Chronic brain stimulation rewarding experience ameliorates depression-induced cognitive deficits and restores aberrant plasticity in the prefrontal cortex

Background

Major depressive disorder (MDD) is a multifactorial disease which often coexists with cognitive deficits. Depression-induced cognitive deficits are known to be associated with aberrant reward processing, neurochemical and structural alterations. Recent studies have shown that chronic electrical stimulation of brain reward areas induces a robust antidepressant effect. However, the effects of repeated electrical self-stimulation of lateral hypothalamus - medial forebrain bundle (LH-MFB) on depression-induced cognitive deficits and associated neurochemical and structural alterations in the prefrontal cortex (PFC) are unknown.

Platelet-Rich Plasma Has Better Long-Term Results Than Corticosteroids or Placebo for Chronic Plantar Fasciitis: Randomized Control Trial

Plantar fasciitis is the most common cause of heel pain. Platelet-rich plasma (PRP) is a supersaturated concentration of autologous platelets that augments the natural healing response of fascia. Previous studies have shown the superiority of PRP over corticosteroids (CS) for chronic plantar fasciitis. The aim of this study was to compare the pain and functional outcomes of PRP with CS and placebo injections for the treatment of chronic plantar fasciitis. We conducted a 3-arm randomized controlled trial of 90 patients: PRP (n?=?30 patients), CS (n?=?30 patients), and placebo (n?=?30 patients). The patients were followed at regular intervals until 18 months postinjection using validated instruments. The mean visual analog scale score showed significant improvement in all groups between baseline and 18-month follow-up (PRP: 8.2 vs 2.1; CS: 8.8 vs 3.6; placebo: 8.1 vs 5.4), with CS showing significantly better improvement than PRP in the short term, whereas longer-term PRP was significantly better than CS. The mean Roles and Maudley score showed significant improvement in all groups between baseline and 18-month follow-up (PRP: 1.7 vs 3.7; CS: 1.2 vs 3.1; placebo: 1.2 vs 2.0), with CS showing significantly better improvement than PRP in the short term, whereas longer-term PRP was significantly better than CS. The mean Short Form 12 score showed significant improvement in all groups between baseline and 18-month follow-up (PRP: 55.4 vs 80.2; CS: 56.2 vs 76.2; placebo: 54.1 vs 62.4). We found that all 3 groups showed significant improvement between baseline and end of the follow-up period with regard to pain, function, and general health. The CS arm showed better improvement in the short term, whereas the PRP arm showed better results in the long term. In contrast to previous studies, we found no significant drop-off effect of CS in the long term, which may be owing to background natural healing process of the disease. In summary, both PRP and CS are safe and effective treatment options for chronic plantar fasciitis, showing superior results to placebo treatment. The longer-term results and less reinjection and/or surgery rate of PRP makes it more attractive as an injection treatment option versus CS injection.     

Heart-type fatty acid-binding protein: an overlooked cardiac biomarker

Abstract

Cardiac troponins (cTn) are currently the standard of care for the diagnosis of acute coronary syndromes (ACS) in patients presenting to the emergency department (ED) with chest pain (CP). However, their plasma kinetics necessitate a prolonged ED stay or overnight hospital admission, especially in those presenting early after CP onset. Moreover, ruling out ACS in low-risk patients requires prolonged ED observation or overnight hospital admission to allow serial measurements of c-Tn, adding cost. Heart-type fatty acid-binding protein (H-FABP) is a novel marker of myocardial injury with putative advantages over cTn. Being present in abundance in the myocellular cytoplasm, it is released rapidly (<1?h) after the onset of myocardial injury and could potentially play an important role in both earlier diagnosis of high-risk patients presenting early after CP onset, as well as in risk-stratifying low-risk patients rapidly. Like cTn, H-FABP also has a potential role as a prognostic marker in other conditions where the myocardial injury occurs, such as acute congestive heart failure (CHF) and acute pulmonary embolism (PE). This review provides an overview of the evidence examining the role of H-FABP in early diagnosis and risk stratification of patients with CP and in non-ACS conditions associated with myocardial injury.

• Key messages

• Heart-type fatty acid-binding protein is a biomarker that is elevated early in myocardial injury

• The routine use in the emergency department complements the use of troponins in ruling out acute coronary syndromes in patients presenting early with chest pain

• It also is useful in risk stratifying patients with other conditions such as heart failure and acute pulmonary embolism.

     

How we managed a difficult to ventilate patient

A 40-year-old female presented with respiratory difficulty, cough and sputum with blood streaking. Her right lung was destroyed, and trachea was shifted to the same side. On mechanical ventilation, she developed hypoxia and rise in blood pressure. Ventilator was not delivering set tidal volume. After looking into the cause, it was decided to reintubate the patient with new endotracheal tube after cutting bevel. Thereafter, there was successful ventilation.