Purpose: The present longitudinal study assessed cardiorespiratory capacity and running economy of Olympic athletes over several decades to measure changes in fitness in an elite group during aging. Methods: Twenty-six male runners training for the 1968 Olympics were recruited. Heart rate, O2max, ventilation, and running economy were measured in 1968, 1993, and 2013. In 2013, 22 of the original runners participated: three passed away between 1993 and 2013, and one declined to participate. Results: The mean (+/-SD) maximum heart rate (bpm) was 178+/-10.6 in 1968, 176+/-13.1 in 1993, and 168+/-16.4 in 2013 with a difference from the predicted maximum heart rates in 1968 and 2013 (both P<.001 the mean v dot above was in and based on original body weight were respectively which higher than measured values at those times p declined each time decline predicted for .500 r2 .567 running economy greater conclusion: our data suggested that initial fitness younger years contributed to with aging despite an expected age-related drop fitness. also older adults could maintain high levels of cardiorespiratory as they age. expectations during should be more robust especially since bolster quality life. american college sports medicine>
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Πέμπτη 17 Αυγούστου 2017
High-Intensity Exercise Enhances Conduit Artery Vascular Function in Older Adults.
Purpose: Modulation of vascular function follows an exercise intensity-dependent pattern in young adults. This study aimed to investigate the potential intensity-dependent effects of an acute bout of exercise on conduit and resistance artery function in healthy older adults. Methods: Eleven healthy older adults (5 males/6 females, 66+/-1 years) completed 30 minutes of recumbent cycling at 50-55% (low-intensity) and 75-80% (high-intensity) of their age-predicted maximal heart rate on two separate study visits. Doppler ultrasound measures of brachial artery flow-mediated dilation (FMD) and reactive hyperemia (RH) were taken at baseline, ten minutes post-exercise, and one hour post-exercise. Additionally, cardiovascular hemodynamics and brachial shear rate were measured every five minutes during exercise. Results: Brachial artery FMD was enhanced ten minutes after high-intensity (4.8+/-0.2 to 9.1+/-0.3%, P0.05). Conclusion: Our data indicate that high-intensity exercise acutely enhances conduit artery function in healthy older adults. Additionally, an acute bout of exercise enhances resistance artery function independent of intensity. (C) 2017 American College of Sports Medicine
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Challenges in the anesthetic management of ambulatory patients in the MRI suites.
Purpose of review: MRI is becoming an indispensable diagnostic tool. The need for prolonged motion-free periods has substantially increased the need for deep sedation or anesthesia in a challenging environment. This review summarises recent literature with respect to pharmacological sedative strategies, nonpharmacological alternative approaches, airway management and safety issues in the ambulatory setting. Recent findings: Most literature researches the pediatric patient population. The American Society of Pediatrics published guidelines for monitoring and management of pediatric patients during sedation for diagnostic procedures. Dexmedetomidine is the most researched agent for sedation. It remains uncertain what the clinical implications are of the potential neurotoxicity of repeat sedation or anesthesia in young children. Airway strategies highlight the use of end-tidal carbon dioxide monitoring. Technical imaging advancement and nonpharmacological sedation alternatives allow for shorter procedures with a lower need for sedation. Summary: The anesthetic management of ambulatory patients in the MRI environment has its specific challenges and safety issues. However, the implementation of safety guidelines, new pharmacological and alternative nonpharmacological sedation strategies offer interesting perspectives to tackle these challenges. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.
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Interactions Between Energy Drink Consumption and Sleep Problems: Associations with Alcohol Use Among Young Adolescents
Journal of Caffeine Research , Vol. 0, No. 0.
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Lung Ultrasound in the Critically Ill: The BLUE Protocol.
No abstract available
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Boring Is Beautiful in Preoperative Assessment.
No abstract available
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Association of STOP-Bang Questionnaire as a Screening Tool for Sleep Apnea and Postoperative Complications: A Systematic Review and Bayesian Meta-analysis of Prospective and Retrospective Cohort Studies.
BACKGROUND: The risk of postoperative complications increases with undiagnosed obstructive sleep apnea (OSA). The high-risk OSA (HR-OSA) patients can be easily identified using the STOP-Bang screening tool. The aim of this systematic review and meta-analysis is to determine the association of postoperative complications in patients screened as HR-OSA versus low-risk OSA (LR-OSA). METHODS: The following data bases were searched from January 1, 2008, to October 31, 2016, to identify the eligible articles: Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, Cochrane Databases of Systematic Reviews, Medline-in-Process & other nonindexed citations, Google Scholar, Embase, Web of Sciences and Scopus. The search included studies with adult surgical patients screened for OSA with STOP-Bang questionnaire that reported at least 1 cardiopulmonary or any other complication requiring intensive care unit admission as diagnosis of outcome. We used a Bayesian random-effects analysis to evaluate the existing evidence of STOP-Bang in relation to OSA and to assess the association of postoperative complications with the identified HR-OSA patients by study design and methodologies. RESULTS: This systematic review and meta-analysis was conducted using 10 cohort studies: 23,609 patients (HR-OSA, 7877; LR-OSA, 15,732). The pooled odds of perioperative complications were higher in the HR-OSA versus LR-OSA patients (odds ratio 3.93, 95% credible interval, 1.85-7.77, P= .003; 6.86% vs 4.62%). The length of hospital stay was longer in HR-OSA by 2 days when compared with LR-OSA (5.0 +/- 4.2 vs 3.4 +/- 2.8 days; mean difference 2.01; 95% credible interval, 0.77-3.24; P= .005). Meta-regression to adjust for baseline confounding factors and subgroup analysis did not materially change the results. CONCLUSIONS: This systematic review and meta-analysis suggests that HR-OSA is related with higher risk of postoperative adverse events and longer length of hospital stay when compared with LR-OSA patients. Our findings support the implementation of the STOP-Bang screening tool for perioperative risk stratification. (C) 2017 International Anesthesia Research Society
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Impact of Simulator-Based Training in Focused Transesophageal Echocardiography: A Randomized Controlled Trial.
BACKGROUND: The aim of the study was to determine if training in transesophageal echocardiography (TEE) using a TEE simulator improves the ability of novice operators to perform and interpret a focused critical care TEE. METHODS: In this prospective, randomized, controlled study with blinded outcome assessment, 44 intensive care unit trainees were randomly assigned to a control group receiving 4 hours of lecture-based training only, or an intervention group which was additionally trained for 4 hours using a TEE simulator. After the training intervention, each participant performed 2 TEEs in intensive care unit patients which were evaluated by blinded assessors. The imaging quality of TEEs was measured using a predefined examination quality score ranging from 0 to 100 points. The correct quantification of pathologies and the interpretation of the TEEs were evaluated by blinded assessors using focused and comprehensive expert TEEs as comparators. RESULTS: A total of 114 TEEs were assessed. The mean examination quality score was 55.9 (95% confidence interval [CI], 50.3-61.5) for TEEs of the control group, 75.6 (95% CI, 70.1-81.0) for TEEs of the intervention group, and 88.5 (95% CI, 79.3-97.7) for TEEs in the expert group. The multiple comparisons revealed significant differences between all groups (19.7 [95% CI, 12.8-26.6], P
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Hypothermia Risk With Intraoperative Continuous Renal Replacement Therapy.
No abstract available
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Surveying the Literature: Synopsis of Recent Key Publications.
No abstract available
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Role of anesthesiologist in the management of a child with cerebral palsy
Anesthesia: Essays and Researches 2017 11(3):544-549
Cerebral palsy (CP) refers to a spectrum of nonprogressive neurological disorders with disturbances in posture and movement, resulting from perinatal intrauterine insult to developing infant brain. Many conditions associated with CP require surgery. Such cases pose important gastrointestinal, respiratory, and other perioperative considerations. Anesthetic management in these cases is delicate. Intraoperative complications including hypovolemia, hypothermia, muscle spasms, seizures, and delayed recovery might complicate the anesthetic management. A thorough preanesthetic evaluation allows for a better intra- and post-operative care. Postoperative analgesia is important, particularly in orthopedic surgeries one for pain relief. This review highlights the clinical manifestations in CP and anesthetic considerations in such child presenting for various surgeries.
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A comparative study of intravenous esmolol, labetalol and lignocaine in low doses for attenuation of sympathomimetic responses to laryngoscopy and endotracheal intubation
Anesthesia: Essays and Researches 2017 11(3):745-750
Background: Direct layngoscopy and endotracheal intubation is a noxious stimuli and induces sympathomimetic responses. Although well tolerated in healthy subjects, it may impose life threatening arrhythmias, left ventricular failure or rupture of cerebral aneurysm in susceptible patients. Esmolol, Labetalol and Lignocaine attenuate these responses but are associated with side effects of bradycardia, hypotension etc. In lower doses, chances of these side effects are comparatively low. So we designed this prospective clinical trial to assess the efficacy of intravenous esmolol, labetalol and lignocaine in low doses for attenuation of sympathomimetic responses to endotracheal intubation. Materials and Methods: Seventy-five consenting patients of ASA physical status I or II of age range 20 to 60 years, scheduled for different general surgical procedures were randomly assigned to one of the three groups; group ES, group LB and group LG. Participants of group ES, group LB and group LG was given esmolol HCL 0.5 mg/Kg, labetalol HCL 0.25 mg/kg and lignocaine HCL 1 mg/Kg body weight respectively. Outcome variables were HR, SBP, DBP, MAP and RPP. These variables were recorded just after intubation and thereafter at 1,3,5, 7 and 10 minutes of intubation. Results: There was no statistically significant difference regarding the demographic characteristics of the groups. Heart rate and systolic blood pressure was lower throughout the study period in labetalol group. But the values of study parameters were always higher than the baseline in esmolol and lignocaine group. Values of mean arterial pressure was slightly higher in labetalol group but it was much higher in two other groups throughout the study period. Diastolic blood pressure was higher in all the groups. Values of rate pressure product was higher during intubation and at 1minute after intubation in labetalol group but thereafter it was always lower than baseline values. Conclusion: Labetalol 0.25 mg Kg-1 is an effective and safe drug to be used for attenuation of sympathomimetic responses to endotracheal intubation. Esmolol 0.5 mg Kg-1 and lignocaine 1 mg Kg-1 are also effective to some extent and are safe.
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Nasogastric tube insertion in anesthetized intubated patients undergoing laparoscopic hysterectomies: A comparative study of three techniques
Anesthesia: Essays and Researches 2017 11(3):550-553
Background: Insertion of a nasogastric tube (NGT) in an anesthetized, comatose intubated patient is not always as easy as in a conscious, cooperative patient. Various techniques have been tried with varying success. The aim of this randomized study was to compare and evaluate the two techniques of NGT insertion with the conventional technique of insertion with respect to success rate, time taken for insertion and adverse effects. Materials and Methods: Patients admitted for laparoscopic hysterectomy were chosen and then were divided into three equal groups of forty each, by randomized technique. Group C included patients in whom conventional method was used to insert NGT. Group R where reverse Sellick's technique was used. Group F where neck flexion with lateral pressure was used. Results: Both the techniques were better than the conventional method. Among both the techniques, reverse Sellick's technique was the best method but not without adverse effects. The required insertion time was very less and success in the first attempt was more in the group where reverse Sellick's was used. Conclusion: Modified techniques of NGT insertion were better than the conventional method. Further studies after eliminating major limitations are required to really find a superior technique.
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Hyperparathyroid crisis: It's not all about calcium!
Anesthesia: Essays and Researches 2017 11(3):804-806
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Influence of addition of dexmedetomidine or fentanyl to bupivacaine lumber spinal subarachnoid anesthesia for inguinal hernioplasty
Anesthesia: Essays and Researches 2017 11(3):554-557
Background: No drug, used as adjuvant to spinal bupivacaine, has yet been identified that specifically inhibits nociception without its associated side effects. Aim of the Work: The purpose of this study is to compare the efficacy of dexmedetomidine and fentanyl with spinal bupivacaine in inguinal hernioplasty. Patients and Methods: Sixty patients of inguinal hernioplasty were randomly allocated to one of three groups, Group C (n = 20) – the patients received 15 mg hyperbaric bupivacaine + 0.5 ml saline. Group D – (n = 20) the patients received 15 mg hyperbaric bupivacaine + 10 μg dexmedetomidine diluted with 0.5 ml saline. Group F (n = 20) – the patients received 15 mg hyperbaric bupivacaine + 25 μg fentanyl (0.5 ml). Onset, duration of anesthesia, degree of sedation, and side effects were recorded. Results: The onset of anesthesia was shorter in Groups D and F as compared with the control Group C, but it was shorter in Group D than in Group F. The duration of sensory and motor block was prolonged in Group D and F as compared with the control Group C, but it was longer in Group D than in Group F. The postoperative analgesic consumption in the first 24 h was lower in Groups D and F than in Group C, and it was lower in Group D than in Group F. Conclusion: Onset of anesthesia is more rapid and duration is longer with less need for postoperative analgesia in patients undergoing inguinal hernioplasty under spinal anesthesia with dexmedetomidine and fentanyl than those with spinal alone with tendency of dexmedetomidine to produce faster onset, longer duration, and less analgesic need than fentanyl with similar safety profile.
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A prospective, observational study to evaluate the role of gabapentin as preventive analgesic in thyroidectomy under general anesthesia
Anesthesia: Essays and Researches 2017 11(3):718-723
Background: Effective management of postoperative pain is a part of well-organized perioperative care, which helps in reduced morbidity and improved patient satisfaction. Preventive analgesia can reduce acute and chronic pain by blocking the noxious inputs to pain pathways, preventing sensitization. Studies have reported efficacy of gabapentin as a preventive analgesic in perioperative pain. In this study, we aimed to determine whether preoperative gabapentin reduced postoperative pain and tramadol consumption after thyroidectomy under general anesthesia. Materials and Methods: Sixty patients scheduled for thyroidectomy were allocated to two groups of thirty each for this prospective, observational study. Patients in Group A and Group B received oral gabapentin 600 mg (6 × 10−4 kg) and diazepam 10 mg (1 × 10−5 kg), respectively, 2 h prior to surgery. Tramadol was given as rescue analgesic for postoperative pain with a verbal rating score of two. The analgesic efficacy of preoperative gabapentin was assessed in terms of postoperative pain scores at rest or swallowing, time to first rescue analgesic, and total tramadol consumption for 24 h. Ramsay sedation score and side effects of drug were also looked into. Results: Postoperative pain scores and total tramadol consumption were significantly lower in Group A during 24 h (P = 0.00). Time to first rescue analgesic was significantly prolonged in Group A (P = 0.001). Side effects were comparable. Conclusion: Oral gabapentin is effective as a preventive analgesic in reducing postoperative pain and tramadol consumption after thyroidectomy under general anesthesia.
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Comparative study of oral gabapentin, pregabalin, and clonidine as premedication for anxiolysis, sedation, and attenuation of pressor response to endotracheal intubation
Anesthesia: Essays and Researches 2017 11(3):558-560
Introduction: The aim of the present study was to evaluate and compare the effect of clonidine 200 μg and gabapentin 900 mg and pregabalin 150 mg in attenuation of the hemodynamic response to laryngoscopy and intubation in normotensive patients undergoing elective surgery. Methods: Ninety adult patients between 18 and 60 years are enrolled in the study. Patients with American Society of Anesthesiologists Grade-I and Grade-II are included which are posted for elective surgery under general anesthesia. Patients were divided into three groups: A, B, and C and received oral drugs 90 min before induction of general anesthesia, pregabalin 150, gabapentin 900mg, and clonidine 200 μg, respectively. Hemodynamic parameters such as heart rate and blood pressure were noted just before the (basal) administration of the drug, and in operation room, readings were recorded before intubation (T0) and after intubation at 1, 3, 5, and 10 min. Sedation and anxiety score were noted after 1 h of oral administration of the drug. Results: Mean arterial pressure was well attenuated by pregabalin than others, and mean heart rate following laryngoscopy and intubation was attenuated by clonidine group significantly. Conclusion: We conclude that oral pregabalin and gabapentin attenuate blood pressure response fairly well and heart rate significantly attenuated by clonidine. All three drugs are very effective for relieving anxiety and improving sedation.
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Postoperative analgesic efficacy of bilateral transversus abdominis plane block in patients undergoing midline colorectal surgeries using ropivacaine: A randomized, double-blind, placebo-controlled trial
Anesthesia: Essays and Researches 2017 11(3):767-772
Background: Ultrasound-guided transversus abdominis plane (TAP) block is done as a part of multimodal analgesia for pain relief after abdominal surgeries. This prospective randomized, double-blind, placebo-controlled trial was conducted to evaluate the postoperative analgesic efficacy of bilateral TAP block in patients undergoing midline colorectal surgeries using ropivacaine. Materials and Methods: Eighty patients scheduled for elective colorectal surgeries involving midline abdominal wall incision under general anesthesia were enrolled in this prospective randomized controlled trial. Group A received TAP block with 20 ml of 0.2% ropivacaine on either side of the abdominal wall, and Group B received 20 ml of normal saline. The time to request for rescue analgesia, total analgesic consumption in 24 h, and satisfaction with the anesthetic technique were assessed. Results: The mean visual analog scale scores at rest and on coughing were higher in control group (P > 0.05). Time (min) to request for the first rescue analgesia was prolonged in study group compared to control group (P < 0.001). The total tramadol consumption in 24 h postoperatively was significantly high in control group (P < 0.001). Nausea/vomiting was more common in control group (P > 0.05). The level of satisfaction concerning postoperative pain control/anesthetic technique was higher in study group (P < 0.001). Conclusion: TAP block produces effective and prolonged postoperative analgesia in patients undergoing midline colorectal surgery. It is a technically simple block to perform with a high margin of safety. It produces a considerable reduction in mean intravenous postoperative tramadol requirements, reduction in postoperative pain scores, and increased time to first request for further analgesia, both at rest and on movement.
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A prospective comparative observational study of clinical efficacy of isobaric ropivacaine 0.75% with of isobaric bupivacaine 0.5% intrathecally in elective inguinal hernia repair surgeries
Anesthesia: Essays and Researches 2017 11(3):561-566
Aims: To evaluate the efficacy of intrathecal isobaric Ropivacaine and its comparison with intrathecal isobaric Bupivacaine in elective inguinal hernia repair surgeries. Settings and Design: A prospective, randomized study was conducted in a tertiary care hospital with 80 patients of ASA grade I-III undergoing elective inguinal hernia repair surgery under spinal anaesthesia .Ethical committee clearance and written consent taken. The patients were randomly divided into two equal groups to the Ropivicaine group (Group R) and to theBupivicaine group (Group B). Parameters observed were onset and duration of sensory and motor block, maximum sensory level achieved degree of motor blockade, two segment regression, and haemodynamic changes. Results: The development of sensory block was faster with Isobaric Ropivicaine (12.1 ± 4.9 minutes) as than isobaric Bupivicaine (13.94 ± 4.52 minutes) but the difference was not statistically significant. Onset of Grade III Motor block was longer with Isobaric Ropivicaine (8.51 ± 3.39 minutes) as compared to isobaric Bupivicaine ( 8.51 ± 3.39 minutes), but the difference was not statistically significant. Time of Complete Sensory Regression was significantly shorter with Isobaric Ropivicaine (212.69 ± 27.31 minutes) with statistical significance. Time to complete motor recovery was significantly shorter in Ropivacaine group (253.38 ± 27.13 minutes)as compared to Bupivacaine group (258.55 ± 35.81min), with statistical significance.Time to achieve discharge criteria was relatively shorter with Isobaric Ropivicaine. Haemodynamic Parameters did not differ significantly in both the groups during the entire study period. Conclusion: Intrathecal administration of isobaric Ropivacaine (0.75%) 15 mg provides similar quality of spinal anaesthesia but of significantly shorter duration, maintaining similar hemodynamic stability and discharge criteria without significant adverse effects when compared to isobaric Bupivicaine (0.5%) 10 mg.
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A complication after percutaneous nephrolithotomy: Anesthesia mumps
Anesthesia: Essays and Researches 2017 11(3):794-796
Some surgical procedures performed under moderate and sometimes extreme positions expose patients to nonphysiological changes. Especially, the manipulations of a patient in prone and lateral decubitus position might increase complications. Anesthesia mumps has been reported as one of these complications. It has been found to be rare but known entity associated with patients of all age groups and all surgical positions. We herein describe an early noticed acute case of unilateral anesthesia mumps that developed after endotracheal intubation in prone position in a 54-year-old female. Anesthesia mumps may occur in the immediate postoperative period with no suspicious predisposing factor. The reports of such cases would increase the awareness among anesthesiologists and postoperative caregivers regarding this benign complication.
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Efficacy of tramadol or dexamethasone as an adjuvant to levobupivacaine in ultrasound-guided supraclavicular plexus block for upper limb surgery: A randomized double-blinded controlled study
Anesthesia: Essays and Researches 2017 11(3):567-571
Aims and Objectives: To evaluate the efficacy of tramadol or dexamethasone as an adjuvant to levobupivacaine in ultrasound-guided supraclavicular brachial plexus block in terms of onset time of complete sensory and motor blockade, duration of motor blockade, duration of analgesia, and any complication. Settings and Design: This was a randomized controlled trial conducted in the Department of Anesthesiology, a tertiary care hospital. Materials and Methods: Sixty consecutive patients of the American Society of Anesthesiologists physical status Class I and II who were posted for upper limb surgeries were recruited. Patients were divided into two groups of thirty patients each. Group T (tramadol) received 20 ml of 0.5% levobupivacaine with 100 mg tramadol, and Group D (dexamethasone) received 20 ml of 0.5% levobupivacaine with 8 mg dexamethasone under ultrasound guidance. Sensory and motor block assessment was done every 2 min until the development of complete sensory and motor block till 45 min. Verbal numerical rating scale score was assessed in postoperative ward at regular intervals. Patients were followed up to check for any residual neurological deficits. Results: There was no statistical difference in demographic data between the two groups. The onset time of sensory and motor blockade shows no significant difference between groups. The mean time duration of motor blockade in Group T was 764.63 min and for Group D was 1150.27 min which was statistically significant (P < 0.05). The duration of analgesia in Group D was 1300.83 min and in Group T was 820.47 min which was statistically significant (P < 0.05). Side effects such as nausea, vomiting, pruritis, hypoxemia, and long-term neurological deficits were not reported in any of the patients in either group. Conclusion: Dexamethasone 8 mg as an adjuvant to 0.5% levobupivacaine for supraclavicular brachial plexus block using ultrasound guidance increases the duration of analgesia in comparison to 100 mg tramadol and provides excellent postoperative pain-free period without any neurological deficits.
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Glucose for children during surgery: Pros, cons, and protocols: A postgraduate educational review
Anesthesia: Essays and Researches 2017 11(3):539-543
The question of whether glucose supplementation is required in children during surgery is still under debate. The impact of perioperative glucose supplementation, or its restriction, on their metabolism remains unclear. We discuss the findings of various studies that have addressed this question and the rationale for current recommendations.
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Evaluating the efficacy of tramadol as an adjuvant to intrathecal isobaric levobupivacaine for elective infraumbilical surgeries
Anesthesia: Essays and Researches 2017 11(3):572-577
Background: Long-acting local anesthetics are used in subarachnoid block to increase the duration of anesthesia. Adjuvants are added to improve the duration of analgesia. Settings: Randomized controlled trial was conducted in the Department of Anesthesiology in a tertiary care hospital.Aims and Objectives: The objective of this study was to evaluate the efficacy of low-dose tramadol as an intrathecal adjuvant to levobupivacaine in terms of duration of analgesia, onset of sensory blockade, onset of motor blockade, and duration of motor blockade. Methodology: After obtaining the Institutional Ethics Committee approval and informed consent, sixty patients posted for infraumbilical surgeries were recruited. Randomization was done using a sealed envelope technique. Patients were divided into two groups: LT received 3 ml of 0.5% isobaric levobupivacaine with tramadol 10 mg (0.2 ml) and LS received 3 ml of 0.5% isobaric levobupivacaine with 0.2 ml of normal saline. Duration of analgesia, onset of sensory blockade, and onset and duration of motor blockade were recorded. Results: There was no statistical difference in demographic data between the two groups. The mean onset time of sensory blockade in Group LS was 12.7 ± 9.81 min and for Group LT was 12.9 ± 0.81 min, which was not statistically significant between two groups (P = 0.93). The mean onset time of motor blockade in Group LS was 13.4 ± 10 min and for Group LT was 14.4 ± 10 min, which was no statistically significant between the two groups (P = 0.71). The mean time duration of analgesia in Group LS was 170.3 ± 59 min and for LT was 198.9 ± 57.33 min. There was mild prolongation of analgesia in Group LT, but it was not statistically significant (P = 0.0615). The mean duration of motor blockade in Group LS was 170.23 ± 58 min and Group LT was 190.76 ± 4 min, which was not statistically significant between the two groups (P = 0.14). Conclusion: Low-dose tramadol as an adjuvant to isobaric intrathecal levobupivacaine does not prolong analgesia significantly.
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Referrral systems development and survey of perioperative and critical care referral to anesthetists
Anesthesia: Essays and Researches 2017 11(3):702-712
Introduction: Anesthetists come in contact with more than two-third of hospital patients. Timely referral to anesthetists is vital in perioperative and remote site settings. Delayed referrals, improper referrals, and referrals at inappropriate levels can result in inadequate preparation, perioperative complications, and poor outcome. Methods: The self administered paper survey to delegates attending anesthesia conferences. Questions were asked on how high-risk, emergency surgical cases remote site and critical care patients were referred to anesthetists and presence of rapid response teams. Results: The response rate was 43.8%. Sixty percent (55.3–64.8, P - 0.001) reported high-risk elective cases were referred after admission. Sixty-eight percent (63.42–72.45, P - 0.001) opined preoperative resting echocardiographs were useful. Six percent (4.16–8.98, P - 0.001) reported emergency room referral before arrival of the patient. Twenty-five percent (20.92–29.42, P - 0.001) indicated high-risk obstetric cases were referred immediately after admission. Consultants practiced preoperative stabilization more commonly than residents (32% vs. 22%) (P - 0.004). For emergency surgery, resident referrals occurred after surgery time was fixed (40% vs. 28%) (P - 0.012). Residents dealt with more cases without full investigations in obstetrics (28% vs. 15) (P = 0.002). Remote site patients were commonly referred to residents after sedation attempts (32% vs. 20%) (P = 0.036). Only 34.8 said hosptals where tbey practiced had dedicated cardiac arrest team in place. Conclusions: Anesthetic departments must periodically assess whether subgroups of patients are being referred in line with current guidelines. Cancellations, critical incidents and complications arising out of referral delays, and improper referrals must be recorded as referral incidents and a separate referral incident registry must be maintained in each department. Regular referral audits must be encouraged.
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A survey of current practice of supraglottic airway devices in pediatric anesthesia from India
Anesthesia: Essays and Researches 2017 11(3):578-582
Background and Objectives: Supraglottic airway devices (SADs) have revolutionized the pediatric anesthetic practice and got a key role in difficult airway (DA) management. Several modifications of SADs design had come up to improve their safety. Aim: The aim of this survey was to determine the current usage of SADs in pediatric anesthetic practice, their availability, and to know any difficulties noted in practice. Methods: It was a questionnaire survey among the anesthesiologists who attended the National Pediatric Anesthesia Conference-2016. The questionnaire assessed the current practice preferences of SADs in routine pediatric cases and DA management, availability of various devices, and any difficulties noted in their usage. Results: First-generation SADs were widely available (97%), and 64% of respondents preferred to use it for pediatric short cases. 64% felt the use of SADs free their hands from holding the facemask and 58% found better airway maintenance with it. Intraoperative displacement (55%) was the common problem reported and only 11% felt aspiration as a problem. Most of the respondents (73%) accepted its use as rescue device in airway emergency, and 84% felt the need of further randomized controlled studies on safety of SADs in children. The majority were not confident to use SADs in neonates. Interpretation and Conclusions: The key role of SADs in DA management was well accepted, and aspiration was not a major problem with the use of SADs. Although many newer versions of SADs are available, classic laryngeal mask remains the preferred SAD for the current practitioner. Further, RCTs to ensure the safety of SADs in children are warranted.
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To evaluate the efficacy of fentanyl and dexmedetomidine as adjuvant to ropivacaine in brachial plexus block: A double-blind, prospective, randomized study
Anesthesia: Essays and Researches 2017 11(3):730-739
Context: Anesthesia and analgesia for surgeries to the upper extremity are commonly provided using brachial plexus anesthesia. There are limited or almost no studies comparing the use of ropivacaine with fentanyl to ropivacaine with dexmedetomidine. Aims: To compare the efficacy of fentanyl and dexmedetomidine as adjuvants to ropivacaine for brachial plexus block among patients undergoing upper limb orthopedic surgeries. Settings and Design: This was a prospective, randomized, double-blinded study. Subjects and Methods: The patients were randomly divided into three groups of 35 each using computerized randomization table. Group I patients received 3 mg/kg of 0.75% ropivacaine with 1 μg/kg of fentanyl diluted with normal saline (NS) to make a total volume of 35 ml. Group II patients received 3 mg/kg of 0.75% ropivacaine with 1 μg/kg of dexmedetomidine diluted with NS to make a total volume of 35 ml. Group III patients received 3 mg/kg of 0.75% ropivacaine with NS making a total volume of 35 ml. Statistical Analysis Used: Statistical analysis was performed using Statistical Package for Social Sciences, version 15.0. Analysis of variance followed by independent samples t-test was performed for parametric data, and Kruskal–Wallis test followed by Mann–Whitney U-test was performed for nonparametric data. Results: Mean motor and sensory block onset time was minimum in Group I and maximum in Group III while mean duration of sensory and motor block was maximum in Group I and minimum in Group III. Time taken for first rescue analgesic dose was also maximum in Group I and minimum in Group III. Conclusions: It can be concluded that 3 mg/kg of 0.75% ropivacaine along with 1 μg/kg of fentanyl diluted with NS to make a total volume of 35 ml was the most efficacious regimen for brachial plexus block among patients undergoing upper limb orthopedic surgeries.
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Comparative efficacy of minimal concentration of racemic bupivacaine (0.0625%) with fentanyl and ropivacaine (0.1%) with fentanyl for epidural labor analgesia
Anesthesia: Essays and Researches 2017 11(3):583-588
Background and Aims: This study aims to compare the minimum effective concentration of local anesthetic (LA) bupivacaine and ropivacaine with highly lipid soluble opioids fentanyl for providing optimal labor epidural analgesia. Settings and Design: The objective of this study was to evaluate the efficacy of racemic bupivacaine 0.0625% and 0.1% of ropivacaine both mixed with 2 μg/ml of fentanyl for epidural labor analgesia in parturients with spontaneous labor and normal fetal heart rate tracing. Methodology: Sixty parturients requesting for labor analgesia were divided into two groups. Group B (n = 30) received racemic bupivacaine (0.0625%) and fentanyl 2 μg/ml of 10 ml and Group R (n = 30) received ropivacaine (0.1%) and fentanyl 2 μg/ml. In both groups, the drug was given in 5 ml fractionated doses at 5 min interval. Parturients not experiencing analgesia within 15 min of initial bolus were supplemented with additional 5 ml of the same concentration of the solution. Epidural analgesia was maintained by timed top ups at the end of 90 min with the dosage equal to the initial dose of the drug. Duration of labor analgesia, motor block, visual analog scale, maternal hemodynamic parameters, mode of delivery, and maternal satisfaction was assessed. Statistical Analysis: Data were analyzed with odds variance, unpaired t-test, and Chi-square tests. P < 0.05 was considered statistically significant. Results: In our study, results indicate that both drugs were equally effective clinically. Maternal demographic characteristics were comparable. There were no statistically significant differences in visual analog pain score, highest sensory block, maternal satisfaction, mode of delivery, total dose of LAs during labor and motor block at delivery between the groups. Conclusions: In our study, both the drugs produced equivalent analgesia for labor at low concentration when used with highly lipid soluble opioid such as fentanyl.
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Single minute of positive end-expiratory pressure at the time of induction: Effect on arterial blood gases and hemodynamics in morbidly obese patients undergoing laparoscopic bariatric surgery
Anesthesia: Essays and Researches 2017 11(3):758-761
Background: The effect of positive end-expiratory pressure (PEEP) has been studied in detail after induction of general anesthesia especially in obese individuals. However, sparse information can be gathered from the literature regarding its effect when applied at the time of induction and the time of onset of its effect. Thus, this study was planned to assess the effect of PEEP when applied for a single minute in morbidly obese patients. Materials and Methods: This was a randomized prospective study comprising seven morbidly obese patients (body mass index ≥40 kg/m2). Control group included 30 patients who received no PEEP at the time of induction. The study group consisted of thirty patients who were given a PEEP of 10 cmH2O. Serial arterial blood gas samples were taken preoperatively, at the time of intubation, 5 min after intubation and 10 min after intubation. Results: PaO2was significantly higher in test group (242.0 ± 116.0 mmHg) than in control group (183.0 ± 107.0 mmHg) just after intubation. PaCO2was comparable in control group (43.73 ± 6.32 mmHg) and test group (44.52 ± 6.33 mmHg) just after intubation but was significantly less in test group than in control group at 5 and 10 min thereafter. Hemodynamic parameters were comparable in both groups at all time intervals. Conclusion: Application of even a single minute of PEEP at the time of induction improves oxygenation without any adverse effects on hemodynamics, in morbidly obese patients undergoing laparoscopic Bariatric surgery.
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Do juveniles help or hinder? Influence of juvenile offspring on maternal behavior and reproductive outcomes in wild chimpanzees (Pan troglodytes)
Source:Journal of Human Evolution, Volume 111
Author(s): Margaret A. Stanton, Elizabeth V. Lonsdorf, Anne E. Pusey, Carson M. Murray
Compared to great apes, humans maintain a relatively rapid reproductive pace despite long periods of dependency. This seemingly contradictory set of traits is made possible by weaning offspring before nutritional independence and alloparents who help provide care. In traditional societies, this help may be provided to mothers in part by their juvenile offspring who carry, supervise, or provision younger siblings. In contrast to humans, chimpanzees (Pan troglodytes) are nutritionally independent after weaning, yet juveniles continue to travel with their mother and younger sibling for an additional 4–5 years. This continued association could be costly to the mother if she continues to invest in weaned offspring. Alternately, while juvenile chimpanzees do not typically provision younger siblings, their presence and social interaction with infants may allow mothers to focus on other tasks. In this study, we investigate the costs and benefits to mothers of continued association with juveniles in wild chimpanzees. Using 26 years of long-term behavioral data we examined how maternal activity budgets varied based on the presence of a dependent juvenile offspring. We found that continued social interaction between mothers and juveniles does not influence the mother's time allocated to interacting with the younger infant, her feeding, resting, or travel time, or time socializing with other community members. Instead, mothers may benefit from the additional social interaction and/or relationship with their older offspring. Using 45 years of demographic data we found that those offspring who had an older sibling tended to be more likely to survive each year from birth to 8 years than those without an older sibling. Additionally, interbirth intervals were more likely to end when the female had an older offspring present. A mutually beneficial mother-juvenile dynamic in great apes provides insight into continued association between mothers and offspring after nutritional independence and the emergence of juvenile helping during hominin evolution.
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Locomotion and basicranial anatomy in primates and marsupials
Source:Journal of Human Evolution, Volume 111
Author(s): Catalina I. Villamil
There is ongoing debate in paleoanthropology about whether and how the anatomy of the cranium, and especially the cranial base, is evolving in response to locomotor and postural changes. However, the majority of studies focus on two-dimensional data, which fails to capture the complexity of cranial anatomy. This study tests whether three-dimensional cranial base anatomy is linked to locomotion or to other factors in primates (n = 473) and marsupials (n = 231). Results indicate that although there is a small effect of locomotion on cranial base anatomy in primates, this is not the case in marsupials. Instead, facial anatomy likely drives variation in cranial base anatomy in both primates and marsupials, with additional roles for body size and brain size. Although some changes to foramen magnum position and orientation are phylogenetically useful among the hominoids, they do not necessarily reflect locomotion or positional behavior. The interplay between locomotion, posture, and facial anatomy in primates requires further investigation.
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Rescue crew uses drones to help save man trapped across river
The drones were used to "make sure there were no hazards" that the crew members didn't see
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25 hippies and a fire truck: Winnie Maggiore reflects on 44 years in EMS
Nearly 50 years ago, W. Ann "Winnie" Maggiore and two friends from Brooklyn squeezed bodies and belongings into a dented, high-mileage, pacific-blue Karmann Ghia and headed west. "It was the summer of love," says Maggiore. "Like so many young people back then, I wanted to see what else the world had to offer. We went from national park to national park. New Mexico caught ...
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Clinical and preclinical perspectives on Chemotherapy-Induced Peripheral Neuropathy (CIPN): a narrative review
Abstract
This review provides an update on the current clinical and preclinical understanding of chemotherapy induced peripheral neuropathy (CIPN). The overview of the clinical syndrome includes a review of its assessment, diagnosis and treatment. CIPN is caused by several widely-used chemotherapeutics including paclitaxel, oxaliplatin, bortezomib. Severe CIPN may require dose reduction, or cessation, of chemotherapy, impacting on patient survival. While CIPN often resolves after chemotherapy, around 30% of patients will have persistent problems, impacting on function and quality of life. Early assessment and diagnosis is important, and we discuss tools developed for this purpose. There are no effective strategies to prevent CIPN, with limited evidence of effective drugs for treating established CIPN. Duloxetine has moderate evidence, with extrapolation from other neuropathic pain states generally being used to direct treatment options for CIPN. The preclinical perspective includes a discussion on the development of clinically-relevant rodent models of CIPN and some of the potentially modifiable mechanisms that have been identified using these models. We focus on the role of mitochondrial dysfunction, oxidative stress, immune cells and changes in ion channels from summary of the latest literature in these areas. Many causal mechanisms of CIPN occur simultaneously and/or can reinforce each other. Thus, combination therapies may well be required for most effective management. More effective treatment of CIPN will require closer links between oncology and pain management clinical teams to ensure CIPN patients are effectively monitored. Furthermore, continued close collaboration between clinical and preclinical research will facilitate the development of novel treatments for CIPN.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2i9Nj7Z
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P2-03. An electrophysiological severity classification system for diabetic polyneuropathy and small fiber dysfunction
Source:Clinical Neurophysiology, Volume 128, Issue 9
Author(s): Chieko Suzuki, Masayuki Baba, Tomoya Kon, Yukihisa Funamizu, Tatsuya Ueno, Rie Haga, Haruo Nishijima, Akira Arai, Jinichi Nunomura, Masahiko Tomiyama, Hiroki Mizukami, Soroku Yagihashi
We reported an electrophysiological severity classification for diabetic polyneuropathy (DPN) using a nerve conduction study (NCS). This new classification system combines of the amplitude and velocity of NCS and classifies DPN into five stages. Stage 0 is the mildest stage, while Stage IV is the most severe. Here, we clarified the association of this classification system with small fiber abnormalities. We measured intra-epidermal nerve fiber densities (IENFD) and pain threshold using intra-epidermal electrical stimulation (IES) to evaluate the function of small fibers. We recruited 65 patients with diabetes, and performed NCS, skin biopsy and pain threshold using IES. The mean IENFD observed in the skin biopsies were 8.27n/mm in Stage 0, 7.79n/mm in Stage I, 4.49n/mm in Stage II, 2.85n/mm in Stage III, and 0n/mm in Stage IV. The mean pain thresholds were 0.05mA in Stage 0, 0.11mA in Stage I, 0.08mA in Stage II, 0.27mA in Stage III, and 0.59mA in Stage IV. In summary, the abnormalities of IENFD and pain threshold correlated with electrophysiological severity. The present results indicate that the large fiber dysfunction in DPN progresses in parallel with the small fiber abnormalities.
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O3-6-04. Optogenetically induced motor evoked potentials in mice
Source:Clinical Neurophysiology, Volume 128, Issue 9
Author(s): Fumiaki Yoshida, Edward S. Boyden
Optogenetics is a powerful tool that utilizes light to control neurons genetically modified to express light-sensitive ion channels. This innovative technology, which allows for the activation or silencing of neurons on a millisecond time-scale, can be aimed at specific cell types, preventing the manipulation of cells that fall outside a target population. As such, optogenetics has the potential to improve impaired brain networks without side effects commonly associated with alternative strategies (e.g., electrical stimulation). Here, we assessed optogenetically induced motor evoked potentials as a first step in testing the therapeutic potential of this tool. We introduced Chronos, a novel light-sensitive ion channel, into the motor cortex of wild-type mice via viral vector injection. Four weeks later, blue laser light (473nm) stimulation was delivered to the affected area through the intact skull.Results: Under ketamine (100mg/kg) and xylazine (10mg/kg) anesthesia, light-evoked muscle responses were successfully recorded from the triceps brachii and biceps femoris. Optogenetic activation of neurons expressing a novel light-sensitive ion channel effectively induced motor responses in wild-type mice, suggesting this technology may prove useful for neuromodulation therapy. Although future studies are needed, optogenetics may be applied in humans to treat neuropsychiatric diseases.
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Editorial Board
Source:Clinical Neurophysiology, Volume 128, Issue 9
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O2-6-08. Mechanism of forelimb motor function restoration after cervical spinal cord hemisection in rats: Electorophysiological verification
Source:Clinical Neurophysiology, Volume 128, Issue 9
Author(s): Takumi Takeuchi, Masahito Takahashi, Kazuhiko Satomi, Atsushi Hasegawa, Hideaki Ohne, Shunsuke Sato, Shoichi Ichimura
The objective of this study was to electrophysiologically assess corticospinal tracts of adult rats and recovery of motor function of their forelimbs after cervical cord hemisection. Of 39 adult rats used, compound muscle action potentials (CMAPs) of forelimbs of 15 rats were evaluated, before they received left C5 segmental hemisection of the spinal cord, by stimulating the pyramid of medulla oblongata on one side using an exciting microelectrode. All 15 rats exhibited contralateral electrical activity, but their CMAPs disappeared after hemisection. The remaining 24 rats received hemisection first, and CMAPs of 12 rats were assessed over time to study their recovery time. All of them exhibited electrical activity of forelimbs in four weeks after surgery. The remaining 12 rats received additional right C2 segmental hemisection, and variation of CMAPs between before and after surgery was examined. The right side of the 12 rats that received the additional hemisection exhibited no electrical activity in response to the stimulation of pyramids on both sides. These results suggest that changes in path between the resected and healthy sides, activation of ventral corticospinal tracts, and propriospinal neurons were involved in the recovery of motor function after cervical cord injury.
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P1-12. L-DOPA may modify function of the sensory cortex in Parkinson’s disease
Source:Clinical Neurophysiology, Volume 128, Issue 9
Author(s): Nobuyuki Ishii, Hitoshi Mochizuki, Kazutaka Shiomi, Masamitsu Nakazato
Sensory disturbance is occasionally accompanied with parkinsonism and is sometimes improved by L-DOPA treatment. The abnormalities in cerebral somatosensory neurons were already revealed by neurophysiological methods. However, whether L-DOPA influences the cerebral somatosensory functions is unknown. We evaluated the effect of L-DOPA on the sensory cortex in Parkinson disease (PD) using neurophysiological technique such as high-frequency oscillations (HFOs) and somatosensory evoked potential recovery functions (SEP-Rs), which could detect slight functional abnormalities of cerebral somatosensory interneurons. We examined ten drug-naïve PD patients in pre- and post-L-DOPA treatment. HFOs were obtained by digitally filtering raw SEPs from 500 to 1000Hz. For SEP-Rs study, paired-pulse stimuli at various interstimulus intervals (ISIs; 20–200ms) were given. There were no significant differences in the HFO study. The SEP-Rs study demonstrated that patients with disease duration of more than one year (n=6) had a significant disinhibition (P=0.003) in P25-N33 of post-treatment compared with pre-treatment. L-DOPA may have some effects on the abnormal GABAergic interneuron function in sensory cortex, which could improve sensory disturbance by L-DOPA therapy in PD patients.
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O1-6-12. Cauda equina conduction time as a test for lumber spinal stenosis
Source:Clinical Neurophysiology, Volume 128, Issue 9
Author(s): Fumiaki Okada, Syunsuke Kumanishi, Kazuki Kusuyama
We examined the cauda equina conduction time (CECT) in 20 patients (11 male), average age, 73years, low back pain therapy criterion score of Japan orthopaedic Association (JOA score), 17 points, and Oswestry Disability Index (ODI), 19 points and aged matched 17 healthy volunteers. Magnetic Augmented Translumbosacral Stimulation (MTATS) at L1 and S1 levels elicited a compound muscle action potential (CMAP) recordable from bilateral abductor hallucis muscle. We calculated the CECT as the difference between the latencies of CAMPs elicited by stimulation at L1 and S1 level. We divided the patients into the two groups, A group with a longer CECT (average, 7.4ms) and B group with a shorter CECT (average, 5.2ms). Statistical analyses of CECT showed a significant difference between the A group and healthy volunteers, a significant negative correlation with JOA score and a tendency to increase with a higher point of ODI. In conclusion, CECT using MATS coil serves usefully in physiologic assessments of lumbar canal spinal stenosis.
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Low intensity transcranial electric stimulation: Safety, ethical, legal regulatory and application guidelines
Publication date: September 2017
Source:Clinical Neurophysiology, Volume 128, Issue 9
Author(s): A. Antal, I. Alekseichuk, M. Bikson, J. Brockmöller, A.R. Brunoni, R. Chen, L.G. Cohen, G. Dowthwaite, J. Ellrich, A. Flöel, F. Fregni, M.S. George, R. Hamilton, J. Haueisen, C.S. Herrmann, F.C. Hummel, J.P. Lefaucheur, D. Liebetanz, C.K. Loo, C.D. McCaig, C. Miniussi, P.C. Miranda, V. Moliadze, M.A. Nitsche, R. Nowak, F. Padberg, A. Pascual-Leone, W. Poppendieck, A. Priori, S. Rossi, P.M. Rossini, J. Rothwell, M.A. Rueger, G. Ruffini, K. Schellhorn, H.R. Siebner, Y. Ugawa, A. Wexler, U. Ziemann, M. Hallett, W. Paulus
Low intensity transcranial electrical stimulation (TES) in humans, encompassing transcranial direct current (tDCS), transcutaneous spinal Direct Current Stimulation (tsDCS), transcranial alternating current (tACS), and transcranial random noise (tRNS) stimulation or their combinations, appears to be safe. No serious adverse events (SAEs) have been reported so far in over 18,000 sessions administered to healthy subjects, neurological and psychiatric patients, as summarized here. Moderate adverse events (AEs), as defined by the necessity to intervene, are rare, and include skin burns with tDCS due to suboptimal electrode-skin contact. Very rarely mania or hypomania was induced in patients with depression (11 documented cases), yet a causal relationship is difficult to prove because of the low incidence rate and limited numbers of subjects in controlled trials. Mild AEs (MAEs) include headache and fatigue following stimulation as well as prickling and burning sensations occurring during tDCS at peak-to-baseline intensities of 1–2mA and during tACS at higher peak-to-peak intensities above 2mA.The prevalence of published AEs is different in studies specifically assessing AEs vs. those not assessing them, being higher in the former. AEs are frequently reported by individuals receiving placebo stimulation. The profile of AEs in terms of frequency, magnitude and type is comparable in healthy and clinical populations, and this is also the case for more vulnerable populations, such as children, elderly persons, or pregnant women. Combined interventions (e.g., co-application of drugs, electrophysiological measurements, neuroimaging) were not associated with further safety issues.Safety is established for low-intensity 'conventional' TES defined as <4mA, up to 60min duration per day. Animal studies and modeling evidence indicate that brain injury could occur at predicted current densities in the brain of 6.3–13A/m2 that are over an order of magnitude above those produced by tDCS in humans. Using AC stimulation fewer AEs were reported compared to DC. In specific paradigms with amplitudes of up to 10mA, frequencies in the kHz range appear to be safe.In this paper we provide structured interviews and recommend their use in future controlled studies, in particular when trying to extend the parameters applied. We also discuss recent regulatory issues, reporting practices and ethical issues. These recommendations achieved consensus in a meeting, which took place in Göttingen, Germany, on September 6–7, 2016 and were refined thereafter by email correspondence.
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O2-6-21. Comparison of muscle ultrasound findings between demyelinating neuropathy and axonopathy
Source:Clinical Neurophysiology, Volume 128, Issue 9
Author(s): Keiichi Hokkoku, Hiroshi Tsukamoto, Yuki Hatanaka, Masahiro Sonoo
Denervation causes increased echo intensity (EI) and decreased muscle thickness (MT) on muscle ultrasound (MUS). Chronic inflammatory demyelinating polyneuropathy (CIDP) does not present with denervation unless secondary axonal degeneration occurs. Hence, few MUS changes would occur compared to amyotrophic lateral sclerosis (ALS). The abductor pollicis brevis, abductor digiti minimi, and first dorsal interosseous muscles of 12 patients with CIDP and 13 patients with ALS were examined. There were no significant differences in Medical Research Council scales of each muscle between the CIDP and ALS group. EI and MT were measured quantitatively in every muscle. Raw values were converted into z-scores using the data from 40 normal controls (NCs). There were no significant differences between the CIDP and NC groups regarding EI and MT. The ALS group exhibited significantly higher EI and significantly lower MT than the other two groups (all P<0.001). Our data suggested that patients with CIDP exhibit few changes on MUS. This finding may help to differentiate CIDP from ALS and predict whether the pathology is demyelination or axonal degeneration.
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O3-7-17. Detection of Resting state network activity using eLORETA-ICA in Dementia with Lewy Bodies
Source:Clinical Neurophysiology, Volume 128, Issue 9
Author(s): Yasunori Aoki, Hiroaki Kazui, Roberto D. Pascual-Marqui, Ryouhei Ishii, Kenji Yoshiyama, Hideki Kanemoto, Yukiko Suzuki, Shunsuke Sato, Shunichiro Ikeda, Masahiro Hata, Masao Iwase
Dementia with Lewy bodies (DLB) is the second most common type of dementia and characterized by progressive cognitive decline, fluctuating cognition, visual hallucinations and Parkinsonism. However, pathophysiological mechanism of these symptoms remain poorly understood. In this study, using exact low resolution brain electromagnetic tomography-independent component analysis (eLORETA-ICA), we assessed activities of five electroencephalography-resting state networks (EEG-RSNs) in 49 DLB patients who were not administered acetylcholinesterase inhibitors. The results were that DLB patients had significantly decreased activities in the occipital visual network and memory perception network, and significantly enhanced activities in the visual perception network and self-referential network compared to 80 healthy controls. Furthermore, we found correlations between these network activities and DLB symptoms. In particular, enhanced visual perception network activity correlated with severe delusions. Enhanced self-referential network activity correlated with worse working memory. Decreased memory perception network activity correlated with worse semantic memory. In addition, sensorimotor network activity correlated with milder delusions, aberrant motor behavior and fluctuating cognition as well as with more severe Parkinsonism. These results indicate that eLORETA-ICA can sensitively detect EEG-RSN activity changes in DLB related to symptoms. Therefore, eLORETA-ICA with EEG data will be a powerful tool for understanding of neurophysiological mechanisms underlying this disease.
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P1-41. Verification of stimulation site in bulbocavernous reflex (BCR) monitoring
Source:Clinical Neurophysiology, Volume 128, Issue 9
Author(s): Kunio Sugiyama, Shunpei Ando, Hiroyuki Masuda, Kosuke Kondo, Akihito Wada, Naoyuki Harada, Masaaki Nemoto, Hiroshi Takahashi, Nobuo Sugo
Bulbocavernosus reflex (BCR) monitoring is useful for lumbar and cauda surgery. However, in some cases BCR may be difficult to record. We report verification of the stimulation site of BCR monitoring. The subjects were 24 patients undergoing BCR monitoring from 2010 to 2015 (0–79years old, 14 males, 10 females). In all cases, BCR was recorded from the needle electrode of the anal sphincter. An adult male stimulated the dorsal side of the penis. The boy stimulated the dorsal and ventral side of the penis. Women were classified into three types: clitoral and labia stimulation, left and right side stimulation of the clitoris, clitoris and pubis stimulation. An adult male was able to record in all cases. An adult female could record with a type that stimulated the clitoris and labia. Childhood cases were difficult to record in all cases. Women's BCR stimulation needs to directly stimulate the clitoris. Children may be involved in neuropathy due to congenital diseases or underdeveloped nerve.
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P2-28. Single-event-related changes in Oxy-Hb during verbal discrimination tasks in schizophrenic patients: Correlation with the symptom
Source:Clinical Neurophysiology, Volume 128, Issue 9
Author(s): Youhei Ishii, Kiichiro Morita, Yoshihisa Shoji, Mamoru Sato, Hiroko Yanagimoto, Naohisa Uchimura
Schizophrenic patients have been associated with cognitive dysfunction including attention and executive functions. "Shiritori" is a very popular word chain game in Japan. This game requires players to generate a word that begins with the last syllable of the preceding word. The present study assessed the difference of hemodynamic changes between schizophrenic patients and healthy controls during a Japanese word production task (shiritori) based on a single-event-related design measured by a multi-channel NIRS system. Relationships between brain activation and clinical symptoms were also examined. The subjects were 30 schizophrenic patients and 30 age- and sex-matched healthy native-Japanese speakers. Two contrasting single events (reading task as non-target stimuli, and Shiritori task as target stimuli) were randomly performed at least 20 times each. Data were calculated as a discrimination task from each averaged waveform. The patients showed significantly less activation of the prefrontal cortex than healthy subjects. In addition, there was a significant correlation between the activation value and negative symptom score as well as general psychopathological score in patients in the left front-polar region. These findings suggest that a single-event-related NIRS measurement using verbal discrimination tasks is a useful psycho-physiological index reflecting the cognitive function of schizophrenic patients.
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Temporal-spatial characteristics of phase-amplitude coupling in electrocorticogram for human temporal lobe epilepsy
Publication date: September 2017
Source:Clinical Neurophysiology, Volume 128, Issue 9
Author(s): Ruihua Zhang, Ye Ren, Chunyan Liu, Na Xu, Xiaoli Li, Fengyu Cong, Tapani Ristaniemi, YuPing Wang
ObjectiveNeural activity of the epileptic human brain contains low- and high-frequency oscillations in different frequency bands, some of which have been used as reliable biomarkers of the epileptogenic brain areas. However, the relationship between the low- and high-frequency oscillations in different cortical areas during the period from pre-seizure to post-seizure has not been completely clarified.MethodsWe recorded electrocorticogram data from the temporal lobe and hippocampus of seven patients with temporal lobe epilepsy. The modulation index based on the Kullback-Leibler distance and the phase-amplitude coupling co-modulogram were adopted to quantify the coupling strength between the phase of low-frequency oscillations (0.2–10Hz) and the amplitude of high-frequency oscillations (11–400Hz) in different seizure epochs. The time-varying phase-amplitude modulogram was used to analyze the phase-amplitude coupling pattern during the entire period from pre-seizure to post-seizure in both the left and right temporal lobe and hippocampus. Channels with strong modulation index were compared with the seizure onset channels identified by the neurosurgeons and the resection channels in the clinical surgery.ResultsThe phase-amplitude coupling strength (modulation index) increased significantly in the mid-seizure epoch and decrease significantly in seizure termination and post-seizure epochs (p<0.001). The strong phase-amplitude-modulating low- and high-frequency oscillations in the mid-seizure epoch were mainly δ, θ, and α oscillations and γ and ripple oscillations, respectively. The phase-amplitude modulation and strength varied among channels and was asymmetrical in the left and right temporal cortex and hippocampus. The "fall-max" phase-amplitude modulation pattern, i.e., high-frequency amplitudes were largest in the low-frequency phase range [−π, 0], which corresponded to the falling edges of low-frequency oscillations, appeared in the middle period of the seizures at epileptic focus channels. Channels with strong modulation index appeared on the corresponding left or right temporal cortex of surgical resection and overlapped with the clinical resection zones in all patients.ConclusionsThe "fall-max" pattern between the phase of low-frequency oscillation and amplitude of high-frequency oscillation that appeared in the middle period of the seizures is a reliable biomarker in epileptogenic cortical areas. The modulation index can be used as a good tool for lateralization and localization for the epileptic focus in patients with epilepsy.SignificancePhase-amplitude coupling can provide meaningful reference for accurate resection of epileptogenic focus and provide insight into the underlying neural dynamics of the epileptic seizure in patients with temporal lobe epilepsy.
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The neural bases of ictal tachycardia in temporal lobe seizures
Publication date: September 2017
Source:Clinical Neurophysiology, Volume 128, Issue 9
Author(s): Florian Chouchou, Romain Bouet, Vincent Pichot, Hélène Catenoix, François Mauguière, Julien Jung
ObjectiveDue to limited information from scalp electroencephalographic (EEG) recordings, brain areas driving changes in cardiac rhythm during Temporal lobe (TL) seizures are not clearly identified. Using stereotactic EEG (SEEG) recordings, we aimed at identifying which of the brain regions involved in autonomic control trigger ictal tachycardia.MethodsThe neural activity of several mesial temporal lobe structures including amygdala, hippocampus, insula, and lateral temporal lobe recorded with SEEG were collected during 37 TL seizures in 9 patients, using indices based on High Frequency Activity (HFA). R-R intervals (RR) monitoring and time-frequency spectral analysis were performed to assess parasympathetic (High frequency power (HF)) and sympathetic (Low frequency/High frequency (LF/HF) ratio) reactivities.ResultsTachycardia was associated with a significant increase in LF/HF ratio and decrease in HF. Autonomic cardiac changes were accompanied by simultaneous SEEG signal changes with an increase in seizure-related HFA in anterior hippocampal formation and amygdala, but not in insula.ConclusionIn our sample, TL seizures are thus accompanied by an early decrease in parasympathetic control of cardiac rhythm and by an increase of sympathetic tone, concomitant to seizure activity in anterior hippocampus and amygdala.SignificanceThese results support a pivotal role of hippocampus and amygdala in tachycardia occurring during TL seizures.
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O2-6-06. The role of gaze in performing the trail making test
Source:Clinical Neurophysiology, Volume 128, Issue 9
Author(s): Yasuo Terao, Shun-ichi Matsuda, Shin-ichi Tokushige, Satomi Inomata-Terada, Masashi Hamada, Yoshikazu Ugawa
We studied the role of gaze in performing the trail-making test (TMT) in eight normal subjects, a task frequently used to assess frontal executive function in neurological patients. TMT was presented on a touch-panel monitor placed in front of the subjects, on which they were asked to connect the presented numbers with their fingers in an ascending order (version A), or with the added task of alternately connecting between the numbers and letters in ascending and alphabetical orders (version B), respectively. The subjects' gaze position on the monitor was recorded by a video-based eye tracking system (Eyelink 1000), as was the hand (finger) position on the touch-panel. The completion time and the total number of saccades made during the task, the amplitude, peak velocity of saccades and the interval between consecutive saccades (i.e., fixation duration) were measured. Multiple regression analysis showed that the task completion time correlated with the total number of saccades and, less prominently, with the mean fixation duration, suggesting that gaze plays an important role in performing TMT, and should be considered when using this task to assess executive function in neurological patients with eye movement disorders.
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O-2-6-15. Immediate effects of anodal tDCS combined with patterned electrical stimulation on gait performance in patients with stroke
Source:Clinical Neurophysiology, Volume 128, Issue 9
Author(s): Tomofumi Yamaguchi, Toshiyuki Fujiwara, Kazuhei Maeda, Tsuyoshi Tatemoto, Shigeo Tanabe, Yoko Takahashi, Katsuhiro Mizuno, Yoshihisa Masakado, Meigen Liu
Anodal transcranial direct current stimulation (tDCS) combined with patterned electrical stimulation (PES) modulates spinal reciprocal inhibition and improves the ankle movement in patients with incomplete spinal cord injury (Yamaguchi et al., 2016). This study aimed to examine the immediate effects of anodal tDCS combined with PES on gait performance in patients with stroke. Twelve patients with subacute stroke participated in this double-masked, sham-controlled cross-over study. They randomly participated in the following sessions on separate days: (1) anodal tDCS+PES; (2) anodal tDCS+sham PES; (3) sham tDCS+PES. The gait speed and surface electromyography (EMG) of tibialis anterior (TA) and soleus (SOL) muscles were measured before and after the intervention. As a result, the gait speed was not changed before and after the stimulation in all interventions. In anodal tDCS+PES condition, the EMG of the TA after the stimulation was significantly greater than that in the swing phase compared with other interventions. Anodal tDCS+PES produced significant improvement in the co-contraction ratio between TA and SOL after the stimulation, while other interventions produced no change. These findings suggest that anodal tDCS+PES could improve walking function in patients with stroke.
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O-2-6-26. Effects of sleep on the epileptiform discharge in benign adult familial myoclonus epilepsy (BAFME)
Source:Clinical Neurophysiology, Volume 128, Issue 9
Author(s): Takefumi Hitomi, Katsuya Kobayashi, Takeyo Sakurai, Shamima Sultana, Kei Sato, Takeshi Inoue, Akihiro Shimotake, Riki Matsumoto, Ryosuke Takahashi, Akio Ikeda
Epileptiform discharges often increase in most epilepsy types. This study sought to clarify the effects of sleep modification on cortical irritability in benign adult familial myoclonus epilepsy (BAFME). We retrospectively reviewed 31 conventional electroencephalographies (EEGs) of 12 BAFME patients and analyzed epileptiform discharges during the awake and sleep periods of 6 EEGs in 5 BAFME patients (5 women, mean age: 49.6±20.3years). Using conventional EEG analysis, EEG was classified into awake (66.6%) and light sleep stages (Stage I and II) (33.4%). Epileptiform discharges were significantly more frequent during the awake (1.3±1.2/min) period than light sleep stages (0.02±0.04/min) (P<0.05). Our study showed that epileptiform discharges were consistently reduced during sleep in patients with BAFME, which indicated a reduction in cortical irritability during the sleep period. Unverricht-Lundborg disease, a relatively milder form of progressive myoclonus epilepsy, showed a similar trend, thus BAFME and ULD may share a similar pathological mechanism of cortical irritability in response to a change in vigilance.
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O3-6-21. Time-dependent changes in intraoperative monitoring findings during microvascular decompression for hemifacial spasm
Source:Clinical Neurophysiology, Volume 128, Issue 9
Author(s): Masafumi Fukuda, Tetsuro Takao, Tetsuya Hiraishi, Yukihiko Fujii
We analyzed time-dependent changes in the intraoperative monitoring of abnormal muscle responses (AMRs) and facial motor evoked potentials (FMEPs) elicited by transcranial electrical stimulation during microvascular decompression (MVD) in 26 patients with hemifacial spasm. In the orbicularis oculi muscle, the AMRs disappeared in 11 patients before MVD, in six after MVD, and in three during dural closure. The AMRs persisted in six patients. FMEP amplitudes decreased to less than 50% in two patients before MVD, in four after MVD, and in six during dural closure. FMEP amplitudes did not decrease in 14 patients (p<0.005). In the mentalis muscle, the AMRs disappeared in eight patients before MVD, in five after MVD, and in four during dural closure. AMRs persisted in nine patients. FMEPs decreased in two patients before MVD and in two during dural closure, although the remaining 22 patients did not have decreased FMEPs (p<0.001). The differences between the time-dependent changes in AMR and FMEP are likely attributable to the different origins of the two responses. AMRs mainly occur around the compression site of the facial nerve and FMEPs mainly originate in the facial nucleus in the brainstem.
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P1-06. Two CIDP patients with anti-CNTN1 IgG4 antibodies and nephrotic syndrome
Source:Clinical Neurophysiology, Volume 128, Issue 9
Author(s): Norito Kokubun, Takahide Nagashima, Kei Funakoshi, Tomoko Komagamine, Koichi Hirata, Nobuhiro Yuki
Previous studies showed that CIDP patients with anti-CNTN1 IgG4 antibodies form a specific subtype, which shows subacute progression and poor prognosis. In contrast, nephropathy has been recognized as a rare complication in CIDP and other immune-mediated neuropathies. We here describe two CIDP patients with anti-CNTN1 IgG4 antibodies and nephrotic syndrome. The patients were 35- (P1) and 69-year-old (P2) males. Both patients developed subacute course of sensory and motor neuropathy. In parallel with neuropathy course, nephrotic syndrome was present. Nerve conduction studies revealed severe demyelinating polyneuropathy. The disease showed resistance to IVIg, cortico steroids, plasma exchange and cyclosporine, and the severe sensory disturbance and muscle atrophies were left. High titer of anti-CNTN1 IgG4 antibodies was detected in their serum. Renal biopsy in P1 showed membranous nephropathy with the deposition of IgG1 and IgG4 on the glomerular-basement membrane. These findings arise a possibility of existence of shared antigen between peripheral nerve and renal glomerular-basement membrane.
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P1-27. Influence of stimulus direction on the efficacy of continuous theta burst stimulation
Source:Clinical Neurophysiology, Volume 128, Issue 9
Author(s): Takuya Sasaki, Masashi Hamada, Shin-ichi Tokushige, Satomi Inomata-Terada, Yasuo Terao, Yoshikazu Ugawa
Continuous theta burst stimulation (cTBS) is a method commonly used to induce long term depression (LTD)-like plasticity in human motor cortex. However, its after-effects are likely to be highly variable between individuals. In this study, we hypothesized that the direction of stimulus current may have a role in the efficacy of cTBS, as cTBS is usually applied using a biphasic stimulus pulse which preferentially induces anterior-to-posterior (AP) current in the second depolarizing phase in the brain. To test this, we investigated changes of motor evoked potentials (MEPs) after cTBS carried out with rotating the stimulation coil 45° clockwise from the conventional position, which preferentially induces medial-to-lateral current in the brain. Nine healthy volunteers participated in the study and transcranial magnetic stimulation (TMS) was given to the M1 representation of the right first dorsal interosseous muscle. We found that the modified cTBS with rotated coil tented to show better responder rate compared with the conventional cTBS (66.7% vs. 33.3%) though there were no statistical differences. We concluded that the after-effects of cTBS were highly variable irrespective of direction of stimulus current.
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Hypoxia affects tissue oxygenation differently in the thigh and calf muscles during incremental running
Abstract
Purpose
The present study was performed to determine the impact of hypoxia on working muscle oxygenation during incremental running, and to compare tissue oxygenation between the thigh and calf muscles.
Methods
Nine distance runners and triathletes performed incremental running tests to exhaustion under normoxic and hypoxic conditions (fraction of inspired oxygen = 0.15). Peak pulmonary oxygen uptake ( \({\dot{\text{V}}\text{O}}_2}}\) ) and tissue oxygen saturation (StO2) were measured simultaneously in both the vastus lateralis and medial gastrocnemius.
Results
Hypoxia significantly decreased peak running speed and \({\dot{\text{V}}\text{O}}_2}}\) (p < 0.01). During incremental running, StO2 in the vastus lateralis decreased almost linearly, and the rate of decrease from warm-up (180 m min−1) to \({\dot{\text{V}}\text{O}}_2}}\) was significantly greater than in the medial gastrocnemius under both normoxic and hypoxic conditions (p < 0.01). StO2 in both muscles was significantly decreased under hypoxic compared with normoxic conditions at all running speeds (p < 0.01). The rate at which StO2 was decreased by hypoxia was greater in the vastus lateralis as the running speed increased, whereas it changed little in the medial gastrocnemius.
Conclusions
These results suggest that the thigh is more deoxygenated than the calf under hypoxic conditions, and that the effects of hypoxia on tissue oxygenation differ between these two muscles during incremental running.
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Radioecological assessment and radiometric dating of sediment cores from dynamic sedimentary systems of Pra and Volta estuaries (Ghana) along the Equatorial Atlantic
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): E. Klubi, J.M. Abril, E. Nyarko, A. Laissaoui, M. Benmansour
The Volta and Pra estuaries (Ghana, West Africa) are dynamical sedimentary systems whose natural equilibrium is being affected by anthropogenic activities. This paper reports depth-distributions of 210Pb, 226Ra, 234Th, 40K, 228Ra and 137Cs for two sediment cores from these estuaries. Bulk densities were not steady-state and well correlated with 40K (p < 0.00005). Unsupported 210Pb profiles were incomplete, non-monotonic and showed large fluctuations. The assumptions involved in the common 210Pb-based dating models were not meet in these dynamical scenarios, and the use of 137Cs as a time-marker is difficult in Equatorial and South-Hemisphere countries due to its low fallout rates. Chronologies have been solved with the new 210Pb-based TERESA model, which operates with varying but statistically correlated fluxes and sediment accumulation rates (SAR). The core from the Volta reflects the conditions prevailing after the construction of the Akosombo Dam, with a mean SAR of 1.05 ± 0.03 g cm−2·y−1, while a higher value of 2.73 ± 0.06 g cm−2·y−1 was found in the Pra, affected by intense gold mining activities along its course. Radiological and radioecological assessments have been conducted by applying the UNSCEAR protocols and the ERICA model, respectively. The measured radionuclide concentrations do not pose any significant risk for the environment and human health.
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Improved performance comparisons of radioxenon systems for low level releases in nuclear explosion monitoring
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Derek A. Haas, Paul W. Eslinger, Theodore W. Bowyer, Ian M. Cameron, James C. Hayes, Justin D. Lowrey, Harry S. Miley
The Comprehensive Nuclear-Test-Ban Treaty bans all nuclear tests and mandates development of verification measures to detect treaty violations. One verification measure is detection of radioactive xenon isotopes produced in the fission of actinides. The International Monitoring System (IMS) currently deploys automated radioxenon systems that can detect four radioxenon isotopes. Radioxenon systems with lower detection limits are currently in development. Historically, the sensitivity of radioxenon systems was measured by the minimum detectable concentration for each isotope. In this paper we analyze the response of radioxenon systems using rigorous metrics in conjunction with hypothetical representative releases indicative of an underground nuclear explosion instead of using only minimum detectable concentrations. Our analyses incorporate the impact of potential spectral interferences on detection limits and the importance of measuring isotopic ratios of the relevant radioxenon isotopes in order to improve discrimination from background sources particularly for low-level releases. To provide a sufficient data set for analysis, hypothetical representative releases are simulated every day from the same location for an entire year. The performance of three types of samplers are evaluated assuming they are located at 15 IMS radionuclide stations in the region of the release point. The performance of two IMS-deployed samplers and a next-generation system is compared with proposed metrics for detection and discrimination using representative releases from the nuclear test site used by the Democratic People's Republic of Korea.
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Applications of radon and radium isotopes to determine submarine groundwater discharge and flushing times in Todos os Santos Bay, Brazil
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Vanessa Hatje, Karina Kammer Attisano, Marcelo Friederichs Landim de Souza, Barbara Mazzilli, Joselene de Oliveira, Tamires de Araújo Mora, William C. Burnett
Todos os Santos Bay (BTS) is the 2nd largest bay in Brazil and an important resource for the people of the State of Bahia. We made measurements of radon and radium in selected areas of the bay to evaluate if these tracers could provide estimates of submarine groundwater discharge (SGD) and flushing times of the Paraguaçu Estuary and BTS. We found that there were a few areas along the eastern and northeastern shorelines that displayed relatively high radon and low salinities, indicating possible sites of enhanced SGD. A time-series mooring over a tidal cycle at Marina do Bonfim showed a systematic enrichment of the short-lived radium isotopes 223Ra and 224Ra during the falling tide. Assuming that the elevated radium isotopes were related to SGD and using measured radium activities from a shallow well at the site, we estimated groundwater seepage at about 70 m3/day per unit width of shoreline. Extrapolating to an estimated total shoreline length provided a first approximation of total (fresh + saline) SGD into BTS of 300 m3/s, about 3 times the average river discharge into the bay. Just applying the shoreline lengths from areas identified with high radon and reduced salinity results in a lower SGD estimate of 20 m3/s. Flushing times of the Paraguaçu Estuary were estimated at about 3–4 days based on changing radium isotope ratios from low to high salinities. The flushing time for the entire BTS was also attempted using the same approach and resulted in a surprisingly low value of only 6–8 days. Although physical oceanographic models have proposed flushing times on the order of months, a simple tidal prism calculation provided results in the range of 4–7 days, consistent with the radium approach. Based on these initial results, we recommend a strategy for refining both SGD and flushing time estimates.
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A new CUL4B variant associated with a mild phenotype and an exceptional pattern of leukoencephalopathy
Cabezas type of X-linked syndromic intellectual disability (MRXSC; MIM300354) is a rare X-linked recessive intellectual disability characterized primarily by intellectual disability, short stature, hypogonadism, and gait abnormalities. It is caused by a wide spectrum of hemizygous variants in CUL4B. In a 10-year-old boy with an exceptional leukoencephalopathy pattern, we identified a new missense variant p.Leu329Gln in CUL4B using "Mendeliome" sequencing. However, his phenotype does not include the severe characteristics currently known for MRXSC. We discuss the divergent phenotype and propose a potential connection between the different CUL4B variants and corresponding phenotypes in the context of the current literature as well as 3D homology modeling.
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Prenatal presentation of Mabry syndrome with congenital diaphragmatic hernia and phenotypic overlap with Fryns syndrome
We report on a family in which initial features were compatible with Fryns syndrome. The first sibling was a stillborn female with a left diaphragmatic hernia (DH). Her clinical features overlapped with Fryns syndrome. The second pregnancy, a male fetus, was followed for polyhydramnios, hypoplastic mandible, mild enlargement of the fetal bladder, hydronephrosis, and rocker bottom foot deformities. He had facial features similar to his sibling and a large cleft of the secondary palate, small jaw, and secundum atrial septal defect. He underwent surgical repair of imperforate anus, intestinal malrotation, and placement of mucous fistula for biopsy positive Hirschsprung disease. An elevated alkaline phosphatase level of 1569 U/L was reported. Whole exome sequencing performed on the second child demonstrated compound heterozygosity for the PIGV gene with the p.A341E and p.A418D variants in trans. Hyperphosphatasia with mental retardation syndrome (HPMRS) is caused by mutations in PIGV and includes hyperphosphatasia as a diagnostic hallmark. Our patient exhibited hyperphosphatasia but without any storage material in his skin cells. His features remain similar to his sister's, but includes seizures and lacks diaphragmatic hernia. Until now, HPMRS and Fryns syndrome, despite overlapping features, were considered mutually exclusive as HPMRS involves hyperphosphatasia and Fryns typically exhibits DH. Recent identification of PIGN mutations associated with several cases of Fryns syndrome point to a common pathogenetic etiology involving inborn errors of the glycosylphosphatidylinositiol anchor biosynthetic pathway. A diagnosis of HPMRS should be considered when DH is encountered on prenatal ultrasound.
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Stakeholders in psychiatry and their attitudes toward receiving pertinent and incident findings in genomic research
Increasingly more psychiatric research studies use whole genome sequencing or whole exome sequencing. Consequently, researchers face difficult questions, such as which genomic findings to return to research participants and how. This study aims to gain more knowledge on the attitudes among potential research participants and health professionals toward receiving pertinent and incidental findings. A cross-sectional online survey was developed to investigate the attitudes among research participants toward receiving genomic findings. A total of 2,637 stakeholders responded: 241 persons with mental disorders, 671 relatives, 1,623 blood donors, 74 psychiatrists, and 28 clinical geneticists. Stakeholders wanted both pertinent findings (95%) and incidental findings (91%) to be made available for research participants. The majority (77%) stated that researchers should not actively search for incidental findings. Persons with mental disorders and relatives were generally more positive about receiving any kind of findings than clinical geneticists and psychiatrists. Compared with blood donors, persons with mental disorders reported to be more positive about receiving raw genomic data and information that is not of serious health importance. Psychiatrists and clinical geneticists were less positive about receiving genomic findings compared with blood donors. The attitudes toward receiving findings were very positive. Stakeholders were willing to refrain from receiving incidental information if it could compromise the research. Our results suggest that research participants consider themselves as altruistic participants. This study offers valuable insight, which may inform future programs aiming to develop new strategies to target issues relating to the return of findings in genomic research.
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Cover Image, Volume 173A, Number 9, September 2017
The cover image, by Paul Kruszka et al., is based on the Original Article Noonan Syndrome in Diverse Populations, DOI: 10.1002/ajmg.a.38362. Design Credit: Darryl Leja.
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Dolichol kinase deficiency (DOLK-CDG): Two new cases and expansion of phenotype
Congenital disorders of glycosylation (CDGs) are a group of genetic diseases caused by mutations in genes that are necessary for the addition of oligosaccharides to acceptor proteins or lipids. An early step in this process requires dolichol kinase (DK) to catalyze the formation of dolichyl phosphate, which acts as a membrane anchor for initial attachment of sugar residues that are subsequently built up to oligosaccharides and transferred to acceptor proteins and lipids for further processing. Biallelic mutations in DOLK, the gene for DK, result in human in a CDG with variable symptoms, ranging from nonsyndromic dilated cardiomypopathy to severe multiorgan involvement. We report two female siblings with novel compound heterozygous mutations in DOLK: c.951C>A (p.Tyr317Ter) and c.1558A>G (p.Thr520Ala). Both patients presented in the neonatal period with severe ichthyosis, unusual distal digital constrictions and dilated cardiomyopathy which resulted in death. Histology of the skin showed lipid droplet accumulation in the stratum corneum and keratinocytes, which suggests defective epidermal lipid metabolism. These patients represent an earlier and more severe form of DOLK-CDG (CDG-1m) with a striking presentation at birth that expands the known phenotypic spectrum.
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Using whiteboards to support college students learning of complex physiological concepts
Research underscores the importance of retrieval-based practice and application of knowledge for meaningful learning. However, the didactic lecture format continues to persist in traditional university physiology courses. A strategy called whiteboarding, where students use handheld dry erase boards and work in small groups to actively retrieve, discuss, and apply concepts presented in the lecture, has the potential to address challenges associated with actively engaging students in science courses for greater learning. The purpose of this study was to empirically examine the potential benefits of whiteboarding for increasing students' understanding of animal physiology concepts. Student performance on physiology questions assessing concepts taught using lecture only vs. concepts taught using lecture and whiteboarding were compared within the term that whiteboarding was used, as well as across whiteboard and lecture-only terms taught by the same instructor. Results showed that when whiteboarding was incorporated in the course, student performance on items that assessed concepts corresponding to the whiteboarding activities were significantly higher compared with performance on items that assessed concepts taught through lecture only. These patterns in student performance were found within and across terms. Taken together, findings point to whiteboarding as an effective tool that can be integrated in traditional lecture courses to promote students' understanding of physiology.
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