Propofol anesthesia alters cortical traveling waves

Oscillatory dynamics in cortex seem to organize into traveling waves that serve a variety of functions. Recent studies show that propofol, a widely used anesthetic, dramatically alters cortical oscillations by increasing slow-delta oscillatory power and coherence. It is not known how this affects traveling waves. We compared traveling waves across the cortex of non-human primates (NHPs) before, during, and after propofol-induced loss-of-consciousness (LOC). After LOC, traveling waves in the slow-delta (~ 1Hz) range increased, grew more organized, and travelled in different directions relative to the awake state. Higher frequency (8-30 Hz) traveling waves, by contrast, decreased, lost structure, and switched to directions where the slow-delta waves were less frequent. The results suggest that LOC may be due, in part, to changes in slow-delta traveling waves that, in turn, alter and disrupt traveling waves in the higher frequencies associated with cognition.

Three cases of difficulty in achieving definitive loss of consciousness with remimazolam

Background Remimazolam is a novel, ultra-short-acting benzodiazepine used for general anesthesia. Because remimazolam is an emerging drug, the tolerance to remimazolam in benzodiazepine-taking patients has been unclear. Also, the efficacy of remimazolam in different races is not fully elucidated so far. Case presentation Here we experienced three cases in which high dose of remimazolam was needed for attempting to achieve appropriate anesthetic depth. Two of the three cases were of preoperatively benzodiazepine-taking patients. The other was a case of a Chinese patient. In all three cases, conversion to general anesthesia with propofol was necessitated. Conclusions When signs of inadequate sedative effect of remimazolam are observed in patients of benzodiazepine users or of different races, conversion to another sedative agent such as propofol should be considered.

Pediatric Electrical Bicycle Road Accidents

Introduction The use of electric bicycles (EBs) among children younger than 18 years of age is rapidly increasing worldwide and becoming a substantial contributor to road accidents. We analyzed patterns and severity of pediatric bicycle-related injuries, comparing children riding EBs and classic bicycles (CBs). Materials and Methods This was a retrospective study (January 2016–December 2018) of patients arriving at our medical center due to a bicycle accident. Data were collected from medical records and included demographics, injury characteristics, treatment, and outcomes. Results Of 561 children, 197 (35%) were EB riders and 364 (65%) were CB riders. Injury severity score (ISS) of EB cyclists was significantly higher than CB cyclists (mean 4.08 ± 4.67 and 3.16 ± 2.84, respectively, p = 0.012). The rate of accidents involving motorized vehicles was higher in the EB versus CB group (25.9 vs. 11.3%, p < 0.001). Head injuries were the most common type of injury in both groups; incidence was higher in CB than in EB cyclists. However, loss of consciousness was more common in the EB group (18.3 and 12.1%, respectively, p = 0.057). Lower extremity injuries were more common in EBs versus CBs (55.8 and 37.6%, respectively, p < 0.001). Orthopaedic surgical interventions were significantly higher in the EB group (49.2 vs. 33.2%, p < 0.001), and length of stay in hospital and admission to pediatric intensive care unit were more common in EB compared with CB, although not significantly. Conclusion Injury severity of EB patients was significantly higher than that of CB patients. Accidents involving motorized vehicles were more common in the EB group. Head injury associated with loss of consciousness was significantly higher in EB patients.

An Embedded Based Electric Shock Prevention for Human Safety

An electric shock is the effect of passing an electric current through the body. The minimum current a human can feel is thought to be about 1 milliampere (mA). The effect can range from minor tingling to muscle spasms, tissue damage, fibrillation of the heart, loss of consciousness, and even death. These effects depend on a variety of factors, including the strength of the current, duration of the current, the area of the body through which the current passes, and whether the person is grounded or insulated from the ground. Death caused by an electric shock is referred to as electrocution.

Jurisprudential characterization of the person infected with the Corona epidemic and the jurisprudential rulings resulting from his disposal in financial compensation contracts: Sale contract as a model: التوصيف الفقهي للمصاب بوباء كورونا والأحكام الفقهية المترتبة على تصرفه في عقود المعاوضات المالية: عقد البيع أنموذجا

This research aims to clarify the jurisprudential characterization of the person infected with the Corona epidemic, and to clarify the jurisprudential provisions resulting from his disposal in the sales contract; This is because the patient may suffer from obsessions that affect his behavior, and the researcher has combined the inductive approach by following the issues related to the topic of research, collecting and categorizing them, and the descriptive approach in terms of mentioning the sayings of the jurists in each issue with its evidence, with mentioning the sayings of the considered schools of jurisprudence, and the discussions on them as possible, and clarifying The most correct, and the reason for the weightingThe researcher came out with results, the most important of which are: The Corona epidemic can be described by what is called jurisprudence as a dreaded disease, selling the person infected with the Corona epidemic if he is not indebted to a foreigner or buying it from him for the same price is valid without the heirs’ permission, whether debtor or not, and it is also true if it is a favoritism of one third or less Pre-emption is established for the partner in the case of the patient selling to an heir or someone else if the sale is made at the same price, pre-emption is established for the intercessor if the purchaser is from the patient by favoritism and the intercessor is foreign, and the option of the condition and the fault of the person suffering from the epidemic is not lost if there is an excuse such as loss of consciousness or the like.

Sex and age impact prevalence and symptoms of vasovagal syncope: Implications for accurate diagnosis

Syncope is characterized by the transient loss of consciousness followed by spontaneous recovery. The mechanism which underlies this condition is reduced blood flow to the brain [1]. Vasovagal syncope, often termed reflex syncope, is the most common type of syncope [1]. Vasovagal Syncope is caused by the abnormal autonomic reflex to certain stimuli such as pain, micturition/defecation, fear, seeing blood, etc., which results in vasodilation and often times, bradycardia [1].

Time to Loss of Behavioral and Brainstem Responses of Ducks following Non-Stunned Slaughter

Non-stunned slaughter has been extensively described for other farmed species but there has been limited research on waterfowl. The study assessed 34 White Pekin ducks (Anas platyrhynchos) (study 1) in a non-stunned halal slaughterhouse in Brazil for time to loss of consciousness using various behavioral and brainstem indices (balance, cranial nerve reflexes, and muscle tension) and assessed the relationship between extent of clotting, location of neck cut, level of damage to neck vessels/tissues, and the time to onset of unconsciousness. In addition, operator practices were separately observed and neck pathology following the cut was examined in 217 carcasses after bleeding (study 2). In study 1 following the neck cut there was a wide variation between birds in the time to loss of behavioral and brainstem indices, ranging from 20 to 334 and 20 to 383 s for neck and beak tension, respectively. The median time to loss of balance following the neck cut was 166 ± 14 (22–355) seconds. There was a moderate correlation (R = 0.60 and 0.62) between distance of the neck cut and time to loss of balance and neck tension, respectively. This is the first investigation of the time to loss of consciousness following non-stunned slaughter of ducks in commercial conditions. The findings could be used to improve the welfare of ducks during non-stunned slaughter, such as recommending performance of the neck cut closer to the jaw line and ensuring appropriate waiting periods between slaughter and birds entering the scalding tanks.

Epilepsy Due to Mild TBI in Children: An Experience at a Tertiary Referral Center

Rationale: Posttraumatic epilepsy (PTE) is a common cause of morbidity in children after a traumatic brain injury (TBI), occurring in 10–20% of children following severe TBI. PTE is diagnosed after two or more unprovoked seizures occurring 1-week post TBI. More often, studies have focused on children with epilepsy due to severe TBI. We aim to understand the utility of head computed tomography (HCT), EEG, and the risk of developing drug-resistant epilepsy in children after mild TBI. Method: We retrospectively studied 321 children with TBI at a tertiary pediatric referral center during a 10-year period. Mild TBI was defined as loss of consciousness (LOC) or amnesia < 30 min, moderate TBI as LOC or amnesia between 30 min and 1 day, and severe TBI as LOC or amnesia > 1 day, subdural hemorrhage, or contusion. Multiple clinical variables were reviewed, including past and present antiepileptic drug(s), seizure control, and mode of injury. First and subsequent post-TBI EEGs/prolonged video-EEGs were obtained acutely, subacutely, and/or chronically (range, day 1–3 years, median 1 month). Descriptive analyses were conducted using medians and ranges for continuous data. Categorical data were reported using frequencies and percentages, while comparisons between groups were made using Fisher’s exact test for small sample sizes. Results: Forty-seven children were diagnosed with posttraumatic epilepsy: eight children (17%) due to mild TBI, 39 children (83%) due to severe TBI. For the eight children with mild TBI whom all had an accidental trauma (non-inflicted), the median follow-up time was 25 months (range 1.5 months–84 months). The median age was 10 years (range 4–18 years), and the median age at the time of injury was seven years (range: 23 months–13 years). No relevant previous medical history was present for six patients (80%), and two patients’ (20%) relevant previous medical histories were unknown. Seven patients (88%) had no history of seizures, and patient #6 (12%) had unknown seizure history. Six patients (75%) had normal routine EEG(s). Patient #6 (13%) had an abnormal VEEG 3 months after the initial normal routine EEG, while patient #1 (13%) had an initial prolonged EEG 8 months after TBI. Compared to the 39 patients with severe TBI, 31 (79%) of whom had abnormal EEGs (routine and/or prolonged with video), mild TBI patients were more likely to have normal EEGs, p = 0.005. Head CT scans were obtained acutely for seven patients (90%), all of which were normal. One patient only had brain magnetic resonance imaging (MRI) 8 months after the injury. Compared to the 39 patients with severe TBI, all of whom had abnormal HCTs, mild TBI patients were less likely to have abnormal HCTs, p < 0.0001. In patients with mild TBI, no patient had both abnormal EEG/VEEG and HCT, and no one was on more than one Antiepileptic drug (AED), p < 0.005. Six patients (75%) had MRIs, of which five (63%) were normal. Two patients (#1, 7) did not have MRIs, while one patient’s (#4) MRI was unavailable. Five patients (63%) had a seizure <24 h post TBI, while the rest had seizures after the first week of injury. Conclusion: Children with epilepsy due to mild TBI, loss of consciousness, or amnesia < 30 min are more likely to have normal HCT and EEG and to be on 0–1 AED. Limitations of our study include the small sample size and retrospective design. The current findings add to the paucity of data in children who suffer from epilepsy due to mild TBI.