An unusual presentation of peripartum cardiomyopathy: Recurrent transient ischemic attacks

Peripartum cardiomyopathy (PPCM) is a rare form of dilated cardiomyopathy that is associated with high maternal morbidity and mortality. Onset is usually between the last month of pregnancy and up to the fifth month postpartum. PPCM usually presents with signs and symptoms of heart failure and rarely with thromboembolic complications. The true incidence of thromboemboli in PPCM is unknown. Herein we report an unusual case of PPCM in a previously healthy woman who presented with recurrent transient ischemic attacks due to thrombus in the left ventricle.     

一种抗CPS控制层欺骗攻击的算法

信息物理系统(CPS)在原本的工控系统中加入了计算单元,使攻击者能够通过对该网络进行攻击。本文考虑攻击者通过恶意篡改信道中传输的传感器测量数据,使计算单元无法根据测量值对物理环境做出正确决策。通过改进针对CPS控制层欺骗攻击的卡尔曼滤波器算法,使改进后的算法对多种类型的欺骗攻击都有较好的检测性能,并能在一定程度上恢复被篡改的数据。本文使用改进算法对田纳西伊斯曼过程中反应釜内的压强测量值进行攻击检测,并与原算法进行比较,通过实验可以验证改进后算法对偏差型和几何型攻击的检测和恢复效果明显优于原算法。     

Effectiveness of intratympanic dexamethasone for the treatment of vertigo attacks in patients with Ménière’s disease compared with betahistine pharmacotherapy

ObjectiveThis study analyzed the possible effects of intratympanic steroid (ITS) therapy in the symptomatic treatment of vertigo attacks in patients with Ménière’s disease.MethodsThirty-five patients treated with ITS (dexamethasone) plus betahistine (Group A) and 35 patients treated with betahistine alone (Group B) were enrolled in this investigation. Complaints were analyzed using medical records and vertigo diaries. Statistical analysis was conducted using IBM SPSS V24 software.ResultsBased on the analysis, there were no significant differences in baseline features between the two groups. When the occurrence of vertigo attacks was compared using the Kaplan–Meier method, no significant difference was detected between Groups A and B (odds ratio [OR] = 1.051, 95% confidence interval [CI] = 0.965–1.067; p = 0.972). In addition, no difference in the incidence of vertigo attacks was noted in group A between the periods of treatment with betahistine alone and betahistine plus ITS when the groups were analyzed via logistic regression (OR = 1.07, 95% CI = 0.065–1.467; p = 0.614).ConclusionIt can be concluded that the addition of ITS therapy to betahistine did not improve outcomes in patients with Ménière’s disease. Further prospective studies should be conducted to analyze the results in a more detailed manner.     

Pseudo subclavian steal syndrome: Case report

IntroductionVertebrobasilar insufficiency (VBI) is a condition that results from restricted blood flow to the posterior portions of the brain, which are primarily served by the vertebral and basilar arteries. It is the most common cause of vertigo in the elderly and is usually accompanied by impaired vision and sensation. Congenital abnormalities, atherosclerosis, stroke and/or trauma may all lead to decreased vertebrobasilar circulation. A syndrome called Subclavian Steal Syndrome (SSS), which manifests with similar neurological symptoms but with a different pathophysiology, may also cause VBI.Case presentationA middle-aged female presented with gradual onset fainting and vertigo attacks. Cardiac, auditory and autonomic etiologies were investigated and excluded. Clinical findings and presentation were highly suggestive of subclavian steal. However, subsequent CT angiography showed normal subclavian arteries. Instead, findings included a persistent right trigeminal artery (PTA), stenosis of the right proximal internal carotid artery, atresis of the left vertebral artery and distal segment of right vertebral artery, congenitally compromised changes in vertebral circulation (bilateral absence of the posterior communicating arteries (PCOMs)) and an absent anterograde vertebrobasilar circulation. Symptoms resolved after carotid endarterectomy.DiscussionDue to the absence of a normally developed posterior circulation, the PTA was the main source of blood supply for the patient. Development of recent artheromatous changes in the right internal carotid artery, however, resulted in decreased blood through PTA, further compromising posterior circulation. This resulted in vertebrobasilar insufficiency, and manifested in symptomology similar to SSS.ConclusionsThis clinical encounter illustrates the relative contribution of anatomical and vasoocclusive factors in closely mimicking symptoms of subclavian steal syndrome.     

老年短暂性脑缺血患者颈动脉结构与血流动力学参数对认知功能的影响

目的：探讨老年短暂性脑缺血(TIA)患者颈动脉结构与血流动力学参数对认知功能的影响。方法48例老年TIA患者均接受超声检查,并接受简易精神状态检查(MMSE)评分及威斯康星卡片分类测验(WCST)评测。根据患者颈动脉狭窄程度将其分为无狭窄-轻度狭窄组(32例)及中重度狭窄组(16例),观察患者颈动脉狭窄及血流动力学指标,比较不同程度颈动脉狭窄患者MMSE评分及WCST各项指标的差异。结果(1)无狭窄-轻度狭窄者血流速度(PSV)显著高于中重度狭窄者,搏动指数(PI)、阻力指数(RI)显著低于中重度狭窄者,差异均有统计学意义(P<0.05);(2)无狭窄-轻度狭窄者MMSE评分为(27.65±7.86)分,显著高于中重度狭窄者的(24.56±6.54)分,差异有统计学意义(P<0.05);WCST各项指标比较,无狭窄-轻度狭窄者完成分类数、概念化水平显著高于WCST中重度狭窄者,错误应答数、持续性错误数及持续性应答数显著低于中重度狭窄者,差异均有统计学意义(P<0.05);(3)颈动脉狭窄程度与MMSE评分存在显著负相关(r=-0.393,P<0.05),与WCST指标持续性应答数间存在显著正相关(r=0.423,P<0.05)。血流动力学指标PSV与MMSE评分存在显著负相关(r=-0.411,P<0.05),与WCST指标持续性应答数间存在显著正相关(r=0.402,-0.05)。结论老年TIA颈动脉狭窄及血流动力学指标与其认知功能间关系密切,颈动脉狭窄程度越重,血流动力学指标改变越明显,患者认知功能障碍越严重。     

Stop violence against medical workers in China

The incidence of patient-doctor disputes are alarmingly increasing in China, this article reviews the current status and causes of violence against medical workers in China, six strategies to tackle the daily worrying problems have been proposed and hopefully could improve the medical working environment in China.     

Negative affect and smoking motives sequentially mediate the effect of panic attacks on tobacco-relevant processes

Introduction: Empirical work has documented a robust and consistent relation between panic attacks and smoking behavior. Theoretical models posit smokers with panic attacks may rely on smoking to help them manage chronically elevated negative affect due to uncomfortable bodily states, which may explain higher levels of nicotine dependence and quit problems. Methods: The current study examined the effects of panic attack history on nicotine dependence, perceived barriers for quitting, smoking inflexibility when emotionally distressed, and expired carbon monoxide among 461 treatment-seeking smokers. A multiple mediator path model was evaluated to examine the indirect effects of negative affect and negative affect reduction motives as mediators of the panic attack-smoking relations. Results: Panic attack history was indirectly related to greater levels of nicotine dependence (b?=?0.039, CI_95%?=?0.008, 0.097), perceived barriers to smoking cessation (b?=?0.195, CI_95%?=?0.043, 0.479), smoking inflexibility/avoidance when emotionally distressed (b?=?0.188, CI_95%?=?0.041, 0.445), and higher levels of expired carbon monoxide (b?=?0.071, CI_95%?=?0.010, 0.230) through the sequential effects of negative affect and negative affect smoking motives. Conclusions: The present results provide empirical support for the sequential mediating role of negative affect and smoking motives for negative affect reduction in the relation between panic attacks and a variety of smoking variables in treatment-seeking smokers. These mediating variables are likely important processes to address in smoking cessation treatment, especially in panic-vulnerable smokers.     

Twin Studies of Suicidal Behavior

Research on twin studies of suicidal behavior are reviewed. No Methodologically sound study on twins reared apart has et appeared, and so firm conclusions cannot be drawn from the research. Monozygotic twins reared together do appear to have higher concordance rates for suicide than dizygotic twins reared together. Confounding factors are discussed and suggestions made for future research.     

The neural processing of voluntary completed,real and virtual violent and nonviolent computer game scenarios displaying predefined actions in gamers and nongamers

Abstract

Studies investigating the effects of violent computer and video game playing have resulted in heterogeneous outcomes. It has been assumed that there is a decreased ability to differentiate between virtuality and reality in people that play these games intensively. FMRI data of a group of young males with (gamers) and without (controls) a history of long-term violent computer game playing experience were obtained during the presentation of computer game and realistic video sequences. In gamers the processing of real violence in contrast to nonviolence produced activation clusters in right inferior frontal, left lingual and superior temporal brain regions. Virtual violence activated a network comprising bilateral inferior frontal, occipital, postcentral, right middle temporal, and left fusiform regions. Control participants showed extended left frontal, insula and superior frontal activations during the processing of real, and posterior activations during the processing of virtual violent scenarios. The data suggest that the ability to differentiate automatically between real and virtual violence has not been diminished by a long-term history of violent video game play, nor have gamers' neural responses to real violence in particular been subject to desensitization processes. However, analyses of individual data indicated that group-related analyses reflect only a small part of actual individual different neural network involvement, suggesting that the consideration of individual learning history is sufficient for the present discussion.     

De novo psychogenic nonepileptic attacks after adult epilepsy surgery: An underestimated entity

We retrospectively assessed all patients in a large cohort of patients with epilepsy surgery at the National Hospital for Neurology and Neurosurgery (NHNN) over 12 years, to identify patients with postoperative psychogenic nonepileptic attacks (PNEA). Twenty‐nine patients (23 women) were identified of a total of 790 patients, a frequency of 3.7%. Female gender and presurgical psychiatric diagnosis, other than psychosis, were significant risk factors for PNEA development. In female patients with a preoperative psychiatric diagnosis the chance of developing PNEA after epilepsy surgery was 8.5%. PNEA developed between 2 weeks and 10 years after epilepsy surgery, independently of outcome of epileptic seizures. In most cases, PNEA differed from the present or past epileptic seizures, and motor symptoms were the most common manifestations. Seizures after epilepsy surgery should be carefully evaluated. Physicians should consider the possibility of PNEA, especially in female patients with preoperative psychiatric comorbidity developing “atypical” seizures with motor manifestations postoperatively, even many years after epilepsy surgery.