Background: The prevalence of carpal tunnel syndrome (CTS) and of anxiety and depression in primary care practice are high. Different studies had shown an increased prevalence of anxiety and depression in CTS patients...Background: The prevalence of carpal tunnel syndrome (CTS) and of anxiety and depression in primary care practice are high. Different studies had shown an increased prevalence of anxiety and depression in CTS patients. Nevertheless, few papers had been published studying the anxiety and depression scales in the treatment of CTS, either with corticosteroid injections (I) or with surgical decompression (S). Objective: To assess whether clinical improvement observed after the treatment of CTS either with I or with S correlates with an improvement in the punctuations of the Hospital Anxiety and Depression scales (HADS), at 3, 6 and 12-month follow-up. Methods: Randomized and open-label clinical trial, comparing I and S. Patients with symptoms suggestive of CTS (nocturnal paraesthesias) of at least 3 months duration and neurophysiological confirmation were included. Patients with clinically apparent motor impairment were excluded. The subjective evaluation of symptoms was carried out using the visual-analogue scale of pain (VAS-p). Clinical reviews were performed 3, 6 and 12 months after treatment. Each patient completed the HADS questionnaire and a VAS-p at 0, 3, 6, and 12 months. Statistical significance was established using the Student’s t test and the Mann-Whitney U test when necessary. A linear regression analysis was used to know the effect of the treatment adjusted for the initial score of both scales. Results: 65 patients were included (30 in group I and 35 in group S). There was no statistical difference between both groups in terms of age, gender distribution, disease duration, VAS-p, neurophysiological testing severity of CTS or the 8 subscales of HADS. Both groups improved significantly in relation to the baseline VAS-p values, in the reviews at 3, 6 and 12 months, with no significant differences between I and S. At 6 months, the reduction in the anxiety scale was around 3 points for both treatments (S = 3.6 and I = 3.2), without reaching significant differences. At 12 months, it was somewhat higher for those treated with I, but always around 3 points and without significant differences. The Depression scale score was slightly reduced at 6 months, and in a similar way for both groups (I = 1 and S = 1.19;p = 0.8). After 12 months, group I doubled the previous reduction, with group S experiencing a very slight change (I = 1.96 and S = 1.03;p = 0.3). When analysing the effect of group S on group I, the result was a reduction of 0.25 points for Anxiety (p = 0.7) and of 0.02 points for Depression (p = 0.9). Conclusions: Treatment of CTS with I or S results in a similar and discrete improvement in Anxiety scores on the HADS scale at 6 and 12 months. For both types of treatment, the Depression scores barely changed at 6 months, being somewhat higher in group I after 12-month follow-up. The independent effect of the S on both scales is small and not significant.展开更多
Background: Involvement of lumbar spinal nerve root, revealed as pain, numbness or weakness in the lower limbs. Typically caused by the compression of nerve at the spine level. Objective: The purpose of the study was ...Background: Involvement of lumbar spinal nerve root, revealed as pain, numbness or weakness in the lower limbs. Typically caused by the compression of nerve at the spine level. Objective: The purpose of the study was to examine the patients with clinically presumed lumbar radiculopathy and find the correlation between their electrodiagnostic study and magnetic resonance imaging. Setting, duration and study type: Retrospective cross-sectional study of one year (January 2019 - February 2020) in Shifa International Hospital Islamabad. Methods: A total of 96 patients with clinically suspected lumbar radiculopathy were included. Chi-square test, international business machines (IBM) SPSS rendition 21.0 was applied on the clinical information, electrodiagnostic study and MRI were coordinated and affectability and particularity were judged. Selected patients were undergone both electrodiagnostic study and magnetic imaging resonance in the selected 1-year span. The study investigated correlation between both diagnostic tools in lumbar radiculopathy patients. Expected outcomes: Anatomical specificity in seen through magnetic resonance imaging while physiological through electrodiagnostic study, which may not correlate in the evaluation of lumbar radiculopathy.展开更多
Epilepsy is one of the most prevalent neurological disorders with no age, racial, social class, and neither national nor geographic boundaries. There are 50 million sufferers in the world today with 2.4 million new ca...Epilepsy is one of the most prevalent neurological disorders with no age, racial, social class, and neither national nor geographic boundaries. There are 50 million sufferers in the world today with 2.4 million new cases occur each year. Electroencephalogram (EEG) has become a traditional procedure to investigate abnormal functioning of brain activity. Epileptic EEG is usually characterized by short transients and sharp waves as spikes. Identification of such event splays a crucial role in epilepsy diagnosis and treatment. The present study proposes a method to detect three epileptic spike types in EEG recordings based mainly on Template Matching Algorithm including multiple signal-processing approaches. The method was applied to real clinical EEG data of epileptic patients and evaluated according to sensitivity, specificity, selectivity and average detection rate. The promising results illuminate that hybrid processing approaches in temporal, frequency and spatial domains can be a real solution to identify fast EEG transients.展开更多
Gonadotropin-releasing hormone(Gn RH) and its synthetic analog leuprolide acetate, a Gn RH agonist, have neurotrophic properties. This study was designed to determine whether administration of leuprolide acetate can i...Gonadotropin-releasing hormone(Gn RH) and its synthetic analog leuprolide acetate, a Gn RH agonist, have neurotrophic properties. This study was designed to determine whether administration of leuprolide acetate can improve locomotor behavior, gait, micturition reflex, spinal cord morphology and the amount of microglia in the lesion epicenter after spinal cord injury in rats. Rats with spinal cord compression injury were administered leuprolide acetate or saline solution for 5 weeks. At the 5th week, leuprolide acetate-treated rats showed locomotor activity recovery by 38%, had improvement in kinematic gait and exhibited voiding reflex recovery by 60%, as compared with the 1st week. By contrast, saline solution-treated rats showed locomotor activity recovery only by 7%, but voiding reflex did not recover. More importantly, leuprolide acetate treatment reduced microglial immunological reaction and induced a trend towards greater area of white and gray matter in the spinal cord. Therefore, leuprolide acetate has great potential to repair spinal cord injury.展开更多
Introduction: The exposure to shift works, and especially to night shift, goes against the circadian rythmicity of the social man, which brings about a multitude of disruptive effects on health. In a hospital environm...Introduction: The exposure to shift works, and especially to night shift, goes against the circadian rythmicity of the social man, which brings about a multitude of disruptive effects on health. In a hospital environment, such night shift is necessary so as to ensure the continuity of care. Sleep and vigilance disorders related to this work mode are frequent and often pose adaptation problems. The objective of this study is to detect the harmful effects of night shift on sleep, vigilance and the quality of life of nurses in Farhat Hached Teaching Hospital in Sousse. Material and Methods: It is a cross-sectional study carried out among two groups of nurses: one group performing a fixed night work and the other one working permanently during the day at Farhat Hached Teaching Hospital in Sousse. Data collection is mainly based on validated questionnaires evaluating sleep quality (Pittsburg sleep quality index), daytime sleepiness (Epworth sleepiness scale), sleep typology (Horne and Ostberg questionnaire), and the quality of life (SF-12). An objective evaluation of vigilance was realized by the study of reaction time and error rates to different tasks of “Super lab” software. Results: 50 night and 50 day nurses have been colligated. Both groups were age- and gender-matched. Sleep quality mean index was significantly higher among night nurses in comparison with day nurses (10.2 ± 5.9 versus 6.76 ± 5.16). After multivariate analysis, sleep quality was significantly correlated to age, department, schedule and the choice of schedule. Night shift was not related to daytime sleepiness. The objective analysis of vigilance showed that the reaction time to different tasks exploring the attentional mechanisms, as well as errors rate, were significantly more important among the night group. The mental score of the quality of life was significantly higher among day nurses. However, such difference was not significant with regard to physical score. Conclusion: The findings of our study highlight not only the alteration of the health and the well being of paramedical staff secondary to night shift, but also a possible threat to safety care lavished by these teams, which involves the necessity to undertake preventive measures on an individual and collective scale.展开更多
<b><span style="font-family:Verdana;">Background and Aim:</span></b><span style="font-family:Verdana;"> Irritable bowel syndrome (IBS) is a common medical disorder tha...<b><span style="font-family:Verdana;">Background and Aim:</span></b><span style="font-family:Verdana;"> Irritable bowel syndrome (IBS) is a common medical disorder that may be severe enough to impair the quality of life. This study aimed to assess the role of each of dietary, psychiatric, autonomic, and microbiology</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">background and their interactions in Egyptian patients with IBS. </span><b><span style="font-family:Verdana;">Patients and Methods:</span></b><span style="font-family:Verdana;"> Forty adult patients diagnosed with IBS, equally divided into 2 groups the diarrhea predominant and the constipation predominant, were recruited from the Endoscopy Unit. Dietary assessment was done by monthly food frequency questionnaire. Psychiatric assessment was done by both the Eysenck Personality Questionnaire (EPQ) and Hopkins Symptom Checklist (HSCL-90). Microbiologic evaluation was done by faecal cultures and neurophysiologic autonomic evaluation was done via the sympathetic skin response and the parasympathetic R-R interval variation. Another 20 healthy subjects were included as control group. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> All IBS patients were young, with significant female predominance (P</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">=</span><span style="font-family:""> </span><span style="font-family:Verdana;">0.007), particularly in IBS-C group (20/20;100%, P</span><span style="font-family:""> </span><span style="font-family:Verdana;">=</span><span style="font-family:""> </span><span style="font-family:Verdana;">0.003). Psychologically, abnormal scores of neuroticism, extraversion and criminality, and depression, obsessive compulsion, somatization, sensitivity and anxiety in both IBS groups with particularly extraversion, criminality and depression were significantly higher in constipation subtype. Microbiologically, Bacteroid</span><span style="font-family:Verdana;">s </span><span style="font-family:""><span style="font-family:Verdana;">were significantly related to IBS, while Klebsiella was significantly deficient without significant difference between its groups. On the contrary, neither diet nor autonomic activity showed any significant relation. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">IBS is a disorder induced by many factors and affected by several interacting agents, thus revealing controversial results when studied simultaneously.展开更多
In the neonatal rat, the olfactory system is a fundamental channel to locate and recognize the mother, to survive and develop early social behavior, and to distinguish related or unrelated members of a litter. Perinat...In the neonatal rat, the olfactory system is a fundamental channel to locate and recognize the mother, to survive and develop early social behavior, and to distinguish related or unrelated members of a litter. Perinatal undernutrition in rats alters the neuronal organization and functioning of the olfactory system and its ascending relays, possibly affecting odor discrimination. In this study we compared the frequency and time spent visiting the source of urine obtained from unrelated female subjects and amyl acetate odors vs water in adult perinatally underfed rats. Each test initiated with one daily presentation during three consecutive aliquots of deionized water (10 μl) placed on a filter paper for 2 min, separated by 1-min intervals for habituation. The water presentations were followed by three exposures to an odor, all at the same dilution (either 1:1 or 1:80) for dishabituation. Control (C) and undernourished (U) subjects display similar, significant habituation/dishabituation responses, except that the U subjects showed greater increases in the frequency and duration of visits to undiluted and diluted urine and amyl acetate cues compared to the controls. These findings are similar to previous studies showing that adult rats investigate novel odors longer than the familiar ones. Thus, perinatal undernutrition appears to interfere with the foundation of the olfactory development causing long-term olfactory discrimination deficits as revealed by the increased frequency and duration of visits to the source of odors that may be relevant for social behavior.展开更多
Dear Editor, The deficit of 3-hydroxyacyl-CoA dehydrogenase (LCHAD)is a disease whose incidence is approximately 3 cases/100 000 births^([1]), with autosomal recessive inheritance^([2]).
Tarsal Tunnel Syndrome [TTS] is the most common lower limb focal neuropathy but it has a poor pick up rate in most Electrodiagnostic (EXD) Laboratories. There is no gold standard for assessing TTS. The tibial nerve ha...Tarsal Tunnel Syndrome [TTS] is the most common lower limb focal neuropathy but it has a poor pick up rate in most Electrodiagnostic (EXD) Laboratories. There is no gold standard for assessing TTS. The tibial nerve has a complex branching system with 4 main branches and 9 different patterns of division. This study evaluated potential TTS with a similar and extensive assessment of the tibial nerve. The protocol involved 2 tibial motor studies to the Adductor Hallucis Longus (AH) and Adductor Digiti Quinti (ADQ) muscles, assessing amplitudes and distal latencies;medial plantar, lateral plantar and calcaneal sensory studies assessing amplitudes and distal latencies. A needle EMG to the tibial innervated AH and ADQ muscles was also performed. This protocol evaluated 12 different parameters which significantly increased the diagnostic yield. TTS has a low pick up rate using current standard assessment methods accounting for between 0.5% and 0.6% of positive cases referred to electrodiagnostic laboratories. This study had a pick up rate of 3.3% with 40 positive cases identified out of a population of 1210 patients referred to an electrodiagnostic laboratory in a calendar year. A combination of positive findings was observed. There were on average 4.3 positive parameters. The calcaneal sensory study and the needle EMG to the distal AH and ADQ muscles were the most sensitive tests. These 3 tests are not routinely performed in most labs. Of the 40 cases of TTS over 80% had a history of either prior injury or surgery to affected lower limb. This study suggests that this 12 parameter assessment will increase diagnostic sensitivity.展开更多
Background: Non-convulsive status epilepticus (NCSE) is defined as a change in mental state of at least 30 minutes associated with continuous or nearly continuous epileptiform discharges. Identification of prognostic ...Background: Non-convulsive status epilepticus (NCSE) is defined as a change in mental state of at least 30 minutes associated with continuous or nearly continuous epileptiform discharges. Identification of prognostic indicators can guide decision making surrounding the use of poorly established treatment interventions in this heterogeneous population. Methods: We identified 66 consecutive inpatients with NCSE. Data surrounding clinical, electrographic, and treatment factors were collected via a retrospective systematic review of medical records and electronic EEGs, and were correlated with discharge outcome (return to baseline, new disability, or death). Results: Of all subjects, 21% returned to baseline, 26% acquired new disability, and 53% died, of whom half had anoxic encephalopathy. On univariate analysis, seventeen variables correlated significantly with death, although multivariate logistic regression analysis subsequently identified only comatose state and number of life threatening comorbidities as independent predictors of mortality. Of survivors, comatose state, critical care environment, length of hospital stay, and acute symptomatic seizures predicted new disability, with the latter two showing independent significance. Following exclusion of cases with anoxic encephalopathy, the use of an anaesthetic infusion was also an independent predictor of mortality. Conclusions: NCSE is associated with variable morbidity and mortality. While one fifth of our NCSE patients returned to baseline, those comatose with acute structural/metabolic seizures, anaesthetic infusions, and life threatening comorbidities were unlikely to survive without disability at discharge.展开更多
A randomized, double blind, and active reference-controlled study was carried out among 116 patients suffering from idiopathic Parkinson’s disease (PD). The aim of the study was to compare the safety and efficacy of ...A randomized, double blind, and active reference-controlled study was carried out among 116 patients suffering from idiopathic Parkinson’s disease (PD). The aim of the study was to compare the safety and efficacy of alpha-dihydroergocryptine (DHEC) vs. pramipexole (PRAM) as an adjunct symptomatic therapy to levodopa in PD patients. The motor symptoms, assessed by the Unified Parkinson’s Disease Rating Scale (UPDRS) III subscale, was identified as efficacy target. Fifty-six patients were randomized to DHEC and 60 to PRAM. Patients included were under constant levodopa dose for at least 3 months before entering the study, with baseline UPDRS III ≥14. They underwent a 16-week treatment. Out of the 116 included patients, 85 (39 in DHEC group and 46 in PRAM group, respectively) completed the study protocol. In DHEC group, UPDRS III decreased by 24.2% from baseline at week 10 and by 28.1% at week 16. In PRAM group, UPDRS III decreased by 27.1% from baseline at week 10 and by 29.2% at week 16. The data were highly significant展开更多
Objective: The current study aimed to assess the viability of sympathetic sudomotor fibers in patients suffering from mild peripheral arterial occlusive disease (PAD). Methods: Sympathetic skin response (SSR) from the...Objective: The current study aimed to assess the viability of sympathetic sudomotor fibers in patients suffering from mild peripheral arterial occlusive disease (PAD). Methods: Sympathetic skin response (SSR) from the hand (electrical stimulation) and sole (electrical and magnetic stimulation) of 25 patients with PAD (19 males and 6 females with mean age 62.7±10.2 years) was recorded unilaterally depending on the side of the affected limb (18 right side, 7 left side). Electrophysiological data were also collected and correlated with the SSR results. Twenty-five, age-and gender-matched healthy volunteers served as controls. Results: No evidence of nerve conduction abnormalities was recorded from the group of patients. Intact SSR recordings were obtained from the upper limb of patients. Nine patients (36%) had absent SSR in the lower limb following electrical stimulation, whilst the same 9 patients had absent SSR following magnetic stimulation. Significant differences occurred between groups in the SSR latency scores recorded from the lower limb. Following electrical stimulation the mean SSR latency in patients was significantly prolonged, compared to that of controls (P=0.000), whilst the same applied following magnetic stimulation (P=0.000). There was no correlation between SSR abnormalities and nerve conduction measurements. The manifestation of intermittent claudication at a walking distance of 250 m was strongly correlated w ith absent lower limb SSR (r=0.71, P=0.035). Conclusions: SSR abnormalities appe ared to be an early and independent finding of neural impairment in our patients . Significance: SSR study, performed at an early stage of PAD may prove useful i n differentiating PAD-induced neuropathy from other neuropathic processes.展开更多
Objective: To compare the intraoperative signal-to-noise ratio (SNR), reproducibility and rapidity of popliteal fossa (PF), optimized P37, standard P37 and P31 potentials. Methods: Raw sweeps and 11 averages doubling ...Objective: To compare the intraoperative signal-to-noise ratio (SNR), reproducibility and rapidity of popliteal fossa (PF), optimized P37, standard P37 and P31 potentials. Methods: Raw sweeps and 11 averages doubling sweep number from 2 to 2048 were compared in 37 patients undergoing scoliosis surgery. Optimized (highest amplitude or SNR) P37 derivations were Cz-CPc (22), CPz-CPc (27), Pz-CPc (7), iCPi-CPc (8), CPi-CPc (1), Cz-Pz (2)orPz-FPz (3), and in two patients with non-decussation, Cz-CPi (1) or CPz-CPi (3). Standard P37 and P31 derivations were CPz-FPz and FPz-C5S. Signal amplitude was measured in 2048 sweep averages; peak noise was measured in raw sweeps and ±averages; SNR was amplitude/noise. Visual superimposability and < 20-30%amplitude variation determined reproducibility. Sweeps to reproducibility determined rapidity. Results: The SNR order was PFoptimized P37 > standard P37 > P31. Mean optimized P37 SNR advantages over the standard P37 and P31 were 2.1:1 and 4.9:1. SNR had powerful non-linear correlations to reproducibility and rapidity. Median sweeps to reproducibility were PF: 2, optimized P37: 128, standard P37: 512 and P31: 1024. EEG noise was greatest in FPz derivations. Burst-suppression increased scalp potential SNR and rapidity. Conclusions: Optimized P37 and PF recordings are most rapidly reproducible due to superior SNRs and are recommended. FPz should be avoided. Burst-suppression may be desirable. Significance: CPz-FPz and FPz-C5S should no longer be standard.展开更多
The ubiquitously expressed transmembrane enzyme Na,K-ATPase(NKA)is vital in maintaining functionality of cells.The association of α-and β-subunits is believed to be essential for forming a functional enzyme.In the l...The ubiquitously expressed transmembrane enzyme Na,K-ATPase(NKA)is vital in maintaining functionality of cells.The association of α-and β-subunits is believed to be essential for forming a functional enzyme.In the large milkweed bug Oncopeltus fasciatus fourα1-paralogs and four β-subunits exist that can associate into NKA complexes.This diversity raises the question of possible tissue-specific distribution and function.While the α1-subunits are known to modulate cardenolide-resistance and ion-transport efficiency,the functional importance of the β-subunits needed further investigation.We here characterize all four different β-subunits at the cellular,tissue,and whole organismal scales.A knockdown of different β-subunits heavily interferes with molting success resulting in strongly hampered phenotypes.The failure of ecdysis might be related to disrupted septate junction(SJ)formation,also reflected in β2-suppression-induced alteration in tracheal morphology.Our data further suggest the existence of isolated β-subunits forming homomeric or β-heteromeric complexes.This possible standalone and structure-specific distribution of the β-subunits predicts further,yet unknown pump-independent functions.The different effects caused byβknockdowns highlight the importance of the various β-subunits to fulfill tissue-specific requirements.展开更多
Recently,a novel workflow known as the virtual epileptic patient(VEP)has been proposed by a research team from Aix Marseille Universitéin their papers published in Lancet Neurology,Science Translational Medicine ...Recently,a novel workflow known as the virtual epileptic patient(VEP)has been proposed by a research team from Aix Marseille Universitéin their papers published in Lancet Neurology,Science Translational Medicine and Epilepsia.This method involves creating an individualized virtual brain model based on computational modelling,which can facilitate clinical decision-making by estimating the epileptogenic zone and performing the virtual surgery.Here,we summarize brief workflow,strengths,and limitations of VEP,as well as its performance in a retrospective study of 53 patients with drug-resistant focal epilepsy who underwent stereoelectroencephalography.A large-scale clinical trial(NCT03643016)is underway to further assess VEP,which is expected to enroll 356 patients prospectively.As supporting evidence accumulates,the clinical application of VEP has the potential to improve clinical practice,leading to better outcomes and qualities of life of patients.展开更多
Background:Surgery is a conventional mature treatment for moyamoya disease(MMD).However,whether surgery is also an effective therapy for epileptic type MMD has seldom been investigated systematically.The study aims to...Background:Surgery is a conventional mature treatment for moyamoya disease(MMD).However,whether surgery is also an effective therapy for epileptic type MMD has seldom been investigated systematically.The study aims to summarize the pooled postoperative incidence of seizure and cerebral infarction in pediatric patients with epileptic type moyamoya disease.Method:The study was a systematic review and critical appraisal with a meta-analysis of cohort studies,both prospective and retrospective.Studies were identified by a computerized search of PubMed,Embase,Web of Science,Wanfang,and CNKI databases.In a literature search,a total of 7 cohort studies were identified.The I2statistic was used to quantify heterogeneity.A fixed-effect model was used to synthesize the results.The linear regression test of funnel plot asymmetry was used to estimate the potential publication bias.Results:The pooled estimated postoperative incidence of seizure in pediatric patients with epileptic type moyamoya disease was 23.44%.The pooled estimated postoperative incidence of cerebral infarction in pediatric patients with epileptic type moyamoya disease was 9.12%.Low substantial heterogeneity and potential publication bias were present.Conclusions:Evidence from this study suggests that the postoperative incidence of seizure and cerebral infarction is relatively low.Surgery is an effective and secure therapy for pediatric patients with epileptic type moyamoya disease.展开更多
Two-photon laser-scanning microscopy has become an essential tool for imaging neuronal functions in vivo and has been applied to different parts of the neural system,including the auditory system.However,many componen...Two-photon laser-scanning microscopy has become an essential tool for imaging neuronal functions in vivo and has been applied to different parts of the neural system,including the auditory system.However,many components of a two-photon microscope,such as galvanometer-based laser scanners,generate mechanical vibrations and thus acoustic artifacts,making it difficult to interpret auditory responses from recorded neurons.Here,we report the development of a silent two-photon imaging system and its applications in the common marmoset(Callithrix Jacchus),a non-human primate species sharing a similar hearing range with humans.By utilizing an orthogonal pair of acoustooptical deflectors(AODs),full-frame raster scanning at video rate was achieved without introducing mechanical vibrations.Imaging depth can be optically controlled by adjusting the chirping speed on the AODs without any mechanical motion along the Z-axis.Furthermore,all other sound-generating components of the system were acoustically isolated,leaving the noise floor of the working system below the marmoset’s hearing threshold.Imaging with the system in awake marmosets revealed many auditory cortex neurons that exhibited maximal responses at low sound levels,which were not possible to study using traditional two-photon imaging systems.This is the first demonstration of a silent two-photon imaging system that is capable of imaging auditory neuronal functions in vivo without acoustic artifacts.This capacity opens new opportunities for a better understanding of auditory functions in the brain and helps isolate animal behavior from microscope-generated acoustic interference.展开更多
Small bowel malignant tumors are rare and sarcomatoid carcinomas have rarely been reported at this site.We report a 56-year-old woman,with history of an excised gliosarcoma,who presented with recurrent obscure gastroi...Small bowel malignant tumors are rare and sarcomatoid carcinomas have rarely been reported at this site.We report a 56-year-old woman,with history of an excised gliosarcoma,who presented with recurrent obscure gastrointestinal bleeding.She underwent endoscopy and colonoscopy,which failed to identify the cause of the bleeding.The abdominal computed tomography scan located a tumor in the small bowel.Pathology revealed a jejunal sarcomatoid carcinoma.She developed tumor recurrence and multiple liver metastases shortly after surgery.Immunohistochemistry is required for accurate diagnosis.Sarcomatoid carcinoma is a rare cause of obscure gastrointestinal bleeding,which is associated with a poor prognosis.展开更多
文摘Background: The prevalence of carpal tunnel syndrome (CTS) and of anxiety and depression in primary care practice are high. Different studies had shown an increased prevalence of anxiety and depression in CTS patients. Nevertheless, few papers had been published studying the anxiety and depression scales in the treatment of CTS, either with corticosteroid injections (I) or with surgical decompression (S). Objective: To assess whether clinical improvement observed after the treatment of CTS either with I or with S correlates with an improvement in the punctuations of the Hospital Anxiety and Depression scales (HADS), at 3, 6 and 12-month follow-up. Methods: Randomized and open-label clinical trial, comparing I and S. Patients with symptoms suggestive of CTS (nocturnal paraesthesias) of at least 3 months duration and neurophysiological confirmation were included. Patients with clinically apparent motor impairment were excluded. The subjective evaluation of symptoms was carried out using the visual-analogue scale of pain (VAS-p). Clinical reviews were performed 3, 6 and 12 months after treatment. Each patient completed the HADS questionnaire and a VAS-p at 0, 3, 6, and 12 months. Statistical significance was established using the Student’s t test and the Mann-Whitney U test when necessary. A linear regression analysis was used to know the effect of the treatment adjusted for the initial score of both scales. Results: 65 patients were included (30 in group I and 35 in group S). There was no statistical difference between both groups in terms of age, gender distribution, disease duration, VAS-p, neurophysiological testing severity of CTS or the 8 subscales of HADS. Both groups improved significantly in relation to the baseline VAS-p values, in the reviews at 3, 6 and 12 months, with no significant differences between I and S. At 6 months, the reduction in the anxiety scale was around 3 points for both treatments (S = 3.6 and I = 3.2), without reaching significant differences. At 12 months, it was somewhat higher for those treated with I, but always around 3 points and without significant differences. The Depression scale score was slightly reduced at 6 months, and in a similar way for both groups (I = 1 and S = 1.19;p = 0.8). After 12 months, group I doubled the previous reduction, with group S experiencing a very slight change (I = 1.96 and S = 1.03;p = 0.3). When analysing the effect of group S on group I, the result was a reduction of 0.25 points for Anxiety (p = 0.7) and of 0.02 points for Depression (p = 0.9). Conclusions: Treatment of CTS with I or S results in a similar and discrete improvement in Anxiety scores on the HADS scale at 6 and 12 months. For both types of treatment, the Depression scores barely changed at 6 months, being somewhat higher in group I after 12-month follow-up. The independent effect of the S on both scales is small and not significant.
文摘Background: Involvement of lumbar spinal nerve root, revealed as pain, numbness or weakness in the lower limbs. Typically caused by the compression of nerve at the spine level. Objective: The purpose of the study was to examine the patients with clinically presumed lumbar radiculopathy and find the correlation between their electrodiagnostic study and magnetic resonance imaging. Setting, duration and study type: Retrospective cross-sectional study of one year (January 2019 - February 2020) in Shifa International Hospital Islamabad. Methods: A total of 96 patients with clinically suspected lumbar radiculopathy were included. Chi-square test, international business machines (IBM) SPSS rendition 21.0 was applied on the clinical information, electrodiagnostic study and MRI were coordinated and affectability and particularity were judged. Selected patients were undergone both electrodiagnostic study and magnetic imaging resonance in the selected 1-year span. The study investigated correlation between both diagnostic tools in lumbar radiculopathy patients. Expected outcomes: Anatomical specificity in seen through magnetic resonance imaging while physiological through electrodiagnostic study, which may not correlate in the evaluation of lumbar radiculopathy.
文摘Epilepsy is one of the most prevalent neurological disorders with no age, racial, social class, and neither national nor geographic boundaries. There are 50 million sufferers in the world today with 2.4 million new cases occur each year. Electroencephalogram (EEG) has become a traditional procedure to investigate abnormal functioning of brain activity. Epileptic EEG is usually characterized by short transients and sharp waves as spikes. Identification of such event splays a crucial role in epilepsy diagnosis and treatment. The present study proposes a method to detect three epileptic spike types in EEG recordings based mainly on Template Matching Algorithm including multiple signal-processing approaches. The method was applied to real clinical EEG data of epileptic patients and evaluated according to sensitivity, specificity, selectivity and average detection rate. The promising results illuminate that hybrid processing approaches in temporal, frequency and spatial domains can be a real solution to identify fast EEG transients.
基金supported by a grant from CONACy T for scholarship 376921/246887
文摘Gonadotropin-releasing hormone(Gn RH) and its synthetic analog leuprolide acetate, a Gn RH agonist, have neurotrophic properties. This study was designed to determine whether administration of leuprolide acetate can improve locomotor behavior, gait, micturition reflex, spinal cord morphology and the amount of microglia in the lesion epicenter after spinal cord injury in rats. Rats with spinal cord compression injury were administered leuprolide acetate or saline solution for 5 weeks. At the 5th week, leuprolide acetate-treated rats showed locomotor activity recovery by 38%, had improvement in kinematic gait and exhibited voiding reflex recovery by 60%, as compared with the 1st week. By contrast, saline solution-treated rats showed locomotor activity recovery only by 7%, but voiding reflex did not recover. More importantly, leuprolide acetate treatment reduced microglial immunological reaction and induced a trend towards greater area of white and gray matter in the spinal cord. Therefore, leuprolide acetate has great potential to repair spinal cord injury.
文摘Introduction: The exposure to shift works, and especially to night shift, goes against the circadian rythmicity of the social man, which brings about a multitude of disruptive effects on health. In a hospital environment, such night shift is necessary so as to ensure the continuity of care. Sleep and vigilance disorders related to this work mode are frequent and often pose adaptation problems. The objective of this study is to detect the harmful effects of night shift on sleep, vigilance and the quality of life of nurses in Farhat Hached Teaching Hospital in Sousse. Material and Methods: It is a cross-sectional study carried out among two groups of nurses: one group performing a fixed night work and the other one working permanently during the day at Farhat Hached Teaching Hospital in Sousse. Data collection is mainly based on validated questionnaires evaluating sleep quality (Pittsburg sleep quality index), daytime sleepiness (Epworth sleepiness scale), sleep typology (Horne and Ostberg questionnaire), and the quality of life (SF-12). An objective evaluation of vigilance was realized by the study of reaction time and error rates to different tasks of “Super lab” software. Results: 50 night and 50 day nurses have been colligated. Both groups were age- and gender-matched. Sleep quality mean index was significantly higher among night nurses in comparison with day nurses (10.2 ± 5.9 versus 6.76 ± 5.16). After multivariate analysis, sleep quality was significantly correlated to age, department, schedule and the choice of schedule. Night shift was not related to daytime sleepiness. The objective analysis of vigilance showed that the reaction time to different tasks exploring the attentional mechanisms, as well as errors rate, were significantly more important among the night group. The mental score of the quality of life was significantly higher among day nurses. However, such difference was not significant with regard to physical score. Conclusion: The findings of our study highlight not only the alteration of the health and the well being of paramedical staff secondary to night shift, but also a possible threat to safety care lavished by these teams, which involves the necessity to undertake preventive measures on an individual and collective scale.
文摘<b><span style="font-family:Verdana;">Background and Aim:</span></b><span style="font-family:Verdana;"> Irritable bowel syndrome (IBS) is a common medical disorder that may be severe enough to impair the quality of life. This study aimed to assess the role of each of dietary, psychiatric, autonomic, and microbiology</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">background and their interactions in Egyptian patients with IBS. </span><b><span style="font-family:Verdana;">Patients and Methods:</span></b><span style="font-family:Verdana;"> Forty adult patients diagnosed with IBS, equally divided into 2 groups the diarrhea predominant and the constipation predominant, were recruited from the Endoscopy Unit. Dietary assessment was done by monthly food frequency questionnaire. Psychiatric assessment was done by both the Eysenck Personality Questionnaire (EPQ) and Hopkins Symptom Checklist (HSCL-90). Microbiologic evaluation was done by faecal cultures and neurophysiologic autonomic evaluation was done via the sympathetic skin response and the parasympathetic R-R interval variation. Another 20 healthy subjects were included as control group. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> All IBS patients were young, with significant female predominance (P</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">=</span><span style="font-family:""> </span><span style="font-family:Verdana;">0.007), particularly in IBS-C group (20/20;100%, P</span><span style="font-family:""> </span><span style="font-family:Verdana;">=</span><span style="font-family:""> </span><span style="font-family:Verdana;">0.003). Psychologically, abnormal scores of neuroticism, extraversion and criminality, and depression, obsessive compulsion, somatization, sensitivity and anxiety in both IBS groups with particularly extraversion, criminality and depression were significantly higher in constipation subtype. Microbiologically, Bacteroid</span><span style="font-family:Verdana;">s </span><span style="font-family:""><span style="font-family:Verdana;">were significantly related to IBS, while Klebsiella was significantly deficient without significant difference between its groups. On the contrary, neither diet nor autonomic activity showed any significant relation. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">IBS is a disorder induced by many factors and affected by several interacting agents, thus revealing controversial results when studied simultaneously.
文摘In the neonatal rat, the olfactory system is a fundamental channel to locate and recognize the mother, to survive and develop early social behavior, and to distinguish related or unrelated members of a litter. Perinatal undernutrition in rats alters the neuronal organization and functioning of the olfactory system and its ascending relays, possibly affecting odor discrimination. In this study we compared the frequency and time spent visiting the source of urine obtained from unrelated female subjects and amyl acetate odors vs water in adult perinatally underfed rats. Each test initiated with one daily presentation during three consecutive aliquots of deionized water (10 μl) placed on a filter paper for 2 min, separated by 1-min intervals for habituation. The water presentations were followed by three exposures to an odor, all at the same dilution (either 1:1 or 1:80) for dishabituation. Control (C) and undernourished (U) subjects display similar, significant habituation/dishabituation responses, except that the U subjects showed greater increases in the frequency and duration of visits to undiluted and diluted urine and amyl acetate cues compared to the controls. These findings are similar to previous studies showing that adult rats investigate novel odors longer than the familiar ones. Thus, perinatal undernutrition appears to interfere with the foundation of the olfactory development causing long-term olfactory discrimination deficits as revealed by the increased frequency and duration of visits to the source of odors that may be relevant for social behavior.
文摘Dear Editor, The deficit of 3-hydroxyacyl-CoA dehydrogenase (LCHAD)is a disease whose incidence is approximately 3 cases/100 000 births^([1]), with autosomal recessive inheritance^([2]).
文摘Tarsal Tunnel Syndrome [TTS] is the most common lower limb focal neuropathy but it has a poor pick up rate in most Electrodiagnostic (EXD) Laboratories. There is no gold standard for assessing TTS. The tibial nerve has a complex branching system with 4 main branches and 9 different patterns of division. This study evaluated potential TTS with a similar and extensive assessment of the tibial nerve. The protocol involved 2 tibial motor studies to the Adductor Hallucis Longus (AH) and Adductor Digiti Quinti (ADQ) muscles, assessing amplitudes and distal latencies;medial plantar, lateral plantar and calcaneal sensory studies assessing amplitudes and distal latencies. A needle EMG to the tibial innervated AH and ADQ muscles was also performed. This protocol evaluated 12 different parameters which significantly increased the diagnostic yield. TTS has a low pick up rate using current standard assessment methods accounting for between 0.5% and 0.6% of positive cases referred to electrodiagnostic laboratories. This study had a pick up rate of 3.3% with 40 positive cases identified out of a population of 1210 patients referred to an electrodiagnostic laboratory in a calendar year. A combination of positive findings was observed. There were on average 4.3 positive parameters. The calcaneal sensory study and the needle EMG to the distal AH and ADQ muscles were the most sensitive tests. These 3 tests are not routinely performed in most labs. Of the 40 cases of TTS over 80% had a history of either prior injury or surgery to affected lower limb. This study suggests that this 12 parameter assessment will increase diagnostic sensitivity.
文摘Background: Non-convulsive status epilepticus (NCSE) is defined as a change in mental state of at least 30 minutes associated with continuous or nearly continuous epileptiform discharges. Identification of prognostic indicators can guide decision making surrounding the use of poorly established treatment interventions in this heterogeneous population. Methods: We identified 66 consecutive inpatients with NCSE. Data surrounding clinical, electrographic, and treatment factors were collected via a retrospective systematic review of medical records and electronic EEGs, and were correlated with discharge outcome (return to baseline, new disability, or death). Results: Of all subjects, 21% returned to baseline, 26% acquired new disability, and 53% died, of whom half had anoxic encephalopathy. On univariate analysis, seventeen variables correlated significantly with death, although multivariate logistic regression analysis subsequently identified only comatose state and number of life threatening comorbidities as independent predictors of mortality. Of survivors, comatose state, critical care environment, length of hospital stay, and acute symptomatic seizures predicted new disability, with the latter two showing independent significance. Following exclusion of cases with anoxic encephalopathy, the use of an anaesthetic infusion was also an independent predictor of mortality. Conclusions: NCSE is associated with variable morbidity and mortality. While one fifth of our NCSE patients returned to baseline, those comatose with acute structural/metabolic seizures, anaesthetic infusions, and life threatening comorbidities were unlikely to survive without disability at discharge.
文摘A randomized, double blind, and active reference-controlled study was carried out among 116 patients suffering from idiopathic Parkinson’s disease (PD). The aim of the study was to compare the safety and efficacy of alpha-dihydroergocryptine (DHEC) vs. pramipexole (PRAM) as an adjunct symptomatic therapy to levodopa in PD patients. The motor symptoms, assessed by the Unified Parkinson’s Disease Rating Scale (UPDRS) III subscale, was identified as efficacy target. Fifty-six patients were randomized to DHEC and 60 to PRAM. Patients included were under constant levodopa dose for at least 3 months before entering the study, with baseline UPDRS III ≥14. They underwent a 16-week treatment. Out of the 116 included patients, 85 (39 in DHEC group and 46 in PRAM group, respectively) completed the study protocol. In DHEC group, UPDRS III decreased by 24.2% from baseline at week 10 and by 28.1% at week 16. In PRAM group, UPDRS III decreased by 27.1% from baseline at week 10 and by 29.2% at week 16. The data were highly significant
文摘Objective: The current study aimed to assess the viability of sympathetic sudomotor fibers in patients suffering from mild peripheral arterial occlusive disease (PAD). Methods: Sympathetic skin response (SSR) from the hand (electrical stimulation) and sole (electrical and magnetic stimulation) of 25 patients with PAD (19 males and 6 females with mean age 62.7±10.2 years) was recorded unilaterally depending on the side of the affected limb (18 right side, 7 left side). Electrophysiological data were also collected and correlated with the SSR results. Twenty-five, age-and gender-matched healthy volunteers served as controls. Results: No evidence of nerve conduction abnormalities was recorded from the group of patients. Intact SSR recordings were obtained from the upper limb of patients. Nine patients (36%) had absent SSR in the lower limb following electrical stimulation, whilst the same 9 patients had absent SSR following magnetic stimulation. Significant differences occurred between groups in the SSR latency scores recorded from the lower limb. Following electrical stimulation the mean SSR latency in patients was significantly prolonged, compared to that of controls (P=0.000), whilst the same applied following magnetic stimulation (P=0.000). There was no correlation between SSR abnormalities and nerve conduction measurements. The manifestation of intermittent claudication at a walking distance of 250 m was strongly correlated w ith absent lower limb SSR (r=0.71, P=0.035). Conclusions: SSR abnormalities appe ared to be an early and independent finding of neural impairment in our patients . Significance: SSR study, performed at an early stage of PAD may prove useful i n differentiating PAD-induced neuropathy from other neuropathic processes.
文摘Objective: To compare the intraoperative signal-to-noise ratio (SNR), reproducibility and rapidity of popliteal fossa (PF), optimized P37, standard P37 and P31 potentials. Methods: Raw sweeps and 11 averages doubling sweep number from 2 to 2048 were compared in 37 patients undergoing scoliosis surgery. Optimized (highest amplitude or SNR) P37 derivations were Cz-CPc (22), CPz-CPc (27), Pz-CPc (7), iCPi-CPc (8), CPi-CPc (1), Cz-Pz (2)orPz-FPz (3), and in two patients with non-decussation, Cz-CPi (1) or CPz-CPi (3). Standard P37 and P31 derivations were CPz-FPz and FPz-C5S. Signal amplitude was measured in 2048 sweep averages; peak noise was measured in raw sweeps and ±averages; SNR was amplitude/noise. Visual superimposability and < 20-30%amplitude variation determined reproducibility. Sweeps to reproducibility determined rapidity. Results: The SNR order was PFoptimized P37 > standard P37 > P31. Mean optimized P37 SNR advantages over the standard P37 and P31 were 2.1:1 and 4.9:1. SNR had powerful non-linear correlations to reproducibility and rapidity. Median sweeps to reproducibility were PF: 2, optimized P37: 128, standard P37: 512 and P31: 1024. EEG noise was greatest in FPz derivations. Burst-suppression increased scalp potential SNR and rapidity. Conclusions: Optimized P37 and PF recordings are most rapidly reproducible due to superior SNRs and are recommended. FPz should be avoided. Burst-suppression may be desirable. Significance: CPz-FPz and FPz-C5S should no longer be standard.
文摘The ubiquitously expressed transmembrane enzyme Na,K-ATPase(NKA)is vital in maintaining functionality of cells.The association of α-and β-subunits is believed to be essential for forming a functional enzyme.In the large milkweed bug Oncopeltus fasciatus fourα1-paralogs and four β-subunits exist that can associate into NKA complexes.This diversity raises the question of possible tissue-specific distribution and function.While the α1-subunits are known to modulate cardenolide-resistance and ion-transport efficiency,the functional importance of the β-subunits needed further investigation.We here characterize all four different β-subunits at the cellular,tissue,and whole organismal scales.A knockdown of different β-subunits heavily interferes with molting success resulting in strongly hampered phenotypes.The failure of ecdysis might be related to disrupted septate junction(SJ)formation,also reflected in β2-suppression-induced alteration in tracheal morphology.Our data further suggest the existence of isolated β-subunits forming homomeric or β-heteromeric complexes.This possible standalone and structure-specific distribution of the β-subunits predicts further,yet unknown pump-independent functions.The different effects caused byβknockdowns highlight the importance of the various β-subunits to fulfill tissue-specific requirements.
基金This work was supported by the National Key R&D Program of China(No.2022YFC2503800)the National Natural Science Foundation of China(No.82071454)Beijing Municipal Science&Technology Commission(No.Z211100002921032).
文摘Recently,a novel workflow known as the virtual epileptic patient(VEP)has been proposed by a research team from Aix Marseille Universitéin their papers published in Lancet Neurology,Science Translational Medicine and Epilepsia.This method involves creating an individualized virtual brain model based on computational modelling,which can facilitate clinical decision-making by estimating the epileptogenic zone and performing the virtual surgery.Here,we summarize brief workflow,strengths,and limitations of VEP,as well as its performance in a retrospective study of 53 patients with drug-resistant focal epilepsy who underwent stereoelectroencephalography.A large-scale clinical trial(NCT03643016)is underway to further assess VEP,which is expected to enroll 356 patients prospectively.As supporting evidence accumulates,the clinical application of VEP has the potential to improve clinical practice,leading to better outcomes and qualities of life of patients.
文摘Background:Surgery is a conventional mature treatment for moyamoya disease(MMD).However,whether surgery is also an effective therapy for epileptic type MMD has seldom been investigated systematically.The study aims to summarize the pooled postoperative incidence of seizure and cerebral infarction in pediatric patients with epileptic type moyamoya disease.Method:The study was a systematic review and critical appraisal with a meta-analysis of cohort studies,both prospective and retrospective.Studies were identified by a computerized search of PubMed,Embase,Web of Science,Wanfang,and CNKI databases.In a literature search,a total of 7 cohort studies were identified.The I2statistic was used to quantify heterogeneity.A fixed-effect model was used to synthesize the results.The linear regression test of funnel plot asymmetry was used to estimate the potential publication bias.Results:The pooled estimated postoperative incidence of seizure in pediatric patients with epileptic type moyamoya disease was 23.44%.The pooled estimated postoperative incidence of cerebral infarction in pediatric patients with epileptic type moyamoya disease was 9.12%.Low substantial heterogeneity and potential publication bias were present.Conclusions:Evidence from this study suggests that the postoperative incidence of seizure and cerebral infarction is relatively low.Surgery is an effective and secure therapy for pediatric patients with epileptic type moyamoya disease.
基金supported by the National Institutes of Health grants#DC003180,DC005808supported by a fellowship from the Kavli Neuroscience Discovery Institute at JHU.
文摘Two-photon laser-scanning microscopy has become an essential tool for imaging neuronal functions in vivo and has been applied to different parts of the neural system,including the auditory system.However,many components of a two-photon microscope,such as galvanometer-based laser scanners,generate mechanical vibrations and thus acoustic artifacts,making it difficult to interpret auditory responses from recorded neurons.Here,we report the development of a silent two-photon imaging system and its applications in the common marmoset(Callithrix Jacchus),a non-human primate species sharing a similar hearing range with humans.By utilizing an orthogonal pair of acoustooptical deflectors(AODs),full-frame raster scanning at video rate was achieved without introducing mechanical vibrations.Imaging depth can be optically controlled by adjusting the chirping speed on the AODs without any mechanical motion along the Z-axis.Furthermore,all other sound-generating components of the system were acoustically isolated,leaving the noise floor of the working system below the marmoset’s hearing threshold.Imaging with the system in awake marmosets revealed many auditory cortex neurons that exhibited maximal responses at low sound levels,which were not possible to study using traditional two-photon imaging systems.This is the first demonstration of a silent two-photon imaging system that is capable of imaging auditory neuronal functions in vivo without acoustic artifacts.This capacity opens new opportunities for a better understanding of auditory functions in the brain and helps isolate animal behavior from microscope-generated acoustic interference.
文摘Small bowel malignant tumors are rare and sarcomatoid carcinomas have rarely been reported at this site.We report a 56-year-old woman,with history of an excised gliosarcoma,who presented with recurrent obscure gastrointestinal bleeding.She underwent endoscopy and colonoscopy,which failed to identify the cause of the bleeding.The abdominal computed tomography scan located a tumor in the small bowel.Pathology revealed a jejunal sarcomatoid carcinoma.She developed tumor recurrence and multiple liver metastases shortly after surgery.Immunohistochemistry is required for accurate diagnosis.Sarcomatoid carcinoma is a rare cause of obscure gastrointestinal bleeding,which is associated with a poor prognosis.
