Perioperative management of rare coagulation factor deficiency states in cardiac surgery

Abstract

Rare bleeding disorders (RBDs) include the hereditary deficiency of fibrinogen, factor (F)II, FV, FV + FVIII, FVII, FX, FXI or FXIII. RBDs do not confer a protective effect against atheromatous plaque formation, and thus the need for cardiovascular (CV) surgery in RBD patients is expected to increase with improved healthcare access (diagnosis and management) and longevity of the population. Clinical data regarding the management of RBDs in this setting are sparse, but the perioperative care team is obliged to gain a better understanding on available biological and pharmacological hemostatic agents. Perioperative management of RBDs in CV surgery is further complicated by heparin anticoagulation, haemodilution, and consumption of procoagulant and anticoagulant proteins associated with cardiopulmonary bypass (CPB). The aims of this review are to summarize pathophysiology of RBDs and laboratory monitoring pertinent to CV surgery, available factor replacement agents, and to provide the framework for perioperative coagulation management of RBD patients.

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Attenuation of ductus arteriosus intimal thickening in preterm sheep twins compared with singletons

Abstract

Preterm twins have a higher morbidity rate of patent ductus arteriosus (PDA) than do singletons. However, the effect of multiple births on maturation of the ductus arteriosus (DA) has not been reported. Because intimal thickening (IT) is required for DA anatomical closure, we examined IT development in the DA of preterm twins and singletons. Sheep DA tissues obtained from preterm fetuses were subjected to elastica van Gieson staining to evaluate IT. The total IT score in each DA was the sum of the IT scores obtained from six evenly divided parts of the DA, which was positively correlated with gestational ages in singletons. Total IT scores were smaller in preterm twins than in singletons, although no difference in gestational age, birth weight, or gender ratio was observed. These data suggest that IT development of the DA is attenuated in sheep preterm twins, which may affect the higher morbidity of PDA.

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White matter fiber integrity of the saccadic eye movement network differs between schizophrenia and healthy groups

Abstract

Recent diffusion tensor imaging (DTI) studies suggest that altered white matter fiber integrity is a pathophysiological feature of schizophrenia. Lower white matter integrity is associated with poor cognitive control, a characteristic of schizophrenia that can be measured using antisaccade tasks. Although the functional neural correlates of poor antisaccade performance have been well documented, fewer studies have investigated the extent to which white matter fibers connecting the functional nodes of this network contribute to antisaccade performance. The aim of the present study was to assess the white matter structural integrity of fibers connecting two functional nodes (putamen and medial frontal eye fields) of the saccadic eye movement network implicated in poor antisaccade performance in schizophrenia. To evaluate white matter integrity, DTI was acquired on subjects with schizophrenia and two comparison groups: (a) behaviorally matched healthy comparison subjects with low levels of cognitive control (LCC group), and (b) healthy subjects with high levels of cognitive control (HCC group). White matter fibers were tracked between functional regions of interest generated from antisaccade fMRI activation maps, and measures of diffusivity were quantified. The results demonstrated lower white matter integrity in the schizophrenia group than in the HCC group, but not the LCC group who showed similarly poor cognitive control performance. Overall, the results suggest that these alterations are not specific to the disease process of schizophrenia, but may rather be a function of uncontrolled cognitive factors that are concomitant with the disease but also observed in some healthy people.

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High quality of evidence is uncommon in Cochrane systematic reviews in Anaesthesia, Critical Care and Emergency Medicine.

BACKGROUND: The association between the quality of evidence in systematic reviews and authors' conclusions regarding the effectiveness of interventions relevant to anaesthesia has not been examined. OBJECTIVE: The objectives of this study were: to determine the proportion of systematic reviews in which the authors made a conclusive statement about the effect of an intervention; to describe the quality of evidence derived from outcomes in reviews that used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) working group system for grading the quality of evidence; and to identify review characteristics associated with conclusiveness. DESIGN: Cross-sectional analysis of Cochrane systematic reviews from the Anaesthesia, Critical Care and Emergency Review Group was undertaken. DATA SOURCES: The Cochrane webpage was used to identify reviews for inclusion ( http://.ace.cochrane.org/). ELIGIBILITY CRITERIA: New and updated versions of systematic reviews published up to 17 September 2015 were eligible. Protocols for systematic reviews were excluded. RESULTS: A total of 159 reviews were included. GRADE was used in 103 reviews (65%). Of these, high-level evidence for the primary outcome was identified in 11 reviews (10%). The main reasons that quality of evidence for the primary outcome was downgraded were risk of bias (n = 44; 43%) and imprecision (n = 36; 35%). Authors of 47% (n = 75) of the total number of reviews made conclusive statements about the effects of interventions. Independent predictors of conclusiveness in the subgroup of reviews with GRADE assessments were quality of evidence for the primary outcome (odds ratio 2.03; 95% confidence interval: [1.18 to 3.52] and an increasing number of studies included in reviews (OR 1.05; 95% CI: [1.01 to 1.09]). CONCLUSION: It was common for conclusive statements to be made about the effects of interventions despite evidence for the primary outcome being rated less than high quality. Improving methodological quality of trials would have the greatest impact on improving the quality of evidence. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://ift.tt/OBJ4xP (C) 2017 European Society of Anaesthesiology

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Ventilation inhibits sympathetic action potential recruitment even during severe chemoreflex stress

This study investigated the influence of ventilation on sympathetic action potential (AP) discharge patterns during varying levels of high chemoreflex stress. In seven trained breath-hold divers (33±12 yrs), we measured muscle sympathetic nerve activity (MSNA) at baseline, during preparatory rebreathing (RBR), and during i) functional residual capacity apnea (FRC_Apnea) and ii) continued RBR. Data from RBR were analyzed at matched (i.e., to FRC_Apnea) hemoglobin saturation (HbSat) levels (RBR_Matched) or more severe levels (RBR_End). A third protocol compared alternating periods (30s) of FRC and RBR (FRC-RBR_ALT). Subjects continued each protocol until 85% volitional tolerance. AP patterns in MSNA (i.e., providing the true neural content of each sympathetic burst) were studied using wavelet-based methodology. First, for similar levels of chemoreflex stress (both HbSat: 71±6%; P=NS), RBR_Matched was associated with reduced AP frequency and APs per burst compared to FRC_Apnea (both P<0.001). When APs were binned according to peak-to-peak amplitude (i.e., into clusters), total AP clusters increased during FRC_Apnea (+10±2; P<0.001), but not RBR_Matched (+1±2; P=NS). Second, despite more severe chemoreflex stress during RBR_End (HbSat: 56±13 vs. 71±6%; P<0.001), RBR_End was associated with a restrained increase in the APs per burst (FRC_Apnea: +18±7; RBR_End: +11±5) and total AP clusters (FRC_Apnea: +10±2; RBR_End: +6±4) (both P<0.01). During FRC-RBR_ALT, all periods of FRC elicited sympathetic AP recruitment (all P<0.001), whereas all periods of RBR were associated with complete withdrawal of AP recruitment (all P=NS). Presently, we demonstrate that ventilation per se restrains and/or inhibits sympathetic axonal recruitment during high, and even, extreme, chemoreflex stress.

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Anatomy and Physiology of Phrenic Afferent Neurons

Large diameter myelinated phrenic afferents discharge in phase with diaphragm contraction and smaller diameter fibers discharge across the respiratory cycle. In this article, we review the phrenic afferent literature and highlight areas in need of further study. We conclude that 1) activation of both myelinated and non-myelinated phrenic sensory afferents can influence respiratory motor output on a breath-by-breath basis; 2) the relative impact of phrenic afferents substantially increases with diaphragm work and fatigue; 3) activation of phrenic afferents has a powerful impact on sympathetic motor outflow, and 4) phrenic afferents contribute to diaphragm somatosensation and the conscious perception of breathing. Much remains to be learned regarding the spinal and supraspinal distribution and synaptic contacts of myelinated and non-myelinated phrenic afferents. Similarly, very little is known regarding the potential role of phrenic afferent neurons in triggering or modulating expression of respiratory neuroplasticity.

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Rapid visuomotor feedback gains are tuned to the task dynamics

Adaptation to novel dynamics requires learning a motor memory, or a new pattern of predictive feedforward motor commands. Recently we demonstrated the up-regulation of rapid visuomotor feedback gains early in curl force field learning, which decrease once a predictive motor memory is learned. However, even after learning is complete, these feedback gains are higher than those observed in the null field trials. Interestingly these up-regulated feedback gains in the curl field were not observed in a constant force field. We therefore suggest that adaptation also involves selectively tuning the feedback sensitivity of the sensorimotor control system to the environment. Here we test this hypothesis by measuring the rapid visuomotor feedback gains after subjects adapt to a variety of novel dynamics generated by a robotic manipulandum in three experiments. To probe the feedback gains, we measured the magnitude of the motor response to rapid shifts in the visual location of the hand during reaching. While the feedback gain magnitude remained similar over a larger than a four-fold increase in constant background load, the feedback gains scaled with increasing lateral resistance and increasing instability. The third experiment demonstrated that the feedback gains could also be independently tuned to perturbations to the left and right depending on the lateral resistance, demonstrating the fractionation of feedback gains to environmental dynamics. Our results demonstrate that the sensorimotor control system regulates the gain of the feedback system as part of the adaptation process to novel dynamics, appropriately tuning them to the environment.

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Role of digit placement control on sensorimotor transformations for dexterous manipulation

Dexterous manipulation relies on the ability to modulate grasp forces to variable digit position. However, the sensorimotor mechanisms underlying such critical ability are not well understood. The present study addressed whether digit force-to-position modulation relies entirely on feedback of digit placement and force, or on the integration of such feedback with motor commands responsible for digit positioning. In two experiments, we asked 25 subjects to estimate the index fingertip position relative to the thumb (Perception test), or grasp and lift an object with an asymmetrical mass distribution while preventing object roll (Action test). Both tests were performed after subjects' digits were placed actively or passively at different distances (Active and Passive condition, respectively) and without visual feedback. As motor commands for digit positioning would be integrated with position and force feedback in the Active condition, we hypothesized this condition to be characterized by greater accuracy of digit position estimation and digit force-to-position modulation. Surprisingly, discrimination of digit position and force-to-position modulation were statistically indistinguishable in the Active and Passive conditions. However, the Active condition of the Action test was characterized by larger peak load force rate and shorter load phase duration (p < 0.05 and 0.001, respectively). We conclude that voluntary commands for digit positioning are not essential for accurate digit force-to-position modulation. Thus, digit force-to-position modulation can be implemented by integrating sensory feedback of digit position and voluntary commands of digit force production following contact.

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Vowel generalization and its relation to adaptation during perturbations of auditory feedback

Repeated perturbations of auditory feedback during vowel production elicit changes not only in the production of the perturbed vowel (adaptation) but also in the production of nearby vowels that were not perturbed (generalization). The finding that adaptation generalizes to other, non-perturbed vowels suggest that sensorimotor representations for vowels are not independent; instead the goals for producing any one vowel may depend in part on the goals for other vowels. The present study investigated the dependence or independence of vowel representations by evaluating adaptation and generalization in two groups of speakers exposed to auditory perturbations of their first formant (F1) during different vowels. The speakers in both groups who adapted to the perturbation exhibited generalization in two non-perturbed vowels that were produced under masking noise. Correlation testing was performed to evaluate the relations between adaptation and generalization as well as between the generalization in the two non-perturbed vowels. These tests identified significant coupling between the F1 changes of adjacent vowels but not non-adjacent vowels. The pattern of correlation findings indicates that generalization was due in part to feedforward representations that are partly shared across adjacent vowels, possibly to maintain their acoustic contrast.

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Parkinsonism and Vigilance: Alteration in neural oscillatory activity and phase-amplitude coupling in the basal ganglia and motor cortex

Oscillatory neural activity in different frequency bands as well as phase-amplitude coupling (PAC) are hypothesized to be biomarkers of Parkinson's disease (PD) that could explain dysfunction in the motor circuit and be used for closed-loop deep brain stimulation (DBS). How these putative biomarkers change from the normal to the parkinsonian state, across nodes in the motor circuit, and within the same subject, however, remains unknown. In this study, we characterized how parkinsonism and vigilance altered oscillatory activity and PAC within the primary motor cortex (M1), subthalamic nucleus (STN), and globus pallidus (GP) in two nonhuman primates. Static and dynamic analyses of local field potential (LFP) recordings indicate that: 1) after induction of parkinsonism using the neurotoxin MPTP, low-frequency power (8-30 Hz) increased in the STN and GP in both subjects, but increased in M1 in only one subject; 2) high-frequency power (~330 Hz) was present in the STN in both normal subjects, but absent in the parkinsonian condition; 3) elevated PAC measurements emerged in the parkinsonian condition in both animals, but in different sites in each animal (M1 in one subject and GPe in the other) and 4) the state of vigilance significantly impacted how oscillatory activity and PAC was expressed in the motor circuit. These results support the hypothesis that changes in low and high frequency oscillatory activity and PAC are features of parkinsonian pathophysiology and provide evidence that closed-loop DBS systems based on these biomarkers may require subject-specific configurations as well as adaptation to changes in vigilance.

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A role for the cystic fibrosis transmembrane conductance regulator in the nitric oxide-dependent release of Cl- from acidic organelles in amacrine cells

Gamma-amino butyric acid (GABA) and glycine typically mediate synaptic inhibition because their ligand-gated ion channels support the influx of Cl^-. However, the electrochemical gradient for Cl^- across the postsynaptic plasma membrane determines the voltage response of the postsynaptic cell. Typically low cytosolic Cl^- supports inhibition while higher levels of cytosolic Cl^- can suppress inhibition or promotes depolarization. We previously reported that nitric oxide (NO) releases Cl^- from acidic organelles and transiently elevates cytosolic Cl^- making the response to GABA and glycine excitatory. Here, we test the hypothesis that the cystic fibrosis transmembrane conductance regulator (CFTR) is involved in the NO-dependent efflux of organellar Cl^-. We first establish the mRNA and protein expression of CFTR in our model system, cultured chick retinal amacrine cells. Using whole cell voltage clamp recordings of currents through GABA-gated Cl^- channels, we examine the effects of pharmacological inhibition of CFTR on the NO-dependent release of internal Cl-. To interfere with the expression of CFTR, we used clustered regularly interspaced short palindromic repeats (CRISPR)/Cas9 genome editing. We find that both pharmacological inhibition and CRISPR/Cas9-mediated knockdown of CFTR blocks the ability of NO to release Cl^- from internal stores. These results demonstrate that CFTR is required for the NO-dependent efflux of Cl^- from acidic organelles.

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Distinct coordinate systems for adaptations of movement direction and extent

Learned compensations for perturbed visual feedback of movement extent and direction generalize differently to unpractised movement directions, which suggests different underlying neural mechanisms. Here we investigated whether gain and rotation adaptations are consistent with representation in different coordinate systems. Subjects performed a force aiming task with the wrist, and learned different gains or rotations for different force directions. Generalization was tested without visual feedback for the same extrinsic directions but with the forearm in a different pronation-supination orientation. When the change in forearm orientation caused the adapted visuomotor map to conflict in extrinsic and joint-based coordinates, rotation generalization occurred in extrinsic coordinates but with reduced magnitude. In contrast, gain generalization appeared reduced and phase-shifted. When the forearm was rotated further such that all imposed perturbations aligned in both joint-based and extrinsic coordinates in both postures, rotation generalization was further reduced, whereas there was neither reduction nor phase shift in the pattern of extent generalization. These results show that rotation generalization was expressed in extrinsic coordinates, and that generalization magnitude was modulated by posture. In contrast, gain generalization appeared to depend on target direction defined by an integrated combination of extrinsic and joint-based coordinates, and was not reduced substantially by posture changes alone. Although the quality of the model fit underlying our interpretation prevents us from making strong conclusions, the data suggest that adaptations of movement direction and extent are represented according to distinct coordinate systems.  

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Functional and molecular plasticity of gamma and alpha-1 GABAA receptor subunits in the dorsal motor nucleus of the vagus after experimentally-induced diabetes

Chronic experimentally-induced hyperglycemia augments subunit specific gamma-aminobutyric acid A (GABA_A) receptor-mediated inhibition of parasympathetic preganglionic motor neurons in the dorsal motor nucleus of the vagus (DMV). However, the contribution of α1 or GABA_A receptor subunits, which are ubiquitously expressed on central nervous system neurons, to this elevation in inhibitory tone have not been determined. This study investigated the effect of chronic hyperglycemia/hypoinsulinemia on α1- and -subunit specific GABA_A receptor-mediated inhibition using electrophysiological recordings in vitro and quantitative (q)RT-PCR. DMV neurons from streptozotocin-treated mice demonstrated enhancement of both phasic and tonic inhibitory currents in response to application of the α1-subunit selective GABA_A receptor positive allosteric modulator, zolpidem. Responses to low concentrations of the GABA_A receptor antagonist, gabazine suggested an additional increased contribution of -subunit-containing receptors to tonic currents in DMV neurons. Consistent with the functional elevation in α1- and -subunit-dependent activity, transcription of both the α1- and 2-subunits was increased in the dorsal vagal complex of streptozotocin-treated mice. Overall these findings suggest an increased sensitivity to both zolpidem and gabazine after several days of hyperglycemia/hypoinsulinemia, which could contribute to altered parasympathetic output from DMV neurons in diabetes.

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Microglia-mediated synaptic elimination in neuronal development and disease

It has recently become clear that microglia, the immune cells of the central nervous system, are far more active in the healthy brain than previously thought. Microglia facilitate many stages of brain development by shaping neuronal connectivity via synaptic elimination. Dysfunction of these same processes likely underlies a wide range of neurological and neurodevelopmental disorders.

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Intrinsic frequency biases and profiles across human cortex

Recent findings in monkeys suggest that intrinsic periodic spiking activity in selective cortical areas occurs at timescales that follow a sensory or lower-order to higher-order processing hierarchy (Murray et al. 2014). It has not yet been fully explored if a similar timescale hierarchy is present in humans. Additionally, these measures in the monkey studies have not addressed findings that rhythmic activity within a brain area can occur at multiple frequencies. Here we investigate in humans if regions may be biased towards particular frequencies of intrinsic activity and if a full cortical mapping still reveals an organization that follows this hierarchy. We examined the spectral power in multiple frequency bands (0.5-150Hz) from task-independent data using magnetoencephalography (MEG). We compared standardized power across bands to find regional frequency biases. Our results demonstrate a mix of lower and higher frequency biases across sensory and higher-order regions. Thus they suggest a more complex cortical organization that does not simply follow this hierarchy. Additionally, some regions do not display a bias for a single band, and a data-driven clustering analysis reveals a regional organization with high standardized power in multiple bands. Specifically, theta and beta are both high in dorsal frontal cortex while delta and gamma are high in ventral frontal cortex and temporal cortex. Occipital and parietal regions are biased more narrowly towards alpha power and ventral temporal lobe displays specific biases towards gamma. Thus intrinsic rhythmic neural activity displays a regional organization but one that is not necessarily hierarchical.

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Impact of prior errors on visuomotor adaptation and savings: experimental considerations and clinical implications

The motor system retains learning from visuomotor adaptation tasks in the form of "savings" to enable faster readaptation to similar perturbations in the future. Leow et al. (J Neurophysiol 116: 1603-1614, 2016) suggest that the experience of prior errors during relearning is necessary for savings while repetition of prior actions may not be sufficient. These findings provide novel insight into factors that contribute to visuomotor adaptation and can be applied to future experimental and clinical research.

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The Divisive-Normalization Model of V1 Neurons: A Comprehensive Comparison of Physiological Data and Model Predictions

The physiological responses of simple and complex cells in the primary visual cortex (V1) have been studied extensively and modeled at different levels. At the functional level, the divisive normalization model (DNM, Heeger, 1992) has accounted for a wide range of single-cell recordings in terms of a combination of linear filtering, nonlinear rectification, and divisive normalization. We propose standardizing the formulation of the DNM and implementing it in software that takes static grayscale images as inputs and produces firing-rate responses as outputs. We also review a comprehensive suite of 30 empirical phenomena and report a series of simulation experiments that qualitatively replicate dozens of key experiments with a standard parameter set consistent with physiological measurements. This systematic approach identifies novel falsifiable predictions of the DNM. We show how the model simultaneously satisfies the conflicting desiderata of flexibility and falsifiability. Our key idea is that, while adjustable parameters are needed to accommodate the diversity across neurons, they must be fixed for a given individual neuron. This requirement introduces falsifiable constraints when this single neuron is probed with multiple stimuli. We also present mathematical analyses and simulation experiments that explicate some of these constraints.

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Fat accumulates preferentially in the right liver lobe than the left in non-diabetic subjects

To examine the distribution of liver fat (LFAT) in non-diabetic subjects and test whether the fat in the right as compared to the left lobe correlates better with components of the metabolic syndrome or not.

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Hepatocellular carcinoma metastasis to sphenoid and cavernous sinus: an unexpected cause of ptosis

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Intramural duodenal hematoma post EUS-guided placement of fiducial radiopaque markers

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E-health in inflammatory bowel diseases: more challenges than opportunities?

Patients with inflammatory bowel disease need close monitoring for an optimal disease management. For this, e-health technologies are promising tools. But the current evidence for the implementation of ehealth in inflammatory bowel disease is weak. For this a critical evaluation of the existing evidence is presented. Furthermore some essential conditions need to be full-filled. We need a robust digital infrastructure that is workable for the patient and the healthcare provider. Important legal issues need to be solved to protect the patient.

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Esophageal perforation and dissection due to echocardiography: endoscopic treatment using an Over-the-Scope clip

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Fat accumulates preferentially in the right liver lobe than the left in non-diabetic subjects

To examine the distribution of liver fat (LFAT) in non-diabetic subjects and test whether the fat in the right as compared to the left lobe correlates better with components of the metabolic syndrome or not.

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Hepatocellular carcinoma metastasis to sphenoid and cavernous sinus: an unexpected cause of ptosis

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Intramural duodenal hematoma post EUS-guided placement of fiducial radiopaque markers

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E-health in inflammatory bowel diseases: more challenges than opportunities?

Patients with inflammatory bowel disease need close monitoring for an optimal disease management. For this, e-health technologies are promising tools. But the current evidence for the implementation of ehealth in inflammatory bowel disease is weak. For this a critical evaluation of the existing evidence is presented. Furthermore some essential conditions need to be full-filled. We need a robust digital infrastructure that is workable for the patient and the healthcare provider. Important legal issues need to be solved to protect the patient.

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Esophageal perforation and dissection due to echocardiography: endoscopic treatment using an Over-the-Scope clip

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Multi-modal sensor based weight drop spinal cord impact system for large animals

A conventional weight drop spinal cord (SC) impact system for large animals is composed of a high-speed video camera, a vision system, and other things. However, a camera with high speed at over 5,000 frames per second (FPS) is very expensive. In addition, the utilization of the vision system involves complex pattern recognition algorithms and accurate arrangement of the camera and the target.

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Event-related potential N270 as an index of social information conflict in explicit processing

Publication date: Available online 23 August 2017
Source:International Journal of Psychophysiology
Author(s): Pei Wang, Chen-hao Tan, Yu Li, Qin Zhang, Yi-bo Wang, Jun-long Luo
As N270 has been widely shown to be sensitive to nonsocial information conflict, the present study investigated whether social information conflict can elicit increased N270 in either explicit or implicit processing conditions. Gender stereotype–related picture-word pairs and picture-word pairs in specific colors were used as social and nonsocial information, respectively. Participants performed an explicit task based on the S1-S2 paradigm in Study 1, and both social and nonsocial information conditions elicited larger N270 than the no-conflict condition. In Study 2, participants performed a word judgment task that was modified from the S1-S2 paradigm of Study 1. However, neither social information nor nonsocial information elicited larger N270 within the conflict condition. Social trials generally elicited a more negative ERP waveform than nonsocial trials overall. These findings suggest that N270 may reflect the processing of social information conflict only in explicit conditions and also that the cognitive basis of N270 is thus a general but explicit processing of working memory representation conflict.



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O161 The effect of food intake on patients with postural orthostatic tachycardia syndrome

The aim of this study was to determine the effect of food intake on heart rate (HR) and blood pressure (BP) in patients with postural orthostatic tachycardia syndrome (POTS).

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S31 Structurally informed analyses of functional connectivity in stroke

Stroke is the leading cause of disability in industrialized countries, has a big impact on quality of life, and is of high socioeconomic relevance. Despite great advances of acute therapy – like thrombolysis and mechanical thrombectomy – approximately 50% of stroke survivors suffer from permanent neurological deficits, mostly because of structural and functional neural network failure.

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S196 New approach to presurgical evaluation in epilepsy surgery

In order to investigate and map the precise epileptic mechanism(network) and seizure onset zone during the planning of epilepsy surgery we use more and more complex imaging and electrophysiological studies. The analysis and evaluation of the ever growing datasets needs such a complex platform which can integrate the spatial information derived from the preoperative structural and functional imaging data with the electrophysiological data coming from the implanted intracranial electrodes.

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O96 Large inter- and intra-rater variation on diagnostic criteria for amyotrophic lateral sclerosis

To study inter- and intra-rater agreement on diagnostic criteria for amyotrophic lateral sclerosis (ALS).

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O127 Neurophysiological localisation of ulnar neuropathy at the elbow: Validation of diagnostic criteria developed by a taskforce of the Danish society of clinical neurophysiology

This study validates consensus criteria for localisation of ulnar neuropathy at elbow (UNE) developed by a taskforce of the Danish Society of Clinical Neurophysiology and compares them to the existing criteria from the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM). The Danish criteria are based on combinations of conduction slowing in the elbow and forearm segments stated in Z-scores, and difference between the segments in m/s. Examining fibres to several muscles and sensory fibres can increase the certainty of the localisation.

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S63 Etiology of clinically established trigeminal neuralgia: Role of MRI

Neurovascular compression (NVC) is the commonest cause of trigeminal neuralgia (TN). The use of MRI for diagnosis and presurgical assessment is problematic, because NVC is commonly reported in asymptomatic subjects or affecting asymptomatic nerves TN patients. We reviewed the literature to evaluate the role of MRI in the diagnostics of TN.

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O177 Novel method of intraoperative ocular movement monitoring using a piezoelectric device: Experimental study of OMNAPP (ocular motor nerve activating piezoelectric potentials) and clinical application for skull base surgeries

Intraoperative monitoring for the extraocular motor nerves (eOMNs) using electromyograms are not widely accepted due to their inherent invasiveness. We established a novel system for the intraoperative monitoring of eOMNs using a piezoelectric device capable of detecting imperceptible vibrations induced by ocular movement, with sensors placed on the eyelids alone.

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S144 Cortical spreading depression, relevance to migraine and acute brain injury in humans, and new mechanisms

Cortical spreading depression/depolarization (CSD) is a depolarization wave in cerebral gray matter that propagates across the brain at slow velocity, 2–5mm/min. For many years it was believed that CSD was an artifact produced in animal experiments and without clinical relevance. In the 1980s, brain scans of cerebral blood flow (CBF) in patients during migraine showed what was termed a 'spreading oligemia', a wave of reduced blood flow that propagated across the brain at the same rate and with the same signs of vascular impairment as CSD.

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S111 Brain reorganization following the use of robotic hand prosthesis in four amputees

The amputation of a hand (as of any other body part) is followed by a cascade of plastic changes on the motor and somatosensory pathways; such changes are probably contributing to the Phantom limb syndrome, a distressing situation affecting the vast majority of amputees. Although many effort, a clear explanation of the phantom syndrome is still missing and it could be considered the result of multiple contributing mechanisms acting both at peripheral and central nervous system. The typical feature of cortical plastic reorganization following limb amputations is the invasion of the "deafferented" cortex by neighbouring areas in both the primary somatosensory and the motor cortices.

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O79 vibro-tactile evoked potentials (EPS) for assessment of consciousness and communication for people with disorders of consciousness

The correct classification of patients in unresponsive wakefulness state (UWS) or minimally conscious state (MCS) is a challenge and misclassifications often occurre. In this publication we present a vibro-tactile EPs Brain-Computer Interface that serves for assessment of consciousness in and for communication.

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S47 Changes in voltage gated channels in regenerated axons distal and proximal to a nerve lesion

We compare function of regenerated motor axons and changes in the parent axons of young and aged mice after a sciatic nerve lesion with focus on voltage gated sodium channels (VGSC).

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S186 Effect of reciprocal pedaling exercise on cortical reorganization and gait in stroke patients

Functional impairment of the lower limb is a major complication in stroke patients. The involvement of the cortex in pedaling has critical clinical implications to control of cyclical motor functions in patients with damaged cortical structures or cortical pathways.The study aimed at determining the effect of reciprocal pedaling exercise (RPE) on the gait and cortical reorganization in the stroke patients.

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S169 Sleep spindles and epilepsy

Sleep spindles (SSPs) are well known EEG phenomena characteristic to slow wave sleep (SWS). It has been demonstrated that SSPs participate in memory consolidation process during sleep. There are evidences of the participation of SSPs in various types of epilepsy ranging from idiopathic generalized to focal ones.Here we report the results of our investigation in human focal epilepsy patients implanted with cortical and thalamic macro-, and microelectrodes. Intracortical generators of SSPs in humans were explored and participation of different thalamic output systems was hypothesized.

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O152 Investigating effective connectivity in the motor network with TMS-evoked cortical potentials

Our purpose was to learn what the spatial distribution of transcranial magnetic stimulation (TMS)-evoked potentials can reveal about connectivity originating from premotor, supplementary, and primary motor cortices.

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O135 Sensory evoked potentials and central motor conduction times in children with dystonia help predict outcomes from Deep Brain Stimulation (DBS)

Deep Brain Stimulation (DBS) of the Globus Pallidus Internus produces dramatic benefits in primary dystonia. Improvements in patients with secondary dystonia are smaller and vary markedly between individuals. Predictive markers are lacking. This study tests the hypothesis that Somatosensory Evoked Potentials (SEPs) and Central Motor Conduction Times (CMCT) may predict outcome from DBS in childhood dystonia.

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S119 Axonal excitability studies in diabetic neuropathy

Diabetic polyneuropathy (DPN) is a complication of diabetes involving complex mechanisms. The introduction of automated threshold-tracking has led to a number of abnormal axonal excitability findings associated with diabetes without neuropathy (DWN) and DPN.The first abnormality described was a striking resistance to ischaemia in DWN. Superexcitability measurements showed that this ischaemic resistance was not due to a depolarized resting potential, but was related to the mean blood glucose over 24h, indicating a rapid effect of glucose on nerve metabolism.

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S103 Polysomnographic features of narcolepsy types 1 and 2, and of idiopathic hypersomnia: Strengths and limitations

Current diagnostic criteria of narcolepsy types 1 (NT1), type 2 (NT2) and idiopathic hypersomnia (IH), including clinical, electrophysiological and biologic criteria are listed in the International classification of sleep disorders, 3rd edition (ICSD-3). Electrophysiological criteria have been recently weakened with the demonstration that the multiple sleep latency test (MSLT) has poor test/retest reliability. Thus the search for additional electrophysiological criteria for these central disorders of hypersomnolence.

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S88 Optimizing the use of electrophysiology in the diagnosis of CIDP

Chronic inflammatory demyelinating polyneuropathy (CIDP) is the most common chronic inflammatory neuropathy. It is heterogeneous in its clinical presentation and electrophysiology has a vital role in achieving the diagnosis, to avoid patients missing out on treatment. The electrophysiology of CIDP consists of features of demyelination. Although commonly seemingly straightforward, the electrodiagnosis can be difficult due to inadequate use of existing criteria as well as of normative values and inconsistent interpretation of findings in relation to the clinical context.

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S71 Motor unit number index (MUNIX)

Loss of motor units (MUs) is the primary disease process in degenerative motor neuron diseases like amyotrophic lateral sclerosis (ALS). Reinnervation can compensate for MU loss. The net result is a reduced number of MUs, and increased MU size. The assessment of the number and size of MUs will be essential to study disease progression, and to study the efficacy of treatment.

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S55 Epileptogenicity biomarkers and effective connectivity in stereo-EEG

By analyzing the responses to intracranial electrical stimulation we aim at im-proving the localization of the seizure onset zone (SOZ) and the connectivity between different areas.

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Pulsara releases version 6.2, debuting 'Flexible Teams' feature

BOZEMAN, Mont. — Pulsara announced today the release of software version 6.2. The highlight of the release is the Flexible Teams feature, which allows hospital admins to create, assign and alert unlimited CUSTOM teams. In addition, users can now go on call for custom teams, with the option of being assigned for MULTIPLE hospitals at the same time. "This feature is a big step in our efforts ...

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Registered Nurse - Falck Northern California

Position Summary The primary responsibility of the Registered Nurse (RN) is to provide or assist in providing an ongoing plan to care for patients through established pre-hospital processes, the environment, instrumentation, other health care team members, and interacting agencies. The primary objective of the Registered Nurse (RN) is to provide safe and expedient response and transport as dispatched ...

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Paramedic - Falck Northern California

Position Summary: The primary responsibility of the Paramedic is to emergency medical care to the sick and injured in accordance with all applicable laws, regulations, and Company policies. Essential Functions: The Paramedic may be assigned one or more duties. These duties may include, but are not limited to, the following: Presents himself/herself in a professional manner and displays a good public ...

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Top EMS Game Changers – #9: ePCRs

Electronic PCRs, now used by roughly three quarters of U.S. EMS agencies, were pretty far from commonplace in 1995 when I started my first two paramedic jobs. One of those positions was administrative; I was responsible for keeping manual records of day-to-day patient encounters by ALS providers in our county. Creating, sorting and sometimes tabulating paper reports was no fun. I'd gotten into ...

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Top EMS Game Changers – #9: ePCRs

ePCRs allow virtually limitless information extraction through automated data storage and retrieval

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A multi-stage genome-wide association study of uterine fibroids in African Americans

Abstract

Uterine fibroids are benign tumors of the uterus affecting up to 77% of women by menopause. They are the leading indication for hysterectomy, and account for $34 billion annually in the United States. Race/ethnicity and age are the strongest known risk factors. African American (AA) women have higher prevalence, earlier onset, and larger and more numerous fibroids than European American women. We conducted a multi-stage genome-wide association study (GWAS) of fibroid risk among AA women followed by in silico genetically predicted gene expression profiling of top hits. In Stage 1, cases and controls were confirmed by pelvic imaging, genotyped and imputed to 1000 Genomes. Stage 2 used self-reported fibroid and GWAS data from 23andMe, Inc. and the Black Women's Health Study. Associations with fibroid risk were modeled using logistic regression adjusted for principal components, followed by meta-analysis of results. We observed a significant association among 3399 AA cases and 4764 AA controls at rs739187 (risk-allele frequency = 0.27) in CYTH4 (OR (95% confidence interval) = 1.23 (1.16–1.30), p value = 7.82 × 10⁻⁹). Evaluation of the genetic association results with MetaXcan identified lower predicted gene expression of CYTH4 in thyroid tissue as significantly associated with fibroid risk (p value = 5.86 × 10⁻⁸). In this first multi-stage GWAS for fibroids among AA women, we identified a novel risk locus for fibroids within CYTH4 that impacts gene expression in thyroid and has potential biological relevance for fibroids.

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Verizon developing FirstNet competitor

Verizon says the network ensures public safety officials "have the opportunity to weigh all their options as they make their important communications network decisions"

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Contraceptive Implant Discontinuation in Huambo and Luanda, Angola: A Qualitative Exploration of Motives

Abstract

Introduction The Government of Angola is engaged in ongoing efforts to increase access to contraceptives, in particular contraceptive implants (CIs). Discontinuation of CIs, however, has been identified as being a challenge to this work, hindering the improvement of contraceptive prevalence, and in turn, maternal and child health. The objective of this study was to understand motives for contraceptive implant discontinuation in Luanda and Huambo, Angola. Methods We conducted 45 in-depth interviews and six focus groups amongst former and current contraceptive implant clients and family planning nurses in eight clinics across the provinces of Huambo and Luanda. Data collectors transcribed and translated key information from Portuguese into English. We used a combined deductive/inductive approach to code and analyze data. Results Participants described adverse side effects, desire for pregnancy, partner dissatisfaction, quality of care, alternative or lack of information, and religion as motives for discontinuation. Adverse side effects, including prolonged bleeding, amenorrhea, and headaches were most commonly cited by both clients and providers. Discussion Motives for discontinuation reflect existing findings from other studies in similar settings, in particular the influence of adverse side effects and desire for pregnancy as motivating factors. We contextualize these findings in the Angolan setting to tease out the relationship between cultural norms of ideal family size and the perceived role of women in regards to fertility and child-bearing. We suggest that programs enter into dialog with communities to address these concerns, rather than working exclusively on improving service delivery and quality.

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Is LARC for Everyone? A Qualitative Study of Sociocultural Perceptions of Family Planning and Contraception Among Refugees in Ethiopia

Abstract

Objective Ethiopia is home to an increasingly large refugee population. Reproductive health care is a critical issue for these groups because refugee women are at high risk for unmet family planning needs. Efforts to expand contraceptive use, particularly long acting reversible contraceptive (LARC) methods are currently underway in several Ethiopian refugee camps. Despite availability of LARC methods, few refugee women opt to use them. The purpose of this study was to explore how culture influences contraceptive attitudes and behaviors, particularly towards LARC methods, among Ethiopia's refugee populations. Methods Focus group discussions and individual interviews were conducted with Eritrean and Somali refugees living in Ethiopia. The qualitative data was analyzed to identify important themes highlighting the relationship between cultural values and contraceptive attitudes and behaviors. Results Childbearing was highly valued among participants in both study groups. Eritreans reported desire to limit family size and attributed this to constraints related to refugee status. Somalis used cultural and religious faith to deal with economic scarcity and were less likely to feel the need to adapt contraceptive behaviors to reduce family size. Participants held overall positive views of the contraceptive implant. Attitudes toward the intrauterine device (IUD) were overwhelmingly negative due to its long-acting nature. Conclusions Culture, religion and refugee status form a complex interplay with family planning attitudes and behaviors among Eritrean and Somali refugees. For these populations, the three-year implant appears to be a more acceptable contraceptive method than the longer-acting IUD because it is in line with their reproductive plans.

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Contralateral cerebral hemoglobin oxygen saturation changes in patients undergoing thoracotomy with general anesthesia with or without paravertebral block: a randomized controlled trial

Abstract

Purpose

Perioperative analgesia during thoracotomy is often achieved by combining paravertebral block (PVB) with general anesthesia (GA). Functional near-infrared spectroscopy (NIRS) can detect changes in cerebral oxygenation resulting from nociceptive stimuli in the awake state or under sedation. We used NIRS to measure changes in cerebral blood flow provoked by thoracotomy incision made under GA and determine how these changes were influenced by supplementation of GA with PVB.

Methods

Thirty-four patients undergoing elective thoracotomy were enrolled. Patients were randomly assigned to a group receiving only GA, or GA combined with PVB (GA + PVB). Changes in cerebral oxygenated hemoglobin (ΔO₂Hb), deoxygenated-Hb (ΔHHb), and total-Hb (ΔtotalHb) were evaluated by NIRS as surgery began.

Results

In the GA group, ΔO₂Hb was significantly higher in the hemisphere contralateral to the side of surgery when the incision was made and 2 min after incision compared with the ipsilateral side (start of surgery, P < 0.01; 2 min, P < 0.05). In contrast, there were no significant changes in the ΔO₂Hb at any of the time points in the GA + PVB group. Comparable with ΔO₂Hb, the concentration of ΔtotalHb was significantly higher in the contralateral hemisphere in the GA group at the start of surgery (P < 0.05).

Conclusions

Changes in the cerebral O₂Hb concentration were detected by NIRS immediately after surgical incision under GA, but not in the presence of a PNB. NIRS could be used to monitor surgical pain. PVB inhibited changes in oxygenation induced by incision-provoked pain.

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Cold water immersion: kill or cure?

Abstract

Like other environmental constituents such as pressure, heat and oxygen, cold water can be either good or bad, threat or treatment depending on circumstance. Given the current increase in the popularly of open cold water swimming it is timely to review the various human responses to cold water immersion (CWI) and consider the strength of the claims made for the effects of CWI. As a consequence, in this review we look at the history of CWI and examine CWI as a pre-cursor to drowning, cardiac arrest and hypothermia. We also assess its role in prolonged survival underwater, extending exercise time in the heat and treating hyperthermic casualties. More recent uses, such as in the prevention of inflammation and treatment of inflammation-related conditions are also considered. It is concluded that the evidence-base for the different claims made for CWI are varied, and whilst in most cases there seems to be a credible rationale for the benefits or otherwise of CWI, in some cases the supporting data remain at the level of anecdotal speculation. Clear directions and requirements for future research are indicated by this review.

This article is protected by copyright. All rights reserved

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Dramatic increase in incidence of ulcerative colitis and Crohn’s disease (1988–2011): A population-based study of French adolescents

The American Journal of Gastroenterology

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Bayer, Johnson and Johnson win third US trial over Xarelto bleeding risk

Reuters Health News

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OCIAD2 suppressed tumor growth and invasion via AKT pathway in hepatocellular carcinoma

Carcinogenesis

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Johnson & Johnson hit with $417 million verdict in talc lawsuit

Healthcare Finance News

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Increased risk of thromboembolic events following gastrointestinal bleeds among left ventricular assist device patients

Journal of Cardiac Failure

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Cigarette smoking adversely affects disease activity and disease-specific quality of life in patients with Crohn’s disease at a tertiary referral center

Clinical and Experimental Gastroenterology

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Accuracy and safety of the cytosponge for assessing histologic activity in eosinophilic esophagitis: A two-center study

The American Journal of Gastroenterology

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A phase 1 randomized open-label clinical study to evaluate the safety and tolerability of a novel recombinant hepatitis E vaccine

Vaccine

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Preoperative stenting in oesophageal cancer has no effect on survival: A propensity-matched case-control study

European Journal of Cardio-Thoracic Surgery

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A phase 1/1B trial of ADI-PEG 20 plus nab-paclitaxel and gemcitabine in patients with advanced pancreatic adenocarcinoma

Cancer

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Impact of resected colon site on quality of bowel preparation in patients who underwent prior colorectal resection

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques

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Non-invasive diagnosis for differentiating non-alcoholic steatohepatitis from simple steatosis: A meta-analysis and systematic review

Clinical Gastroenterology and Hepatology

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US study revives argument over mammogram screening

Reuters Health News

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The higher prevalence of truncal obesity and diabetes in American than Chinese patients with chronic hepatitis C might contribute to more rapid progression to advanced liver disease

Alimentary Pharmacology and Therapeutics

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Threonine and tyrosine kinase may serve as a prognostic biomarker for gallbladder cancer

World Journal of Gastroenterology

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Serum levels of caspase-cleaved cytokeratin 18 (CK18-Asp396) predict severity of liver disease in chronic hepatitis B

Clinical and Experimental Gastroenterology

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Short-term outcomes and nutritional status after laparoscopic subtotal gastrectomy with a very small remnant stomach for cStage I proximal gastric carcinoma

Gastric Cancer

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Modifiable factors and esophageal cancer: A systematic review of published meta-analyses

Journal of Gastroenterology

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The impact of frailty and sarcopenia on postoperative outcomes in older patients undergoing gastrectomy surgery: A systematic review and meta-analysis

BMC Geriatrics

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Electro-radiological observations of grade III/IV hepatic encephalopathy patients with seizures

Neurocritical Care

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Physiological and psychological effects of imagery techniques on health anxiety

Abstract

Previous research has shown that intrusions are part of the psychopathology of mental disorders. Imagery techniques seem to be an effective treatment of negative intrusions. Since negative mental imagery is part of health anxiety, the present study investigated the impact of imagery techniques on health anxiety. A total of 159 students with elevated scores in a health anxiety questionnaire watched an aversive film concerning a cancer patient and were randomly allocated to one of three interventions (positive imagery, imagery reexperiencing, imagery rescripting) or the control group. The intervention lasted 9 min. Physiological data (heart rate and cortisol) as well as psychological measures, such as mood ratings, health anxiety scores, and intrusions, were assessed during the appointment, while psychological measures were assessed over a period of 1 week after the intervention. Cortisol levels changed over time depending on the intervention. Heart rate changed during the 9-min interventions as well, with the fastest decrease during imagery rescripting. Moreover, negative mood and distress decreased after the intervention, while intrusions were reduced 1 week after the intervention in all groups equally. The results suggest that imagery rescripting is a promising technique that seems to activate a process of deep elaboration. Therefore, it might be an adequate way to target health anxiety symptoms such as anxiety, intrusions, and avoidance or safety-seeking behavior. Further studies should focus on imagery rescripting in clinical samples with health anxiety and target individual intrusive images to increase effectiveness. Nevertheless, the development of a long-term explanatory model of rescripting is needed.

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Musical training modulates the early but not the late stage of rhythmic syntactic processing

Abstract

Syntactic processing is essential for musical understanding. Although the processing of harmonic syntax has been well studied, very little is known about the neural mechanisms underlying rhythmic syntactic processing. The present study investigated the neural processing of rhythmic syntax and whether and to what extent long-term musical training impacts such processing. Fourteen musicians and 14 nonmusicians listened to syntactic-regular or syntactic-irregular rhythmic sequences and judged the completeness of these sequences. Nonmusicians, as well as musicians, showed a P600 effect to syntactic-irregular endings, indicating that musical exposure and perceptual learning of music are sufficient to enable nonmusicians to process rhythmic syntax at the late stage. However, musicians, but not nonmusicians, also exhibited an early right anterior negativity (ERAN) response to syntactic-irregular endings, which suggests that musical training only modulates the early but not the late stage of rhythmic syntactic processing. These findings revealed for the first time the neural mechanisms underlying the processing of rhythmic syntax in music, which has important implications for theories of hierarchically organized music cognition and comparative studies of syntactic processing in music and language.

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The effects of stimulus parameters on auditory evoked potentials of Carassius auratus

Abstract

Whole-brain responses to sound are easily measured through auditory evoked potentials (AEP), but it is unclear how differences in experimental parameters affect these responses. The effect of varying parameters is especially unclear in fish studies, the majority of which use simple sound types and then extrapolate to natural conditions. The current study investigated AEPs in goldfish (Carassius auratus) using sounds of different durations (5, 10, and 20 ms) and frequencies (200, 500, 600 and 700 Hz) to test stimulus effects on latency and thresholds. We quantified differences in latency and threshold in comparison to a 10-ms test tone, a duration often used in AEP fish studies. Both response latency and threshold were significantly affected by stimulus duration, with latency patterning suggesting that AEP fires coincident with a decrease in stimulus strength. Response latency was also significantly affected by presentation frequency. These results show that stimulus type has important effects on AEP measures of hearing and call for clearer standards across different measures of AEP. Duration effects also suggest that AEP measures represent summed responses of duration-detecting neural circuit, but more effort is needed to understand the neural drivers of this commonly used technique.

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