Intra-hospital Transport of Brain-Injured Patients: A Prospective, Observational Study

Introduction

Discrepant data exist regarding the incidence and severity of clinical problems related to intra-hospital transport of brain-injured patients and no consensus exists whether modern-day intra-hospital transport represents a safe or potentially problematic environment for neurointensive care unit (NICU) patients.

Methods

We examined the incidence of clinical complications and physiological derangements that occurred in 160 neurologically injured patients (90 males, 70 females, mean age 57 ± 17 years) who underwent intra-hospital transport (288 cases, 237 scheduled, 51 unscheduled) for computed tomography scans.

Results

Our findings indicate that (1) at least one significant complication (predominantly hemodynamic) occurred in over one-third (36 %) of all transports (p = n.s scheduled vs. unscheduled) necessitating the deployment of interventions designed to treat changes in arterial pressure (2) despite the presence of trained medical personnel and availability of specialized equipment, intra-cranial pressure was not adequately monitored during transports (especially in patients with intra-cranial hypertension prior to transport) (3) intra-hospital transfer was associated with minor but statistically significant clinical changes, including a reduction in arterial partial pressure of oxygen ( $ {\text{Pa}}_{{{\text{O}}_{ 2} }} $ )/inspired oxygen fraction ( $ {\text{Fi}}_{{{\text{O}}_{ 2} }} $ ) (only in the scheduled transport population), decreased arterial lactate levels (scheduled transport population), lowered body temperature (scheduled transport population), and increased arterial partial pressure of carbon dioxide ( $ {\text{Pa}}_{{{\text{CO}}_{ 2} }} $ ) (scheduled transport population).

Conclusions

Intra-hospital transport of brain-injured NICU patients may present some hazards even if performed by skilled personnel with specialized equipment. In Trauma Centers such as ours, an improvement in the frequency of neuromonitoring [intra-cranial pressure (ICP) and end-tidal CO₂ ( $ {\text{ET}}_{{{\text{CO}}_{ 2} }} $ )] during transport is recommended.     

Infarct Volume After Hyperacute Infusion of Hypertonic Saline in a Rat Model of Acute Embolic Stroke

Introduction

Hypertonic saline (HS) can treat cerebral edema arising from a number of pathologic conditions. However, physicians are reluctant to use it during the first 24 h after stroke because of experimental evidence that it increases infarct volume when administered early after reperfusion. Here, we determined the effect of HS on infarct size in an embolic clot model without planned reperfusion.

Methods

A clot was injected into the internal carotid artery of male Wistar rats to reduce perfusion in the middle cerebral artery territory to less than 40 % of baseline, as monitored by laser-Doppler flowmetry. After 25 min, rats were randomized to receive 10 mL/kg of 7.5 % HS (50:50 chloride:acetate) or normal saline (NS) followed by a 0.5 mL/h infusion of the same solution for 22 h.

Results

Infarct volume was similar between NS and HS groups (in mm³: cortex 102 ± 65 mm³ vs. 93 ± 49 mm³, p = 0.72; caudoputamenal complex 15 ± 9 mm³ vs. 21 ± 14, p = 0.22; total hemisphere 119 ± 76 mm³ vs. 114 ± 62, p = 0.88, respectively). Percent water content was unchanged in the infarcted hemisphere (NS 81.6 ± 1.5 %; HS 80.7 ± 1.3 %, p = 0.16), whereas the HS-treated contralateral hemisphere was significantly dehydrated (NS 79.4 ± 0.8 %; HS 77.5 ± 0.8 %, p < 0.01).

Conclusions

HS reduced contralateral hemispheric water content but did not affect ipsilateral brain water content when compared to NS. Infarct volume was unaffected by HS administration at all evaluated locations.     

Diffusion-weighted imaging in Sydenham’s chorea

Purpose

The purpose of this study was to determine of caudate nucleus changes in diffusion-weighted magnetic resonance imaging.

Methods

A total of 13 children (four males and nine females) with history of Sydenham’s chorea and 13 healthy controls were included in to the study. Diffusion cranial magnetic resonance imaging was performed in all subjects before prednisone treatment. Prednisone (2 mg/kg/day, maximum dose 60 mg/day) was used during 4 weeks and then progressively discontinued (20 % of the initial dose was reduced at each 5 days). Two months later, magnetic resonance imaging was repeated.

Results

Before and after 8 weeks of prednisone treatment, apparent diffusion coefficients (ADCs) were calculated for right and left caudate nucleus. The ADC values were significantly different before treatment and 2 months after imaging. For the left caudate nucleus, ADC values before treatment (0.69?±?0.038) were significantly lower than after treatment (0.95?±?0.04). For the right caudate nucleus, ADC values before treatment (0.72?±?0.06?×?10^?3) were significantly lower than after treatment (0.93?±?0.04?×?10^?3).

Conclusions

Although cranial and caudate nucleus magnetic resonance imaging findings were normal, the low ADC value findings in our study support the autoimmune inflammation in basal ganglia of Sydenham’s chorea.     

Clinical and CN-SFEMG evaluation of neostigmine test in myasthenia gravis

Neostigmine test (NT) is a pharmacological test, demonstrating a clinical improvement in patients affected by myasthenia gravis (MG). We aim to compare clinical evaluation and neurophysiological recordings by concentric-needle single-fiber electromyography (CN-SFEMG) in response to acute administration of neostigmine in ocular and generalized MG patients. Twenty-three MG patients (10 with ocular MG and 13 with generalized MG) were evaluated before and after 90 min neostigmine 0.5-mg administration. Clinical responsiveness was assessed by MG composite (MGC) scale. Neurophysiological evaluation by CN-SFEMG considered analysis of mean value of consecutive differences (MCD), single-pair jitter, and blocks. MGC scores significantly improved after NT in generalized MG patients (MGC 11.1?±?7.6 vs 9.1?±?6.7, p?=?0.02), whereas the improvement was not significant in the ocular group. CN-SFEMG recordings significantly improved after NT in generalized MG patients (MCD 58.9?±?18.8 vs 45.9?±?23.2 μs, p?=?0.003; single-pair jitter 49.8?±?26.9 vs 24.1?±?26.7%, p?=?0.0001; blocks 6.2?±?9.5 vs 2.6?±?7.4%, p?=?0.03) as well as in ocular MG patients (MCD 50.8?±?22.7 vs 40.1?±?22.9 μs, p?=?0.01; single-pair jitter 35.9?±?23.7 vs 20.0?±?25.1%, p?=?0.001). CN-SFEMG is a reliable tool to evaluate responsiveness to acute administration of neostigmine in MG. Moreover, neurophysiological modifications to NT could show subclinical improvement in ocular MG better than that of the clinical scale.     

Elevated resting heart rate and reduced orthostatic tolerance in obese humans

Background

Obesity is linked with numerous physiological impairments; however, its impact on orthostatic tolerance (OT) remains unknown. This study tested the hypothesis that OT is reduced in obese individuals, and that reduced heart rate (HR) reserve and impaired cerebral autoregulation contribute to impaired OT.

Methods

Eleven obese (8 females) and 22 non-obese (10 females) individuals were exposed to incremental lower body negative pressure (LBNP) to presyncope while HR, arterial blood pressure, and cerebral perfusion (middle cerebral artery blood velocity; MCA V _mean) were measured. OT was quantified with a cumulative stress index (CSI).

Results

OT was reduced in obese subjects, and there was an inverse relationship between body mass index (BMI) and OT (R = ?0.47). HR was higher at rest and during each level of LBNP completed by all subjects. Similar peak HR (HR_peak) during LBNP between obese and non-obese subjects resulted in obese having a higher %peak HR at rest and at each stage of LBNP compared. Relationships existed for BMI and resting %HR_peak (R = 0.45) and resting %HR_peak and CSI (R = ?0.52). Despite lower CSI in obese, MCA V _mean and indices of cerebral autoregulation were similar between groups at all time points.

Conclusions

These data suggest that OT is reduced in obese and a higher resting HR, but not impaired regulation of cerebral perfusion, may contribute to this reduction.     

Sympathetic cardiovascular hyperactivity precedes brain death

Objective

The time preceding brain death is associated with complex dysregulation including autonomic dysfunction that may compromise organ perfusion, thus inducing final organ failure. In this study, we assessed autonomic function in patients prior to brain death.

Methods

In 5 patients (2 women, median 60 years, age range 52–75 years) with fatal cerebral hemorrhage or stroke and negative prognosis, we monitored RR-intervals (RRI), systolic and diastolic blood pressure (BP), and oxygen saturation. Adjustment of mechanical ventilation remained constant. We assessed autonomic function from spectral powers of RRI and BP in the mainly sympathetic low- (LF, 0.04–0.15 Hz) and parasympathetic high-frequencies (HF, 0.15–0.5 Hz), and calculated the RRI-LF/HF-ratio as index of sympathovagal balance. Three patients required norepinephrine (0.5–1.6 mg/h) for up to 72 h to maintain organ perfusion. Norepinephrine was reduced to 0.2–0.5 mg/h within 2 h before brain death was diagnosed according to the criteria of the German Medical Association. Wilcoxon test compared average values of ten 2-min epochs determined 2–3 h (measurement 1) and 1 h (measurement 2) before brain death.

Results

We found higher systolic (127.3 ± 15.9 vs. 159.4 ± 44.8 mmHg) and diastolic BP (60.1 ± 15.6 vs. 74.0 ± 15.2 mmHg), RRI-LF/HF-ratio (1.2 ± 1.6 vs. 3.9 ± 4.0), and BP-LF-powers (2.7 ± 4.8 vs. 23.1 ± 28.3 mmHg²) during measurement 2 than during measurement 1 (p < 0.05).

Conclusions

The increase in BPs, in sympathetically mediated BP-LF-powers, and in the RRI-LF/HF-ratio suggests prominent sympathetic activity shortly before brain death. Prefinal sympathetic hyperactivity might cause final organ failure with catecholamine-induced tissue damage which impedes post-mortem organ transplantation.     

Results of posterior cranial vault remodeling for plagiocephaly and brachycephaly by the meander technique

Objective

Several techniques to remodel the posterior calvarium in order to increase intracranial volume (ICV) and to improve cosmetic appearance are reported. This study presents the results of meander technique in patients with brachycephaly and posterior plagiocephaly.

Methods

During December 2011 and July 2013, a total of 12 children (median age: 15 months) underwent posterior cranial vault remodeling by the meander technique (brachycephaly, n?=?6; posterior plagiocephaly, n?=?6). The available pre- and postoperative MRIs were assessed with regard to ICV, cranial index (CI) and asymmetry index (AI) as well as the position of the cerebellar tonsils.

Results

No intra- or postoperative complications were observed. Blood transfusions were necessary in nine of 12 patients. A significant increase of the ICV from 1,178.4?±?134.5 to 1,293.0?±?137.5 cm³ (p?p?p?p?p?p?Conclusion The presented surgical technique is considered to be safe. The technique is capable to significantly increase ICV and improve cosmetic appearance of the remodeled calvarium. Further evidence that posterior cranial vault remodeling influences the position of the cerebellar tonsils is added by the results of the study.     

The role of weather conditions and normal level of air pollution in appearance of stroke in the region of Southeast Europe

We investigated correlation between the normal level of air pollution, weather conditions and stroke occurrence in the region of Southeast Europe with a humid continental climate. This retrospective study included 1963 patients, 1712 (87.2%) with ischemic (IS) and 251 (12.8%) with hemorrhagic stroke (HS) admitted to emergency department. The number of patients, values of weather condition (meteorological parameters) [air temperature (°C), atmospheric pressure (kPa), relative humidity (%)] and concentrations of air pollutants [particulate matter (PM₁₀), nitrogen dioxide (NO₂), ozone (O₃)], were recorded and evaluated for each season (spring, summer, autumn, winter) during 2 years (July 2008–June 2010). The highest rate of IS was observed during spring (28.9%) (p = 0.0002) and HS in winter (33.9%) (p = 0.0006). We have found negative Spearman’s correlations (after Bonferroni adjustment for the multiple correlations) of the number of males with values of relative humidity (%) (day 0, rho = ? 0.15), the total number of strokes (day 2, rho = ? 0.12), females (day 2, rho = ? 0.12) and IS (day 2, rho = ? 0.13) with concentrations of PM₁₀ (µg/m³), as well as negative correlations of the number of females (day 2, rho = ? 0.12) and IS (day 2, rho = ? 0.12) with concentrations of NO₂ (µg/m³) (for all p < 0.002). In winter, the number of HS (day 0, rho = 0.25, p = 0.001) positively correlated with concentrations of O₃ (µg/m³). The appearance of stroke has seasonal variations, with the highest rates during spring and winter. Positive correlation between the number of HS and values of O₃ requires an additional reduction of the legally permitted pollutants concentrations.     

Exercise effects in Huntington disease

Huntington disease (HD) is a relentlessly progressive neurodegenerative disorder with symptoms across a wide range of neurological domains, including cognitive and motor dysfunction. There is still no causative treatment for HD but environmental factors such as passive lifestyle may modulate disease onset and progression. In humans, multidisciplinary rehabilitation has a positive impact on cognitive functions. However, a specific role for exercise as a component of an environmental enrichment effect has been difficult to demonstrate. We aimed at investigating whether endurance training (ET) stabilizes the progression of motor and cognitive dysfunction and ameliorates cardiovascular function in HD patients. Twelve male HD patients (mean ± SD, 54.8 ± 7.1 years) and twelve male controls (49.1 ± 6.8 years) completed 26 weeks of endurance training. Before and after the training intervention, clinical assessments, exercise physiological tests, and a body composition measurement were conducted and a muscle biopsy was taken from M. vastus lateralis. To examine the natural course of the disease, HD patients were additionally assessed 6 months prior to ET. During the ET period, there was a motor deficit stabilization as indicated by the Unified Huntington’s Disease Rating Scale motor section score in HD patients (baseline: 18.6 ± 9.2, pre-training: 26.0 ± 13.7, post-training: 26.8 ± 16.4). Peak oxygen uptake (\(\dot{V}{\text{O}}_{{ 2 {\text{peak}}}}\)) significantly increased in HD patients (?\(\dot{V}{\text{O}}_{{ 2 {\text{peak}}}}\) = +0.33 ± 0.28 l) and controls (?\(\dot{V}{\text{O}}_{{ 2 {\text{peak}}}}\) = +0.29 ± 0.41 l). No adverse effects of the training intervention were reported. Our results confirm that HD patients are amenable to a specific exercise-induced therapeutic strategy indicated by an increased cardiovascular function and a stabilization of motor function.     

Efficacy of Selective Brain Cooling Using a Nasopharyngeal Method in Piglets

Background

Mild hypothermia is an effective neuroprotective strategy for a variety of acute brain injuries. Cooling the nasopharynx may offer the capability to cool the brain selectively due to anatomic proximity of the internal carotid artery to the cavernous sinus. This study investigated the feasibility and efficiency of nasopharyngeal brain cooling by continuously blowing room temperature or cold air at different flow rates into the nostrils of normal newborn piglets.

Methods

Experiments were conducted on thirty piglets (n = 30, weight = 2.7 ± 1.5 kg). Piglets were anesthetized with 1–2 % isoflurane and were randomized to receive one of four different nasopharyngeal cooling treatments: I. Room temperature at a flow rate of 3–4 L min^?1 (n = 6); II. ?1 ± 2 °C at a flow rate of 3–4 L min^?1 (n = 6); III. Room temperature at a flow rate of 14–15 L min^?1 (n = 6); IV. ?8 ± 2 °C at a flow rate of 14–15 L min^?1 (n = 6). To control for the normal thermal regulatory response of piglets without nasopharyngeal cooling, a control group of piglets (n = 6) had their brain temperature monitored without nasopharyngeal cooling. The duration of treatment was 60 min, with additional 30 min of observation.

Results

In group I, median cooling rate was 1.7 ± 0.9 °C/h by setting the flow rate of room temperature air to 3–4 L min^?1. Results of comparing different temperatures and flow rates in the nasopharyngeal cooling approach reveal that the brain temperature could be reduced rapidly at a rate of 5.5 ± 1.1 °C/h by blowing ?8 ± 2 °C air at a flow rate of 14–15 L min^?1.

Conclusions

Nasopharyngeal cooling via cooled insufflated air can lower the brain temperature, with higher flows and lower temperatures of insufflated air being more effective.

     

Ventriculosubgaleal shunt in the treatment of posthemorrhagic and postinfectious hydrocephalus of premature infants

Purpose

The aim of the study was to compare the characteristics of ventriculosubgaleal shunts during the clinical course of posthemorrhagic and postinfectious hydrocephalus in the neonatal period.

Patients and methods

The study comprised 102 premature babies in whom subgaleal shunt was consecutively inserted between 2006 and 2011. Seventy-two patients had posthemorrhagic hydrocephalus (mean gestational age 27.3?±?2.1 weeks, mean birth weight 1,036.9?±?327.7 g, mean age at insertion 51.4?±?56.2 days) and 30 patients were operated postinfectiously (27.5?±?2.2 weeks, 1,064.7 g?±?310.7 g, 115.9?±?47.8 days).

Results

The mean survival of subgaleal shunts was 87.9 days for the posthemorrhagic group and 75.6 days for the postinfectious group. Only six infants (8.3 %) did not need ventriculoperitoneal shunts later, all posthemorrhagic. There were meaningful differences between two groups with regard to ventriculosubgaleal shunt-related infections (8.3 % in posthemorrhagic versus 20.0 % in postinfectious) and shunt revision rate (6.9 % in posthemorrhagic versus 13.3 % in postinfectious), but these were not statistically significant. The need of ventriculoscopic procedures was notably more frequent in postinfectious group (1.4 versus 23.3 %).

Conclusion

In premature infants with ventriculomegaly, the subgaleal shunt is an effective temporary diversion tool. The complications were less with posthemorrhagic than with postinfectious hydrocephalus. With previous severe infections of prematures, the risk for complications regarding infection and obstruction will be 2.75 and 2.06 (odds ratios) times higher and more frequent need of ventriculoscopic procedures should be considered (odds ratio 21.6).     

Computer-Delivered Social Norm Message Increases Pain Tolerance

Background

Few experimental studies have been conducted on social determinants of pain tolerance.

Purpose

This study tests a brief, computer-delivered social norm message for increasing pain tolerance.

Methods

Healthy young adults (N?=?260; 44 % Caucasian; 27 % Hispanic) were randomly assigned into a 2 (social norm)?×?2 (challenge) cold pressor study, stratified by gender. They received standard instructions or standard instructions plus a message that contained artifically elevated information about typical performance of others.

Results

Those receiving a social norm message displayed significantly higher pain tolerance, F(1, 255)?=?26.95, p?<?.001, η _p ² ?=?.10 and pain threshold F(1, 244)?=?9.81, p?=?.002, η _p ² ?=?.04, but comparable pain intensity, p?>?.05. There were no interactions between condition and gender on any outcome variables, p?>?.05.

Conclusions

Social norms can significantly increase pain tolerance, even with a brief verbal message delivered by a video.     

Normative data for fetal cisterna magna length measurement between 18 and 24 weeks of pregnancy

Purpose

The aim of this study was to determine normative data for fetal cisterna magna length (CML) measurement in a Brazilian population.

Methods

This was a retrospective cross-sectional study on 3,862 normal singleton pregnancies between the 18th and 24th weeks of pregnancy. Fetal CML was measured in the axial plane of the fetal head, at lateral ventricle level, including the cavum septum pellucidum, thalamus, third ventricle, and transverse cerebellar diameter. The anteroposterior measurement was made between the posterior border of the cerebellar vermis and the internal face of the occipital bone. To assess the correlation between CML and gestational age (GA), polynomial equations were calculated, with adjustments using determination coefficient (R ²).

Results

The mean CML ranged from 4.29?±?0.93 mm at 18 to 18?+?6 weeks to 5.58?±?1.23 mm at 24 to 24?+?6 weeks of pregnancy. There was a good correlation between CML and GA, best represented by a linear equation: CML?=?0.535?+?0.208*GA (R ²?=?0.084).

Conclusion

We established normative data for fetal CML in the second trimester of pregnancy, in a large Brazilian population.     

Fronto-cerebellar fiber tractography in pediatric patients following posterior fossa tumor surgery

Objective

Fronto-cerebellar association fibers (FCF) are involved in neurocognitive regulatory circuitry. This may also be relevant for cerebellar mutism syndrome (CMS) as a complication following posterior fossa tumor removal in children. In the present study, we investigated FCF by diffusion tensor imaging in affected children and controls.

Methods

Diffusion-weighted MR imaging at 3 T (GE) allowed tractography of FCF using a fiber tracking algorithm software (Brainlab 2.6) in 29 patients after posterior fossa tumor removal and in 10 healthy peers. Fiber tract volumes were assessed and fiber signals were evaluated in a semiquantitative manner along the anatomical course.

Results

Volumes of FCF revealed significant diminished values in pediatric patients with symptoms of CMS (19.3?±?11.7 cm³) when compared with patients without symptoms of CMS (26.9?±?11.9 cm³) and with healthy peers (36.5?±?13.82 cm³). In medulloblastoma patients, the volume of FCF was also significantly reduced in patients with symptoms of CMS despite having the same antitumor therapy. In semiquantitative analysis of the fiber tract signals, differences were observed in the superior cerebellar peduncles and midline cerebellar structures in patients with symptoms of CMS.

Conclusion

Using DTI, which allows the visualization of fronto-cerebellar fiber tracts, lower FCF tract volumes and diminished fiber signal intensities at the level of the superior cerebellar peduncles and in midline cerebellar structures were identified in patients with postoperative symptoms of CMS. Our study refers to the role of a neural circuitry between frontal lobes and the cerebellum being involved in neurocognitive impairment after posterior fossa tumor treatment in children.     

Energy expenditure in obesity associated with craniopharyngioma

Background and purpose

Obesity is a common yet incompletely understood complication of childhood craniopharyngioma. We hypothesized that craniopharyngioma is associated with specific defects in energy balance compared to obese control children.

Methods

Eleven craniopharyngioma patients were recruited for a study on body composition and energy balance. Eight subjects were obese. The obese craniopharyngioma patients had a mean age (±SD) of 11.2?±?1.7 years. The average body mass index z score was 2.33 (±0.32). A previously studied group of obese children (BMI z score 2.46?±?0.46) served as controls. Resting energy expenditure (REE) was determined by indirect calorimetry and body composition by dual energy X-ray absorptiometry in all children.

Results

Obese craniopharyngioma patient subjects had increased mean (±standard error) fat-free mass compared to obese controls (57%?±?0.88 % vs 50.0%?±?0.87%, p?=?0.02). The obese craniopharyngioma patients had a 17% lower REE compared to values expected from the World Health Organization equation (1,541?±?112.6 vs 1,809?±?151.8 kcal; p?=?0.01). In contrast, the obese control children had measured REE within 1% of predicted (1,647?±?33.2 vs. 1,652?±?40.2; p?=?0.8). In a linear regression model, REE remained significantly lower than predicted after controlling for FFM.

Conclusions

Lower REE may be a factor contributing to obesity in children with craniopharyngioma. Further study is needed into the mechanisms for reduced energy expenditure in patients with craniopharyngioma.     

The roles of methylenetetrahydrofolate reductase 677C>T and 1298A>C polymorphisms in moyamoya disease patients

Purpose

The methylenetetrahydrofolate reductase (MTHFR) 677C>T and 1298A>C polymorphisms, which are associated with hyperhomocysteinemia and nitric oxide (NO) deficiency (which is related to atherothrombosis and cerebral ischemia), have not been studied in moyamoya disease. A case-control study was performed to investigate whether the MTHFR 677C>T and 1298A>C polymorphisms contribute to moyamoya disease (MMD).

Methods

One hundred and seven Korean patients with MMD (mean age, 20.85?±?15.89 years; 66.4 % female) and 232 healthy control subjects (mean age, 23.99?±?16.16 years; 56.8 % female) were included. Genotyping for the MTHFR 677C>T and 1298A>C polymorphisms and measurements of homocysteine, folate, vitamin B₁₂, and NO in the cerebrospinal fluid (CSF) were performed. The statistical analysis was performed by multivariate linear regression and logistic regression.

Result

The MTHFR 677CT+TT genotype frequency was significantly increased with early-onset MMD (<10 years) compared with late-onset MMD (≥10 years) (adjusted odds ratio, 3.392; 95 % confidence interval, 1.294–8.893, P?=?0.013). The MTHFR 677C-1298C/677T-1298A diplotype (1.71?±?1.23 arbitrary units) presented significantly lower NO levels in the CSF compared with the 677C-1298A/677C-1298A diplotype (11.40?±?12.24 arbitrary units).

Conclusion

The MTHFR 677C>T and 1298A>C polymorphisms have restricted roles in the Korean MMD population. Therefore, further studies involving larger and more heterogeneous cohorts are needed to extend our understanding of the influence of polymorphisms in MTHFR and other thrombophilic genes on MMD.     

An Ecological Momentary Assessment of Lapse Occurrences in Dieters

Purpose

The aim of this study is to investigate the factors related to dietary lapse occurrence in a community sample of dieters.

Methods

An ecological momentary assessment (EMA) methodology, via mobile phone-based diaries, was employed to record dietary lapse occurrences in a group of dieters (N?=?80; M _age ?=?41.21?±?15.60 years; M _BMI?=?30.78?±?7.26) over 7 days.

Results

Analyses indicated that lapses were positively associated with the strength of dietary temptation, presence of others, coping responses, and the environment (exposure to food cues) in which the dieters were in; lapses were more likely to occur in the evening and were negatively associated with the use of coping mechanisms. Additionally, lapse occurrence was found to mediate the relationships among the above predictors of lapse and the self-efficacy to resist future dietary temptations.

Conclusions

Results provide an insight into the occurrence of lapses in dieters and have implications for interventions focusing on weight loss maintenance and relapse prevention.     

Cerebrovascular Pressure Reactivity and Cerebral Oxygen Regulation After Severe Head Injury

Background

To investigate the relationship between cerebrovascular pressure reactivity and cerebral oxygen regulation after head injury.

Methods

Continuous monitoring of the partial pressure of brain tissue oxygen (P_brO₂), mean arterial blood pressure (MAP), and intracranial pressure (ICP) in 11 patients. The cerebrovascular pressure reactivity index (PRx) was calculated as the moving correlation coefficient between MAP and ICP. For assessment of the cerebral oxygen regulation system a brain tissue oxygen response (TOR) was calculated, where the response of P_brO₂ to an increase of the arterial oxygen through ventilation with 100 % oxygen for 15 min is tested. Arterial blood gas analysis was performed before and after changing ventilator settings.

Results

Arterial oxygen increased from 108 ± 6 mmHg to 494 ± 68 mmHg during ventilation with 100 % oxygen. P_brO₂ increased from 28 ± 7 mmHg to 78 ± 29 mmHg, resulting in a mean TOR of 0.48 ± 0.24. Mean PRx was 0.05 ± 0.22. The correlation between PRx and TOR was r = 0.69, P = 0.019. The correlation of PRx and TOR with the Glasgow outcome scale at 6 months was r = 0.47, P = 0.142; and r = ?0.33, P = 0.32, respectively.

Conclusions

The results suggest a strong link between cerebrovascular pressure reactivity and the brain’s ability to control for its extracellular oxygen content. Their simultaneous impairment indicates that their common actuating element for cerebral blood flow control, the cerebral resistance vessels, are equally impaired in their ability to regulate for MAP fluctuations and changes in brain oxygen.     

High-intensity intermittent exercise and cardiovascular and autonomic function

Objective

The effect of 12 weeks of high-intensity intermittent exercise (HIIE) on cardiac, vascular, and autonomic function of young males was examined.

Methods

Thirty-eight young men with a BMI of 28.7 ± 3.1 kg m^?2 and age 24.9 ± 4.3 years were randomly assigned to either an HIIE or control group. The exercise group underwent HIIE three times per week, 20 min per session, for 12 weeks. Aerobic power and a range of cardiac, vascular, and autonomic measures were recorded before and after the exercise intervention.

Results

The exercise, compared to the control group, recorded a significant reduction in heart rate accompanied by an increase in stroke volume. For the exercise group forearm vasodilatory capacity was significantly enhanced, P < 0.05. Arterial stiffness, determined by pulse wave velocity and augmentation index, was also significantly improved, after the 12-week intervention. For the exercise group, heart period variability (low- and high-frequency power) and baroreceptor sensitivity were significantly increased.

Conclusion

High-intensity intermittent exercise induced significant cardiac, vascular, and autonomic improvements after 12 weeks of training.