Linking stages of non-rapid-eye-movement sleep to the spectral EEG markers of the drives for sleep and wake

The conventional staging classification reduces all patterns of sleep polysomnogram signals to a small number of yes-or-no variables labeled wake or a stage of sleep (e.g., W, N1, N2, N3, and R for wake, the 1st, 2nd and 3rd stages of non-rapid-eye-movement sleep, and rapid-eye-movement sleep, respectively). However, the neurobiological underpinnings of such stages remained to be elucidated. We tried to evaluate their link to scores on the 1st and 2nd principal components of the EEG spectrum (1PCS and 2PCS), the markers of two major groups of promoters/inhibitors of sleep/wakefulness delineated as the drives for sleep and wake, respectively. On two occasions, polysomnographic records were obtained from 69 university students during 50-min afternoon naps, and 30-s stage epochs were assigned to 1PCS and 2PCS. Results suggested two-dimensionality of the structure of individual differences in amounts of stages. Amount of N1 loaded exclusively on one of two dimensions associated with 1PCS, amounts of W and N2 loaded exclusively on another dimension associated with 2PCS, and amount of N3 equally loaded on both dimensions. Scores demonstrated stability within each stage, but a drastic change in just one of two scores occurred during transitions from one stage to another on the way from wakefulness to deeper sleep (e.g., 2PCS changed from >0 to <0 during transition W→N1, 1PCS changed from <0 to >0 during transition N1→N2). Therefore, the transitions between stages observed during short naps might be linked to rapid changes in the reciprocal interactions between the promoters/inhibitors of sleep/wakefulness.

Sarcoma

Sarcomas are malignant tumours of the soft tissues or bone. Epidemiology, aetiology, pathology, clinical features, investigations, diagnosis, staging, classification, and management of soft tissue sarcomas are described in this chapter. These tumours are relatively uncommon but require a systematic approach to treatment involving a multidisciplinary team.

Inspecting Management Strategies of Hepatocellular Carcinoma in a Tertiary Centre in Western Rajasthan

BACKGROUND Hepatocellular carcinoma (HCC) is a lethal malignancy which mostly develops in patients with cirrhosis. It is usually diagnosed late in the course of the illness and the median survival following diagnosis ranges between 6 - 20 months. India lacks data on management strategies and their efficacy. In the absence of data on treatment protocols and its adequacy; we evaluated our own centre data for a period of 1 year to get the estimate of incidence, aetiology, treatment adequacy and response to treatment. Barcelona Clinic Liver Cancer (BCLC) prognostic staging classification comprising five stages is used for prognostication, which is based on the extent of the primary lesion, performance status, vascular invasion and extrahepatic spread. Surgical therapies including resection and transplantation are feasible in early stages (BCLC stage 0 and stage A). Trans arterial chemoembolisation is recommended in intermediate stage (BCLC stage B) while systemic therapies are recommended in advanced stage (BCLC stage C). Best supportive care is recommended in terminal stage (BCLC stage D). This study has included BCLC staging for staging classification and patients were assessed for adequacy of management. METHODS This study was done as a retrospective hospital based observational study. All HCC patients presenting to Mahatma Gandhi Hospital attached to Dr. Sampurnanand Medical College, Jodhpur, Western Rajasthan from January to December 2014 were included. HCC was diagnosed based on European Association for the study of the Liver–European Organisation for Research and Treatment of Cancer (EASL–EORTC) clinical practice guidelines 2011. Patients were classified according to Barcelona Clinic Liver Cancer staging and management given was recorded. RESULTS Thirty-two patients who were diagnosed with HCC between January to December 2014 were included in the study. In three fourths of the patients (24) HCC was diagnosed based on typical findings on dynamic imaging studies (triple phase contrast enhanced CT-computed tomography abdomen and / or MRI- magnetic resonance imaging abdomen). Liver biopsy was needed in one fourth of the patients. Majority of the patients (87.5 %) had cirrhosis of the liver at the time of diagnosis of HCC. Some of these patients [5 (17.8 %)] were known cirrhotic patients. CONCLUSIONS Hepatitis B was the most common aetiology of HCC as mentioned previously in other studies, which is vaccine preventable. HCC is rarely diagnosed at an early stage in developing countries. Various treatment modalities are available which depend on the stage, local expertise and affordability. If the surveillance recommendations are strictly adhered,HCC can be diagnosed at an early stage. Affordability and compliance will remain issues in HCC management in our country increasing the socio-economic burden on the society. KEY WORDS Hepatocellular Carcinoma (HCC), BCLC Staging, Survival

Delayed Improvement of Depression and Anxiety after Transcatheter Aortic Valve Implantation (TAVI) in Stages of Extended Extra-Valvular Cardiac Damage

Background: Depression and anxiety are frequently occurring and likely to be linked to the severity of cardiac diseases like aortic stenosis (AS). This seems to be of interest since a staging classification of extra-valvular cardiac damage in AS has been introduced and shown to be of prognostic relevance. Objective: The current study aimed to investigate the frequency of depression and anxiety in association to staging and their dynamics after transcatheter aortic valve implantation (TAVI). Methods: A total number of 224 AS patients undergoing TAVI were classified according to the 2017 staging classification into stage 0 to 4 and further dichotomized into group A (stage 0 to 2) and B (stage 3 and 4). Using the Hospital Anxiety and Depression Scale (HADS-D), patients were assigned to depressive versus non-depressive or anxious versus non-anxious per staging group respectively, and analyzed at baseline, 6 weeks, 6 months and 12 months after TAVI. Results: After dichotomization, 158 patients (70.5%) were assigned to group A and 66 patients (29.5%) to group B. The part showing pathologic values for depression was 25.4% (57/224 patients) in the entire collective, 26.6% (42/158 patients) in group A and 22.7% (15/66 patients) in group B (p = n.s.). The proportion showing pathologic values for anxiety was 26.8% (60/224 patients) in the entire collective and did not differ between group A (24.7%, 39/158 patients) and B (31.8%, 21/66 patients) (p = n.s.). In patients revealing pathologic values for depression or anxiety prior to TAVI, there were significant and stable improvements over time observable already in short-term (6 weeks) follow-up in group A, and likewise, but later, in long-term (6/12 months) follow-up in group B. Conclusions: Although of proven prognostic relevance, higher stages of extra-valvular cardiac damage are not associated with higher rates of pre-existing depression or anxiety. The TAVI procedure resulted in a persisting reduction of depression and anxiety in patients showing pathologic values at baseline. Notably, these improvements are timely delayed in higher stages.