scholarly journals Towards Deciphering the Fetal Foundation of Normal Cognition and Cognitive Symptoms From Sulcation of the Cortex

2021 ◽  
Vol 15 ◽  
Author(s):  
Arnaud Cachia ◽  
Grégoire Borst ◽  
Renaud Jardri ◽  
Armin Raznahan ◽  
Graham K. Murray ◽  
...  
Keyword(s):  
Cognitive Abilities ◽  
Spatial Organization ◽  
Clinical Symptoms ◽  
Bipolar Disorders ◽  
Postnatal Life ◽  
Cognitive Symptoms ◽  
Interesting Candidate ◽  
Clinical Conditions ◽  
Normal Cognition ◽  
Selection Of

Growing evidence supports that prenatal processes play an important role for cognitive ability in normal and clinical conditions. In this context, several neuroimaging studies searched for features in postnatal life that could serve as a proxy for earlier developmental events. A very interesting candidate is the sulcal, or sulco-gyral, patterns, macroscopic features of the cortex anatomy related to the fold topology—e.g., continuous vs. interrupted/broken fold, present vs. absent fold-or their spatial organization. Indeed, as opposed to quantitative features of the cortical sheet (e.g., thickness, surface area or curvature) taking decades to reach the levels measured in adult, the qualitative sulcal patterns are mainly determined before birth and stable across the lifespan. The sulcal patterns therefore offer a window on the fetal constraints on specific brain areas on cognitive abilities and clinical symptoms that manifest later in life. After a global review of the cerebral cortex sulcation, its mechanisms, its ontogenesis along with methodological issues on how to measure the sulcal patterns, we present a selection of studies illustrating that analysis of the sulcal patterns can provide information on prenatal dispositions to cognition (with a focus on cognitive control and academic abilities) and cognitive symptoms (with a focus on schizophrenia and bipolar disorders). Finally, perspectives of sulcal studies are discussed.

scholarly journals The importance of early detection of endotoxemia

2016 ◽  
Vol 22 (7) ◽  
pp. 503-509 ◽  
Author(s):  
Barbara Adamik ◽  
Jakub Smiechowicz ◽  
Andrzej Kübler
Keyword(s):  
Septic Shock ◽  
Point Of Care ◽  
Point Of Care Testing ◽  
Clinical Challenge ◽  
Endotoxin Activity ◽  
Sepsis And Septic Shock ◽  
Clinical Conditions ◽  
Endotoxin Elimination ◽  
Selection Of Patients ◽  
Selection Of

Endotoxin is considered a key signaling molecule in the pathogenesis of sepsis and septic shock. Anti-endotoxin therapies may result in the improvement of a patient’s clinical condition and lower mortality. The pressing clinical challenge is to identify patients for whom endotoxin elimination would be the most beneficial. An endotoxin activity assay (EAA) has been available for detection of endotoxins, allowing selection of patients at high risk of endotoxemia in intensive care units (ICUs). We studied a cohort of 172 consecutive patients who had septic shock on admission to the ICU. Endotoxin activity (EA) was measured with a rapid chemiluminescent EAA, regarded as point-of-care testing. Endotoxemia with a mean EA of 0.59 ± 0.14 EAU was present in 104 patients (60%) and absent in 68 patients (EA = 0.25 ± 0.11 EAU). The risk of endotoxemia increased with the presence of a Gram-negative infection [odds ratio (OR) 3.1, 95% confidence interval (CI) 1.6–5.9; P = 0.001] and bacteremia (OR 3.8, 95% CI 1.6–8.9; P = 0.02) but did not change with a diagnosis of peritonitis (OR 1.03, 95% CI 0.54–1.97; P = 0.90). These findings indicate that anti-endotoxin interventions should be tailored to individual patients based on both clinical conditions and measured endotoxin levels.

scholarly journals Correlation of clinical features with the risk of lower limb deep vein thrombosis assessed by duplex ultrasound

2013 ◽  
Vol 12 (2) ◽  
pp. 118-122
Author(s):  
Liz Andrea Villela Baroncini ◽  
Graciliano Jose Franca ◽  
Aguinaldo de Oliveira ◽  
Enrique AntonioVidal ◽  
Carlos Eduardo Del Valle ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Vein Thrombosis ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Duplex Ultrasound ◽  
Iliac Vein ◽  
Vein Thrombosis ◽  
Below The Knee ◽  
Clinical Conditions ◽  
Deep Vein

BACKGROUND: Symptoms and clinical signs suggestive of deep vein thrombosis (DVT) are common but may have numerous possible causes. OBJECTIVES: 1) To identify the most frequent clinical symptoms and correlate them with duplex ultrasound scan (DS) findings; 2) to identify high-risk clinical conditions for DVT; and 3) to evaluate time since the onset of symptoms and DS examination. METHODS: A total of 528 patients with a clinical suspicion of DVT were evaluated by DS performed by experienced vascular ultrasonographists. RESULTS: DVT was present in 192 (36.4%) of the patients. The external iliac vein was involved in 53 patients (10.04%), the femoral veins in 110 (20.83%), the popliteal vein in 124 (23.48%), and veins below the knee were involved in 157 (29.73%) of the cases. Limb swelling was present in 359 cases (68%), and 303 (57.4%) complained of pain. Sixty nine patients received a DS due to suspected or proven pulmonary embolism (PE); 79 patients were in postoperative period. In the multivariate analysis, independent risk factors for DVT included age>65 years (OR=1.49; 95% confidence interval [95%CI] 1.01-2.18; p=0.042), edema (OR=2.83; 95%CI 1.72-4.65; p<0.001), pain (OR=1.99; 95%CI 1.3-3.05; p=0.002), cancer (OR=2.32; 95%CI 1.45-3.72; p<0.001), and PE (OR=2.62; 95%CI 1.29-5.32; p=0.008).Time since the onset of symptoms did not differ between the groups. CONCLUSIONS: In the present study, 36.4% of the patients referred to DS had DVT. Age > 65 years, presence of limb swelling, pain, cancer, and suspected or proven PE should be considered as major risk factors for DVT.

scholarly journals Experimental Study of Diamond Burr Polishing Methods of Bowman’s Membrane

2018 ◽  
Vol 15 (2) ◽  
pp. 176-181 ◽  
Author(s):  
S. V. Trufanov ◽  
A. A. Fedorov ◽  
V. R. Mamikonyan ◽  
L. Yu. Tekeeva ◽  
S. A. Malozhen ◽  
...  
Keyword(s):  
Corneal Epithelium ◽  
Surgical Intervention ◽  
Rotation Frequency ◽  
Basal Membrane ◽  
Corneal Erosion ◽  
Recurrent Corneal Erosion ◽  
Diamond Burr ◽  
Clinical Conditions ◽  
Histopathological Investigation ◽  
Selection Of

Purpose: to develop the optimal (safe and effective) method of diamond burr polishing of Bowman’s membrane (DBPBM) for the possible use it in the treatment of the recurrent corneal erosion syndrome (RCES) in the experiment.Material and methods. DBPBM in different modifications of the  method and the mechanical deepithelization were performed in  experiment on 19 human cadaver eyes. We use system Ophtho-Burr  for DBPBM that includes a tip and ophthalmic burrs with diameter  1mm, 2.5 mm, 5 mm, varying the speed of rotation of burr. For 3  eyes — polishing with the application of burr with a diameter of 5  mm, the rotation frequency of 4000 rpm using 2 passes over the  surface of the cornea. For 3 eyes — burr with a diameter of 2.5 mm,  rotation frequency of 4000 rpm in 2 perpendicular passes. For 3 eyes — diameter burr 1 mm at speed of 8000 rpm in 2 perpendicular  passes. For 3 eyes — diameter burr 1 mm at speed 4000 rpm with 4  passes along the surface of the cornea. For 4 eyes — diameter was 1 mm at speed of 4000 rpm in 2 perpendicular passes. For 3 the eyes  was conducted mechanical deepithelization. Subsequent histopathological investigation of the cornea was  performed by method of semi-thin section, with polychrome staining.Results. The obtained results of histological studies of DBPBM in  different versions on cadaver cornea is allowed to choose the optimal variant of surgical intervention for use in clinical conditions. It  consisted in a selection of burr with a diameter of 1 mm, the rotation frequency of the 4000 rpm and 2 perpendicular passes with a  moderate compression of the cornea. The abovementioned technique of intervention allows removing completely the corneal epithelium  with a basal membrane and save uniform in thickness, fully  deepitelizationed Bowman’s membrane.Conclusion.Careful and accurate removal of dysplastic corneal epithelium in cases of the recurrent corneal erosion syndrome using  proposed method in clinical conditions should contribute to the  creation optimal environments for adequate reepithelization with  steady epithelial-stromal adhesion. The remaining nearly intact  Bowman’s membrane after procedure can prevent some postoperative complications such as haze and induced refractive disorders.

scholarly journals P240 Can ultrasound alone predict the need to treat ACPA positive individuals without synovitis?

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Laurence M Duquenne ◽  
Kulveer Mankia ◽  
Leticia Garcia Montoya ◽  
Andrea Di Matteo ◽  
Jacqueline Nam ◽  
...  
Keyword(s):  
At Risk ◽  
Predictive Value ◽  
Cox Regression ◽  
Clinical Symptoms ◽  
Power Doppler ◽  
Musculoskeletal Symptoms ◽  
Features Selection ◽  
Moderate Sensitivity ◽  
Us Scan ◽  
Selection Of

Abstract Background In anti-cyclic citrullinated peptide antibody-positive (ACPA+) individuals without clinical synovitis (at-risk), to define the critical ultrasound (US) features sufficiently predictive for inflammatory arthritis (IA) to enable logical initiation of therapy. Methods In a single centre prospective cohort, at risk ACPA+ individuals with a new musculoskeletal symptoms underwent an US scan of 38 joints and 18 tendons at first visit. The predictive value of US abnormalities (Power Doppler (PD), Grey Scale (GS), erosion or tenosynovitis (TSV)) for progression to IA was analysed and the best predictive joints determined by Multivariable Cox Regression, adjusted for confounders. The US results were combined with clinical symptoms/findings to produce predictive models. Results Consecutive at-risk ACPA+ individuals (n = 457, mean age 50.3 years old, 74.2% women) were followed up for median of 15.4 months (range 0.1-127.4), a complete dataset with follow-up of at least 6 months was available for 319 of them. 135 (29.5%) developed IA after a median of 11.3 months (range 0.1-111.7). The negative predictive value of a US scan without any abnormality was 82%. In multivariable Cox regression, both PD and TSV were predictive of progression, with respectively hazard ratios of 1.2 (9=0.026) and 1.13 (p = 0.025). All US abnormalities had a high specificity (spec) but only moderate sensitivity (sens), PD was the most specific with a spec/sens of 0.94/0.23, followed by TSV with a spec/sens of 0.91/0.26 but the best area under the curve (AUC) of 0.599 (P = 0.0015). The addition ACPA titre (high compared to low), but not GS, improved spec/sens up to 0.92/0.34 and AUC to 0.964 (p &lt; 0.001). A selection of US and clinical data of 14 joints also improved prediction, with an AUC of 0.670 (p &lt; 0.001) and a spec/sens of 0.65/0.62. A selection of the 34 most predictive features reached the same sens/spec as the ACR/EULAR 2010 classification criteria for RA, showing a spec/sens of 0.80/0.56. Conclusion In at-risk ACPA+ individuals, the presence of sub-clinical US abnormalities are highly specific for progression to IA. The only moderate sensitivity can be improved by using joints or features selection in combination with clinical examination. These results are the first step in providing guidance for which at-risk ACPA+ individuals to treat. Disclosures L.M. Duquenne None. K. Mankia None. L. Garcia Montoya None. A. Di Matteo None. J. Nam None. P. Emery None.

WHOLE BLOOD AGGREGOMETER IN THE ASSESSMENT OF PLATELET HYPER-AGGREGABILITY

1987 ◽  
Author(s):  
R Abbate ◽  
M Boddi ◽  
S Favilla ◽  
G Costanzo ◽  
R Paniccia ◽  
...  
Keyword(s):  
Platelet Aggregation ◽  
Whole Blood ◽  
Platelet Rich Plasma ◽  
Vascular Complications ◽  
Thromboembolic Complications ◽  
Significant Difference ◽  
Platelet Number ◽  
Patient Groups ◽  
Clinical Conditions ◽  
Selection Of

The aim of this study has been to investigate the reliability of platelet aggregation in whole blood in some clinical conditions associated to thromboembolic complications.18 healthy subjects, 15 patients affected by ischemic heart disease (IHD) and 15 patients affected by insulin independent diabetes, free of vascular complications, were studied. Collagen induced (2.5 mg/L f.c.) platelet aggregation was evaluated both in whole blood (WB) by using impedance whole blood aggregometer (Chrono-Log) and in platelet rich plasma (PRP) by Born aggregometer. Aggregation was significantly higher in whole blood than in PRP in all the groups investigated (p < 0.01). No significant difference was found in PRP aggregation among the three groups, whereas WB aggregation was significantly higher in the two patient groups (IHD 79.5 + 14.2%, Diabetes 81.3 + 17.6%) than in controls (64.8 ± 14.1%) (p < 0.01 for both comparisons). No relationship was found between WB aggregation and Hct or platelet number in any of the groups studied. A slight relationship was found between megathrombocyte count and WE aggregation values (r=0.31, p < 0.05).Collagen platelet aggregation in WB seems to be provided with higher sensibility than PRP aggregation in detecting hyper-aggregability, probably because it does not imply the selection of platelet populations with loss of larger platelets and of other blood cells.

Use of Molecular Profiling to Guide Treatment Decisions in Patients with Neuroendocrine Tumors: Preliminary Results

2016 ◽  
Vol 82 (4) ◽  
pp. 369-375 ◽  
Author(s):  
Holt S. Cutler ◽  
Paul Ogando ◽  
Joshua H. Uhr ◽  
Dani O. Gonzalez ◽  
Richard R.P. Warner ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Clinical Symptoms ◽  
Case Series ◽  
Molecular Profiling ◽  
Serum Markers ◽  
Carcinoid Tumors ◽  
Molecular Profile ◽  
Chemotherapy Response ◽  
Choice Of Treatment ◽  
Selection Of

This case series demonstrates the potential of molecular profiling to improve selection of anti-tumor therapies in the treatment of patients with neuroendocrine and carcinoid tumors. Carcinoid tumors resected at one institution over a 3-year period were sent for molecular profiling to guide choice of treatment. Potentially beneficial therapies were identified based on the measured expression of 20 proteins and oncogenes and a comprehensive review of the chemotherapy response literature. The clinical charts of 41 patients were reviewed retrospectively, and 12 were selected as representatives of the range of effects molecular profiling has on carcinoid treatment. Their presentation, molecular profile results, treatment, and disease progression is reviewed in the following case series. A total of nine patients were treated with drugs identified as potentially beneficial by molecular profile reports. These include capecitabine, 5-fluorouracil, temozolomide, oxaliplatin, and gemcitabine. Based on clinical symptoms, serum markers of disease, and radio-graphic evidence five of nine patients responded to treatment, two had mixed responses, and two did not respond to treatment. At this early juncture, our critique of molecular profiling for neuroendocrine tumors is favorable, as a significant number of our patients responded to drugs identified by molecular profiling as potentially beneficial.

Outbreak of Foodborne Botulism Associated with Improperly Earthenware Cheese (Koupé): A Case Report

2020 ◽  
Author(s):  
Parshang FAGHIH SOLAYMANI, ◽  
Ardeshir RAHIMZADEH ◽  
Farideh MOSTAFAVI
Keyword(s):  
Case Report ◽  
Infectious Diseases ◽  
Hospital Admission ◽  
Clinical Symptoms ◽  
Cottage Cheese ◽  
Local Hospital ◽  
Western Iran ◽  
Foodborne Botulism ◽  
Clinical Conditions ◽  
Specific Symptoms

Here we report the consumption of traditional cottage cheese (Koupé) in western Iran, as a new way of transmission of botulism. All the patients (a nine member family) had at least two specific symptoms of botulism. Given the clinical symptoms and contact history, anti-toxins were injected in the early hours of hospital admission. On Jan 27, 2017, three patients clinically suspected of foodborne botulism were referred to the hospital in Sanandaj, western Iran from their local hospital in Baneh, western, Iran. Because of the worsening of clinical conditions, a 34-yr-old man with both gastrointestinal and neurological symptoms was admitted to the ICU, while other family members were treated in the infectious diseases ward of the hospital. The disease was diagnosed through isolating toxin A from the cheese and testing the serum sample of one of the patients. This case of botulism showed that traditional Koupé cheese could cause foodborne botulism. Hence, it is necessary to train and inform people about how to process and keep the cheese to prevent similar cases.

scholarly journals The role of physician assistants in pediatric emergency medicine: the physician's view

CJEM ◽  
2013 ◽  
Vol 15 (06) ◽  
pp. 321-329 ◽  
Author(s):  
Quynh Doan ◽  
Shalea Piteau ◽  
Sam Sheps ◽  
Joel Singer ◽  
Hubert Wong ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Work ◽  
Physician Assistants ◽  
Pediatric Emergency ◽  
Cross Sectional ◽  
Survey Tool ◽  
Clinical Encounters ◽  
Clinical Conditions ◽  
Selection Of

ABSTRACTObjective:To define the range of clinical conditions Canadian emergency pediatricians consider appropriate formanagement by physician assistants (PAs) and the degree of autonomy PAs should have in the pediatric emergency department (PED).Methods:We conducted a cross–sectional, pan-Canadian survey using electronic questionnaire technology: the Active Campaign Survey tool. We targeted PED physicians using the Pediatric Emergency Research Canada (PERC) network database (N = 297). Three outcome measures were assessed: demographic information, familiarity with PAs, and PA clinical roles in the PED. The level of PA involvement was assessed for 57 common nonemergent clinical conditions.Results:Of 297 physicians, 152 completed the survey, for a response rate of 51.2%. None of the 57 clinical categories achieved at least 85% agreement regarding PA management without direct physician involvement. Twenty-four clinical conditions had ≥ 15% agreement that any PA involvement would be inappropriate. For the remaining 33 clinical conditions, more than 85% of respondents felt that PA could appropriately manage but were divided between requiring direct and only indirect physician supervision. Respondents' selection of the number of conditions felt to be appropriate for PA involvement varied between the size of the emergency department (ED) in which they work (larger EDs 87.7–89.1% v. smaller EDs 74.2%) and familiarity with the clinical work of PAs in the ED (90.5–91.5% v. 82.2–84.7%).Conclusion:This national survey of Canadian PED physicians suggests that they feel PAs could help care for a large number of nonemergent clinical cases coming to the PED, but these clinical encounters would have to be directly supervised by a physician.

scholarly journals Experience in the treatment of patients with fusiform aneurysms of cerebral vessels

2020 ◽  
Vol 30 (4) ◽  
pp. 23-30
Author(s):  
D.V. Shchehlov ◽  
Ya.E. Kudelskyi ◽  
O.A. Pastushyn ◽  
O.E. Svyrydiuk ◽  
O.M. Goncharuk
Keyword(s):  
Postoperative Period ◽  
Neurological Deficit ◽  
Clinical Symptoms ◽  
Control Period ◽  
Clinical Manifestations ◽  
Clinical Results ◽  
Early Postoperative Period ◽  
Neurological Symptoms ◽  
Selection Of Patients ◽  
Selection Of

Objective – to analyze there sults of treatment of patients with fusiform aneurysms (FA) depending on localization and type of surgery.Materials and methods. In the period from 2007 to 2019 127 patients with intracranial fusiform cerebral aneurysms underwen treatment in Scientific and Practical Center of Endovascular Neuroradiology of the National Academy of Medical Sciences of Ukraine. 133 fusiform aneurysms were identified. The following neuroimaging methods were used to diagnose FA: magnetic resonance imaging, multispiral computed tomography and cerebral selective angiography according to Seldinger. In this study, patients with fusiform aneurysms are divided according to localization in the FA of the carotid poolsand the FA of the vertebrobasilar basin. Patients with FA of carotid basins were 56 (27 (29 (51.8 %) men and 48.2 %) women). The average age of patients was 45.2 year. 31 (55.3 %) patients were operated. Patients with FA in the vertebrobasilar basin were 71 (43 (60.6 %) men and 28 (39.4 %) women). The average age of patients was 54.5 year. It was operated 48 (67.6 %) patients.Results. It was possible to completely eliminate FA from the bloodstream intraoperative in 16 (51.6 %) patients. In the early postoperative period in this group 5 (16.1 %) patients had a decrease in disease symptoms, in 3 (9.6 %) patients neurological symptoms increased. In other patients the dynamics of neurological manifestations remained unchanged. There were nofatal out comes in either the early or late post operative period. According to the extended Glasgow outcome scale at the time of discharge from the hospital 22 (71 %) patients had > 5 points, 9 (29 %) – 4 points. In the period from 3 to 5 weeks 2 symptomatic thromboses of flow-directingstents were noted, in the form of clinical manifestations of ischemic stroke. In the period from 3 to 6 months 22 (71 %) patients underwent control examination. Angiographically in 19 (86.3 %) revealed a completes hut down of FA from the bloodstream, in 3 (13.7 %) – decrease of volume of FA > 65 %. Clinical symptoms completely regressed in 16 (72.7 %) patients, partially regressed – in 3 (13.7 %), increased – in 2 (13.6 %). In the period from 12 to 18 months 7 (31.8 %) patients underwent control examination. Total FA shut down from the bloodstream was detected in 5 (71.4 %) patients, in 2 (28.6 %) aneurysms decreased by 80 %. Eighteen-month survival was 100 %.It was possible to intraoperatively switch off FA in the vertebrobasilar basin from the bloodstream in 11 (22.9 %) cases. In the early postoperative period a partial regression of neurological symptoms was observed in 7 (14.5 %) patients. In 10 (20.8 %) cases a new or increasing neurological deficit was observed after intracranial stent implantation, which partially regressed against the background of conservative treatment. Four (8.3 %) deaths were recorded in the early postoperative period. The clinical results of 48 patients on the Glasgo woutcome scale at the time of discharge were > 5 points in 27 (56.2 %) patients, 4 points – in 17 (35.4 %) and 1 points – in 4 (8.3 %). In the period from 3 to 6 months 19 (39.5 %) patients underwent control examination. Angiographically in 14 (73.7 %) patients the aneurysm was completely turned off from the blood circulation, in 2 (10.5 %) the decrease in the volume of the aneurysm was > 70 %, in 3 (15.8 %) patients the decrease in the volume of the aneurysm was 47–64 %. Clinical symptoms regressed in 7 (36.8 %) patients, a decrease in neurological deficit was noted in 2 (10.5 %) patients, an increase in neurological deficit in 3 (15.8 %) patients. Three deaths were recorded. In the period from 12 to 18 months, 12 (25 %) patients underwent control examination. Angiographically in 10 (83.3 %) patients FA was excluded totally from the bloodcirculation, in 2 (16.7 %) – the volume of aneurysm was reduced by 80 %. Clinical symptoms regressed in 8 (66.6 %) patients and increased in 1 (8.3 %). During the control period 2 patients died. The 18-month survival rate was 89.5 %, 5 (10.5 %) patients died.Conclusions. Fusiform aneurysms are more common in people of working age, more common in men. A more unfavorable course of the disease occursin patients with symptomatic FA of the vertebrobasilar basin, due to the compression and dysfunction of the brainstem and stem structures. Deconstructive methods for eliminating FA from the bloodstream provide long-termsatis factory treatment results, butrequire careful selection of patients for such in terventions. Endovascular treatment should be considered as the main treatment, asitentails fewer risks for the patient. For aneurysms that cannot be treated with endovascular methods, microsurgical treatments hould be considered. The main forsuccess ful treatment of patients with fusiform aneurysms is th ecareful selection of patients and individual approach to the choice of treatment based on the shape, location and size of the FA.

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