145 DRIVING SIMULATION AND COGNITIVE TESTING CAN IMPROVE INSIGHT INTO IMPAIRED DRIVING SKILLS IN CIRRHOTIC PATIENTS WITH MHE

Background Ambulatory surgical patients are advised to refrain from driving for 24 h postoperatively. However, currently there is no strong evidence to show that driving skills and alertness have resumed in patients by 24 h after general anesthesia. The purpose of this study was to determine whether impaired driver alertness had been restored to normal by 2 and 24 h after general anesthesia in patients who underwent ambulatory surgery. Methods Twenty patients who underwent left knee arthroscopic surgery were studied. Their driving simulation performance, electroencephalographically verified parameters of sleepiness, subjective assessment of sleepiness, fatigue, alertness, and pain were measured preoperatively and 2 and 24 h postoperatively. The same measurements were performed in a matched control group of 20 healthy individuals. Results Preoperatively, patients had significantly higher attention lapses and lower alertness levels versus normal controls. Significantly impaired driving skills and alertness, including longer reaction time, higher occurrence of attention lapses, and microsleep intrusions, were found 2 h postoperatively versus preoperatively. No significantly differences were found in any driving performance parameters or electroencephalographically verified parameters 24 h postoperatively versus preoperatively. Conclusions Patients showed lower alertness levels and impaired driving skills preoperatively and 2 h postoperatively. Based on driving simulation performance and subjective assessments, patients are safe to drive 24 h after general anesthesia.

Download Full-text

P1-273: Sociolinguistic reflection on neuropsychological assessment: Insight into a selected culturally adapted battery of lebanese arabic cognitive testing

Alzheimer s & Dementia ◽

10.1016/j.jalz.2015.06.474 ◽

2015 ◽

Vol 11 (7S_Part_10) ◽

pp. P460-P460

Author(s):

Fadi Abou-Mrad ◽

Lubna Tarabey ◽

Edward Zamrini ◽

Gordon Chelune ◽

Florence Pasquier ◽

...

Keyword(s):

Neuropsychological Assessment ◽

Cognitive Testing ◽

Culturally Adapted ◽

Lebanese Arabic ◽

Insight Into

Download Full-text

Driving on ice: impaired driving skills in current methamphetamine users

Psychopharmacology ◽

10.1007/s00213-012-2805-y ◽

2012 ◽

Vol 225 (1) ◽

pp. 161-172 ◽

Cited By ~ 10

Author(s):

David Bosanquet ◽

Hamish G. MacDougall ◽

Stephen J. Rogers ◽

Graham A. Starmer ◽

Rebecca McKetin ◽

...

Keyword(s):

Impaired Driving ◽

Driving Skills

Download Full-text

Lactitol Supplementation Modulates Intestinal Microbiome in Liver Cirrhotic Patients

Frontiers in Medicine ◽

10.3389/fmed.2021.762930 ◽

2021 ◽

Vol 8 ◽

Author(s):

Haifeng Lu ◽

Liang Chen ◽

Xiaxia Pan ◽

Yujun Yao ◽

Hua Zhang ◽

...

Keyword(s):

Bifidobacterium Longum ◽

Short Chain Fatty Acids ◽

Intestinal Microbiome ◽

Klebsiella Pneumonia ◽

Antibiotic Resistant ◽

Shotgun Metagenomics ◽

Pathogenic Genes ◽

Health Promoting ◽

Cirrhotic Patients ◽

Insight Into

Background: Cirrhosis is a common chronic liver disease characterized by irreversible diffuse liver damage. Intestinal microbiome dysbiosis and metabolite dysfunction contribute to the development of cirrhosis. Lactitol (4-β-D-galactopyranosyl-D-glucitol) was previously reported to promote the growth of intestinal Bifidobacteria. However, the effect of lactitol on the intestinal microbiome and fecal short-chain fatty acids (SCFAs) and bile acids (BAs) and the interactions among these factors in cirrhotic patients pre- and post-lactitol treatment remain poorly understood.Methods: Here, using shotgun metagenomics and targeted metabolomics methods.Results: we found that health-promoting lactic acid bacteria, including Bifidobacterium longum, B.pseudocatenulatum, and Lactobacillus salivarius, were increased after lactitol intervention, and significant decrease of pathogen Klebsiella pneumonia and associated antibiotic resistant genes /virulence factors. Functionally, pathways including Pseudomonas aeruginosa biofilm formation, endotoxin biosynthesis, and horizontal transfer of pathogenic genes were decreased in cirrhotic patients after 4-week lactitol intervention compared with before treatment.Conclusion: We identified lactitol-associated metagenomic changes, and provide insight into the understanding of the roles of lactitol in modulating gut microbiome in cirrhotic patients.

Download Full-text

Colonic mucosal microbiome differs from stool microbiome in cirrhosis and hepatic encephalopathy and is linked to cognition and inflammation

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00152.2012 ◽

2012 ◽

Vol 303 (6) ◽

pp. G675-G685 ◽

Cited By ~ 255

Author(s):

Jasmohan S. Bajaj ◽

Phillip B. Hylemon ◽

Jason M. Ridlon ◽

Douglas M. Heuman ◽

Kalyani Daita ◽

...

Keyword(s):

Hepatic Encephalopathy ◽

Cognitive Testing ◽

Disease Score ◽

Network Analyses ◽

Microbiome Analysis ◽

End Stage Liver Disease ◽

Cirrhotic Patients ◽

End Stage ◽

Stool Microbiota ◽

Poor Cognition

Although hepatic encephalopathy (HE) is linked to the gut microbiota, stool microbiome analysis has not found differences between HE and no-HE patients. This study aimed to compare sigmoid mucosal microbiome of cirrhotic patients to controls, between HE vs. no-HE patients, and to study their linkage with cognition and inflammation. Sixty cirrhotic patients (36 HE and 24 no-HE) underwent cognitive testing, stool collection, cytokine (Th1, Th2, Th17, and innate immunity), and endotoxin analysis. Thirty-six patients (19 HE and 17 no-HE) and 17 age-matched controls underwent sigmoid biopsies. Multitag pyrosequencing (including autochthonous genera, i.e., Blautia, Roseburia, Fecalibacterium, Dorea) was performed on stool and mucosa. Stool and mucosal microbiome differences within/between groups and correlation network analyses were performed. Controls had significantly higher autochthonous and lower pathogenic genera compared with cirrhotic patients, especially HE patients. HE patients had worse MELD (model for end-stage liver disease) score and cognition and higher IL-6 and endotoxin than no-HE. Mucosal microbiota was different from stool within both HE/no-HE groups. Between HE/no-HE patients, there was no difference in stool microbiota but mucosal microbiome was different with lower Roseburia and higher Enterococcus, Veillonella, Megasphaera, and Burkholderia abundance in HE. On network analysis, autochthonous genera ( Blautia, Fecalibacterium, Roseburia, and Dorea) were associated with good cognition and decreased inflammation in both HE/no-HE, whereas genera overrepresented in HE ( Enterococcus, Megasphaera, and Burkholderia) were linked to poor cognition and inflammation. Sigmoid mucosal microbiome differs significantly from stool microbiome in cirrhosis. Cirrhotic, especially HE, patients' mucosal microbiota is significantly different from controls with a lack of potentially beneficial autochthonous and overgrowth of potentially pathogenic genera, which are associated with poor cognition and inflammation.

Download Full-text

P: 16 Traditional Prognostic Tools are Superior to Cognitive Testing and Stool Frequency as Predictors of Poor Outcomes in Cirrhotic Patients Admitted with Hepatic Encephalopathy

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000582040.74212.2f ◽

2019 ◽

Vol 114 (1) ◽

pp. S9-S9

Author(s):

Patricia Pringle Bloom

Keyword(s):

Hepatic Encephalopathy ◽

Stool Frequency ◽

Cognitive Testing ◽

P 16 ◽

Cirrhotic Patients ◽

Poor Outcomes

Download Full-text

Avoidance Behavior Is an Independent Indicator of Poorer On-road Driving Skills in Older Adults

The Journals of Gerontology Series B ◽

10.1093/geronb/gbz063 ◽

2019 ◽

Vol 75 (10) ◽

pp. 2152-2161 ◽

Cited By ~ 2

Author(s):

Philipp Schulz ◽

Thomas Beblo ◽

Stefan Spannhorst ◽

Kirsten Labudda ◽

Thomas Wagner ◽

...

Keyword(s):

Older Adults ◽

Avoidance Behavior ◽

Cognitive Skills ◽

Older Drivers ◽

Impaired Driving ◽

Driving Skills ◽

Reported Health ◽

Bad Weather ◽

The Relationship ◽

Independent Indicator

Abstract Objectives The aim of the current work was to investigate the relationship between avoidance of specific driving situations and on-road driving skills in older drivers considering factors found to be related to both avoidance behavior and driving skills. Method Seventy-two older drivers (M = 76 years) from the general population were included in this study. Self-reported avoidance behavior, driving practice, perceived driving difficulties, driving-related cognitive functions, as well as medical conditions were assessed within two sessions. Standardized on-road assessments served for assessing on-road driving skills in a third session. Results Self-reported avoidance behavior was associated with reduced driving skills (r = −.41), and this relationship remained significant beyond the influence of cognitive skills, self-reported health, driving practice, and perceived driving difficulties. Specifically, avoidance of driving in bad weather, poor visibility and complicated parking was found to be associated with reduced driving skills. Discussion This study suggest that avoidance behavior is an independent indicator of impaired driving skills in older drivers. Our results argue against the assumption that avoidance behavior may be a reasonable strategy for safe traffic participation. Longitudinal studies are urgently needed to get more evidence on safety aspects of avoidance behavior.

Download Full-text