A rapid gene sequencing panel strategy to facilitate precision neonatal medicine

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Male child with somatic mosaic Osteopathia Striata with Cranial Sclerosis caused by a novel pathogenic AMER1 frameshift mutation

Osteopathia striata with cranial sclerosis (OSCS; OMIM #300373) is a rare X-linked dominant condition caused by mutations in the AMER1 gene (also known as WTX or FAM123B). It is a condition which usually affects females in whom the clinical phenotype can be extremely variable. Conversely affected males typically die in utero or during the neonatal period [Perdu et al. (); Clinical Genetics 80: 383-388; Vasiljevic et al. (); Prenatal Diagnosis 35: 302-304]. There have been a small number of reported cases of surviving males, including three patients who are somatic mosaic for the condition [Chénier, Noor, Dupuis, Stavropoulos, & Mendoza-Londono, (); American Journal of Medical Genetics Part A 158A: 2946-2952; Holman et al. (); American Journal of Medical Genetics Part A 155A: 2397-2408; Joseph, Shoji, & Econs, (); The Journal of Clinical Endocrinology and Metabolism 95: 1506-1507]. We report a case of a male child who has proven somatic mosaicism for OSCS associated with a novel pathogenic frameshift mutation, c.607_611delAGGCC (p.Arg203 fs) in AMER1. We describe the multisystemic clinical features which include macrocephaly with ventriculomegaly and requirement for ventriculoperitoneal shunt, cleft palate, and respiratory difficulties after birth requiring tracheostomy insertion, persistent patent ductus arteriosus, failure to thrive and gastrostomy insertion, growth retardation, ophthalmoplegia, kidney malformation, cryptorchidism, and developmental delay. The use of new technologies with next generation sequencing (NGS) may improve the detection rate of mosaicism in rare conditions.

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Neuropsychological phenotypes of 76 individuals with Joubert syndrome evaluated at a single center

Joubert syndrome (JS) is a genetically heterogeneous ciliopathy characterized by hypo-dysplasia of the cerebellar vermis, a distinct hindbrain/midbrain malformation (molar tooth sign), and intellectual disability. We evaluated the neuropsychological profiles of 76 participants with JS in the context of molecular genetics and clinical covariates. Evaluations included neuropsychological testing, structured parental interviews, DNA sequencing, brain magnetic resonance imaging (MRI), electroencephalography (EEG), ophthalmologic examination, and assessment for renal and hepatic disease. On average, participants manifested Full Scale Intelligence Quotients (FSIQ) in the moderately to profoundly low range (M = 64.3 ± 15.3). Of the Wechsler index scores, verbal comprehension was least affected and processing speed was most affected. Receptive language was rated as better than expressive language on the Vineland Adaptive Behavior Scales-Second Edition. Those with abnormal EEG had a significantly lower FSIQ (n = 15; M = 50.7 ± 12.9) compared to participants with normal EEG (n = 39; M = 64.7 ± 16.3; p = .004). Participants taking psychiatric medications manifested a lower FSIQ (n = 20; M = 54.8 ± 13.2) than those not taking them (n = 42; M = 65.0 ± 17.2; p = .022). These correlations were also present in the TMEM67-related JS sub-cohort (n = 14). Based on parental assessment, psychiatric and behavioral problems were significantly more common than in the general population for all measures (p < .004 for all). The majority (65%) of individuals with JS have some degree of intellectual disability. Abnormal EEG is associated with lower neuropsychological function. Processing speed is a weakness, while verbal comprehension and receptive language are relative strengths. These findings may guide parents, teachers, therapists, and doctors to determine appropriate therapies, accommodations, and academic goals for individuals with JS.

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Title Page/Sections Editors

Publication date: June 2017
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms, Volume 1860, Issue 6





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Current FDA-approved injection pattern versus targeted peripheral nerve–directed injection pattern. The current FDA-approved injection pattern includes chemodenervation of 7 head and neck muscle groups (A–C). The total units of BOTOX injected for each site bilaterally include: corrugators 10U, procerus 5U, frontalis 20U (A), temporalis 40U (B), occipitalis 30U, cervical paraspinal 20U, and trapezius 30U (C). By comparison, peripheral nerve–directed BOTOX injection targets fewer sites with a smaller total quantity of BOTOX (D–F). The total units of BOTOX injected for each site bilaterally include: supraorbital nerve/supratrochlear nerve 25U (D), zygomaticotemporal nerve 37.5U (E), and greater occipital nerve 50U (F). Source Targeted Peripheral Nerve-directed Onabotulinumtoxin A Injection for Effective Long-term Therapy for Migraine Headache

http://otorhinolaryngology-crete.blogspot.com/2017/05/current-fda-approved-injection-pattern.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Autologous Platelet-rich Plasma Glue : Seroma and hematoma formations are the most common complications after plastic surgery. The aim of this study was to assess the efficacy of autologous platelet-rich plasma (A-PRP) glue to reduce postoperative wound complications and improve surgical outcomes.

http://otorhinolaryngology-crete.blogspot.com/2017/05/autologous-platelet-rich-plasma-glue.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Single and multiple sevoflurane exposures during pregnancy and offspring behavior in mice

Summary

Background

The second trimester is a period of neurogenesis and neuronal migration, which can be affected by exposure to anesthetics. Studies also suggest that multiple exposures may have a greater impact on neurodevelopment.

Aim

We investigated whether in utero single or multiple exposures to anesthetics caused long-term behavior changes.

Methods

Pregnant mice were randomly divided into four groups on gestational day 14 (GD 14). Mice in the Control × 1 group were exposed to 100% oxygen for 150 min. Mice in the Sevo × 1 group were also exposed to 100% oxygen for 150 min, except that 2.5% sevoflurane was added during the first 120 min. Mice in the Control × 3 and Sevo × 3 group were identically treated as Control × 1 and Sevo × 1 group for three consecutive days, respectively (GD 14–16). Behavioral tests were performed only with the male offspring at the age of 2–4 months. Synaptic plasticity was also compared by inducing long-term potentiation in acute hippocampal slices.

Results

Single or multiple sevoflurane exposures in pregnant mice during the second trimester did not cause long-lasting behavioral consequences or changes in long-term synaptic plasticity of their offspring.

Conclusion

Our study suggests that neither single nor multiple exposures of mice to sevoflurane during the fetal developmental period induces long-term behavioral dysfunctions or affects long-term synaptic plasticity. Additional studies focusing on early stages of neurodevelopment are necessary to confirm the effects of sevoflurane exposure during pregnancy.

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Nitrous oxide for procedural analgesia at home in a child with epidermolysis bullosa

Summary

Epidermolysis bullosa comprises a range of conditions characterized by fragile skin with painful blistering induced by minor trauma and friction. The Dowling-Meara variant is a severe form characterized by disseminated painful blistering requiring lifelong skin and wound care. The natural history of the disease is characterized by a chronic course that tends to improve with advancing age. Various multimodal analgesic strategies have been proposed for painful procedures in children with epidermolysis bullosa. In this case report, we describe the use of nitrous oxide for pain control at home of blister treatments in a 4-year-old child with the Dowling-Meara variant.

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Multilevel schwab grade II osteotomies for sagittal plane correction in the management of adult spinal deformity

Prior reports have compared posterior column osteotomies to pedicle subtraction osteotomies in terms of utility for correcting fixed sagittal imbalance in adolescent patients with deformity. No prior reports have described the use of multilevel Smith-Petersen Osteotomies (SPOs) alone for surgical correction in the adult spinal deformity (ASD) population.

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Inflammatory responses to acute elevations of carbon dioxide in mice.

Health risks are described from elevated indoor air carbon dioxide (CO₂), which often ranges from 1000 to 4000 parts per million (ppm), but mechanisms are unknown. Here, we demonstrate that mice exposed for 2 hours to 2000 or 4000 ppm CO₂ exhibit, respectively, 3.4 + 0.9 (SE, n=6) and 4.1 + 0.7 (n=10)-fold elevations in circulating microparticles (MPs); neutrophil and platelet activation and vascular leak in brain, muscle and distal colon. Interleukin (IL)-1β content of MPs also increases after 2000 ppm by 3.8 + 0.6 (n=6) and after 4000 ppm CO₂ by 9.3 + 1.1 (n=10)-fold greater than control. CO₂-induced vascular damage is abrogated by treating mice with an antibody to IL-1β or an IL-1β receptor inhibitor. Injecting naïve mice with CO₂-induced MPs expressing a protein found on mature neutrophils recapitulates vascular damage as seen with elevated CO₂, and destruction of MPs in CO₂-exposed mice abrogates vascular injuries without altering neutrophil or platelet activation. We conclude that environmentally relevant elevations of CO₂ trigger neutrophils to generate MPs containing high concentrations of IL-1β that cause diffuse inflammatory vascular injury.

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Nonlinearities of heart rate variability in animal models of impaired cardiac control: contribution of different time scales

Heart rate variability (HRV) has been extensively explored by traditional linear approaches (e.g. spectral analysis). However, several studies have pointed to the presence of nonlinear features in HRV, suggesting that linear tools might fail to account for the complexity of the HRV dynamics. Even though the prevalent notion is that HRV is nonlinear, the actual presence of nonlinear features is rarely verified. In this study, the presence of nonlinear dynamics was checked as a function of time scales in three experimental models of rats with different impairment of the cardiac control, namely rats with heart failure (HF), spontaneously hypertensive rats (SHRs) and sinoaortic denervated (SAD) rats. Multiscale entropy (MSE) and refined MSE (RMSE) were chosen as discriminating statistic for the surrogate test utilized to detect nonlinearity. Nonlinear dynamics is less present in HF animals at both short and long time scales compared to controls. A similar finding was found in SHR only at short time scales. SAD increased the presence of nonlinear dynamics exclusively at short time scales. Those findings suggest that a working baroreflex contributes to linearize HRV and to reduce the likelihood to observe nonlinear components of the cardiac control at short time scales. In addition, an increased sympathetic modulation seems to be a source of nonlinear dynamics at long time scales. Testing nonlinear dynamics as a function of the time scales can provide a characterization of the cardiac control complementary to more traditional markers in time, frequency and information domains

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Molecular Imaging of Postprandial Metabolism

Disordered postprandial metabolism of energy substrates is one of the main defining features of prediabetes and contributes to the development of several chronic diseases associated with obesity such as type 2 diabetes and cardiovascular diseases. Postprandial energy metabolism has been studied using classical isotopic tracer approaches that are limited by the poor access to splanchnic metabolism and the highly dynamic and complex exchanges of energy substrates involving multiple organs and systems. Advances in non-invasive molecular imaging modalities such as positron emission tomography (PET) and magnetic resonance imaging and spectroscopy (MRI/MRS) have recently allowed important advances in our understanding of postprandial energy metabolism in humans. The present review describes some of these recent advances, with particular focus on glucose and fatty acid metabolism in postprandial state, and discusses current gaps in knowledge and new perspectives of application of PET and MRI/MRS for the investigation and treatment of human metabolic diseases.

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Physical activity modulates corticospinal excitability of the lower limb in young and old adults

Aging is associated with reduced neuromuscular function, which may be due in part to altered corticospinal excitability. Regular physical activity (PA) may ameliorate these age-related declines, but the influence of PA on corticospinal excitability is unknown. The purpose of this study was to determine the influence of age, sex and PA on corticospinal excitability by comparing the stimulus-response curves of motor evoked potentials (MEP) in 28 young (22.4±2.2 yrs, 14 women, 14 men) and 50 old adults (70.2±6.1 yrs, 22 women, 28 men) who varied in activity levels. Transcranial magnetic stimulation was used to elicit MEPs in the active vastus lateralis muscle (10% maximal voluntary contraction, MVC) with 5% increments in stimulator intensity until the maximum MEP amplitude. Stimulus-response curves of MEP amplitudes were fit with a 4-parameter sigmoidal curve, and the maximal slope calculated (slope_max). Habitual PA was assessed with tri-axial accelerometry, and participants categorized into either those meeting current PA guidelines for optimal health benefits (>10,000 steps•day^-1, high-PA, n=21) or those not meeting guidelines (<10,000 steps•day^-1, low-PA, n=41). The MEP amplitudes and slope_max were greater in the low-PA compared with the high-PA group (P<0.05). Neither age nor sex influenced the stimulus-response curve parameters (P>0.05) suggesting that habitual PA influenced the excitability of the corticospinal tract projecting to the lower limb similarly in both young and old adults. These findings provide evidence that achieving the recommended PA guidelines for optimal health may mediate its effects on the nervous system by decreasing corticospinal excitability.

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The impact of ocular hemodynamics and intracranial pressure on intraocular pressure during acute gravitational changes

Exposure to microgravity causes a bulk fluid shift toward the head, with concomitant changes in blood volume/pressure, intraocular pressure (IOP), and intracranial pressure (ICP). These and other factors are thought to contribute to Visual Impairment and Intracranial Pressure syndrome, a significant health concern for astronauts, characterized by degradation of visual function and ocular anatomical changes. Here we describe a lumped-parameter numerical model to simulate volume/pressure alterations in the eye during gravitational changes. The model includes the effects of blood and aqueous humor dynamics, ICP, and IOP-dependent ocular compliance. It is formulated as a series of coupled differential equations and was validated against three existing datasets on parabolic flight, body inversion, and head-down tilt (HDT). The model accurately predicted acute IOP changes in parabolic flight and HDT, and was satisfactory for the more extreme case of inversion. The short-term response to the changing gravitational field was dominated by ocular blood pressures and compliance, while longer-term responses were more dependent on aqueous humor dynamics. ICP had a surprisingly small effect on acute IOP changes. This relatively simple numerical model shows promising predictive capability. To extend the model to more chronic conditions, additional data on longer-term autoregulation of blood and aqueous humor dynamics are needed.

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Edmund Goodwyn and the first description of diving bradycardia

Diving bradycardia is a primordial oxygen-conserving reflex by which the heart rate of air-breathing vertebrates, including humans, slows down in response to water immersion. Its discovery is attributed to Paul Bert whose seminal observation was published in 1870 as part of a series of experiments that examined physiological adaptations to asphyxia in ducks and other animals. However, Edmund Goodwyn, a British physician who studied medicine at the University of Edinburgh had already published descriptions of this reflex in his doctoral thesis, which was originally published in Latin in 1786, and again in English in 1788. Ironically, even though Goodwyn's work has yet to be recognized in the diving physiology literature, it was referenced in the very publication that contains Bert's original observation. Thus, this article brings Goodwyn's work and its historical context to light and argues that he should be credited with the first description of diving bradycardia.

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Treating fructose-induced metabolic changes in mice with high-intensity interval training: insights in the liver, white adipose tissue and skeletal muscle

Fructose-rich caloric sweeteners induce adverse changes in the population metabolism. The study evaluated the effects of high-intensity interval training (HIIT) on a fructose feeding model, focusing on the liver, white adipose tissue (WAT), skeletal muscle, and their interplay. Male C57BL/6 mice were fed for 18 weeks one of the following diets: control (C; 5 % of total energy from fructose), or fructose (F; 55 % of total energy from fructose). In the 10th week, for an additional eight-week period the groups were divided into non-trained (NT) or HIIT groups, totaling four groups: C-NT, C-HIIT, F-NT, and F-HIIT. At the end of the experiment, fructose consumption in the F-NT group led to a high systolic blood pressure, high plasma triglycerides, insulin resistance with glucose intolerance, and lower insulin sensitivity. We also observed liver steatosis, adipocyte hypertrophy, and diminished gene expressions of peroxisome proliferator-activated receptor gamma coactivator 1-alpha and fibronectin type III domain containing 5 (FNDC5; irisin) in this F-NT group. These results were accompanied by decreased gene expressions of nuclear respiratory factor 1 and mitochondrial transcription factor A (markers of mitochondrial biogenesis), and peroxisome proliferator-activated receptor alpha and carnitine palmitoyltransferase 1 (markers of beta-oxidation). HIIT improved all these data in the C-HIIT and F-HIIT groups. In conclusion, in mice fed a fructose diet, HIIT improved body mass, blood pressure, glucose metabolism and plasma triglycerides. Liver, WAT, and skeletal muscle were positively modulated by HIIT, indicating HIIT as a coadjutant treatment for diseases affecting these tissues.

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LOWER-BODY NEGATIVE PRESSURE DECREASES NON-INVASIVELY MEASURED INTRACRANIAL PRESSURE AND INTERNAL JUGULAR VEIN CROSS-SECTIONAL AREA DURING HEAD-DOWN TILT

Introduction: Long-term space flight induces a near visual acuity change in approximately 50% of astronauts. In some crew members, postflight cerebrospinal fluid (CSF) opening pressures by lumbar puncture are as high as 20.9 mmHg who demonstrated optic disc edema. CSF communicates through the cochlear aqueduct to affect perilymphatic pressure and tympanic membrane motion. We hypothesized that 50 mmHg of lower-body negative pressure (LBNP) during 15° head-down tilt (HDT) would mitigate elevations in internal jugular vein cross-sectional area (IJV CSA) and intracranial pressure (ICP). Methods: Fifteen healthy adult volunteers were positioned in sitting (5 min), supine (5 min), 15° HDT (5 min), and 15° HDT with LBNP (10 min) postures for data collection. Evoked tympanic membrane displacements (TMD) quantified ICP noninvasively. IJV CSA was measured using standard ultrasound techniques. Results: ICP and IJV CSA increased significantly from the seated-upright to the 15° HDT posture (P < 0.05), and LBNP mitigated these increases. LBNP at 25 mmHg reduced ICP during HDT (TMD of 322.13 ± 419.17 nL) to 232.38 ± 445.85 nL, and at 50 mmHg ICP was reduced further to TMD of 199.76 ± 429.69 nL. In addition, 50 mmHg LBNP significantly reduced IJV CSA (1.50 ± 0.33 cm²) during 15° HDT to 0.83 ± 0.42 cm². Discussion: LBNP counteracts the headward fluid shift elevation of ICP and IJV CSA experienced during microgravity as simulated by 15° HDT . These data provide quantitative evidence that LBNP shifts cephalic fluid to the lower body, reducing IJV CSA and ICP.

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Dispelling the myth that habitual caffeine consumption influences the performance response to acute caffeine supplementation

Objective: To investigate the influence of habitual caffeine intake on exercise performance to acute caffeine supplementation. Methods: A double-blind, crossover, counterbalanced study was performed. Forty endurance-trained cyclists were allocated into tertiles according to their daily caffeine intake: low (58 ± 29 mg^.d^-1), moderate (143 ± 25 mg^.d^-1), and high consumers (351 ± 139 mg^.d^-1). Participants completed three trials in which they performed simulated cycling time-trials in the fastest time possible following ingestion of: caffeine (CAF: 6 mg^.kg^-1 BM), placebo (PLA), and no supplement (CON). Results: Mixed-model analysis revealed time-trial performance was significantly improved in CAF compared to PLA and CON (29.92±2.18 min vs 30.81±2.67 and 31.14±2.71 min; P = <0.0002). ANCOVA revealed no influence of habitual caffeine intake as a covariate on exercise performance (P=0.47). Time-trial performance was not significantly different between tertiles (P=0.75). No correlation was observed between habitual caffeine intake and absolute changes (CAF - CON) in time-trial performance with caffeine (P=0.524). Individual analysis showed that eight, seven and five individuals improved above the variation of the test in CAF in the low, moderate and high tertiles. A Fisher's Exact Test did not show any significant differences in the number of individuals who improved in CAF between the tertiles (P>0.05). Blood lactate and ratings of perceived exertion were not different between trials and tertiles (P>0.05). Conclusion: Performance effects of acute caffeine supplementation during a ~30 min cycling TT performance were not influenced by the level of habitual caffeine consumption.

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Engaging Overweight Adolescents in a Health and Fitness Program Using Wearable Activity Trackers

Our objectives were to (a) examine feasibility and receptivity of overweight adolescents joining a community-based group fitness program and (b) test preliminary efficacy of a 12-week pilot intervention designed to promote health, fitness, and self-efficacy for the identified teens.

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AST to Platelet Ratio Index and fibrosis 4 calculator scores for non-invasive assessment of hepatic fibrosis in patients with non-alcoholic fatty liver disease

Liver fibrosis is the single most important prognostic factor in patients with non-alcoholic fatty liver disease (NAFLD). The predictive value of the AST to Platelet Ratio Index (APRI) score, originally developed for fibrosis assessment in HCV patients, is much less known in the context of NAFLD patients.

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The effect of pressure-controlled inverse ratio ventilation on lung protection in obese patients undergoing gynecological laparoscopic surgery

Abstract

Specific aim

To examine the effects of pressure-controlled inverse ratio ventilation (PCIRV) and volume-control ventilation (VCV) on arterial oxygenation, pulmonary function, hemodynamics, levels of surfactant protein A (SP-A), and tumor necrosis factor-α (TNF-α) in obese patients undergoing gynecological laparoscopic surgery.

Methods

Sixty patients, body mass index (BMI) ≥30 kg/m², scheduled for elective gynecological laparoscopic surgery were enrolled in the study. Patients were randomly allocated to receive either PCIRV with an inspiratory–expiratory (I:E) ratio of 1.5:1 (PCIRV group n = 30) or VCV with an I:E ratio of 1:2 (VCV group n = 30). Ventilation variables, viz. tidal volume (V _T), dynamic respiratory-system compliance (C _RS), driving pressure (ΔP = V _T/C _RS), arterial blood oxygen partial pressure/fraction of inspiration oxygen (PaO₂/FiO₂) and arterial blood carbon dioxide partial pressure (PaCO₂), were measured. Hemodynamic variables, viz. mean arterial pressure (MAP), heart rate (HR), and serum levels of SP-A and TNF-α, were also measured.

Results

When compared to patients in the VCV group, patients in the PCIRV group had higher V _T, dynamic C_RS, and PaO₂/FiO₂, and lower ΔP and PaCO₂ at 20 and 60 min after the start of pneumoperitoneum (p < 0.05). Patients in the PCIRV group had lower SP-A and TNF-α levels at 24 and 48 h after surgery than those in the VCV group (p < 0.05).

Conclusion

In obese patients undergoing gynecological laparoscopic surgery, PCIRV can improve ventilation, promote gas exchange and oxygenation, and is associated with decreased levels of SP-A and TNF-α. These effects demonstrate improved lung protection provided by PCIRV in this patient population.

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AST to Platelet Ratio Index and fibrosis 4 calculator scores for non-invasive assessment of hepatic fibrosis in patients with non-alcoholic fatty liver disease

Liver fibrosis is the single most important prognostic factor in patients with non-alcoholic fatty liver disease (NAFLD). The predictive value of the AST to Platelet Ratio Index (APRI) score, originally developed for fibrosis assessment in HCV patients, is much less known in the context of NAFLD patients.

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Changes in resting-state directed connectivity in cortico-subcortical networks correlate with cognitive function in Parkinson’s disease

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by prominent motor symptoms, as well as a wide range of non-motor disturbances in early disease stages, among which cognitive dysfunction (Chaudhuri et al., 2006; Dickson et al., 2009). Over time, dementia develops in up to 75% of PD patients (Aarsland and Kurz. 2010), contributing significantly to an impaired quality of life and putting a heavy burden on caregivers (Aarsland et al., 1999; Schrag et al., 2006). The pathophysiological mechanisms underlying cognitive decline and conversion to PD dementia (PDD) are not well understood.

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Heart rate changes according to the complexity of motor events in REM sleep behavior disorder

Reduced Heart Rate Variability (HRV) is considered a marker of autonomic system dysfunction in REM sleep behavior disorder (RBD) (Fantini et al. 2002; Sorensen et al. 2012). Blunted Heart Rate (HR) response was described in RBD and Parkinson's Disease (PD) patients following limb movements during sleep (Fantini et al. 2002; Sorensen et al. 2012) and in PD after arousals (Sorensen et al. 2012). We found no study on the effect of RBD motor events (ME) on HR. RBD related ME can be classified in two types: short lasting, small amplitude, non-purposeful movements and complex, scenic ones, in which patients enact the content of their dreams, usually negative or violent (Frauscher et al.

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Motor unit number estimation (MUNE): An important – though imperfect – measure receives some needed scholarship

"MUNE has the potential to serve as the most sensitive quantitative measure of early disease progression in ALS." (Shefner and Gooch, 2003)

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Evoked potentials recorded during routine EEG predict outcome after perinatal asphyxia

Hypoxic-ischaemic encephalopathy (HIE) due to perinatal asphyxia occurs in approximately 2,5 per 1000 live full-term births (Graham et al., 2008), and is one of the leading causes of neonatal deaths and severe neurodevelopmental compromise (Lai and Yang, 2011). Recent data show that even when treated with therapeutic hypothermia (TH), 40-50% of newborns with moderate-to-severe HIE will die or develop with severe handicap (Tagin et al., 2012).

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9-Phenanthrol modulates postinhibitory rebound and afterhyperpolarizing potentials in an excitatory motor neuron of the medicinal leech

Abstract

Postinhibitory rebound (PIR) responses in leech dorsal excitatory motor neurons (cell DE-3) are eliminated by Ca²⁺ channel blockers but also exhibit a strong dependence on extracellular Na⁺. These features could be explained by a voltage-gated Ca²⁺ current acting in concert with a Ca²⁺-activated nonspecific current (I_CAN). In vertebrates, I_CAN is associated with TRPM4 channels which are blocked selectively by 9-phenanthrol. Here, we show that 9-phenanthrol selectively inhibits a late phase of PIR and simultaneously enhances afterhyperpolarizing potentials (AHPs). Bath application of NNC 55-0396 or Cd²⁺ combined with ion substitution experiments indicate that a low-voltage-activated Ca²⁺ current plays a key role in generating PIR and that Ca²⁺ influx through low- or high-voltage-activated Ca²⁺ channels can trigger AHPs via activation of a Ca²⁺-dependent K⁺ current. We also demonstrate modulation of rebound responses by other I_CAN blockers such as gadolinium and flufenamic acid, as well as the calmodulin antagonist W-7. We discuss how these results provide additional insights into the specific types of ionic currents underlying rebound responses of motor neuron DE-3 in the medicinal leech.

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Effects of juvenile hormone analogue (methoprene) and 20-hydroxyecdysone on reproduction in Polygonia c-aureum (Lepidoptera: Nymphalidae) in relation to adult diapause

Abstract

We investigated the effects of juvenile hormone analogue (methoprene) and 20-hydroxyecdysone on female and male reproduction in a nymphalid butterfly, Polygonia c-aureum. This butterfly has a facultative adult diapause controlled by the corpora allata and brain. Methoprene seems to terminate reproductive diapause, although transplantation experiments indicate that the activity of the corpora allata does not affect male mating behavior Endo (Dev Growth Differ 15:1–10, 1973a), suggesting that the brain may be involved in diapause. We found that exposure to methoprene promoted the development of ovaries and of the male accessory glands and simplex. On the other hand, exposure to 20-hydroxyecdysone did not promote the development of female and male reproductive organs and eupyrene sperm movement from the testis to the duplex in the adult stage. Ecdysteroid titer in both sexes was consistently low in adults. These results suggest that imaginal diapause is largely regulated by juvenile hormone in this butterfly.

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Firefighter Paramedic - DC Fire and Emergency Medical Services Department

Job Summary: This position is located in the District of Columbia Fire and Emergency Medical Services Department (DCFEMS). DCFEMS provides fire suppression, technical rescue, fire prevention and education, and pre-hospital emergency medical care and transportation services to people within the District in order to protect life and property. A Firefighter/Paramedic is assigned to one of approximately ...

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High intensity interval training does not impair strength gains in response to resistance training in premenopausal women

Abstract

Purpose

To compare the increases in upper- and lower-body muscle strength in premenopausal women performing resistance training (RT) alone or alongside concurrent high-intensity interval training (CT).

Methods

Sixteen women (26–40 years) were randomly assigned into two groups that performed either RT or CT. Both groups performed the same RT program; however, CT performed additional high-intensity interval training (HIIT) on a bicycle ergometer before RT. The study lasted 8 weeks and the participants were tested for ten repetition maximum (10RM) load in elbow flexion (barbell biceps curl) and knee extension exercises pre- and post-intervention. RT was performed with 10–12 repetitions to self-determined repetition maximum in the first four weeks and then progressed to 8–10. During CT, HIIT was performed before RT with six 1-min bouts at 7–8 of perceived subjective exertion (RPE) and then progressed to eight bouts at 9–10 RPE.

Results

Analysis of variance revealed significant increases in upper and lower body strength for both the RT and CT groups. Biceps barbell curl 10RM load increased from 12.9 ± 3.2 kg to 14 ± 1.5 kg in CT (p < 0.05) and from 13 ± 1.8 kg to 15.9 ± 2.5 kg in RT (p < 0.05), with no significant between-groups differences. Knee extension 10RM increase from 31.9 ± 11.6 kg to 37.5 ± 8.5 kg for CT (p < 0.05) and from 30.6 ± 8.6 kg to 41.2 ± 7.4 kg for RT (p < 0.05).

Conclusion

In conclusion, performing HIIT on a cycle ergometer before resistance training does not seem to impair muscle strength increases in the knee extensors or elbow flexors of pre-menopausal women. This information should be considered when prescribing exercise sessions, since both activities may be combined without negative effects in muscle strength.

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Factors influencing the post-exercise hepcidin-25 response in elite athletes

Abstract

Purpose

The extent to which hepcidin regulation after acute bouts of exercise is influenced by baseline (resting) concentrations of key iron parameters remains uncertain. This investigation explored the influence of selected iron parameters and 25-km race walk time on 3-h post-exercise hepcidin-25 levels in international-level race walkers.

Methods

Twenty-four male race walkers completed a graded exercise test and a 25-km race-walk trial. Throughout the 25-km race-walk, venous blood samples were collected pre-exercise, immediately post-exercise, and at 3-h post-exercise. Blood was analysed for serum ferritin, serum iron, Interleukin-6 (IL-6), and hepcidin-25 concentration.

Results

IL-6 and hepcidin-25 increased (7.6- and 7.5-fold, respectively) in response to the 25-km race-walk trial (both p < 0.01). Significant individual relationships were evident between 3-h post-exercise hepcidin-25, baseline serum ferritin and serum iron (r > 0.62; p < 0.05). Multiple regression analysis showed that these two iron parameters, in addition to post-exercise IL-6 concentration and 25-km race-walk time, accounted for ~77% of the variance in 3-h post-exercise hepcidin-25 (p < 0.01). A median split by the cohort's baseline serum ferritin concentration (LOW: 58.0 vs. HIGH: 101.8 µg/L; p < 0.01) showed a significant between group difference in the 3-h post-exercise hepcidin-25 (LOW: 6.0 ± 3.6 vs. 11.3 ± 5.4 nM; p = 0.01), despite no differences in baseline serum iron, post-exercise IL-6, or 25-km race-walk time (all p > 0.05).

Conclusion

Despite exercise activating numerous hepcidin regulators, baseline iron status appears to play a dominant role in the regulation of hepcidin-25 in elite-level athletes subsequent to endurance exercise.

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Muscle size and strength: debunking the “completely separate phenomena” suggestion

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Spinal and corticospinal pathways are differently modulated when standing at the bottom and the top of a three-step staircase in young and older adults

Abstract

Purpose

This study investigated the modulation of spinal (group Ia afferents) and corticospinal pathways when young (22.7 ± 1.3 years) and older adults (72.2 ± 7.9 years) stood at the bottom and at the top of a three-step staircase equipped with force platforms.

Method

Changes in submaximal H-reflex amplitude (H ₅₀) and slope of the H-reflex input–output relation (spinal pathway), and in amplitude of motor-evoked potentials (MEP) triggered by transcranial magnetic stimulation (corticospinal pathway) at two intensities (1.1× and 1.2× motor threshold) were recorded in soleus when subjects stood as steady as possible downstairs and upstairs. The centre of pressure (CoP) excursion was analyzed in the time and frequency domains in both conditions.

Results

Regardless of age, the mean CoP velocity was greater when standing upstairs (11.1 ± 3.5 mm s⁻¹) than downstairs (9.0 ± 2.3 mm s⁻¹; p = 0.002). The CoP power spectral density (PSD) in the 0–0.5 Hz band was greater upstairs than downstairs (+18.4%; p = 0.03) whereas PSD in the 2–20Hz frequency band was lesser (−41%) upstairs than downstairs (p < 0.001), regardless of age. In both groups, the H ₅₀ amplitude (−30.6%; p < 0.001) and slope of H-reflex input–output relation (−10.2%; p = 0.002) were lesser when standing upstairs than downstairs, whereas no significant difference was observed in MEP amplitude and silent period between balance conditions (p > 0.05).

Conclusion

These results indicate a lower dependence on spinal pathway to control soleus motor neurones when standing upstairs than downstairs accompanied by a change in postural control. This suggests that healthy older adults preserved their ability to adjust postural control to environmental demands.

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Middle cerebral artery blood flow velocity during a 4 km cycling time trial

Abstract

Purpose

This study sought to describe middle cerebral artery blood flow velocity (MCA_v) during a 4 km cycling time trial, and relate it to different pacing strategies adopted by participants.

Methods

After familiarisation and a standardised exercise protocol, 15 male trained cyclists rode a 4 km time trial on a cycling ergometer. MCA_v was assessed via transcranial Doppler ultrasound in the right hemisphere at resting baseline, and throughout the time trial. Mean arterial pressure, end-tidal partial pressure of carbon dioxide (P_etCO₂) and heart rate were assessed alongside MCA_v. Plasma lactate was assessed post time trial. Data were compared depending upon whether participants completed the time trial with a positive (first half faster than the last) or negative pacing profile although there was no difference in the time to completion with either pacing strategy (positive 344 ± 23 s, negative 334 ± 14 s; p = 0.394).

Results

Lower mean MCA_v (positive pacing −7.6 ± 14.2%, negative pacing +21.2 ± 15.0% compared to resting baseline measures; p = 0.004) and lower P_etCO₂ (significant interaction p < 0.001) towards the end of the time trial were observed with positive compared to negative pacing. Heart rate and lactate did not differ between pacing strategies.

Conclusions

Changes in MCA_v appear to depend on the pacing strategy adopted, with a positive pacing strategy likely to contribute to a hyperventilatory drop in P_etCO₂ and subsequent reduction in MCA_v. Although lower cerebral blood flow cannot be directly linked to an inability to raise or maintain power output during the closing stages of the time trial, this potential contributor to fatigue is worth further investigation.

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Muscle size and strength: another study not designed to answer the question

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Associations of maximal voluntary isometric hip extension torque with muscle size of hamstring and gluteus maximus and intra-abdominal pressure

Abstract

Purpose

Muscle size of the hamstring and gluteus maximus (GM) as well as intra-abdominal pressure (IAP) are considered as factors affecting the torque development during hip extension. This study examined the associations of torque development during maximal voluntary isometric hip extension with IAP and muscle size of the hamstring and GM.

Methods

Anatomical cross-sectional area (ACSA) of the hamstring and thickness of GM were determined in 20 healthy young males using an ultrasonography apparatus (Experiment 1). Torque and IAP were simultaneously measured while subjects performed maximal voluntary isometric hip extension. The IAP was measured using a pressure transducer placed in the rectum and determined at the time at which the developed torque reached to the maximal. In Experiment 2, torque and IAP were measured during maximal voluntary isometric hip flexion in 18 healthy young males.

Results

The maximal hip extension torque was significantly correlated with the IAP (r = 0.504, P = 0.024), not with the ACSA of the hamstring (r = 0.307, P = 0.188) or the thickness of GM (r = 0.405, P = 0.076). The relationship was still significant even when the ACSA of the hamstring and the thickness of GM were adjusted statistically (r = 0.486, P = 0.041). The maximal hip flexion torque was not significantly correlated with the IAP (r = −0.118, P = 0.642).

Conclusion

The current results suggest that IAP can contribute independently of the muscle size of the agonists to maximal voluntary hip extension torque.

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The effect of high-intensity aerobic interval training on markers of systemic inflammation in sedentary populations

Abstract

Purpose

This study examined the effects of high-intensity interval training (HIIT; 30 s sprint, 4–5 min passive recovery) and prolonged intermittent sprint training (PIST; 10 s sprint, 2–3 min moderate exercise) on the systemic inflammatory markers C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α), aerobic capacity, and anthropometry in a middle-aged, sedentary population.

Methods

Fifty-five sedentary adults (age 49.2 ± 6.1 years) were randomised into HIIT (n = 20), PIST (n = 21), or a sedentary control group (CTRL n = 14). HIIT and PIST performed three training sessions per week for 9 weeks on a cycle ergometer, matched for total high-intensity time, while CTRL continued normal sedentary behaviours. Pre- and post-intervention testing involved measures of anthropometry, peak oxygen consumption (VO_2peak), and venous blood collection for analyses of CRP and TNF-α.

Results

HIIT and PIST increased VO_2peak compared to CTRL (+3.66 ± 2.23 and 3.74 ± 2.62 mL kg min⁻¹). A group × time interaction (p = 0.042) and main effect of time (p = 0.026) were evident for waist girth, with only HIIT showing a significant reduction compared to CTRL (−2.1 ± 2.8 cm). TNF-α and CRP showed no group × time interaction or time effect (p > 0.05).

Conclusions

In sedentary individuals, 9 weeks of HIIT or PIST were effective to improve aerobic capacity; however, only HIIT significantly reduced waist girth and WHR compared to CTRL. Markers of systemic inflammation remained unchanged across all groups. Accordingly, for inflammation and VO2_peak, the distribution of sprints and the active or passive recovery periods are inconsequential provided that total duration of high-intensity efforts is similar.

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The efficacy of periodised resistance training on neuromuscular adaptation in older adults

Abstract

Purpose

This study compared the effect of periodised versus non-periodised (NP) resistance training on neuromuscular adaptions in older adults.

Methods

Forty-one apparently healthy untrained older adults (female = 21, male = 20; 70.9 ± 5.1 years; 166.3 ± 8.2 cm; 72.9 ± 13.4 kg) were recruited and randomly stratified to an NP, block periodised (BP), or daily undulating periodised (DUP) training group. Outcome measures were assessed at baseline and following a 22-week resistance training intervention (3 day week⁻¹), including: muscle cross-sectional area (CSA), vertical jump performance, isometric and isokinetic peak torque, isometric rate of force development (RFD), and muscle activation. Thirty-three participants satisfied all study requirements and were included in analyses (female = 17, male = 16; 71.3 ± 5.4 years; 166.3 ± 8.5 cm; 72.5 ± 13.7 kg).

Results

Block periodisation, DUP, and NP resistance training induced statistically significant improvements in muscle CSA, vertical jump peak velocity, peak power and jump height, and peak isometric and isokinetic torque of the knee extensors at 60 and 180° s⁻¹, with no between-group differences. Muscle activity and absolute RFD measures were statistically unchanged following resistance training across the entire cohort.

Conclusions

Periodised resistance training, specifically BP and DUP, and NP resistance training are equally effective for promoting increases in muscular hypertrophy, strength, and power among untrained older adults. Consequently, periodisation strategies are not essential for optimising neuromuscular adaptations during the initial stages of resistance training in the aging population.

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The effect of nitric oxide synthase inhibition with and without inhibition of prostaglandins on blood flow in different human skeletal muscles

Abstract

Purpose

Animal studies suggest that the inhibition of nitric oxide synthase (NOS) affects blood flow differently in different skeletal muscles according to their muscle fibre type composition (oxidative vs glycolytic). Quadriceps femoris (QF) muscle consists of four different muscle parts: vastus intermedius (VI), rectus femoris (RF), vastus medialis (VM), and vastus lateralis (VL) of which VI is located deep within the muscle group and is generally regarded to consist mostly of oxidative muscle fibres.

Methods

We studied the effect of NOS inhibition on blood flow in these four different muscles by positron emission tomography in eight young healthy men at rest and during one-leg dynamic exercise, with and without combined blockade with prostaglandins.

Results

At rest blood flow in the VI (2.6 ± 1.1 ml/100 g/min) was significantly higher than in VL (1.9 ± 0.6 ml/100 g/min, p = 0.015) and RF (1.7 ± 0.6 ml/100 g/min, p = 0.0015), but comparable to VM (2.4 ± 1.1 ml/100 g/min). NOS inhibition alone or with prostaglandins reduced blood flow by almost 50% (p < 0.001), but decrements were similar in all four muscles (drug × muscle interaction, p = 0.43). During exercise blood flow was also the highest in VI (45.4 ± 5.5 ml/100 g/min) and higher compared to VL (35.0 ± 5.5 ml/100 g/min), RF (38.4 ± 7.4 ml/100 g/min), and VM (36.2 ± 6.8 ml/100 g/min). NOS inhibition alone did not reduce exercise hyperemia (p = 0.51), but combined NOS and prostaglandin inhibition reduced blood flow during exercise (p = 0.002), similarly in all muscles (drug × muscle interaction, p = 0.99).

Conclusion

NOS inhibition, with or without prostaglandins inhibition, affects blood flow similarly in different human QF muscles both at rest and during low-to-moderate intensity exercise.

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Spirit Central WI Paramedic Opening - $2000 Sign-on Bonus - Spirit Medical Transportation

Spirit Medical Transportation is Hiring Paramedics and RNs in Stevens Point, Woodruff, Rhinelander, Weston! Sign-on Bonus available up to $2000 This is a career opportunity for qualified EMS Staff to join a Central and Northern Wisconsin's leading link for safe patient transport. Ministry Health Care's Spirit Medical Transportation is one of fewer than 200 critical care transport services ...

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The model for end-stage liver disease predicts outcomes in patients undergoing cholecystectomy

Abstract

Background

The magnitude of risk for patients undergoing cholecystectomy with high model for end-stage liver disease (MELD) scores is poorly understood.

Methods

The American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2013 was used to study patients undergoing cholecystectomy. Patients were excluded if they had choledocholithiasis or preoperative dialysis. Bivariate data analysis was performed and logistic regression modeling was conducted to calculate risk-adjusted 30-day outcomes.

Results

A total of 63,464 patients were included in the study. Unadjusted mortality significantly increased as the MELD score increased in the laparoscopic (MELD = 6–10, 0.2%; 11–15, 1.1%; 16–20, 3.2%; >20, 5.8%) and open groups (MELD = 6–10, 1.5%; 11–15, 3.7%; 16–20, 8.6%; >20, 17.9%) (p-value <0.001 for both). Unadjusted morbidity also increased with MELD score increases in the laparoscopic (MELD = 6–10, 3.8%; 11–15, 9.9%; 16–20, 16.3%; >20, 22.8%) and open groups (MELD = 6–10, 18.7%; 11–15, 28.2%; 16–20, 40.7%; >20, 57.8%) (p-value <0.001 for both). Patients with ascites and high MELD scores had higher rates of mortality (laparoscopic, MELD > 20, 33.3%; open, MELD > 20, 48.5%) and morbidity (laparoscopic, MELD > 20, 66.7%; open, MELD > 20, 75.8%) across all MELD scores. After adjustment, MELD score acted as a progressive and independent predictor of morbidity and mortality.

Conclusions

The MELD score is an objective and easy to calculate scoring system that independently predicts postoperative morbidity and mortality in patients undergoing cholecystectomy. Patients with ascites have substantially worse outcomes across all MELD scores. Open cholecystectomy is associated with significantly more morbidity and mortality than laparoscopic cholecystectomy across all MELD groups.

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A comparison between totally laparoscopic hydrocelectomy and scrotal incision hydrocelectomy with laparoscopic high ligation for pediatric cord hydrocele

Abstract

Background

The purpose of this study is to report clinical characteristics and to investigate the feasibility and safety of totally laparoscopic hydrocelectomy (TLH) compared to scrotal incision hydrocelectomy with laparoscopic high ligation (SIH) for pediatric cord hydrocele (CH).

Methods

From September 2011 to February 2016, 148 patients underwent SIH, and 342 patients underwent TLH for CH. In the TLH group, a large hydrocele that could not pass through the internal ring was removed after percutaneous syringe aspiration. Age, laterality of hydrocele, inguinal comorbidities, operation time, surgical complications, and recurrences were evaluated.

Results

All the patients had spermatic cord cysts and patent processus vaginalis in proximity to hydrocele (mixed type). The mean age of CH patients was 34.1 ± 22.1 months. CHs are more common on the right side (61.0%) than on the left (35.7%). Bilaterality occurred in 3.3%. Comorbidities such as hernia (8.6%) and cryptorchidism (1.2%) were observed. There were no complications except for two cases of wound hematoma in SIH group. There was one (0.7%) case of recurrence appeared in communicating hydrocele in SIH group. There were no significant differences in the age, laterality of hydrocele, inguinal comorbidities, operation time, complications, and recurrences between TLH and SIH groups. However, TLH for unilateral cord hydrocele had significantly shorter operation time compared to SIH. The mean operation time in TLH group was 15.6 ± 5.96 min and there was no conversion to open surgery.

Conclusions

TLH for pediatric CH is a feasible and safe procedure without additional incisions. Therefore, TLH can be one of the surgical options for pediatric CH especially in mixed type.

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Single-setting endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy improve the rate of surgical site infection

Abstract

Introduction

Cholecystectomy is a common surgical procedure. The presence of common bile duct stones complicates treatment, often requiring a second procedure for stone retrieval. For such patients, endoscopic retrograde cholangiopancreatography (ERCP) provides adequate therapy, and can be performed before, after, or at the same time as cholecystectomy. In 2013, duodenoscopes were implicated by the Centers for Disease Control and Prevention in transmission of carbapenem-resistant Enterobacteriaceae. In this study, we sought to determine if the addition of ERCP to cholecystectomy was associated with higher rates of surgical site infections and microbial resistance.

Hypothesis

Adding ERCP to cholecystectomy increases the SSI rate.

Methods

For this retrospective review, we used the SSI surveillance database at our tertiary-care academic hospital. Cholecystectomy cases between 2010 and 2015 were included in the analysis. SSI was diagnosed using criteria of CDC's National Healthcare Safety Network (NHSN). We applied a logistic regression model to our data (SAS Studio software, v3.4, Enterprise Edition).

Results

Our 6-year study period included 2201 cholecystectomies. The SSI rate was 4.1 times higher for patients who underwent open cholecystectomy as compared with laparoscopic cholecystectomy (95% CI 1.61–10.24). When adjusted for wound class and procedure type, the SSI rate was significantly higher for patients who underwent ERCP within 60 days before cholecystectomy (P = 0.04; OR 2.2; CI 1.04–4.49). Rates of resistant pathogens were significantly higher in patients who underwent ERCP in addition to cholecystectomy (1.1% vs. 0.2%, P = 0.02, Fisher's exact test).

Conclusions

ERCP performed in the same setting as cholecystectomy carries no increased risk of SSI and should be the treatment of choice in patients with choledocholithiasis. ERCP performed separately within 60 days before cholecystectomy doubles the risk of SSI. Contaminated equipment might play a role, but other factors are likely at play, and should be taken into account when selecting treatment pathways for patients with choledocholithiasis.

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Primary versus redo paraesophageal hiatal hernia repair: a comparative analysis of operative and quality of life outcomes

Abstract

Introduction

We compared patient outcomes after initial versus redo paraesophageal hernia (PEH) repair at two high-volume GI surgery centers.

Materials and methods

Retrospective review analyzed one-year outcomes after initial versus redo elective laparoscopic PEH repair, including wound/non-wound-related complications and quality of life benefits as measured by four validated instruments: reflux symptom index, gastroesophageal reflux disease health-related, laryngopharyngeal reflux, and swallowing scales.

Results

Three hundred and seventeen patients (271 initial and 46 redo) underwent laparoscopic PEH repair. Groups differed with respect to age (64.6 vs. 60.2 years, p = 0.027), but were comparable in gender (71.2 vs. 67.4% female, p = 0.596), BMI (29.0 vs. 27.6 kg/m², p = 0.100), and ASA score (2.3 vs. 2.3 p = 0.666). Redo surgery was more complex with longer mean operative times (112.2 vs. 139.1 min, p < 0.001). Groups did not statistically differ with respect to 30-day wound (0.7 vs. 2.2%, p = 0.363) and non-wound (6.0 vs. 8.7%, p = 0.511)-related complications. After one year of follow-up, QOL analysis revealed that initial versus redo groups significantly benefited from operative intervention.

Conclusions

Although redo PEH repairs are more complex, patients enjoy equivalent operative outcomes and quality of life benefits compared to initial surgery lending support to the significance of surgeon experience and high-volume centers in optimizing outcomes.

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Diagnostic yield of small histological cores obtained with a new EUS-guided fine needle biopsy system

Abstract

Background

As endoscopic ultrasound-guided tissue acquisition techniques evolve, there is increasing interest in obtaining optimal histological samples to improve diagnostic accuracy. In this study, we aimed to assess the tissue acquisition success rate and test performance characteristics of a novel endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) system.

Methods

We performed a retrospective review of consecutive patients undergoing EUS-guided tissue sampling of solid lesions using the SharkCore fine needle system in a tertiary referral facility. At least two passes were submitted for histology and diagnostic accuracy was evaluated. Comparison standard was based on final surgical pathology or minimum six-month clinical follow-up.

Results

Seventy-nine patients underwent 85 EUS-FNB procedures. Of the 85 histology specimens, 78 (91.7%) were adequate for diagnostic examination (includes six atypical/suspicious for adenocarcinoma). The sensitivity, specificity, and accuracy for diagnosis of malignancy with FNB were 87.1, 100, and 90.6%, respectively. Cytology was simultaneously sent in 43 cases with the same needle in addition to histology. Out of the 14 cases that were atypical/suspicious for adenocarcinoma or non-diagnostic on cytology, 11 cases (78.6%) achieved definite diagnoses on histology. The overall sensitivity, specificity, and accuracy for diagnosis of malignancy combining histology and cytology were 90.3, 100, and 92.9%, respectively. No complications were reported after the procedures.

Conclusion

In this initial experience with a new EUS-guided FNB system, obtaining small cores to submit for histological analysis was safe, technically feasible, and highly accurate. Most of the histological cores obtained via FNB yielded a definite diagnosis including in cases with equivocal cytomorphology. Further study is required to confirm these findings.

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Minimally invasive distal pancreatectomy: greatest benefit for the frail

Abstract

Objective

The benefits of minimally invasive distal pancreatectomy (MIDP) over open surgery continue to be investigated. Frailty is a known predictor of postoperative outcome. We hypothesized that the benefit of minimally invasive distal pancreatectomy is the greatest for the frailest of patients.

Methods

Data from the pancreas-targeted National Surgical Quality Improvement Program (NSQIP) database for 2014 were reviewed. A modified frailty index (mFI) with 11 preoperative variables previously validated for use in NSQIP was used to determine the correlation between frailty and postoperative outcomes, including Clavien grade IV complications. Patients were classified into non-frail (mFI = 0) or frail (mIF > 0), in which they were subclassified into mildly frail (mFI 1 or 2) or severely frail (mFI = 3).

Results

A total of 1,038 distal pancreatectomies (DP) were included in the analysis, of which 387 were minimally invasive (MIDP: laparoscopic: 285, robotic: 102), 558 open DP (ODP), and 93 MIDP converted to open (MIDPcODP: laparoscopic: 80, robotic: 13). More than 90% of patients had an mFI of 0 or 1 (mFI 0 = 473 (45.6%), 1 = 466 (44.9%), 2 = 94 (9.1%), and 3 = 5 (0.5%), respectively). Overall, 4.6% of patients experienced Clavien grade IV complications and 1.1% a mortality. Non-frail patients experienced a similar rate of grade IV Clavien complications with MIDP vs. ODP vs. MIDPcOP (2.3 vs. 2.3 vs. 4.9%; p = 0.6), whereas frail patients (mFI > 0) had a lower rate of complications with MIDP (2.4 vs. 8.3 vs. 11.5; p = 0.007). Worsening frailty correlated with an increase in complications (non-frail: 2.5%; mildly frail: 6.3%; severely frail: 20%; p = 0.005).

Conclusion

MIDP is associated with a lower risk of Clavien grade IV complications compared to ODP for frail patients, especially for benign disease. Thus, minimally invasive approach may mitigate risk in frail patients.

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Psychometric properties of the Fundamentals of Endoscopic Surgery (FES) skills examination

Abstract

Background

The Fundamentals of Endoscopic Surgery (FES) manual skills examination is a simulation-based assessment of five foundational skills in endoscopic surgery. With the FES skills exam becoming part of the board certification process in general surgery, continual investigation is needed to determine the validity with which the exam is supporting inferences and decision-making about examinees, as well as how it might be improved.

Methods

The present study retrospectively analyzed performance and demographic details for the initial 344 examinees completing the FES skills exam.

Results

The five tasks showed distinct degrees of difficulty, with Loop Reduction being especially difficult for examinees. Tasks related to one another positively but moderately, suggesting that the exam assesses both general and task-specific skills. The number of lower-endoscopic cases completed by an examinee strongly predicted performance, while upper endoscopy experience and career level (e.g., resident vs. fellow vs. practicing) did not. Hand dominance and the type of simulator used were not found to be related to scores. However, three demographic variables that related to one another—gender, glove size, and height—were also related to performance and pass/fail status.

Conclusions

This study's results generally support the validity argument for the FES skills exam while pointing to additional investigations to be undertaken as the exam is applied more broadly.

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Cardiac arrest survivor thanks paramedics who saved his life

Throughout the reunion event, fire officials stressed the importance of everyone learning CPR

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Evidence-Based Prerequisites and Precursors of Athletic Talent: A Review

Abstract

Extensive findings related to nature and nurture in determining athletic talent (AT) have been reviewed. Available data demonstrate the important contribution of hereditary factors as well as the crucial importance of environmental prerequisites for identifying and developing AT. Recent publications provide examples of contemporary approaches intended to solve the problem of how to discover and nurture AT. A number of cross-sectional and longitudinal studies highlighted possibilities of revealing a predisposition to certain sports among youthful prospects, but were unable to predict attainment of world-class status. Data pertaining to Olympic champions indicate that their superiority compared with other elite athletes is determined by high intrinsic motivation, determination, dedication, persistence, and creativity. These salient manifestations of personality could be successfully recognized even in the initial stages of their preparation, where exceptionally gifted individuals manifested high learnability and a high rate of athletic improvement. Moreover, future champions were characterized by an exceptional attitude to training and a willingness to perform more voluminous and high-quality training routines. Exceptionally talented athletes in endurance, power, and combat sports attained world-class status after 4–7 years of specialized preparation, accumulating 3000–7000 h of purposeful training. This stands in contradiction to Ericsson's theory of deliberate practice and the 10-year rule. In contrast, Olympic artistic gymnastics champions attained world-class status following an average of 9.7 years of specialized preparation, accumulating an average of 8918 h of specialized training. Apparently, the theory of 10,000 h of deliberate practice and the 10-year rule are selectively applicable to highly coordinative esthetic sports but not to general preparation trends in endurance, power, and combat sports.

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Comment on: “Are Prepubertal Children Metabolically Comparable to Well-Trained Adult Endurance Athletes?”

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Chronotype, Physical Activity, and Sport Performance: A Systematic Review

Abstract

Background

Many variables related to sport have been shown to have circadian rhythms. Chronotype is the expression of circadian rhythmicity in an individual, and three categories of chronotype are defined: morning types (M-types), evening types (E-types), and neither types (N-types). M-types show earlier peaks of several psychophysiological variables during the day than E-types. The effect of chronotype on athletic performance has not been extensively investigated.

Objective

The objective of the present review was to study the effect of chronotype on athletic performance and the psychophysiological responses to physical activity.

Methods

The present review adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. We searched PubMed, Scopus, and Web of Science for scientific papers using the keywords "chronotype", "circadian typology", "morningness", and "eveningness" in combination with each of the words "sport", "performance", and "athletic." Relevant reference lists were inspected. We limited the search results to peer-reviewed papers published in English from 1985 to 2015.

Results

Ten papers met our inclusion criteria. Rating of perceived exertion and fatigue scores in relation to athletic performances are influenced by chronotype: M-types perceived less effort when performing a submaximal physical task in the morning than did N- and E-types. In addition, M-types generally showed better athletic performances, as measured by race times, in the morning than did N- and E-types. Other results concerning chronotype effect on physiological responses to physical activity were not always consistent: heterogeneous samples and different kinds of physical activity could partially explain these discrepancies.

Conclusions

Sports trainers and coaches should take into account the influence of both the time of day and chronotype effect when scheduling training sessions into specific time periods.

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Authors’ Reply to Dotan and Falk: “Are Prepubertal Children Metabolically Comparable to Well-Trained Adult Endurance Athletes?”

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Synthetic Turf Fields, Crumb Rubber, and Alleged Cancer Risk

Abstract

Most synthetic turf fields have crumb rubber interspersed among the simulated grass fibers to reduce athletic injuries by allowing users to turn and slide more readily as they play sports or exercise on the fields. Recently, the crumbs have been implicated in causing cancer in adolescents and young adults who use the fields, particularly lymphoma and primarily in soccer goalkeepers. This concern has led to the initiation of large-scale studies by local and federal governments that are expected to take years to complete. Meanwhile, should the existing synthetic turf fields with crumb rubber be avoided? What should parents, players, coaches, school administrators, and playground developers do? What should sports medicine specialists and other health professionals recommend? Use grass fields when weather and field conditions permit? Exercise indoors? Three basic premises regarding the nature of the reported cancers, the latency of exposure to environmental causes of cancer to the development of clinically detectable cancer, and the rarity of environmental causation of cancer in children, adolescents, and young adults suggest otherwise.

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Paramedic turns to painting to manage stress

By EMS1 Staff TAMPA, Fla. — A paramedic turned to painting to help deal with the stresses of the job. FOX13.com reported that Jason Skeldon, who worked as a paramedic for eight years, said painting helped him relax and sleep at night. "Art helped me with anxiety and the day-to-day of being a paramedic, because it's stressful on your body and mind," Skeldon said. In fear of judgement ...

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Division Chief, Manager Emergency Medical Services - University of Colorado Hospital

At UCHealth, we do things differently We believe in something different: a focus on the individuality of every person. In big ways and small, we exist to improve the extraordinary lives of all those we serve. As Colorado's largest and most innovative health care system, we as a team deliver on the commitment to provide the best possible experience for our patients and their families. We foster a true ...

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Efficacy and safety of inhaled anaesthetic for postoperative sedation during mechanical ventilation in adult cardiac surgery patients: a systematic review and meta-analysis

<span class="paragraphSection"><div class="boxTitle">Abstract</div>The aim was to evaluate the efficacy and safety of volatile anaesthetic for postoperative sedation in adult cardiac surgery patients through a systematic review and meta-analysis. We retrieved randomized controlled trials from MEDLINE, EMBASE, CENTRAL, Web of Science, clinical trials registries, conference proceedings, and reference lists of included articles. Independent reviewers extracted data, including patient characteristics, type of intraoperative anaesthesia, inhaled anaesthetic used, comparator sedation, and outcomes of interest, using pre-piloted forms. We assessed risk of bias using the Cochrane Tool and evaluated the strength of the evidence using the GRADE approach. Eight studies enrolling 610 patients were included. Seven had a high and one a low risk of bias. The times to extubation after intensive care unit (ICU) admission and sedation discontinuation were, respectively, 76 [95% confidence interval (CI) −150 to − 2, <span style="font-style:italic;">I</span>²=79%] and 74 min (95% CI − 126 to − 23, <span style="font-style:italic;">I</span>²=96%) less in patients who were sedated using volatile anaesthetic. There was no difference in ICU or hospital length of stay. Patients who received volatile anaesthetic sedation had troponin concentrations that were 0.71 ng ml⁻¹ (95% CI 0.23–1.2) lower than control patients. Reporting on other outcomes was varied and not suitable for meta-analysis. Volatile anaesthetic sedation may be associated with a shorter time to extubation after cardiac surgery but no change in ICU or hospital length of stay. It is associated with a significantly lower postoperative troponin concentration, but the impact of this on adverse cardiovascular outcomes is uncertain. Blinded randomized trials using intention-to-treat analysis are required. PROSPERO registry number: 2016:CRD42016033874. Available from <a href="http://ift.tt/2pCmIQf">http://ift.tt/2q6Jv9z;

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Efficacy and safety of carbetocin given as an intravenous bolus compared with short infusion for Caesarean section - double-blind, double-dummy, randomized controlled non-inferiority trial

<span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>Background.</strong> Carbetocin is a synthetic oxytocin-analogue, which should be administered as bolus according to manufacturer's recommendations. A higher speed of oxytocin administration leads to increased cardiovascular side-effects. It is unclear whether carbetocin administration as short infusion has the same efficacy on uterine tone compared with bolus administration and whether haemodynamic parameters differ.<strong>Methods.</strong> In this randomized, double-blind, non-inferiority trial, women undergoing planned or unplanned Caesarean section (CS) under regional anaesthesia received a bolus and a short infusion, only one of which contained carbetocin 100 mcg (double dummy). Obstetricians quantified uterine tone two, three, five and 10 min after cord-clamping by manual palpation using a linear analogue scale from 0 to 100. We evaluated whether the lower limit of the 95% CI of the difference in maximum uterine tone within the first five min after cord-clamping did not include the pre-specified non-inferiority limit of −10.<strong>Results.</strong> Between December 2014 and November 2015, 69 patients were randomized to receive carbetocin as bolus and 71 to receive it as short infusion. Maximal uterine tone was 89 in the bolus and 88 in the short infusion group (mean difference −1.3, 95% CI −5.7 to 3.1). Bp, calculated blood loss, use of additional uterotonics, and side-effects were comparable.<strong>Conclusions.</strong> Administration of carbetocin as short infusion does not compromise uterine tone and has similar cardiovascular side-effects as a slow i.v. bolus. In accordance with current recommendations for oxytocin, carbetocin can safely be administered as short -infusion during planned or unplanned CS.<strong>Clinical trial registration.</strong> ClinicalTrials.gov NCT02221531 and <a href="http://www.kofam.ch">http://ift.tt/2pCMX9m; SNCTP000001197.</span>

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A muscle ultrasound score in the diagnosis of amyotrophic lateral sclerosis

Publication date: June 2017
Source:Clinical Neurophysiology, Volume 128, Issue 6
Author(s): Yukiko Tsuji, Yu-ichi Noto, Kensuke Shiga, Satoshi Teramukai, Masanori Nakagawa, Toshiki Mizuno
ObjectiveThe aims of this study are to elucidate the frequencies and distribution of fasciculations using muscle ultrasound in patients with amyotrophic lateral sclerosis (ALS) and those with other conditions mimicking ALS, and subsequently to develop a novel fasciculation score for the diagnosis of ALS.MethodsUltrasound of 21 muscles was performed to detect fasciculations in 36 consecutive patients suspected of having ALS. We developed a fasciculation ultrasound score that indicated the number of muscles with fasciculations in statistically selected muscles.ResultsA total of 525 muscles in 25 ALS patients and 231 in 11 non-ALS patients were analysed. Using relative operating characteristic and multivariate logistic regression analysis, we selected the trapezius, deltoid, biceps brachii, abductor pollicis brevis, abdominal, vastus lateralis, vastus medialis, biceps femoris, and gastrocnemius muscles for the fasciculation ultrasound score. The mean scores were higher in the ALS group than those in the non-ALS group (5.3±0.5vs. 0.3±0.7) (mean±SD); p<0.001.ConclusionsTwo or more of the fasciculation ultrasound scores showed high sensitivity and specificity in differentiating ALS patients from non-ALS patients.SignificanceThe fasciculation ultrasound score can be a simple and useful diagnostic marker of ALS.



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3-2-01. Decreased motor axonal potassium currents in peripheral nerve hyperexcitability syndrome with negativity for anti-VGKC antibody and positivity for anti-CRMP5 antibody

Publication date: June 2017
Source:Clinical Neurophysiology, Volume 128, Issue 6
Author(s): Tomoko Nakazato, Kazuaki Kanai, Kenya Nishioka, Motoki Fujimaki, Genko Oyama, Yasushi Shimo, Kazumasa Yokoyama, Nobutaka Hattori
Peripheral nerve hyperexcitability (PNH) syndromes are caused by spontaneous discharges originating from motor axons. Antibodies against voltage-gated potassium channels (VGKC) are detected in some patients with PNH syndrome, but the cause in the remaining patients has not yet been clarified. The index patient was a 46-year-old female with recurred thymoma and myasthenia gravis. Six month after the start of chemotherapy, she developed myokymia, fasciculations and muscle cramps in both her lower limbs. A nerve conduction studies revealed mild axonal polyneuropathy and a motor F-wave examination showed marked after-discharges. Needle electromyography showed fasciculation potentials and myokymic discharges. From these results, the patient was diagnosed with PNH syndrome. Nerve excitability study showed extremely greater supernormality in the recovery cycle and greater changes in depolarizing threshold electrotonus than control, suggesting decreased slow potassium currents in the motor axons. Serological tests revealed the absence of anti-VGKC antibody and the presence of anti-collapsin response mediator protein 5 (CRMP5) antibody. A recent study reported that CRMP5 plays an important role in axon–Schwann cell cooperation during development and nerve regeneration. The coexistence of nerve regeneration and anti-CRMP5 antibody may cause abnormal axon–Schwann cell interaction, which would result in slow potassium channel dysfunction and associated symptoms such as myokymia.



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Contents

Publication date: June 2017
Source:Clinical Neurophysiology, Volume 128, Issue 6





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1-1-05. Electroencephalographic diagnosis of prion disease in Japanese CJD surveillance

Publication date: June 2017
Source:Clinical Neurophysiology, Volume 128, Issue 6
Author(s): Yoshiyuki Kuroiwa, Ichiro Takumi, Hiroyuki Murai, Kensaku Kasuga, Yoshikazu Nakamura, Kimihiro Fujino, Takashi Kurokawa, Yasuhisa Baba, Katsuya Sato, Masashi Harada, Tetsuyuki Kitamoto, Tadashi Tsukamoto, Masahito Yamada, Hidehiro Mizusawa
The electroencephalographic finding of periodic synchronous discharges (PSDs) is a basic clue for the diagnosis of Creutzfeldt-Jacob disease (CJD). We proposed grading of PSDs. We defined grade A as typical PSDs, grade B as PSDs of relatively longer periodic intervals, grade C as PSDs of relatively rare appearance, grade D as PSDs of rudimentary appearance, and grade E as absent PSDs. The occurrence rate of PSDs in Japanese CJD surveillance was 62% in total CJD (490/794), 72% in sporadic CJD (441/610), 24% in genetic CJD (41/171), and 61% in dura CJD patients (8/13). Among 171 genetic CJD patients, the occurrence rate of PSDs was 0% in P105L mutation CJD (0/2), 3% in V180I mutation CJD (3/90), 14% in P102L mutation CJD (4/29), 70% in E200K mutation CJD (16/23), and 71% in M232R mutation CJD patients (17/24). The occurrence rate of MRI changes in both cortical and basal ganglia was significantly higher in the s-CJD group with PSDs than in the s-CJD group without PSDs. The occurrence rate of PSDs in non-CJD patients who needed differential diagnosis of CJD was 10% (37/355). Non-CJD diseases associated with PSDs were status epilepticus, diffuse Lewy disease, Hashimoto encephalopathy, Wernicke encephalopathy and uremic encephalopathy.



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Single pulse electrical stimulation and high-frequency oscillations, a complicated marriage

Publication date: June 2017
Source:Clinical Neurophysiology, Volume 128, Issue 6
Author(s): Antonio Valentín, Gonzalo Alarcón




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2-1-102. Changes in corrected QT interval during electroconvulsive therapy

Publication date: June 2017
Source:Clinical Neurophysiology, Volume 128, Issue 6
Author(s): Yoko Suzuki, Miho Miyajima, Katsuya Ohta, Noriko Yoshida, Mayo Fujiwara, Masaki Okumura, Mitsuru Nakamura, Tetsuo Sasano, Tokuhiro Kawara, Masato Matsuura, Eisuke Matsushima
Corrected QT interval (QTc) prolongation can trigger ventricular arrhythmia, including torsade de pointes (TdP). A QTc greater than 500ms is considered to provide a high risk of TdP. Herein, we evaluated the risk of TdP during electroconvulsive therapy (ECT) using QTc. Twenty-two patients who underwent ECT were included. QTc were calculated with Hodges formula to avoid overcorrection of heart rate in a total of 201 ECT sessions. Baseline QTc was averaged over 30 s before stimulus onset. A QTc >457ms was classified as a significant prolongation, and >500ms as marked prolongation. The number of significant and marked QTc prolongations at baseline and the post-stimulus period were counted. At baseline, significant QTc prolongation was observed in 15 of 201 ECTs, while no patients showed marked prolongation. For post-stimulation, significant QTc prolongation and marked QTc prolongation was observed in 109 and 5 out of 201 ECT sessions, respectively. All the five marked QTc prolongations during post-ECT stimulation followed significant baseline QTc prolongation. These data suggest that a prolonged pre-stimulus QTc may be a risk factor of post-stimulus TdP in ECT.



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Editorial Board

Publication date: June 2017
Source:Clinical Neurophysiology, Volume 128, Issue 6





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1-1-55. Changes of resting-state functional connectivity during prism adaptation in healthy adults: A fMRI study

Publication date: June 2017
Source:Clinical Neurophysiology, Volume 128, Issue 6
Author(s): Daisuke Nishida, Katsuhiro Mizuno, Emi Yamada, Kenji Kato, Hiroki Ebata, Meigen Liu
Prism adaptation (PA) is one of the effective therapies for unilateral spatial neglect (USN), but its mechanism is not well understood. Under the hypothesis that PA is related to functional connectivity (FC) of visual attention network, we investigated the effects of the PA on FC in healthy adults with resting state functional magnetic resonance imaging (rsfMRI). Participants were 5 healthy right-handed volunteers. They wore prism glasses that deviate visual field to the right, and performed reaching task for the target without seeing the trajectory of their own hand. The angle of the prism glasses was gradually increased and the task was repeated 90 times. We estimated brain connectivity with rsfMRI before, immediately after, and one hour after the PA task. With pooled data of all the participants, the FC between left and right middle frontal gyrus decreased significantly immediately after the PA, and returned to baseline in one hour. Leftward deviation as a behavioral after effect seen immediately after the PA seemed to disappear in one hour. These results suggest that the FC in this region is modified by short term visuomotor adaptation. This study suggests that the PA can influence resting-state-functional connectivity between left and right visual attention network.



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2-3-11. Pairing of kinesthetic illusion induced by visual stimulus and peripheral nerve stimulation causes sustained enhancement of corticospinal tract excitability

Publication date: June 2017
Source:Clinical Neurophysiology, Volume 128, Issue 6
Author(s): Fuminari Kaneko, Ryosuke Takahashi, Eriko Shibata
The aim of the present study was to explore if associative stimulus of the kinesthetic illusion induced by visual stimulus (KiNvis) and peripheral nerve stimulation (PENS) induces the corticospinal excitability change. Twelve healthy subjects participated. To induce KiNvis, the index finger movement was presented on the display, which covered the subject's actual hand. PENS was applied during the index finger flexion phase in the movie at the 90% intensity of the motor threshold for 15min as a main intervention (KiNvis+PENS). As control conditions, KiNvis+shamPENS, and Observation (no KiNvis)+PENS were set. Single and paired-pulse TMS (ISI: 2 and 3ms) were applied as an examination. MEP was recorded from the right first dorsal interosseous (FDI) muscle. Stimulus intensity of single TMS, and the test stimuli of paired-pulse TMS were adjusted to induce MEP of approximately 1mV amplitude at resting condition. MEP after KiNvis+PENS significantly increased for 60min at least, without significant change in KiNvis+ShamPENS and Observation+PENS. Moreover, short-interval intracortical inhibition of 2 and 3ms significantly decreased after intervention. These findings indicated that associative stimulation of KiNvis and PENS induce a sustained enhancement of corticospinal tract excitability, and cognitive effect of kinesthetic perception is crucial.



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3-2-03. Does cervical radiculopathy complicate brachial plexopathy? An electrophysiological analysis

Publication date: June 2017
Source:Clinical Neurophysiology, Volume 128, Issue 6
Author(s): Takeshi Yoshida, Shugo Suwazono, Masahito Suehara
It is well known that cervical radiculopathy (CR) and neuralgic amyotrophy (NA) show very similar phenotype and sometimes difficult to differentiate each other. In 2015, we reported brachial plexus abnormality on three tesla magnetic resonance neurography (3T-MRN) in patients with CR. The purpose of this study is, to investigate signs of brachial plexus involvement with electrophysiological tests. We underwent retrospective chart review of 24 patients with CR from 2009 to 2014. In all patients, we performed 3T-MRN and nerve conduction study (NCS) to evaluate brachial plexus involvement. Mean age is 58years old, and male patients dominated. Median disease duration was 60days. Weakness and intervertebral foraminal stenosis were most frequent in C5 and C6 level. On 3T-MRN, brachial plexus involvement was detected in 70% of patients. Among NCS, Abnormal lateral antebrachial cutaneous nerve amplitude was most frequently detected (45%). Possible explanation for the brachial plexus involvement in patients with CR includes damage to dorsal root ganglion by herniated disc, and secondary immune-mediated mechanism involving brachial plexus, as suggested by van Alfen. We suggest phenotype of CR and NA may significantly overlap and we need to be cautious when making a diagnosis of NA.



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1-1-04. Positive rate of giant somatosensory evoked potential (giant SEP) and C reflex in benign adult familial myoclonus epilepsy (BAFME)

Publication date: June 2017
Source:Clinical Neurophysiology, Volume 128, Issue 6
Author(s): Takefumi Hitomi, Katsuya Kobayashi, Tomohiko Murai, Takeyo Sakurai, Riki Matsumoto, Ryosuke Takahashi, Akio Ikeda
Benign adult familial myoclonus epilepsy (BAFME) manifests an autosomal dominant trait, cortical tremor resembling essential tremor and infrequent generalized tonic-clonic seizures. BAFME also shows electrophysiological features of cortical reflex myoclonus. To clarify the positive rate of giant somatosensory evoked potential (giant SEP) and C reflex in BAFME, we retrospectively analyzed 19 patients in a total of 14 families (5 men and 14 women, age: 51±16years) about positive rate of giant SEP and C reflex. The positive rates of giant SEP and C reflex were 17/19 (89%) and 16/18 (88%), respectively. Relatively young 3 patients (27, 30, and 34years old) showed no giant SEP or no C reflex. 1 patient (34years old) showed neither giant SEP nor C reflex, who was examined within 1year from the clinical onset. Whereas even 1 patient without cortical tremor showed giant SEP. The positive rate of giant SEP and C reflex is quite high in BAFME. Even presymptomatic patient showed giant SEP. However, some younger patients did not show giant SEP and/or C reflex. Therefore, family history of both clinical and electrophysiological findings is crucial for the diagnosis of BAFME.



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1-1-06. Repeated, cortical stimulation can modify the wideband cortical activity correlates of interictal epileptiform discharge

Publication date: June 2017
Source:Clinical Neurophysiology, Volume 128, Issue 6
Author(s): Mitsuyoshi Nakatani, Riki Matsumoto, Katsuya Kobayashi, Takefumi Hitomi, Morito Inouchi, Masao Matsuhashi, Masako Kinoshita, Takayuki
Electric cortical stimulation (ECS) is known to have suppressive effects on epileptic focus. However, the inhibitory mechanism remains to be elucidated. We investigated the effect of ECS on human epileptic focus by evaluating wideband cortical activities accompanied with interictal epileptiform discharges (IEDs). We recruited 9 patients with intractable partial epilepsy who underwent invasive pre-surgical evaluation with subdural electrodes. 50-Hz stimulation (0.3ms pulse, 1–15mA, 1–5s) was applied at seizure onset zone (SOZ) as a part of functional cortical mapping. By performing Hilbert transform, we calculated the power of 4 frequency bands: fast ripple (200–300Hz), ripple (80–200Hz), low gamma (30–50Hz) and beta (15–30Hz). We compared them between pre- and post ECS at the timing of spike peak of IEDs. 2 patients were excluded due to artifacts or no examinations. In 3 patients, the power decreased after ECS in all frequency bands. The power did not change in 1, and the power change varied depending on the frequency band or the time after ECS in 3. We demonstrated that 50-Hz ECS on epileptic focus can suppress wide-band activities accompanied with IEDs, suggesting its potential ability to modulate cortical excitability toward less excitation and more inhibition.



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2-1-05. PR interval of electrocardiography is significantly correlated with the findings of cardiac MIBG scintigraphy in Parkinson’s disease

Publication date: June 2017
Source:Clinical Neurophysiology, Volume 128, Issue 6
Author(s): Hitoshi Mochizuki, Nobuyuki Ishii, Yoshikazu Ugawa, Akitoshi Taniguchi, Takashi Sugiyama, Kazutaka Shiomi, Masamitsu Nakazato
Cardiac 123I-metaiodobenzylguanidine scintigraphy (MIBG) has been used to assess the postganglionic presynaptic cardiac sympathetic nerve endings and demonstrated an uptake reduction in patients with Parkinson's disease (PD). On the other hand, epidemiologic research showed that electrocardiography (ECG) abnormalities occurred prior to motor signs in PD. In this study, we investigated whether the electrical conduction system of the heart was impaired in PD. Clinical features, ECG and MIBG parameters were analyzed in 191 patients with PD, 42 with multiple system atrophy (MSA) and 124 normal controls (NL). PR interval in ECG was significantly longer in patients with PD than in NL, and the PR interval negatively correlated with early and delayed heart-to-mediastinum ratios in MIBG scintigraphy in PD and MSA patients. No significant differences were detected in QTc between the three groups. This study is the first to demonstrate the prolongation of the PR interval in PD and its correlation with MIBG scintigraphy parameters. The PR prolongation must reflect some sympathetic system abnormality since it is mainly controlled by sympathetic nervous system. Repeated measures of PR interval might be one alternative tool to predict autonomic dysfunction in a part of PD patients.



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2-3-10. Development of cerebral activity examination that is simple and robust against repetition by using wearable NIRS

Publication date: June 2017
Source:Clinical Neurophysiology, Volume 128, Issue 6
Author(s): Senichiro Kikuchi, Yukie Kurosawa, Nami Murooka, Kaori Shimoda, Masaki Nishida, Fumikazu Miwakeichi, Fusae Tozato
Monitoring of cerebral activity during long-term therapy such as occupational therapy is useful for the development of new protocols and assessments of the therapy. For clinical use, the authors tried to develop an examination by using a wearable Near infra-red Spectroscopy (NIRS) device with a neurocognitive task that is robust against repetition (habituation). The study was approved by the Ethics Committee of Gunma University Graduate School. Participants were fourteen healthy university students. We used a WOT-100, ten channel wearable NIRS device. Each participant underwent three tasks (deceitful reverse rock paper scissors, Stroop test, animal Stroop test) on a zero day, one week after, two weeks after, and three weeks after. Then the integral values of the oxyhemoglobin during the task were calculated. Stroop task was the only task with minimum habituation especially in the right frontal lobes. We concluded that the Stroop task was the most favorable of the three at this time.



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2-3-13. Components analysis of transcranial electrical stimulation motor evoked potentials

Publication date: June 2017
Source:Clinical Neurophysiology, Volume 128, Issue 6
Author(s): Daitoku Mishima, Katsutoshi Abe, Kimihiko Mii, Tomonari Suwa, Kazuko Hasegawa, Emiko Saito
Muscle action potentials induced by transcranial electrical stimulation (TCSMEP) are well used to know the impairment of motor function under general anesthesia. Though the components of waveforms are not known. We analyzed the origin or meaning of TCSMEP waveforms. All data were obtained from gastrocnemius with a pair of needle electrodes (belly-tendon method) during six times spinal surgeries (intramedurally tumor 5, disk herniation 1). Waveforms consisted of the initial negative spiky wave's complex (INSWC) and the dull wave of the latter half (LHDW). The smallest negative peak amplitude (SNPA) had positive correlation with the average of other negative peak amplitudes among the initial wave complex. And SNPA is not affected by the fluctuation of positive waveforms. SNPA seemed to be suitable for the indicator of intraoperative monitoring. Furthermore, there was a positive relationship between SNPA and the positive peak amplitudes of LHDW. LHDW seemed to show the difference of electrical potentials that resulted from the shortening of gap distance while the muscle contracted. TCSMEP waveform may consist of major 2 parts at least. INSWC is electrical activity around EC junctions. LHDW is mechanical activity of muscle contractions. These findings are helpful to evaluate and assess TCSMEP precisely.



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3-2-02. Texture Analysis of Muscle Ultrasound can differentiate myopathic conditions

Publication date: June 2017
Source:Clinical Neurophysiology, Volume 128, Issue 6
Author(s): Kazuki Sogawa, Hiroyuki Nodera, Naoko Takamatsu, Atsuko Mori, Yuishin Izumi, Syuji Hashiguchi, Ryuji Kaji
Muscle sonography may show high densities in various myopathic conditions. Further classification among myopathic conditions could be possible by texture analysis, which analyzes relationships between the neighboring pixel densities.The following groups of subjects were assessed: (1) 19 patients with myotonic dystrophy type 1 (MD1), (2) 11 patients with inflammatory myopathy (IM), and (3) 16 normal control. A LOGIQe ultrasonography and an 11-MHz linear probe were used to obtain muscle images of medial gastrocnemius. Texture parameters were obtained by MaZda software. Linear Discriminant Analysis (LDA) was performed for texture-based classification.The mean echodensities of MD1 and IM were higher than those of the control, which yielded high areas under curve (AUC) >0.95. However, MD1 and IM were poorly discriminated by any of the histogram-related parameters (AUC<0.8). LDA yielded 95.7% of correct classification among the three groups. The parameters related to run-length matrix had the highest discriminating power between MD1 and IM. In conclusion, texture analysis of a sonographic muscle image can infer underlying disease mechanisms in myopathic conditions.



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3-2-04. Ultrasonographic evaluation of facial muscles in myathenia gravis

Publication date: June 2017
Source:Clinical Neurophysiology, Volume 128, Issue 6
Author(s): Hiroshi Tsukamoto, Giuseppe Granata, Daniele Coraci, Ilaria Paolasso, Amelia Evoli, Luca Padua
It is known that the differences of clinical features in myasthenia gravis (MG) depends on the types of antibodies, such as anti-acetylcholine receptor (AChR) or anti-muscle-specific receptor tyrosine kinase (MuSK) antibodies. To evaluate facial muscles in patients with MG using ultrasonography (US), we performed US to measure thickness of facial muscles. Fifty patients with MG (39 AchR positive, 7 MuSK positive, and 4 double-senegative), 8 chronic progressive external ophthalmologia (CPEO) and 36 healthy subjects were enrolled prospectively. Furthermore, the differentiations of thicknesses among three subtypes of MG patients were evaluated to notice antibody-specificity.The Esaote Mylab Gold US system with high-frequency linear probe was used. Muscle thickness was bilaterally measured in frontalis, masseter, and both superior and inferior sites in orbicularis oculi and orbicularis oris. CPEO showed the significant thinning of orbicularis oculi and frontalis (P<0.01). MG showed significant thinning of orbicularis oculi, the superior sites of orbicularis oris and masseter (P<0.05). Moreover, the thickness in the inferior sites of orbicularis oris was thinnest in patients with MuSK positive MG (P<0.01) among three subtypes. US is very useful for evaluating pathological specificity of facial muscles in patients with MG and CPEO.



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3-2-04. Ultrasonographic evaluation of facial muscles in myathenia gravis

It is known that the differences of clinical features in myasthenia gravis (MG) depends on the types of antibodies, such as anti-acetylcholine receptor (AChR) or anti-muscle-specific receptor tyrosine kinase (MuSK) antibodies. To evaluate facial muscles in patients with MG using ultrasonography (US), we performed US to measure thickness of facial muscles. Fifty patients with MG (39 AchR positive, 7 MuSK positive, and 4 double-senegative), 8 chronic progressive external ophthalmologia (CPEO) and 36 healthy subjects were enrolled prospectively.

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