clinical assessments provide tools for characterizing abilities in motor-impaired individuals, concerns remain over their repeatability and reliability. Typical robot-assisted training studies focus on r...

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Quick Clip: What's different about pediatric assessment?

Download this quick clip on iTunes, SoundCloud or via RSS feed

In this week's Quick Clip, co-hosts Chris Cebollero and Kelly Grayson comment on how EMS providers are dealing with pediatric calls and assessment. Chris argues that providers aren't completing enough education, training and continuing education courses on pediatric care. He begs the question: if we know pediatric assessment is a weakness in our career field, why aren't providers doing more to learn how to deal with this population"

Do you think pediatric education needs to be more extensive" Sound off in the comment section below.



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Static balance ability as an indication of static stability among healthy physical therapy students at Taibah University

2016-03-10T04-06-36Z
Source: International Journal of Health and Rehabilitation Sciences (IJHRS)
Tarek M. El-gohary, Hala Abdelmonem Nassar, Abdullah M. Alshenqiti, Mahmoud I. Ibrahim, Osama A. Khaled, Mostafa S. Ahmed, Hatem A. Emara, Sameh R. Ibrahim.
Background: Balance is an essential component for the overall physical performance among individuals. Objectives: The purpose of this study was to investigate and to compare the static balance ability, in terms of endurance time, during trunk stability push-up and during deep squat. Method and Materials: Twenty three healthy physical therapy students, aged between 20 and 23 years, were recruited from college of medical rehabilitation to participate in the study. The physical therapy testers demonstrated the activity to the participants. Every participant had to maintain his balance as long as tolerated during deep squat and during doing push-up while maintaining the trunk stable. The order of measurement was counterbalanced. Results: The mean score, in seconds, for trunk stability push-up was 49.57 (SD=22.07), and the mean score for deep squat was 52.83 (SD=24.60). No significant difference between trunk stability push-up and deep squat mean value, was found [ t (22)= -0.639, p >0.05]. Also, a moderate positive correlation was found [r (21) = 0.454, p


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Presynaptic BK channels control transmitter release: Physiological relevance and potential therapeutic implications

Abstract

BK channels are large conductance potassium channels characterized by four pore-forming α subunits, often co-assembled with auxiliary β and γ subunits to regulate Ca2+ sensitivity, voltage dependence and gating properties. Abundantly expressed in the CNS, they have the peculiar characteristic of being activated by both voltage and intracellular calcium rise. The increase in intracellular calcium via voltage-dependent calcium channels (Cav) during spiking triggers conformational changes and BK channel opening. This narrows the action potential and induces a fast after-hyperpolarization that shuts calcium channels. The tight coupling between BK and Cav channels at presynaptic active zones makes them particularly suitable for regulating calcium entry and neurotransmitter release. While in most synapses, BK channels exert a negative control on transmitter release under basal conditions, in others only under pathological conditions, serving as an emergency brake to protect against hyperactivity. In particular cases, by interacting with other channels (i.e. limiting the activation of the delayed rectifier and the inactivation of Na+ channels), BK channels induce spike shortening, increase in firing rate and transmitter release. Changes in transmitter release, following BK channel dysfunctions have been implicated in several neurological disorders including epilepsy, schizophrenia, Fragile X syndrome, mental retardation and autism. In particular, two mutations, in the α and in the β3 subunits, respectively, resulting in a gain of function, have been associated with epilepsy. Hence, these discoveries have allowed identifying BK channels as new drug targets for therapeutic intervention.

This article is protected by copyright. All rights reserved



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Framing the grid: Effect of boundaries on grid cells and navigation

Abstract

Cells in the mammalian hippocampal formation subserve neuronal representations of environmental location and support navigation in familiar environments. Grid cells constitute one of the main cell types in the hippocampal formation and are widely believed to represent a universal metric of space independent of external stimuli. Recent evidence showing that grid symmetry is distorted in non-symmetrical environments suggests that a re-examination of this hypothesis is warranted. In this review we will discuss behavioural and physiological evidence for how environmental shape and in particular enclosure boundaries influence grid cell firing properties. We propose that grid cells encode the geometric layout of enclosures.

This article is protected by copyright. All rights reserved



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A rising trend in the incidence of advanced gastric cancer in young Hispanic men

Gastric Cancer

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Tobacco smoking is not associated with accelerated liver disease in HIV-Hepatitis C Co-infection: A longitudinal cohort analysis

Open Forum Infectious Diseases

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Exploratory analysis on overall survival after either surgery or stereotactic radiotherapy for lung oligometastases from colorectal cancer

Clinical Oncology

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Proton pump inhibitor therapy for the treatment of laryngopharyngeal reflux: a meta-analysis of randomized controlled trials

Journal of Clinical Gastroenterology

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GS-9857 in patients with chronic hepatitis C virus genotype 1–4 infection: a randomized, double-blind, dose-ranging phase 1 study

Journal of Viral Hepatitis

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Inflammatory bowel disease in pregnancy: A population-based study of prevalence and pregnancy outcomes

BJOG: An International Journal of Obstetrics and Gynaecology

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Nomogram for predicting lymph node metastasis rate of submucosal gastric cancer by analyzing clinicopathological characteristics associated with lymph node metastasis

Chinese Journal of Cancer Research

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Risk of vascular thrombotic events following discontinuation of antithrombotics after peptic ulcer bleeding

Journal of Clinical Gastroenterology

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Intrahepatic bile ducts are developed through formation of homogeneous continuous luminal network and its dynamic rearrangement

Hepatology

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Fluorouracil-based preoperative chemoradiotherapy with or without oxaliplatin for stage II/III rectal cancer: a 3-year follow-up study

Chinese Journal of Cancer Research

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Utility of esophagram versus high-resolution manometry in the detection of esophageal dysmotility

Otolaryngology - Head and Neck Surgery

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Identification of a serum transglutaminase threshold value for the noninvasive diagnosis of symptomatic adult celiac disease patients: A retrospective study

Journal of Gastroenterology

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Association of vitamin D level with clinical status in inflammatory bowel disease: A 5-year longitudinal study

The American Journal of Gastroenterology

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Chronic vagus nerve stimulation in Crohn's disease: A 6-month follow-up pilot study

Neurogastroenterology & Motility

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Multicenter clinical evaluation of the new 3rd generation assay for detection of antibodies against hepatitis C virus on the VIDAS system

Journal of Clinical Virology

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What is the likelihood of colorectal cancer when surgery for ulcerative colitis associated dysplasia is deferred?

Colorectal Disease

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Modeling how substitution of sedentary behavior with standing or physical activity is associated with health-related quality of life in colorectal cancer survivors

Cancer Causes and Control

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Influence of sorafenib and bevacizumab on pancreatic volume - A monocentric CT based analysis

Pancreatology

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Minimizing the acquisition time for intravoxel incoherent motion magnetic resonance imaging acquisitions in the liver and pancreas

Investigative Radiology

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Derived neutrophil lymphocyte ratio is predictive of survival from intermittent therapy in advanced colorectal cancer: A post hoc analysis of the MRC COIN study

British Journal of Cancer

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Evaluation of the HystSim™-virtual reality trainer: an essential additional tool to train hysteroscopic skills outside the operation theater

Abstract

Background

Minimally invasive surgery is a major pillar of gynecological surgery. However, there are very few training opportunities outside the operation theater (OR) due to the cost and equipment requirements of organ simulators, virtual reality trainers (VRT) are promising tools to fill this gap.

Methods

Experienced and inexperienced participants of a minimally invasive surgery course followed the standardized HystSim™-VRT training program.

Results

Performance of 39 Participants (15 inexperienced and 24 experienced) was evaluated in the standardized hysteroscopic program HystSim™. Tasks included three rounds of both a polyp and a myoma resection. Primary measurements were improvement in resection time, cumulative resection path length, and distention media use.

Conclusion

The HystSim™-VRT is an effective tool to improve the psychomotor skills needed in hysteroscopic surgery for experienced and inexperienced surgeons prior to OR exposure. Additional organ models training is advisable for hysteroscopic haptic skills



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Perioperative spleen embolization as a useful tool in laparoscopic splenectomy for simple and massive splenomegaly in children: a prospective study

Abstract

Objective

The purpose of this prospective study is to evaluate the efficiency of perioperative spleen embolization prior to laparoscopic splenectomy indicated for hypersplenism.

Methods

We conducted a prospective study exploring a technique combining ultra-selective perioperative embolization and splenectomy. Between January 2008 and March 2013, 16 splenectomies were performed in children suffering from hypersplenism due to varying hematologic diseases. Spleen embolization was performed by an interventional radiologist in the operating room (OR) just before splenectomy and during the same general anesthesia. Ages varied from 3 to 17 years. Spleen volume was measured by preoperative ultrasound. One patient underwent a laparotomy because of suspected adhesions due to previous surgery. All other operations were performed laparoscopically.

Results

One complication arose from embolization: a perforation of the splenic artery. After immediately placing a platinum coil proximal to the perforation, the splenectomy was carried out as usual. Fourteen children (87.5 %) had splenomegaly, of which eight (50 %) had massive splenomegaly. There were no deaths, no conversions to laparotomy, no reoperations and none of these patients had to be transfused.

Conclusions

Perioperative spleen embolization performed in the OR by an interventional radiologist makes laparoscopic splenectomy a safer procedure. We propose a preoperative method for spleen measurement that is adapted to children: simple and massive splenomegaly is defined through patient body weight and a preoperative ultrasound. We conclude that spleen size is no more a limiting factor for laparoscopic splenectomy in children.



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Retrospective analysis of oral cavity squamous cell carcinoma treated with surgery and adjuvent radiotherapy

2016-03-10T01-33-04Z
Source: International Journal of Research in Medical Sciences
Mohit Sharma, Abhinav Deshpandey, Nayan Gupta, Mahesh Patel.
Background: Oral cavity cancer is one of the leading causes of cancer related deaths in developing countries. Most of the failures occur due to locoregional recurrence. The present study was conducted to find out the pattern of recurrences and factors responsible for that in oral cavity squamous cell carcinoma (SCC). Methods: The study was conducted at Gujarat cancer and research institute Ahmedabad, India. Total 260 patients were evaluated in study from year January 2013 to December 2013 retrospectively. Two year follow up was studied to find out the pattern of failure in terms of local, regional (nodal) and systemic. Results: Oral cavity SCC has high chances of local failure when removed inadequately during surgery. Perineural spread, lymphovascular involvement and perinodal spread are important prognostic factors. Conclusions: Most patients of oral cavity cancer present in advanced stages. Close margins and perineural involvement are responsible for local recurrences while perinodal spread and lymphovascular involvement contributes to nodal recurrences. Tobacco consumption is important responsible factor.


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Serum magnesium levels in type 2 diabetes

2016-03-10T01-33-04Z
Source: International Journal of Research in Medical Sciences
Yeluri Seshagiri Rao, Dharma Rao V..
Background: Several studies undertaken in different parts of the world have shown that hypomagnesemia occur at an increased frequency among patients with type 2 diabetes compared with their counterparts without diabetes. As current data suggest adverse outcomes in association with hypomagnesemia, it is prudent to monitor magnesium routinely in this patient population and treat the condition whenever possible. Therefore, this study was undertaken to determine the serum magnesium levels in type 2 diabetes in this part of our country. Methods: A cross-sectional study was conducted in 100 subjects, 50 diabetics without complications (group I), 50 diabetics with complications (group II) and 100 normal healthy controls (group III). Blood sugar levels, magnesium, HbA1C (%), cholesterol and triglyceride level were measured. Results: Serum magnesium levels were found low in study group as compared to control group. A significant correlation between HbA1C and magnesium levels was seen. The patients with diabetic complications have significantly higher values of serum cholesterol and triglycerides. Conclusions: Hypomagnesemia in type 2 diabetes was associated with poor glycemic control and with increased frequency of long term complications.


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Awareness of glaucoma among non-medical students in South India

2016-03-10T01-33-04Z
Source: International Journal of Research in Medical Sciences
Sanjeev Kumar Puri, Suma Elangovan.
Background: Glaucoma is one of the leading causes of blindness in the world. According to World health organization glaucoma is the second leading cause of blindness worldwide. The objective was to study the level of awareness about glaucoma among students (non-medical). Methods: A questionnaire based study was conducted among 430 students (non-medical) which tests the basic knowledge about glaucoma. Results: Out of 430 students 94.18% (405/430) did not know what glaucoma was. 3.95% (17/430) have heard about glaucoma and they knew that it was a disease of the eye. Only 8 students 1.86% (8/430) were aware of the fact that glaucoma can lead to blindness. Conclusions: The level of awareness of glaucoma is very low among students (non-medical). Efforts should be made to increase the awareness among them so that not only they will subject themselves for screening but also persuade their family members, friends and relatives for the same.


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Perception of refractive surgery among undergraduate medical students and their preferred method of refractive correction

2016-03-10T01-33-04Z
Source: International Journal of Research in Medical Sciences
Sanjeev Kumar Puri, Suma Elangovan.
Background: Refractive errors are a major cause of defective visual acuity in all age groups. Spectacles are the traditional and most widely used method of optical correction among all age groups. The main objective was to study the perception about refractive surgery among undergraduate medical students with refractive errors and their preferred method of refractive correction. Methods: A questionnaire based study was conducted among 227 undergraduate medical students with refractive errors. Results: Among 227 students, the prevalence of myopia was 89.42% and hypermetropia was 10.13%.There was one case of keratoconus (0.44%). None of them had undergone refractive surgery. 84.14 % were using only spectacles for correction of refractive error. 13.21% were using contact lenses. 0.88% was using both. Among spectacle users, 71.35% were satisfied with the use of spectacles, the reasons being ease of use and maintenance. 35.41% were not satisfied with spectacles and the main reason was dependency. Among the spectacle users, 23.56% wanted to switch over to contact lenses and the main reason was cosmetic. 92.51% were aware of refractive surgery, out of which 36.66% were willing to undergo refractive surgery. 65.92% were not willing to undergo refractive surgery, the main reason being risk of complications. Conclusions: The preference and willingness to undergo refractive surgery was less due to the fear of complications and the cost of the procedure. Spectacles remain the most preferred method the main reason being ease of use and it is maintenance free. Contact lenses are the next preferred method and the main reason was cosmetic.


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Construction and Validation of a Dual-Transgene Vector System for Stable Transformation in Plants

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Publication date: Available online 10 March 2016
Source:Journal of Genetics and Genomics
Author(s): Zhimin He, Bin Liu, Xu Wang, Mingdi Bian, Reqing He, Jindong Yan, Ming Zhong, Xiaoying Zhao, Xuanming Liu
In this study, we constructed dual-transgene vectors (pDT1, pDT7, and pDT7G) that simultaneously co-expressed two genes for use in plants, and ACTIN2 and UBQ10 promoters were used to control the expression of these two genes. The use of 4×Myc, 3×HA, and 3×Flag reporter genes allowed for the convenient identification of a tunable co-expression system in plants, whereas the dexamethasone (Dex) inducible reporter gene c-terminus of the glucocorticoid receptor (cGR) provided Dex-dependent translocation of the fusion gene between the nucleus and cytoplasm. The function of pDT vectors was validated using four pairwise genes in Nicotiana benthamiana or Arabidopsis thaliana. The co-expression efficiency of two genes from the pDT1 and pDT7G vectors was 35% and 42%, respectively, which ensured the generation of sufficient transgenic materials. These pDT vectors are simple, reliable, efficient, and time-saving tools for the co-expression of two genes through a single transformation event and can be used in the study of protein-protein interactions or multi-component complexes.



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Non-invasive Assessment of NASH and NASH-related Fibrosis: is There a Role for Cytokeratin 18?.

No abstract available

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Are We Overdoing Pediatric Lower Gastrointestinal Endoscopy?.

Introduction: Lower gastrointestinal endoscopy (LGIE)/colonoscopy is frequently performed for rectal bleeding, recurrent abdominal pain and the diagnosis of Inflammatory Bowel Disease (IBD). Although these are common indications, the yield for isolated rectal bleeding and recurrent abdominal pain in the otherwise well child has not been described. Methods: A retrospective analysis of patients who had had a LGIE/colonoscopy from January 2001 - December 2010 was performed. The following data were collected: demographic data, indication, distance reached, macroscopic findings, microscopic findings, diagnosis, additional procedures and complications. Results: There were a total of 999 colonoscopies. The colonoscopy was normal in 390/999 (39%). The commonest indication for colonoscopy was for a diagnosis of suspected IBD, 449/999 (45%). IBD was confirmed in 282/449 (63%) but colonoscopy was normal in 143/449 (32%) of suspected IBD. Colonoscopy was performed for rectal bleeding in 197/999 (20%) of whom 141/197 (72%) were normal. There were 46 (5%) colonoscopies performed for recurrent abdominal pain which were all normal. Our completion rate to the cecum and beyond was 521/999 (52%). Our perforation rate over the 10 years was 0.2%. Conclusions: Colonoscopy is a safe procedure in pediatrics, however thirty-nine percent of colonoscopies in this series were normal. Many of these could have been avoided by eliminating colonoscopy in patients with recurrent abdominal pain in the absence of other clinical features, conservative management with laxatives for those with fresh blood per rectum typical of anal fissures, and fecal calprotectin screening prior to endoscopy in patients with suspected IBD. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Identification of Circulating MicroRNAs in Biliary Atresia by Next-Generation Sequencing.

Objectives: Biliary atresia (BA) is an idiopathic neonatal liver disease, characterized by inflammatory and fibrotic obliteration of extrahepatic bile ducts. Therefore, reliable methods for noninvasive diagnosis are needed. This study aimed to analyze circulating microRNAs (miRNAs) in patients with BA using next-generation sequencing (NGS) for identifying novel diagnostic biomarkers. Methods: An initial screening of miRNAs in plasma from patients with BA and healthy controls (HCs) was performed on an Illumina NGS platform. Differential miRNAs were validated by quantitative real-time PCR (qPCR). Target genes and related signal transduction pathways of differential miRNAs were predicted by online software. Results: In total, 146 differential miRNAs were identified by deep sequencing. Fifteen miRNAs with read counts more than 1000, that included 7 upregulated and 8 downregulated miRNAs, were predicted to be associated with liver fibrosis, biliary differentiation and bile duct development. Of these, six miRNAs with read counts more than 5000 were analyzed by qPCR on an independent sample set comprising 44 patients with BA, 20 cholestatic disease controls and 20 HCs. Two up-regulated miRNAs (miR-122-5p, miR-100-5p) and two down-regulated miRNAs (miR-140-3p, miR-126-3p) were confirmed by individual qPCR. Only miR-140-3p was significantly different from controls (P

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Influence of Partial External Biliary Diversion on the Lipid Profile in Children with PFIC.

Background and aim: The concentration of bile acids is highly increased in progressive familial intrahepatic cholestasis (PFIC). Bile acids are the end products of cholesterol metabolism, and aid in the absorption of fat-soluble vitamins and dietary fat. The aim of our study was to investigate lipid metabolism in PFIC patients with focus on the effect of partial external biliary diversion (PEBD). Methods: In 26 patients with PFIC, who underwent PEBD surgery at the median age of 2.2 years (range: 0.4-16.6),we analyzed the concentrations of lipids and apolipoproteins both before and 6 months after PEBD. Patients were split into two groups according to the outcome of surgery (either "good" or "poor"), and were analyzed separately. A "good" result following surgery was defined as complete relief from pruritus, and normalization of total bilirubin ( 190 mg/dl) in 13 patients, phospholipids were increased (>250 mg/dl) in five patients, and triglyceride concentration was increased (>150 mg/dl) in 13 patients. After PEBD, the concentrations of plasma cholesterol, triglycerides, and phospholipids decreased significantly; whereas, ApoA-I and HDL-C concentrations increased and the concentrations of ApoB, LDL-C and VLDL-C significantly decreased. PEBD had neither an effect on ApoE concentration nor on LCAT activity. In the group with a "poor" outcome report following PEBD, total serum cholesterol concentration decreased significantly, and no effect on the concentrations of triglycerides and phospholipids were observed. Conclusion: Patients with PFIC present with a high risk of lipid disturbances. PEBD has a beneficial effect on lipid profile in the majority of cases. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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