Conjunctivitis with Regional Lymphadenopathy in a Trainee Microbiologist

We report a case of conjunctival tuberculosis in a trainee microbiologist caused by direct inoculation. The resident strain was analyzed by DNA fingerprinting, and an identical pattern was found in an isolate from sputum handled by the resident. After 6 months of treatment, the patient was cured.     

Non-invasive atrial fibrillation organization follow-up under successive attempts of electrical cardioversion

The development of non-invasive tools able to provide valuable information about the effectiveness of a shock in external electrical cardioversion (ECV) is clinically relevant to enhance these protocols in the treatment of atrial fibrillation (AF). The present contribution analyzes the ability of a non-linear regularity index, such as sample entropy (SampEn), to follow-up non-invasively AF organization under successive attempts of ECV and to predict the effectiveness of every single shock. To this respect, the atrial activity (AA) preceding each delivered shock was extracted by using a QRST cancellation method. Next, the main atrial wave (MAW), which can be considered as the fundamental waveform associated to the AA, was obtained by applying a selective filtering centered on the dominant atrial frequency (DAF). Finally, the MAW organization was estimated with SampEn and two thresholds (Th1 = 0.1223 and Th2 = 0.0832) were established to predict the ECV outcome. Results indicated that, prior to the first attempt, all the patients who needed only one shock to restore NSR were below Th1. In addition, most of them were above Th2 in case of AF relapsing during the first month. Regarding several shocks, all the patients who maintained NSR more than one month were below Th2 after the first shock. Moreover, all the patients who relapsed to AF during the first month were between Th1 and Th2 and, finally, all the patients with ineffective ECV were above Th1. After each unsuccessful shock, a SampEn relative decrease was observed for the patients who finally reverted to NSR, but the largest variation took place after the first attempt, thus indicating that this shock plays the most important role in the procedure. Indeed, by considering jointly the patients who needed only one shock and the patients who needed several shocks, 91.67% (22 out of 24) of ECVs resulting in NSR, 93.55% (29 out of 31) of ECVs relapsing to AF during the first month and 100% (10 out of 10) of ECVs in which NSR was not restored were correctly classified. As conclusion, the MAW organization analysis via SampEn can provide useful information that could improve the effectiveness of conventional external ECV protocols used in AF treatment.     

Reciprocal modulation of eye-blink and pinna-flexion components of startle during reward anticipation

Because expectancies play a central role in current theories of dopaminergic neuron function, it is important to develop measures of reward anticipation processes. In the present study, reflexogenic bursts of white noise were presented to 39 healthy young adults as they awaited rewards and punishments in a gambling-like task. The rewards were small pieces of chocolate; the punishments, segments of bitter-tasting banana peel. Consistent with prior research on affective valence, postauricular reflexes were larger prior to rewards than punishments, whereas the reverse was true for acoustic blink reflexes. We theorized that potentiation of the postauricular reflex prior to consuming appetizing food is related to the priming of ear-retraction musculature during nursing in our remote ancestors.     

Increased plasma levels of brain-derived neurotrophic factor in patients with long-term bipolar disorder

Recent data indicate that neurotrophins may play a role in the physiopathology of bipolar disorder (BD) and may be useful as biomarkers of the disease. The aim of this study was to evaluate the plasma concentrations of brain-derived neurotrophic factor (BDNF) in BD patients, and to correlate their levels with clinical parameters. BDNF was measured in plasma from 53 BD type I subjects (34 during mania and 19 during euthymia) and 38 healthy controls by enzyme-linked immuno-sorbent assay (ELISA). Patients were assessed by a structured clinical interview (Mini-plus), Young mania and Hamilton depression rating scales. Plasma BDNF levels were significantly increased in patients with mania (P ≤ 0.001) and euthymia (P ≤ 0.001) when compared with controls, but did not correlate with any clinical parameters. BDNF concentration was higher in BD patients with 10 or more years of disease. BDNF plasma levels were increased in BD patients, mainly in those with a longer course of disease. In line with previous studies, it is conceivable that BDNF may play a role in the pathophysiology of BD.     

Quantitative Effects of Coil Packing Density on Cerebral Aneurysm Fluid Dynamics: An <Emphasis Type="Italic">In Vitro</Emphasis> Steady Flow Study

Over the past 15 years, coil embolization has emerged as an effective treatment option for cerebral aneurysms that is far less invasive than the long-standing convention of surgical clipping. However, aneurysm recurrence after coil embolization is not uncommon: recurrence rates as high as 50% have been reported in the literature. One factor that may contribute to recurrence after coiling is residual flow into the aneurysmal sac. At present, there is limited quantitative knowledge of the relationship between coil packing density and aneurysmal inflow. We present an in vitro fluid dynamic study of basilar tip aneurysm models that elucidates this relationship. At physiologically normal flow rates, we found that a packing density of 28.4% decreased aneurysmal inflow by 31.6% in a wide-neck model, and that a packing density of 36.5% decreased aneurysmal inflow by 49.6% in a narrow-neck model. Results also indicated that coiling reduced aneurysmal inflow more significantly at lower parent vessel flow rates, and that coiling reduced neck-plane velocity magnitudes more significantly for narrow-neck aneurysms. Our study provides novel quantitative information that could ultimately contribute to improved outcomes for patients with cerebral aneurysms by enabling more effective coil embolization.     

Tractographical model of the cortico‐basal ganglia and corticothalamic connections

The cortico‐basal ganglia and corticothalamic projections have been extensively studied in the context of neurological and psychiatric disorders. Deep brain stimulation (DBS) is known to modulate many of these pathways to produce the desired clinical effect. The aim of this work is to describe the anatomy of the main circuits of the basal ganglia using tractography in a surgical planning station. We used imaging studies of 20 patients who underwent DBS for movement and psychiatric disorders. We segmented the putamen, caudate nucleus (CN), thalamus, and subthalamic nucleus (STN), and we also segmented the cortical areas connected with these subcortical areas. We used tractography to define the subdivisions of the basal ganglia and thalamus through the generation of fibers from the cortical areas to the subcortical structures. We were able to generate the corticostriatal and corticothalamic connections involved in the motor, associative and limbic circuits. Furthermore, we were able to reconstruct the hyperdirect pathway through the corticosubthalamic connections and we found subregions in the STN. Finally, we reconstructed the cortico‐subcortical connections of the ventral intermediate nucleus, the nucleus accumbens and the CN. We identified a feasible delineation of the basal ganglia and thalamus connections using tractography. These results could be potentially useful in DBS if the parcellations are used as targets during surgery. Clin. Anat. 29:481–492, 2016. © 2016 Wiley Periodicals, Inc.     

Postprandial hypertriglyceridemia predicts improvement in insulin resistance in obese patients after bariatric surgery

BackgroundMorbidly obese patients have associated diseases, such as diabetes, hypertension, hyperlipidemia, and cardiovascular disease. Bariatric surgery improves these obesity-related co-morbidities, including insulin resistance. Evidence has shown that patients with morbid obesity have postprandial hypertriglyceridemia (HTG) and that this type of HTG is related to the degree of insulin resistance. Also, bariatric surgery produces a dramatic reduction in triglyceride levels. However, it is unknown whether patients with postprandial HTG have a different clinical evolution after bariatric surgery. The setting of our study was a university hospital.MethodsWe studied 57 morbidly obese patients who had mild or severe postprandial HTG after fat overload (<30 mg/dL or >90 mg/dL increase in triglycerides, respectively). All the patients underwent bariatric surgery. After surgery, the anthropometric and biochemical variables and the Homeostasis Model Assessment of Insulin Resistance were measured for 1 year at 0, 15, 30, 45, 90, 180, and 365 days after surgery.ResultsThe patients with more severe postprandial HTG had a greater percentage of change in the Homeostasis Model Assessment of Insulin Resistance at 30, 90, and 180 days after surgery than the patients with less severe postprandial HTG. Multiple regression analysis showed that the postprandial triglyceride levels predict the variation in the Homeostasis Model Assessment of Insulin Resistance index, more so than did traditional variables, such as anthropometric, inflammatory, or hormonal data.ConclusionThe postprandial HTG level might be the best predictor of improved insulin resistance in morbidly obese patients after bariatric surgery.