Publication date: Available online 11 May 2016
Source:Mutation Research/Reviews in Mutation Research
Author(s): M. Villarini, V. Gianfredi, S. Levorato, S. Vannini, T. Salvatori, M. Moretti
Many studies have reported the occurrence of work-environment contamination by antineoplastic drugs (ANPD), with significant incorporation of trace amounts of these hazardous drugs in hospital personnel. Given the ability of most ANPD to actively bind DNA, thus inducing genotoxic effects, it is of pivotal importance to assess the degree of genotoxic damage (i.e., residual genotoxic risk) in occupationally exposed subjects. The lymphocyte cytokinesis-block micronucleus (L-CBMN) assay is largely used for biological effect monitoring in subjects occupationally exposed to ANPD. In this study, we identified and analyzed the studies published reporting the use of the L-CBMN assay as biomarker of genotoxic risk in health care workers exposed to ANPD with the aim of performing meta-analysis and providing a meta-estimate of the genotoxic effect of exposure. We retrieved 24 studies, published from 1988 to 2015, measuring MN in peripheral blood lymphocytes in health care workers occupationally exposed to ANPD. In 15 out of the 24 studies (62.5%), increased MN frequencies were recognized in exposed subjects as compared to controls. The meta-analysis of MN frequency of the combined studies confirmed an association between occupational exposure to ANPD and cytogenetic effects with an overall meta-estimate of 1.67 [95% CI: 1.41–1.98]. In 16 out of the 24 studies (66.6%) at least one other genotoxicity biomarker, besides L-CBMN assay, was employed for biological effect monitoring. In several studies the effect of exposure to ANPD was evaluated also in terms of MN in exfoliated buccal cells. Other studies focused on genotoxicity endpoints, such as sister chromatid exchanges (3 studies), chromosome aberrations (6 studies), or primary DNA damage investigated by comet assay (7 studies). Overall, there was good agreement between other genotoxicity tests employed and L-CBMN assay outcomes.
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Τετάρτη 11 Μαΐου 2016
Occupational exposure to cytostatic/antineoplastic drugs and cytogenetic damage measured using the lymphocyte cytokinesis-block micronucleus assay: A systematic review of the literature and meta-analysis
Questioning a Central Asian origin of dogs [Biological Sciences]
A recent study by Shannon et al. (1) proposes a Central Asian domestication origin of dogs, based upon the finding that Central Asia had the lowest short-range linkage disequilibrium (LD) among village dogs across the globe. A reanalysis of their data, however, suggests that these conclusions may require revision. First,...
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Reply to Wang et al: Central Asian origin of dogs [Biological Sciences]
We welcome the additional data and analyses of Wang et al. (1), but believe there are some misunderstandings regarding the methods and findings of Shannon et al. (2). First, although we merged Nepal and Mongolia when plotting linkage disequilibrium (LD) decay in figure 5B of ref. 2 for legibility, we...
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Rational elicitation of cold-sensitive phenotypes [Genetics]
Cold-sensitive phenotypes have helped us understand macromolecular assembly and biological phenomena, yet few attempts have been made to understand the basis of cold sensitivity or to elicit it by design. We report a method for rational design of cold-sensitive phenotypes. The method involves generation of partial loss-of-function mutants, at either...
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Acute ethanol effects on neural encoding of reward size and delay in the nucleus accumbens
Acute ethanol administration can cause impulsivity, resulting in increased preference for immediately available rewards over delayed but more valuable alternatives. The manner in which reward size and delay are represented in neural firing are not fully understood, and very little is known about ethanol effects on this encoding. To address this issue, we used in vivo electrophysiology to characterize neural firing in the core of the nucleus accumbens (NAcc) in rats responding for rewards that varied in size or delay after vehicle or ethanol administration. The NAcc is a central element in the circuit that governs decision making and importantly promotes choice of delayed rewards. We found that NAcc firing in response to reward-predictive cues encoded anticipated reward value after vehicle administration, but ethanol administration disrupted this encoding, resulting in a loss of discrimination between immediate and delayed rewards in cue-evoked neural responses. In addition, NAcc firing occurring at the time of the operant response (lever pressing) was inversely correlated with behavioral response latency, such that increased firing rates were associated with decreased latencies to lever press. Ethanol administration selectively attenuated this lever press-evoked firing when delayed but not immediate rewards were expected. These effects on neural firing were accompanied by increased behavioral latencies to respond for delayed rewards. Our results suggest ethanol effects on NAcc cue-and lever press-evoked encoding may contribute to ethanol-induced impulsivity.
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Trauma care OUS.
Trauma care Oslo Univerety Hospital: First stop E.R., next door it`s a "Hybrid room" (combined O.R. and diagnose room (so surgery can start,-and further diagnose- during life-saving surgery). CT next door. Simmilar set-up for Medical emergencys. Heliport 5 floors upp, dedicated elevator. Put you`r shoulder to the wheel: https://youtu.be/RcZDL6dQA0M ExEMTNor
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Trauma care OUS.
Trauma care Oslo Univerety Hospital: First stop E.R., next door it`s a "Hybrid room" (combined O.R. and diagnose room (so surgery can start,-and further diagnose- during life-saving surgery). CT next door. Simmilar set-up for Medical emergencys. Heliport 5 floors upp, dedicated elevator. Put you`r shoulder to the wheel: https://youtu.be/RcZDL6dQA0M ExEMTNor
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Trauma care OUS.
Trauma care Oslo Univerety Hospital: First stop E.R., next door it`s a "Hybrid room" (combined O.R. and diagnose room (so surgery can start,-and further diagnose- during life-saving surgery). CT next door. Simmilar set-up for Medical emergencys. Heliport 5 floors upp, dedicated elevator. ExEMTNor
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Role of anesthesiologists in the management of trauma patients: Updates
Ain-Shams Journal of Anaesthesiology 2016 9(2):153-158
Trauma is the leading cause of death for individuals up to the age of 45 years and the third leading cause of death overall for every age groups. In the United States, trauma accounts for more than 180.000 deaths per year and about 2.8 million hospital admissions, Trauma anesthesiologists are prepared to immediate care of patients with any form and severity of injury, who may require any kind of operations regardless of the day time of night. Therefore trauma anesthesiologists offer a unique expertise and skill set that are significantly different from those offered by other medical specialists and being a part of the hospital trauma team.
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Ultrasound-guided transversus abdominis plane block versus caudal block for postoperative analgesia in children undergoing unilateral open inguinal herniotomy: A comparative study
Ain-Shams Journal of Anaesthesiology 2016 9(2):284-289
Background Ultrasound (US)-guided transversus abdominis plane (TAP) block is an effective technique in providing analgesia for abdominal surgery. This study was designed to evaluate the efficacy of a US-guided TAP block and to compare it with a caudal block in unilateral day-case open inguinal hernia repair in children. Patients and Methods Forty ASA I-II, 1-5-year-old children scheduled for elective unilateral open inguinal herniotomy were studied. All patients received general anesthesia; sevoflurane was used for induction and maintenance of anesthesia and laryngeal mask airway (LMA) was used to secure the airway. After securing an intravenous cannula, patients were randomized to a US-guided TAP block (n = 20) (group T) using 0.5 ml/kg 0.25% bupivacaine, injected on the same side of surgery, and group C received a caudal block using 1 ml/kg 0.2% bupivacaine (n = 20). Surgery was allowed 15 min after administration the block. Block failure was considered in case of gross movement or more than 20% change in heart rate and/or ABP persisting more than 1 min after skin incision. Any adverse events were recorded. After surgery, patients remained for 4 h in the recovery room. Postoperative analgesia was evaluated using Children and Infants Postoperative Pain Scale (CHIPPS). An anesthesiologist, who was not part of the study team, evaluated the need for rescue analgesia in the intraoperative and postoperative period and a recovery nurse collected the data. If the CHIPPS score was greater than 4, a rescue analgesia of 20 mg/kg acetaminophen was administered. Results No difference was found in hemodynamics in both groups. Also, intraoperative fentanyl consumption was not different and no rescue analgesia was required in the postanesthesia care unit. Conclusion A US-guided TAP block is as effective as a caudal block in providing immediate postoperative analgesia in inguinal hernia repair.
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The effects of dexmedetomidine added to bupivacaine for parasternal intercostal block in pediatric open heart surgery
Ain-Shams Journal of Anaesthesiology 2016 9(2):159-164
Background Regional analgesia is used for pain relief after pediatric open heart surgery. This study was designed to compare the analgesic effect of dexmedetomidine added to bupivacaine in performing parasternal block after sternotomy. Patients and methods Sixty American Society of Anesthesiologists (ASA) III-IV patients who were submitted to corrective open cardiac surgery were enrolled in this study and randomly allocated either into the dexmedetomidine group in which patients were given a mixture of 0.25% bupivacaine, 0.6 ml/kg and dexmedetomidine 1 mg/kg (dexmedetomidine group, n = 30) or into the control group in which patients were given 0.25% bupivacaine and 0.6 ml/kg (control group, n = 30). Postoperative pain (FLACC) scores, hemodynamics, opioid consumption, and hospital length of stay were evaluated in all patients. Results Heart rate, mean arterial pressure, and FLACC score were significantly lower in the dexmedetomidine group compared with the control group after 4 and 8 h in ICU. Duration of intubation and ICU stay were significantly shorter in the dexmedetomidine group compared with the control group. Ramsay sedation score was lower in the dexmedetomidine group compared with the control group at 4 h in ICU. Bradycardia and hypotension incidence were higher in the dexmedetomidine group compared with that in the control group. Conclusion Adding dexmedetomidine to bupivacaine for parasternal block in pediatric patients submitted to open heart surgery leads to good pain control, less analgesic consumption, early extubation, and short ICU length of stay.
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Efficacy of sacral epidural blockade with bupivacaine versus morphine as pre-emptive analgesia for lumbar laminectomy surgeries
Ain-Shams Journal of Anaesthesiology 2016 9(2):260-266
Objectives Patients undergoing lumbar laminectomy experience severe pain in the postoperative period, which may increase the incidence of postoperative morbidity and complications. Adequate pain relief hastens rehabilitation and decreases the incidence of chronic pain. This study was designed to compare the efficacy of pre-emptive image-guided caudal epidural blockade with bupivacaine at low concentrations versus morphine administration on the attenuation of the stress response during and after lumbar laminectomy surgeries. Patients and methods Ninety adult American Society of Anaesthesiologists' physical status I and II patients were scheduled to undergo a single-level lumbar laminectomy and were administered a pre-emptive caudal injection of either 30 ml of bupivacaine 0.125% (group A) or 50 mg/kg preservative-free morphine added to a total dose of 30 ml saline (group B) or 30 ml saline (group C). Intraoperative vital data (heart rate, systolic, and diastolic blood pressure) were collected. The postoperative verbal rating scale score, the time of the first rescue analgesia, the total dose of rescue analgesia, and adverse effects were recorded for all patients in the first 24 h after surgery. Results The total verbal rating scale score and the need for rescue analgesia were significantly less in group A and group B than in group C, indicating better analgesia. There was no significant difference between the three groups in itching or the sedation score. Group C had a higher incidence of vomiting than groups A and B, whereas there was delayed ambulation in group A in comparison with the other groups. Conclusion A single caudal epidural injection of morphine is a safe, simple, and effective technique that provides prolonged postoperative duration of analgesia with fewer analgesic requirements postoperatively with earlier patients' ambulation without occurrence of any hemodynamic changes or increased incidence of adverse effects in lumber laminectomy surgeries.
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Use of dexmedetomidine for fast-track anesthesia in noncomplex pediatric cardiac surgery
Ain-Shams Journal of Anaesthesiology 2016 9(2):165-169
Introduction Fast-track anesthesia technique is now an important aspect for reducing or eliminating the adverse effects of prolonged postoperative ventilation together with reducing ICU and hospital length of stay. This study was conducted to evaluate the effect of using dexmedetomidine as an adjuvant drug for fast-track technique in pediatric cardiac surgery. Patients and methods Sixty patients of both sexes with ages ranging from 1 to 12 years indicated for correction of noncomplex congenital heart diseases with cardiopulmonary bypass (CPB) were included in this study. After standard inhalational induction using sevoflurane for all patients, they were randomly classified into two groups of 30 each. In the dexmedetomidine group (group D), the patients received an initial bolus dose of dexmedetomidine (0.4 mg/kg) over 10 min, followed by continuous infusion of 0.5 mg/kg/h until the end of CPB. In the propofol group (group P) the patients received an initial bolus dose of propofol (2 mg/kg) over 30 s, followed by infusion at rate of 0.5 mg/kg/min until the end of CPB. Results There were significant differences between the two groups (P < 0.05). As regards hemodynamics, heart rate was higher in the propofol group, whereas mean arterial pressure was higher in the dexmedetomidine group. Moreover, total dose of fentanyl, time of extubation in ICU, postoperative pain score, and need for postoperative analgesia were significantly higher in the propofol group. Conclusion Dexmedetomidine helps in fast-track anesthesia in pediatric cardiac surgery and has many desirable effects that encourage its use in the perioperative period.
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Exacerbation of phantom limb pain following spinal anaesthesia: A case report and review of the literatures
Ain-Shams Journal of Anaesthesiology 2016 9(2):309-310
Phantom limb pain has been reported in patients with lower limb amputation during subsequent spinal anaesthesia. No therapy has been proven to be uniformly effective. Here, we report a case managed successfully with ketamine and magnesium sulphate.
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Root cause analysis of ventilator-associated pneumonia and the effect of analysis of expanded ventilator bundle of care
Ain-Shams Journal of Anaesthesiology 2016 9(2):170-177
Objectives The study had the following aims: (i) assess the risk factors and causes of ventilator-associated pneumonia (VAP) by means of the root cause analysis (RCA) module; (ii) compare the compliance with expanded ventilator bundle (EVB) and the effect of EVB on VAP rate, length of ICU stay (LOS), and mortality rate before and after bundle implementation; and (iii) suggest an action plan to reduce VAP. Patients and methods An 18-month study was conducted on all ventilated patients in our ICU. The preinterventional period was 9 months before implementing the bundle. We analyzed the causes and risk factors of VAP by using the RCA module. The postinterventional period was 9 months after implementing the bundle. Compliance with EVB was compared before and after implementing the bundle on a quarterly basis. We analyzed the effect of the bundle on VAP rate, LOS, and mortality rate. We suggested an action plan to reduce the VAP rate. Results There was lower compliance with the bundle in the preinterventional period than in the postinterventional period (P < 0.001). There were highly statistically significant reductions in VAP rate, LOS, and mortality rate after implementation of EVB (P < 0.001). Conclusion EVB was associated with effective and significant reductions in VAP rate, LOS, and mortality rate. Implementation of the RCA module was helpful in suggesting a new action plan that would improve bundle of care and its compliance.
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Comparison between colloid preload, coload, and no load in the prevention of spinal anesthesia-induced hypotension in patients undergoing inguinal hernia repair
Ain-Shams Journal of Anaesthesiology 2016 9(2):250-255
Background and objective The aim of this study was to know whether colloid fluid administration (either preloading or coloading) can decrease the incidence of hypotension secondary to spinal anesthesia in an elderly population undergoing inguinal hernia repair without mesh. Patients and methods After obtaining institutional ethical committee's approval and patients' informed consent, 84 patients (aged 61-89 years) scheduled for elective inguinal hernia repair were enrolled in this prospective, randomized study. We compared the incidence of hypotension and ephedrine requirement after spinal anesthesia between three groups: group P (n = 28), in which patients were preloaded with 500 ml of 6% hydroxyethyl starch solution (130/0.4), group C (n = 28), in which patients were coloaded with 6% hydroxyethyl starch solution during spinal anesthesia, and group N (n = 28), in which patients were not given any fluid. Results The incidence of hypotension and the mean dose of ephedrine were not significantly different between the three groups. Conclusion We concluded that, in elderly patients undergoing inguinal hernia repair, withholding fluid loading (whether preloading or coloading) did not increase the incidence of spinal anesthesia-induced hypotension and did not affect the dose of ephedrine required to correct hypotension, if occurred.
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Dexmedetomidine versus midazolam for sedation of critically ill patients on noninvasive mechanical ventilation
Ain-Shams Journal of Anaesthesiology 2016 9(2):178-185
Introduction Dexmedetomidine is a highly selective a-2 adrenoceptor agonist and eight times more specific than clonidine. It exerts its major sedative and analgesic effect through stimulation of the a-2 adrenoceptor and the locus coeruleus. Its analgesic effect is also produced by direct stimulation of the a-2 adrenoceptor in the spinal cord. The unique sedative effect of dexmedetomidine that mimics natural sleep makes the postsedative delirium after stopping dexmedetomidine very rare. Moreover, even on the sedative score Richmond Agitation-Sedation Scale (RASS)-1-2, patients can respond easily to verbal command and go back to sleep. The most commonly reported adverse effects are bradycardia and hypotension. Aim of the work This was a comparative prospective double-blind study comparing dexmedetomidine versus midazolam as a sedative agent used in noninvasive ventilation (NIV) and short-term intubation and mechanical ventilation (5 days). Patients and methods In all, 200 patients admitted to King Abd el Aziz Specialist Hospital, Taif, in the ICU with acute hypoxemia with SpO 2 less than 80% were allocated randomly to two groups. All patients in both groups were subjected to NIV for 3 days and if this failed (persistent hypoxemia, became hemodynamically unstable, or showed marked tracheal secretion), intubation and mechanical ventilation was considered for 5 days. Group A included 100 patients who received midazolam as a sedative agent, whereas group B included 100 patients who received dexmedetomidine as a sedative agent. The number of patients who responded to NIV in both groups was recorded and the number of patients who were extubated and weaned from mechanical ventilation in 5 days in both groups was also recorded together with the complications from sedation. Results There was a significant increase in the number of patients who responded to NIV in group B compared with group A. Moreover, there was a significant increase in the number of patients extubated and weaned from mechanical ventilation in the 5-day period in group B compared with group A. Conclusion Dexmedetomidine is a safer agent for sedation of critically ill patients with fewer incidences of delirium, and less morbidity and mortality compared with midazolam with the same efficacy.
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Enhancement of bupivacaine caudal analgesia by using dexamethasone or clonidine in children undergoing subumbilical surgery
Ain-Shams Journal of Anaesthesiology 2016 9(2):274-279
Background and aims Caudal analgesia produces profound intraoperative, as well as postoperative analgesia, with minimal psychological alteration in children. Because of its short duration, various additives have been used to prolong the duration of analgesia. The present study aimed to evaluate the effect of adding dexamethasone and clonidine to bupivacaine in caudal analgesia for children undergoing subumbilical surgeries. Patients and methods We conducted a prospective, randomized, single-blinded study on 100 patients of either sex belonging to the American Society of Anesthesiologists' physical status I, II in the age group 1-12 years, and undergoing subumbilical surgery under general anesthesia, were enrolled. Written informed consent was obtained from their parents. Patients were randomly divided into two groups (group D and C). Group D received 1 ml/kg of 0.25% bupivacaine with 0.2 mg/kg of dexamethasone in normal saline and group C received 1 ml/kg of 0.25% bupivacaine with 1 mg/kg of clonidine in normal saline, with maximum volume of 12 ml in both the groups. All patients were assessed intraoperatively for hemodynamic changes and requirement of sevoflurane concentration and postoperatively for pain by using FLACC pain score and for sedation by using four-point sedation score. Results The mean duration of analgesia was 18-24 h in group D, whereas in group C it was 12-15 h. Group C had a higher sedation score up to 2 in immediate postoperative period for 1 h compared with below 1 h in group D. Conclusion Postoperative analgesia is longer with dexamethasone compared with clonidine without any side effects.
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Terlipressin versus adrenaline in refractory septic shock
Ain-Shams Journal of Anaesthesiology 2016 9(2):186-193
Objective The aim of this study was to compare terlipressin versus adrenaline in refractory septic shock. Patients and methods In this interventional prospective randomized study, 80 patients between 18 and 60 years of age who presented with refractory septic shock were enrolled. The patients were divided randomly into two groups of 40 patients each. Group A patients were treated with adrenaline and group T patients were treated with terlipressin. The goals of the therapy were to achieve and maintain for 6 h all of the following: (i) mean blood pressure greater than 65 mmHg; (ii) systemic vascular resistance index greater than 1300 dynes s/cm 5 /m 2 ; (iii) cardiac index (CI) greater than 4.0 l/min/m 2 ; and (iv) oxygen delivery index greater than 550 ml/min/m 2 . The patients were classified into responders and nonresponders to the drugs used. Results The number of responders was significantly higher in the terlipressin group. There were 23 (58.97%) responders in the T group and 13 (35.13%) responders in the A group. The terlipressin group showed a significant increase in mean blood pressure from 49.9 ± 14.82 to 77.79 ± 20 mmHg and a significant increase in systemic vascular resistance index from 898 ± 292 to 1420 ± 537 dynes s/cm 5 /m 2 ; urine output and creatinine clearance also showed an increase. Group T patients showed a significant decrease in heart rate and norepinephrine infusion. As regards cardiac index and oxygen delivery index, they showed minimal decrease at the end of the study, but their levels were still above our target levels. Conclusion Terlipressin therapy is better than adrenaline in improving the hemodynamic variables and kidney functions in refractory septic-shock patients.
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Shoulder block versus interscalene block for postoperative pain relief after shoulder arthroscopy
Ain-Shams Journal of Anaesthesiology 2016 9(2):296-303
Background Adequate pain control allows early rehabilitation and improves outcome after shoulder arthroscopic procedures. Objective The aim of this study was to compare the interscalene nerve block (ISB) with shoulder block (ShB) (suprascapular and axillary nerve blocks) for postoperative pain relief after arthroscopic shoulder surgery. Design This was a prospective, randomized, comparative study. Patients and methods A total of 75 patients of ASA grade I or II scheduled for shoulder arthroscopic surgery were equally divided into three groups (25 patients each): the general anesthesia (GA)-only group; the GA with ISB group; and the GA with ShB group. The nerve block was guided by both ultrasound and nerve stimulator. Visual analogue scale score was evaluated at the recovery room and 2, 4, 8, 16, and 24 h postoperatively. The time to first call for analgesia, total analgesic requirement for 24 h postoperatively, patient satisfaction, and any complications were recorded. Results The visual analogue scale score was significantly less in the GA + ISB and GA + ShB groups compared with the GA-only group (P < 0.001). The time to first analgesic request was significantly longer in the GA + ISB group [10 (9-10 h)] and GA + ShB group [9 (9-10 h)] compared with the GA-only group [1 (1 h)] (P < 0.001). The total dose of morphine consumption was significantly higher in the GA-only group [10 (9-10 mg)] compared with the GA + ISB group [6 (5-6 mg)] and the GA + ShB group [6 (6-7 mg)] (P < 0.001). Patient satisfaction was significantly higher in the GA + ISB group [9 (9-10)] and in the GA + ShB group [8 (8-9)] compared with the GA-only group [1 (1-2)] (P < 0.001). The incidence of complications was significantly higher in the GA + ISB group compared with the other two groups (P < 0.001). Conclusion ShB was as effective as ISB for postoperative pain relief but with fewer complications. Thus, ShB is a good alternative for patients at high risk for adverse events with ISB.
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Effect of recombinant growth hormone on immune response in pediatric burn patients
Ain-Shams Journal of Anaesthesiology 2016 9(2):194-200
Background Management of severely burnt children is one of the most challenging situations in the ICU. Control of the hypercatabolic state is the most limiting step that determines patient survival. Immunocompromisation and delayed wound healing usually result in severe sepsis, which is the most common direct cause of death in these patients. There is debate about the efficacy and safety of recombinant human growth hormone (rGH), although it has been used to improve healing of burnt patients. Role of growth hormone in immunomodulation has been proposed theoretically and serologically, but it has not been tested clinically. We reported in this study how far the use of rGH in the management of burnt patients can improve their immune status and increase survival. Patients and methods Forty pediatric patients were enrolled in this study, randomly assigned into two groups. Group A received rGH and was compared with group B, which did not receive rGH. Those two groups were compared with respect to overall mortality rate, hospital and ICU stay, serum transferrin, C-reactive protein, and positivity of blood culture. Results The overall mortality rate was slightly lower in group A (20%) compared with B group (25%). No significant decrease in hospital stay was noticed between the two groups. There was significant improvement in serum transferrin especially by day 14 in addition to a significant drop in C-reactive protein in group A. Group A was found to be more protected from bacteremia. Conclusion The use of rGH in pediatric burnt patients improves overall mortality and optimizes immune status, in addition to improvement of wound healing and donor site healing. This eventually reduces the length of hospital stay.
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Intrathecal ketamine as an adjuvant in day-case surgeries: Comments
Ain-Shams Journal of Anaesthesiology 2016 9(2):314-315
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Deliberate hypotensive anesthesia during maxillofacial surgery: A comparative study between dexmedetomidine and sodium nitroprusside
Ain-Shams Journal of Anaesthesiology 2016 9(2):201-206
Background The aim of the present study was to evaluate the anesthetic properties such as the onset of required hypotension, the quality of the surgical field, the percentage of inhaled anesthesia, intraoperative consumption of fentanyl, time to recovery, and adverse events of dexmedetomidine (DEX) as a hypotensive agent in comparison with sodium nitroprusside (SNP) in maxillofacial surgery. Patients and methods A total of 70 ASA I or II patients, aged 20-60 years, scheduled for maxillofacial surgery were randomly assigned to receive either DEX 1 mg/kg before induction of anesthesia for over 10 min followed by 0.2-0.5 mg/kg/h infusion during maintenance (DEX group; n = 35 patients) or SNP 0.25 mg/kg/min infusion after induction of anesthesia (SNP group; n = 35 patients) to maintain mean arterial blood pressure (MAP) between 50 and 65 mmHg. Hemodynamic variables and end-tidal isoflurane concentration were recorded, quality of surgical field was assessed by the same surgeon who was blinded of the selected hypotensive agent, and intraoperative fentanyl consumption and recovery time were recorded. Results Heart rate was significantly lower (P < 0.05) in DEX group. Both drugs were effective in achieving the desired level of hypotension (MAP: 50-65 mmHg). However, the time needed to reach the target MAP was significantly shorter in the SNP group than in the DEX group. End-tidal isoflurane concentration and intraoperative fentanyl consumption were significantly lower in the DEX group than in the SNP group, and the quality of the surgical field was better in the DEX group compared with the SNP group, but the time for recovery was significantly longer in the DEX group than in the SNP group. Conclusion We concluded that DEX is an effective and safe agent with anesthetic benefits for controlled hypotension, and that compared with SNP DEX offers the advantage of better quality of the surgical field and decreased anesthetic and fentanyl requirements intraoperatively. However, DEX was associated with significantly longer time to reach the target MAP and delayed recovery from anesthesia compared with SNP.
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Ketamine-propofol sedation versus propofol-pethidine sedation for minor plastic surgery procedures
Ain-Shams Journal of Anaesthesiology 2016 9(2):245-249
Objective The aim of the study was to compare the efficacy of ketamine-propofol (KP) sedation versus propofol-pethidine (PP) sedation for minor plastic surgery procedures. Patients and methods This prospective study was conducted by randomization of 60 patients undergoing minor plastic surgery procedures. Patients were randomly divided into two groups by means of the sealed envelope technique: the KP group (n = 30) and the PP group (n = 30). In the former group, patients received induction with a bolus dose of ketamine 1 mg/kg dissolved in 10 ml saline, and in the latter group patients received induction with a bolus dose of 1 mg/kg pethidine dissolved in 10 ml saline intravenously. In both groups propofol was given as 1 mg/kg propofol, intravenous, bolus dose, additional doses of propofol 30 mg IV were given if sedation score was less than 4 in both groups followed by 5 mg/kg/h intravenous infusion. Sedation score, pain score, mean arterial blood pressure, total dose of propofol, conversion to general anesthesia, postoperative patient satisfaction score, and incidence of postoperative complications such as hypotension, oxygen desaturation, and vomiting were all recorded. Results Intraoperative pain scores, mean arterial blood pressure, and postoperative patient satisfaction scores were significantly higher in the PP group compared with the KP group. The sedation score was significantly higher in the KP group than in the PP group. Total dose of propofol was significantly lower in the KP group than in the PP group. There was no significant difference between the study groups regarding conversion to general anesthesia. Recovery time was significantly longer in the KP group compared with the PP group. There were significant differences in the incidence of complications such as oxygen desaturation and postoperative vomiting among the study groups. Conclusion The KP combination provides an attractive combination for procedural sedation compared with PP combination in terms of better sedation, hemodynamic stability, and lower incidence of complications.
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Efficacy of dexmedetomidine as an anesthetic adjuvant for functional endoscopic sinus surgery under general anesthesia: A randomized-controlled study
Ain-Shams Journal of Anaesthesiology 2016 9(2):207-211
Background Functional endoscopic sinus surgery (FESS) requires effective control of bleeding for better visibility of the operating field and reduced risk of injury to the optic nerve or the internal carotid artery. Dexmedetomidine can provide controlled hypotension, analgesia, and sedation. The present study aimed to evaluate the clinical efficacy, safety, and advantages of dexmedetomidine as an anesthetic adjuvant for FESS. Patients and methods Fifty adult consented patients of comparable demographic profile, scheduled for FESS, were assigned randomly to two groups. Patients of group D received a loading dose of dexmedetomidine 1 mg/kg over 10 min, followed by an infusion at 0.4-0.7 mg/kg/h and patients of group C were administered an identical amount of saline solution. During the procedure, hemodynamic changes, intraoperative surgical grade of bleeding (on the basis of the Fromme-Boezaart scale), intraoperative fentanyl consumption, emergence time, and total recovery from anesthesia (Aldrete's score ≥9) were recorded. Results Patients of group D comparatively had a lower intraoperative heart rate and mean arterial blood pressure, along with a significantly lower bleeding score (P < 0.001). The mean intraoperative fentanyl consumption was significantly lower in patients of group D. Emergence time and time to achieve an Aldrete's score 9 or more were significantly lower in group C at 15 and 30 min postoperatively. Conclusion Dexmedetomidine has effectively provided the ideal oligemic surgical field during FESS and offers the inherent advantages of analgesia, sedation, and anesthetic-sparing effects.
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Dexmedetomidine and sodium bicarbonate as adjuvants to epidural lidocaine: A comparative study
Ain-Shams Journal of Anaesthesiology 2016 9(2):256-259
Context Efforts to find a better adjuvant in regional anesthesia have been underway since long. Dexmedetomidine and sodium bicarbonate have been proven to be effective in providing the same pharmacological benefit through two different mechanisms of action. In this study, we sought to investigate which is superior between the two. Aims The aim of the study was to compare the efficacy of dexmedetomidine and sodium bicarbonate as adjuvants to lidocaine in epidural anesthesia. Settings and design This was a prospective, randomized, double-blind study. Materials and methods Sixty patients scheduled for lower-limb trauma orthopedic surgeries under epidural anesthesia were divided into two groups group D and group S, with 30 patients in each. Patients in group D received 12.5 ml of 2% lidocaine+dexmedetomidine 0.5 mg/kg in 1.5 ml solution, making a total volume of 14 ml. Patients in group S received 12.5 ml of 2% lidocaine+1.5 ml of 7.5% sodium bicarbonate, making a total volume of 14 ml. Onset, time for peak sensory level, time for two-segment regression, and the total mephentermine consumed to maintain the hemodynamics were recorded, tabulated, and statistically analyzed. Results The onset of sensory block was quicker in group D. The time for attaining peak sensory level and the mephentermine consumption was nearly the same in both groups. The time for two-segment regression was more in group D than in group S. Conclusion Dexmedetomidine is more effective than sodium bicarbonate in hastening the onset and prolonging the duration of blockade when used as an adjuvant to epidural lidocaine.
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Insertion characteristics of three supraglottic airway devices: A randomized comparative trial
Ain-Shams Journal of Anaesthesiology 2016 9(2):212-218
Background I-gel is a new single-use supraglottic airway device without an inflatable cuff. The aim of this study was to compare I-gel, a Proseal laryngeal mask airway (PLMA), and a laryngeal tube (LT) for ease of insertion, hemodynamic effects of insertion, and associated airway morbidity. Patients and methods Seventy-five adult patients, both sexes, were assigned randomly to I-gel (I), PLMA (P), and LT (L) groups according to the supraglottic device applied. Insertion time, airway sealing pressure, insertion success rate, insertion-associated hemodynamic effects, ease of gastric tube insertion, and associated airway morbidities were assessed. Results Demographic data and duration of both surgery and anesthesia in the three groups were comparable. Insertion time (s) was significantly shorter in group I (18.9 ± 0.9) compared with group P (26.2 ± 1.1) and group L (26.2 ± 1.0). Airway sealing pressure (cm H 2 O) was higher in group P (29.6 ± 1.2) compared with group I (26.0 ± 1.0) and group L (22.9 ± 0.9). The success rate at the first insertion attempt was higher in group I (96.0%) compared with group P (84.0%) and group L (88%). Blood-stained devices and occurrence of postoperative sore throat were lower in group I than the P and L group, with no significant differences. Heart rate, mean arterial pressure, and cardiac index were significantly increased in the postinsertion period in the P and L group compared with group I. Conclusion In the I-gel group, higher insertion success rate, and lower both hemodynamic changes and airway morbidities were noted compared with PLMA and LT. However, airway sealing ability was better with PLMA.
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Percutaneous vertebroplasty under epidural anesthesia: comparative study versus local anesthesia
Ain-Shams Journal of Anaesthesiology 2016 9(2):267-273
Objectives This study aimed to evaluate percutaneous vertebroplasty (PVP) under epidural (EPI) anesthesia and its effect on patients' and surgeons' satisfaction. Patients and methods Sixty-three patients undergoing thoracolumbar PVP were divided randomly as follows: the LA group received local anesthesia (LA) and the EPI group received EPI anesthesia as one pre-emptive shot of 8-10 ml plain levobupivacaine 0.25% (2.5 mg/ml). PVP involved an injection of 4-8 ml polymethlymethacrylate into each treated vertebra. Anesthetic outcome was defined as assessment of injection pain using a 10-point numeric rating scale, hemodynamic stability; efficacy of postoperative (PO) analgesia and patients' satisfaction were rated using the Iowa Satisfaction with Anesthesia Scale for monitored anesthesia care and surgeons' satisfaction was evaluated using a seven-point Likert scale. Surgical outcome was defined as patients' disease-related pain levels assessed before and 24-h PO using numeric rating scale. Results EPI anesthesia provided multiple advantages over LA; injection pain and anxiety-induced tachycardia and hypertension were significantly lower. EPI anesthesia allowed multiple-level PVP in the same setting with a single anesthetic injection; this was reflected as significantly higher surgeon and patient satisfaction. PO pain was significantly lower with EPI versus LA, with less need for PO analgesia. Both groups showed PO improvement in their disease-related pain. Conclusion EPI anesthesia is a safe and effective alternative for LA during PVP. It allowed multiple-level corrections in the same setting, adequate hemodynamic stability and PO analgesia, and resulted in significantly higher surgeon and patient satisfaction, especially those who had one-setting multiple-level corrections.
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Double dissociation of configural and featural face processing on P1 and P2 components as a function of spatial attention
Abstract
Face recognition relies on both configural and featural processing. Previous research has shown that P1 is sensitive to configural face processing, but it is unclear whether any component is sensitive to featural face processing; moreover, if there is such a component, its temporal sequence relative to P1 is unknown. Thus, to avoid confounding physical stimuli differences between configural and featural face processing on ERP components, a spatial attention paradigm was employed by instructing participants to attend an image stream (faces and houses) or an alphanumeric character stream. The interaction between attention and face processing type on P1 and P2 components indicates different mechanisms of configural and featural face processing as a function of spatial attention. The steady-state visual evoked potential (SSVEP) results clearly demonstrated that participants could selectively attend to different streams of information. Importantly, configural face processing elicited a larger posterior P1 (approximately 128 ms) than featural face processing, whereas P2 (approximately 248 ms) was greater for featural than for configural face processing under attended condition. The interaction between attention and face processing type (configural vs. featural) on P1 and P2 components indicates that there are different mechanisms of configural and featural face processing operating as functions of spatial attention. While the P1 result confirms previous findings separating configural and featural face processing, the newly observed P2 finding in the present study extends this separation to a double dissociation. Therefore, configural and featural face processing are modulated differently by spatial attention, and configural face processing precedes featural face processing.
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Psychometric properties of startle and corrugator response in NPU, affective picture viewing, and resting state tasks
Abstract
The current study provides a comprehensive evaluation of critical psychometric properties of commonly used psychophysiology laboratory tasks/measures within the NIMH RDoC. Participants (N = 128) completed the no-shock, predictable shock, unpredictable shock (NPU) task, affective picture viewing task, and resting state task at two study visits separated by 1 week. We examined potentiation/modulation scores in NPU (predictable or unpredictable shock vs. no-shock) and affective picture viewing tasks (pleasant or unpleasant vs. neutral pictures) for startle and corrugator responses with two commonly used quantification methods. We quantified startle potentiation/modulation scores with raw and standardized responses. We quantified corrugator potentiation/modulation in the time and frequency domains. We quantified general startle reactivity in the resting state task as the mean raw startle response during the task. For these three tasks, two measures, and two quantification methods, we evaluated effect size robustness and stability, internal consistency (i.e., split-half reliability), and 1-week temporal stability. The psychometric properties of startle potentiation in the NPU task were good, but concerns were noted for corrugator potentiation in this task. Some concerns also were noted for the psychometric properties of both startle and corrugator modulation in the affective picture viewing task, in particular, for pleasant picture modulation. Psychometric properties of general startle reactivity in the resting state task were good. Some salient differences in the psychometric properties of the NPU and affective picture viewing tasks were observed within and across quantification methods.
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Loneliness among People with Spinal Cord Injury: Exploring the Psychometric Properties of the 3-item Loneliness Scale
Publication date: Available online 11 May 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Susan Robinson-Whelen, Heather B. Taylor, Michelle Feltz, Megan Whelen
ObjectiveTo examine a measure of loneliness and its correlates in people with spinal cord injury (SCI) to enhance our understanding of loneliness, which has received limited scientific study in the context of SCI, and to conduct preliminary analyses of the reliability and validity of the measure, including an evaluation of the unique impact of loneliness on psychological health.DesignCross-sectional.SettingSCI Model Systems.ParticipantsPeople with SCI (N=175) participating in SCI Model Systems Follow-up Interviews at one study site between April 2014 and June 2015.InterventionsNot applicable.Main Outcome MeasureThe 3-item Loneliness ScaleResultsExamining individual items, approximately 40% of the sample reporting that they felt they lacked companionship, felt left out, and felt isolated from others either some of the time or often. Mean scores in our sample were elevated compared to published data on middle-aged and older adults. Results provided evidence of internal consistency, comparable to that reported in the literature, and preliminary evidence of convergent and divergent validity. Loneliness was related to psychological health even after controlling for measures of demographics, disability, and social integration, suggesting that loneliness captures more than just social isolation or social integration in people with SCI.ConclusionsLoneliness, which may be more common among people with SCI, is related to poorer psychological health. Given the serious physical and psychological health consequences of loneliness documented in the general literature, it is imperative that the experience of loneliness among people with SCI be given serious and systematic attention in the literature as well as in clinical practice.
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Rehabilitation outcomes after inpatient rehabilitation for lower extremity amputations in patients with diabetes
Publication date: Available online 11 May 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Kavita Venkataraman, Ngan Phoon Fong, Kin Ming Chan, Boon Yeow Tan, Edward Menon, Chye Hua Ee, Kok Keng Lee, Gerald Choon-Huat Koh
ObjectiveTo identify factors associated with functional gain, discharge destination and long-term survival following inpatient rehabilitation in patients with lower extremity amputation and diabetes.DesignRetrospective medical records reviewSettingAll community hospitals in Singapore (n=4) between 1996 and 2005Participants256 patients with diabetes, admitted for inpatient rehabilitation following lower extremity amputation.InterventionsNoneMain outcomes measuresAbsolute functional gain (AFG) using Shah-modified Barthel Index, discharge destination and long-term survival for each patientResultsLength of stay (B=0.15, 95%confidence interval (CI):0.08–0.21, p<0.001) and admission functional status (B=-0.09, 95%CI:-0.18─-0.01, p=0.032) were significantly associated with AFG. Availability of caregiver (foreign domestic worker odds ratio (OR)=16.39, 95%CI:4.65-57.78, p<0.001; child OR=3.82, 95%CI:1.31-11.12, p=0.014; spouse OR=2.82; 95%CI:1.07-7.46, p=0.037 versus none), Charlson Comorbidity Index score of 1(OR=4.32; 95%CI:1.34-13.93, p=0.014 versus 4 or more), and younger age (OR for age=0.96; 95%CI:0.93-0.99, p=0.02) were significantly associated with being discharged home. Admission functional status(hazard ratio (HR)=0.98; 95%CI:0.97-0.99, p<0.001), AFG(0.99; 95%CI:0.97-1.00, p=0.058), Charlson Comorbidity Index score(1 versus 4 or more, HR=0.42; 95%CI:0.24-0.77, p=0.004, ischaemic heart disease (HR=2.25; 95%CI:1.27-4.0, p=0.006), discharge destination (other versus home, HR=1.82; 95%CI:1.02-3.23, p=0.041) age (HR=1.02; 95%CI:1.00-1.03, p=0.082) and ethnicity (Malay versus Chinese HR=0.37; 95%CI:0.16-0.87, p=0.022) predicted survival post-amputation.ConclusionsAdmission functional status predicted both functional gain during rehabilitation as well as survival among these patients. We also found ethnic differences in outcomes with Malays having better survival after amputation. Lastly, there appears to be greater reliance on foreign domestic workers as caregivers, with patients with foreign domestic workers as their primary caregiver having the highest odds of being discharged home.
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Correlation of Fractional Anisotropy with Motor Recovery in Stroke Patients following Post-Acute Rehabilitation
Publication date: Available online 11 May 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Hongmei Wen, Mohamad J. Alshikho, Yao Wang, Xun Luo, Ross Zafonte, Martha R. Herbert, Qing Mei Wang
ObjectiveTo investigate the relationship between fractional anisotropy (FA), a suggested biomarker for tissue integrity, and motor recovery in stroke patients following post-acute rehabilitation.DesignRetrospective study.SettingAcute rehabilitation hospital.Participants43 subjects, 28 diagnosed with ischemic stroke, and 15 diagnosed with hemorrhagic stroke. The average age for subjects was (68±14 years).InterventionsMRI and Diffusion Tensor Imaging (DTI) were conducted on all patients.Main Outcome Measure(s)This is a retrospective study. The admission and discharge motor sub-scores of the Functional Independence Measure (FIM) were obtained from medical records, and relative gain was calculated using the Montebello Rehabilitation Factor Score (MRFS). K-means cluster analysis (K=3) using both MRFS and gain of FIM motor sub-score (ΔFIM) was performed. ANOVA test was used to determine the difference in FA among the clusters. Spearman analysis was conducted to examine the relationship between FA, ΔFIM, and MRFS in each cluster.ResultsFA was significantly higher in the clusters of good and moderate recovery in the corticospinal tract (CST), peduncle, and posterior limb of the internal capsule (PLIC) bilaterally (all P<0.05) compared to the poor recovery group. Significant positive correlations were observed in multiple regions along CST between FA, ΔFIM, and MRFS in the clusters of good and moderate recovery, but not in the poor recovery group.ConclusionOur results showed an association between FA values within the corticospinal tract and motor recovery in stroke patients undergoing post-acute rehabilitation. This finding may help to identify novel targets for new interventions to promote stroke recovery.
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Electrical Stimulation for hemiplegic shoulder function: A systematic review and meta-analysis of 15 randomized controlled trials
Publication date: Available online 11 May 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Ping Gu, Juan-juan Ran, Lei Yu
ObjectivesThe objective of this meta-analysis was to review the evidence for the effect of FES on shoulder subluxation, pain, upper arm motor function, daily function and quality of life in stroke patients, when added to conventional therapy.Data SourcesPubMed, Cochrane library, Google Scholar and Embase databases were searched for all relevant studies published before February 20, 2016.Study SelectionKeywords included "subluxation" or "pain", "stroke" or "hemiplegia" and "electrical stimulation" or "FES" or "NMES". Trials examining the effect of FES on shoulder and upper arm outcomes were included.Data ExtractionFrom the 1307 retrieved articles, 15 RCTs were selected for final analysis and were rated based on the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 and the Sackett's levels of evidence. A meta-analysis was performed for all considered outcomes.Data SynthesisThe results of this meta-analyses showed a significant difference in shoulder subluxation in FES groups compared to Placebo groups, only if FES was applied early after stroke. And a significant difference was observed Post-Tx in Fugl-Meyer motor assessment in FES groups compared to Placebo groups. No effects were found on pain, upper arm motor function, daily function and quality of life outcomes.ConclusionsFES can be used to prevent or reduce shoulder subluxation early after stroke. However, findings did not support the efficacy of use of FES for pain reduction, improvement in arm strength, movement, functional use, daily function or quality of life after stroke.
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Academy News – May PM&R Journal
As the primary medical society for the specialty of PM&R, your Academy is focused on moving the specialty and you forward. Academy membership supports initiatives to assist our members with:
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The Value of Physical Medicine and Rehabilitation in the New Health Care Market
Value has become a central component of health care reform and may well be the major determinant of payment in the near future. In a historic announcement, Secretary of Health and Human Services Sylvia M. Burwell stated that the Centers for Medicare and Medicaid Services (CMS) has goals of linking 85% of Medicare fee-for-service payments to quality or value by the end of 2016 and 50% of all payments to quality and value through alternative payment models by 2018 [1]. Achieving this will require a fundamental change in the delivery of health care.
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Cumulative length of bowel resection in a population-based cohort of patients with Crohn’s disease
Clinical Gastroenterology and Hepatology
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Association of Hepatitis C Virus With Alcohol Use Among U.S. Adults: NHANES 2003–2010
American Journal of Preventive Medicine
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Advances in inducing adaptive immunity using cell-based cancer vaccines: Clinical applications in pancreatic cancer
World Journal of Gastroenterology
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Impact of laparoscopic antireflux surgery on belching in pediatric GERD patients
Neurogastroenterology & Motility
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Alterations in inflammatory biomarkers and energy intake in cancer cachexia: A prospective study in patients with inoperable pancreatic cancer
Medical Oncology
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Treatment of alcohol use disorders in patients with alcoholic liver disease
Journal of Hepatology
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Diagnostic performance of conventional endoscopy in the identification of submucosal invasion by early gastric cancer: The non-extension sign as a simple diagnostic marker
Gastric Cancer
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Fasting plasma insulin concentrations are associated with changes in hepatic fatty acid synthesis and partitioning prior to changes in liver fat content in healthy adults
Diabetes
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Expression of B7-H4 and hepatitis B virus X in hepatitis B virus-related hepatocellular carcinoma
World Journal of Gastroenterology
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Predicting Barrett's esophagus in families: An esophagus translational research network (Betrnet) model fitting clinical data to a familial paradigm
Cancer Epidemiology, Biomarkers & Prevention
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Management of gastroschisis
Current Opinion in Pediatrics
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Prognostic implication of antitumor immunity measured by the neutrophil–lymphocyte ratio and serum cytokines and angiogenic factors in gastric cancer
Gastric Cancer
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Current status of surgical management of gastroesophageal reflux in children
Current Opinion in Pediatrics
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Cost-Effectiveness Analysis of Different Sequences of the Use of Epidermal Growth Factor Receptor Inhibitors for Wild-Type KRAS Unresectable Metastatic Colorectal Cancer
Journal of Oncology Practice
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Continuing decrease in hepatitis B virus infection 30 years after initiation of infant vaccination program in Taiwan
Clinical Gastroenterology and Hepatology
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Surgical options for the management of severe functional constipation in children
Current Opinion in Pediatrics
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Inhaled anaesthetics and nitrous oxide: Complexities overlooked: things may not be what they seem.
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Are transdermal opioids contraindicated in patients at risk of suicide?.
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Fitness Effects of Spontaneous Mutations in Picoeukaryotic Marine Green Algae
Estimates of the fitness effects of spontaneous mutations are important for understanding the adaptive potential of species. Here, we present the results of mutation accumulation experiments over 265 to 512 sequential generations in four species of marine unicellular green algae, Ostreococcus tauri RCC4221, Ostreococcus mediterraneus RCC2590, Micromonas pusilla RCC299 and Bathycoccus prasinos RCC1105. Cell division rates, taken as a proxy for fitness, systematically decline over the course of the experiment in O. tauri, but not in the three other species where the MA experiments were carried out over for a smaller number of generations. However, evidence of mutation accumulation in 24 MA lines arises when they are exposed to stressful conditions, such as changes in osmolarity or exposure to herbicides. The selection coefficients, estimated from the number of cell divisions per day, varies significantly between the different environmental conditions tested in MA lines, providing evidence for advantageous and deleterious effects of spontaneous mutations. This suggests a common environmental dependence of the fitness effects of mutations and allows the minimum per genome per generation mutation rates to be inferred at 0.0037 in these species.
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Approach behavior and sympathetic nervous system reactivity predict substance use in young adults
Publication date: Available online 10 May 2016
Source:International Journal of Psychophysiology
Author(s): J. Benjamin Hinnant, Alissa B. Forman-Alberti, Anna Freedman, Lindsay Byrnes, Kathryn A. Degnan
A behavioral measure of approach (performance on a resource gathering task) in combination with sympathetic nervous system (SNS) reactivity was used to predict substance use in a sample of young adults (n=93). Pre-ejection period reactivity (PEP-R), a cardiac index of SNS reactivity, was recorded during the resource gathering task (task PEP – resting PEP). Higher levels of approach behaviors on the task in combination with less PEP-R (blunted SNS reactivity) predicted the highest levels of substance use. Findings are discussed in the context of behavioral and physiological systems of approach and avoidance.
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Conscious brain, metacognition and schizophrenia
Publication date: Available online 10 May 2016
Source:International Journal of Psychophysiology
Author(s): Petr Bob, Ondrej Pec, Aaron L. Mishara, Tereza Touskova, Paul H. Lysaker
Recent findings indicate that the binding and synchronization of distributed neural activities are crucial for cognitive processes and consciousness. In addition, there is increasing evidence that disrupted feature binding is related to experiences of disintegration of consciousness in schizophrenia. These data suggest that the disrupted binding and disintegration of consciousness could be typically related to schizophrenia in terms of Bleuler's concept of "splitting". In this context, deficits in metacognitive capacity in schizophrenia may be conceptualized as a spectrum from more discrete to more synthetic activities, related to specific levels of neural binding and neurocognitive deficits. This review summarizes the recent research on metacognition and its relationship to deficits of conscious awareness that may be found in schizophrenia patients. Deficits in synthetic metacognition are likely linked to the integration of information during specific processes of neural binding. Those in turn may be related to a range of mental activities including reasoning style, learning potential and insight.
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Vestibular evoked myogenic potentials (VEMPs): Tailoring methodology to specific conditions
Source:Clinical Neurophysiology, Volume 127, Issue 6
Author(s): Eleftherios S. Papathanasiou
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Towards the application of HD-EMG decomposition in clinical practice
Source:Clinical Neurophysiology, Volume 127, Issue 6
Author(s): Miguel A. Mañanas, Mónica Rojas-Martínez, Joan F. Alonso
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Editorial Board
Source:Clinical Neurophysiology, Volume 127, Issue 6
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