The effects of digital filtering on mismatch negativity in wakefulness and slow-wave sleep

The mismatch negativity (MMN) is a response to a deviant auditory stimulus that occurs infrequently in a sequence of otherwise repetitive, homogeneous standard auditory stimuli. The MMN is presumed automatic and independent of conscious awareness. Recording of the MMN during unconscious states may be problematic. The frequency content of the long-lasting MMN may overlap and summate with other event-related slow potentials and low-frequency background electroencephalogram (EEG) activity. The purpose of this study is to determine the optimal filter settings for recording the MMN during unconscious states. Auditory event-related potentials (ERPs) were recorded from eight subjects in an oddball paradigm during wakefulness and Stages 3 and 4 of sleep [slow-wave sleep (SWS)] using a 0.16-35 Hz analogue bandpass. Deviant probability was 0.033. Stimulus-onset asynchrony was 150 ms. The EEG data were subsequently digitally filtered in the frequency domain. The low-pass filter was set at either 24, 12 or 6 Hz, and the high-pass filter at either 1, 2, 3 or 4 Hz. Applying a low-pass filter down to 12 Hz had a minimal impact on the waking or sleeping MMN amplitude. On the other hand, increasing the high-pass setting from 2 to 3 Hz permitted the visualization of the MMN recorded during sleep. The 4 Hz filter showed a similar trend but also markedly attenuated the amplitude of the waking MMN. A high-pass setting of 3 Hz provides a reasonable compromise. It has only a slight effect on the MMN when the subject is conscious, but still attenuates most of the unwanted slow potential activity when the subject enters SWS.     

醒脑静注射液对脑出血病人高热昏迷的疗效观察

目的：观察醒脑静注射液对脑出血病人高热与意识障碍的疗效。方法：按随机分组法将100例有高热与意识障碍的脑出血病人随机分为治疗组及对照组,治疗组在常规方法上加用醒脑静注射液,对照组采用常规方法。结果：治疗组恢复时间明显短于对照组。结论：醒脑静注射液对脑出血高热及意识障碍有明显治疗效果。     

新型冠状病毒肺炎常见病症经方辨治纲要

《伤寒杂病论》为诊治传染性疾病并杂病提出了辨证纲领和治疗方法。根据张仲景学术思想,将新型冠状病毒肺炎按常见病症分类辨证用药。发热:寒湿郁肺证推荐处方葛根加半夏汤;湿热侵肺证推荐处方小柴胡汤合麻杏薏甘汤;疫毒闭肺证推荐处方麻杏石甘汤和大柴胡汤合白虎加人参汤。咳痰:痰热壅肺证推荐处方越婢汤合小陷胸汤合苇茎汤;痰湿阻肺证推荐处方小青龙汤合五苓散。喘息,实喘:寒水射肺证推荐处方射干麻黄汤合苓桂术甘汤;虚喘:肺肾气虚证推荐处方附子汤合防己黄芪汤合桂枝甘草龙骨牡蛎汤。大便秘结:实秘推荐处方大承气汤;虚秘推荐处方麻子仁丸合百合地黄汤合枳术丸。神昏:阳闭推荐处方白虎汤合大承气汤;阴闭推荐处方乌头汤合当归四逆汤;脱证推荐处方四逆汤合人参汤。     

Prognosis in Patients Presenting with Non-Traumatic Coma

Background: Studies of patients presenting with coma are limited, and little is known about the prognosis of these cases. Objective: The aim of this study was to investigate the acute and long-term prognosis after an episode of non-traumatic coma. Methods: Adults admitted consecutively to an emergency department in Stockholm, Sweden between February 2003 and May 2005 with a Glasgow Coma Scale (GCS) score of 10 or below were enrolled prospectively. All available data were used to explore the cause of the impaired consciousness on admission. Patients surviving hospitalization were followed-up for 2 years regarding survival. Results: The final study population of 865 patients had the following eight different coma etiologies: poisoning (n = 329), stroke (n = 213), epilepsy (n = 113), circulatory failure (n = 60), infection (n = 56), metabolic disorder (n = 44), respiratory insufficiency (n = 33), and intracranial malignancy (n = 17). The hospital mortality rate among the 865 patients was 26.5%, varying from 0.9% for epilepsy to 71.7% for circulatory failure. The accumulated total 2-year mortality rate was 43.0%, varying from 13.7% for poisoning to 88.2% for malignancy. The level of consciousness on admission also influenced the prognosis: a GCS score of 3–6 was associated with a significantly higher hospital mortality rate than a GCS score of 7–10. Conclusion: The prognosis in patients presenting with non-traumatic coma is serious and depends largely on both the level of consciousness on admission and the etiology of the coma. Adding the suspected coma etiology to the routine coma grading of these emergencies may more accurately predict their prognosis.     

芬太尼透皮贴剂引起意识丧失

1例59岁乳腺癌患者,因腰背部疼痛加剧,给予芬太尼透皮贴剂1贴（8.4 mg）。30 min后患者入睡,持续约4 h患者突然出现意识丧失,头向后上仰,颈项强直,四肢抽搐,双侧瞳孔缩小,对光反射迟钝,呼吸深、慢（6～7次/min）,脉搏血氧饱和度下降至0.77。考虑和芬太尼过量有关。立即去除芬太尼透皮贴剂,给予吸氧,静脉注射纳洛酮0.2 mg。之后,患者四肢抽搐缓解,呼吸升至18次/min,意识恢复,无肢体感觉、运动功能障碍。     

Fearful and sexual pictures not consciously seen modulate the startle reflex in human beings.

BACKGROUND: Animal and human studies consistently have demonstrated that the startle reflex elicited by intense auditory stimulation is enhanced by the previous presentation of fear-evoking stimuli. There is also growing and varied evidence of the nonconscious processing of fear stimuli in human beings eliciting brain and autonomic fear responses. METHODS: We report two studies using the startle probe paradigm and the backward-masking procedure to examine the modulation of the eye-blink component of the startle reflex by consciously and nonconsciously presented emotional pictures. RESULTS: Conscious and nonconscious presentation of fearful pictures amplified the magnitude of the startle reflex in both studies. The opposite tendency was observed for conscious and nonconscious presentation of sexually attractive pictures in the second study. CONCLUSIONS: These findings support the notion that negative (and possibly positive) biologically relevant stimuli can be nonconsciously processed, presumably via amygdala activation, and can affect behavioral responding.     

Unconsciousness after One Therapeutic Dose of Nalidixic Acid

Abstract Administration of a single dose of 2 g nalidixic acid to a young previously healthy woman led to three hours of unconsciousness combined with intracranial hypertension and hyperkinetics of the facial musculature. An unexpectedly high serum concentration of nalidixic acid was recorded during the period of unconsciousness. After omission of nalidixic acid, the symptoms were reversed without any persisting sequelae. To our knowledge, this type of adverse reaction has not been described previously.     

Median effective effect-site concentration of intravenous anesthetics for loss of consciousness in neoadjuvant chemotherapy patients

Background  In recent years, increasing numbers of patients are accepting neoadjuvant chemotherapy before their operation in order to get a better prognosis. But chemotherapy has many side-effects. We have observed that patients who accepted neoadjuvant chemotherapy are more sensitive to anesthetics. The aim of this study was to determine the median effective dose (EC₅₀) of intravenous anesthetics for neoadjuvant chemotherapy patients to lose consciousness during target-controlled infusion.

Methods  Two hundred and forty breast cancer patients undergoing elective operations were assigned to six groups according to treatment received before their operation and the use of intravenous anesthetics during anesthesia; non-adjuvant chemotherapy+propofol group (group NP, n=40), Taxol+propofol group (group TP, n=40), adriamycine+cyclophosphamide+5-Fu+propofol group (group CP, n=40), non-adjuvant chemotherapy+etomidate group (group NE, n=40), taxol+etomidate group (group TE, n=40), adriamycine+cyclophosphamide+5-Fu+etomidate group (group CE, n=40). We set the beginning effect-site concentration (Ce) of propofol as 3.0 μg/ml and etomidate as 0.2 μg/ml. The concentration was increased by steps until the patient was asleep, (OAAS class I–II), then gave fentanyl 3 μg/kg and rocuronium 0.6 mg/kg and intubated three minutes later. The patients’ age, height, and weight were recorded. BIS was recorded before induction, at the initial effect-site concentration and at loss of consciousness. The effect-site concentration was recorded when patient lost consciousness.

Results  There were no significant differences between groups in general conditions before treatment; such as BIS of consciousness, age, sex and body mass index. The EC₅₀ of propofol in the NP, TP and CP groups was 4.11 μg/ml (95% CI: 3.96–4.26), 2.94 μg/ml (95% CI: 3.36–3.47) and 2.91 μg/ml (95% CI: 3.35–3.86), respectively. The EC₅₀ of etomidate in the NE, TE and CE groups was 0.61 μg/ml (95% CI: 0.55–0.67), 0.38 μg/ml (95% CI: 0.33–0.44), and 0.35 μg/ml (95% CI: 0.34–0.36), respectively. There was no significant difference of BIS level before induction or in BIS50 level in any group when patients lost consciousness.

Conclusions  The EC₅₀ of intravenous anesthetics to cause loss of consciousness in neoadjuvant chemotherapy groups is lower than in the control group. There was no significant difference of BIS level at which patients lost consciousness.

     

Failure to demonstrate unconscious perception during balanced anaesthesia by postoperative motor response

Eighty patients undergoing a standardized balanced anaesthesia were randomly assigned to either a suggestion group (N = 38) or a control group (N = 42), in a double-blind design. Anaesthesia was maintained with nitrous oxide, enflurane and fentanyl. Patients in the suggestion group were played seaside sounds, interrupted by statements of the importance of touching the ear during a postoperative visit, by means of a prerecorded audiotape and headphones. Tapes containing these suggestions were played from 30 min after the first incision, for a duration of 15 min. Patients in the control group were only played seaside sounds. There were no significant differences between the groups in either the number of patients touching their ears postoperatively or the number and duration of ear touches.