The prognostic value of postoperative seizures following epilepsy surgery

Among 55 patients undergoing temporal lobectomy for refractory epilepsy, patients with seizures in the week following surgery had a poor long-term, seizure-free outcome compared with patients without seizures. Outcome for patients with single seizures or seizures restricted to the first postoperative day seemed favorable compared with patients with multiple or later seizures. Seizure type and similarity to preoperative events did not predict outcome.     

Demographic characteristics and prevalence of serologic markers among donors who use the confidential unit exclusion process: the Retrovirus Epidemiology Donor Study

BACKGROUND: Most blood centers utilize a confidential unit exclusion (CUE) process, intended to reduce the risk of transfusion-associated infectious diseases by allowing high-risk donors confidentially to exclude their blood from use for transfusion. The effectiveness of this method remains controversial. STUDY DESIGN AND METHODS: Confirmatory or supplemental test results for antibodies to human immunodeficiency virus, human T-lymphotropic virus type I, and hepatitis C virus, as well as hepatitis B surface antigen and syphilis and screening test results for antibodies to hepatitis B core (antigen) and alanine aminotransferase levels were obtained for approximately 1.8 million units donated during 1991 and 1992 at five blood centers within the United States. The prevalences of these infectious disease markers in units that the donors confidentially excluded (CUE+) and units that the donors did not exclude (CUE-) were calculated and examined within demographic subgroups. RESULTS: Units that were CUE+ were 8 to 41 times more likely to be seropositive for antibodies to human immunodeficiency virus and hepatitis C virus, hepatitis B surface antigen, and syphilis and three to four times more likely to react for antibody to hepatitis B core (antigen) or to have elevated alanine aminotransferase levels than units that were CUE- (p < 0.001). The positive predictive value of CUE (the percentage of CUE+ units that were confirmed seropositive for any marker) was 3.5 percent, and the sensitivity of CUE (the percentage of confirmed-seropositive units that were CUE+) was 2.3 percent. CONCLUSION: The current CUE process has low sensitivity and apparently low positive predictive value, and in many cases, it appeared that donors misunderstood it. Yet, CUE was not a “random process,” as CUE+ units were more likely to be seropositive for any infectious disease marker than CUE- units. This suggests that efforts to improve the CUE system may be warranted. As risk factors for transfusion-transmitted infection become more difficult to identify by history-based screening, however, such efforts may have limited effect.     

Interaction Behaviors of Bilingual Parents With Their Young Children With Autism Spectrum Disorder

Given concerns that bilingual exposure might confuse children with disabilities—including autism spectrum disorder (ASD)—bilingual parents may restrict exposure to one language, often the community-dominant language. We investigated a potential consequence of this decision; the possibility that non-native language use might influence parental communicative behaviors during interaction with the child. We recruited 39 parent–child dyads, each with a young child with ASD (mostly boys) and parent/carer (mostly mothers). Parents were either monolingual speakers of community-dominant English (n = 20) or bilingual with English as the second language (n = 19). We confirmed our assumption that the latter group would have significantly poorer non-native English language via standardized assessment of expressive vocabulary, and ensured children were matched on age, ASD symptoms, and developmental level. We sampled parent–child interaction—including in each of bilinguals’ native and non-native languages—and coded parents’ amount and complexity of speech, communicative synchrony, and imitations and expansions of their child’s speech. Few differences presented across bilingual parents’ native versus non-native language samples, but this group showed reduced synchrony and use of expansions compared to monolinguals. Further, bilinguals’ English-language knowledge was associated with self-reported comfort using this language and with two coded interaction measures. These empirical data only partially support qualitative accounts that non-native language use may influence bilingual parents’ interaction behaviors with their young children. With growing rates of ASD diagnosis and increasing cultural/linguistic diversity around the world, further dedicated clinical and experimental attention to this issue is clearly warranted.     

Is there a best approach for extracorporeal life support cannulation: a review of the extracorporeal life support organization

Background

Neurologic complications are common, and amongst the most devastating complications in pediatric patients undergoing extracorporeal life support (ECLS). Carotid artery cannulation (CAN) has been associated with an increase in these complications, thereby shaping practices to avoid this approach in most pediatric patients in which other cannulation approaches are viable.

Mapping the organization of atrial fibrillation with basket catheters. Part II: Regional patterns in chronic patients

The aim of this study was to investigate the spatial patterns of organization of fibrillation in the right atrium using bipolar recordings from a basket catheter in a population of 17 patients with persistent AF. The number of occurrences (NO) (i.e., the number of points laying on the baseline) was used as an objective measure of organization. This parameter significantly matches Wells' criteria for the classification of bipolar recordings during AF. The anatomic correspondence of the splines with eight atrial regions (namely anterior free wall, lateral free wall, posterolateral free wall, posterior free wall, posterior atrial septum, atrial septum, tricuspid valve, and anterior tricuspid valve) was assessed by fluoroscopic projections and electrogram morphology. Each region was further divided into high, mid-high, mid-low, and low segments. It was observed that individual and well-defined patterns of organization characterize the electrical activity of the right atrium in patients with persistent AF. When observed over 10 minutes, these patterns are rather stable in time. In each patient, the NO measurements were significantly different in the various right atrium regions (P < 0.0001 for all patients, Friedman test). The NO averaged over the population was significantly different among the regions (P < 0.001, Kruskal-Wallis test), owing to a common disorganized pattern observed in the tricuspid valve and anterior tricuspid valve regions. When these regions were removed from the analysis, the differences among the remaining regions were not statistically significant (P = 0.77). In conclusion, the quantitative assessment of organization in the entire right atrium showed an individual rather than common distribution. This may have implications in the choice of regions candidate for ablation.     

Cardiac autonomic imbalance in patients with reversible ventricular dysfunction takotsubo cardiomyopathy

BACKGROUND: Although in reversible takotsubo cardiomyopathy (TC), wall motion generally recovers dramatically within a few weeks, there are few data on changes in autonomic function in this condition. AIM: To investigate cardiac autonomic function in the acute and chronic phases of TC. METHODS: Ten patients with TC (mean age 70.1 +/- 13.7 years) underwent cardiac catheterization on the first hospital day, when left ventricular (LV) ejection fraction (EF) was calculated. A Holter electrocardiographic study was performed within 3 days after the onset of symptoms (0 months) and 3 months after discharge (3 months). The standard deviation of the mean cycle length of normal-normal R-R (NN) intervals over 24 h (SDNN), and the 24-h standard deviation of the mean value of the difference between the NN intervals for each 5-min segment (SDANN), were calculated according to time-area analysis of heart rate variability over 24 h. Frequency domain analysis was also done. RESULTS: Coronary angiography in the acute and chronic phases revealed no significant stenosis in any TC patient. LV wall motion returned to normal in 17.6 +/- 6.4 days. LVEF was 45.7 +/- 8.8% in the acute phase and 69.8 +/- 6.8% after the improvement of wall motion (p < 0.001). Between 0 months and 3 months, SDNN and SDANN improved significantly, from 88.8 +/- 35.5 to 109.5 +/- 33.4 ms (p = 0.01) and from 79.9 +/- 34.7 to 99.3 +/- 40.3 ms (p = 0.03), respectively. No significant changes were observed in frequency domain parameters. DISCUSSION: These results support our previous hypothesis that TC might be caused by neurogenic stunning of the myocardium, due to acute autonomic dysfunction.     

Neocortical hyperexcitability in a human case of tuberous sclerosis complex and mice lacking neuronal expression of TSC1

OBJECTIVE: To identify brain regions, cell types, or both that generate abnormal electrical discharge in tuberous sclerosis complex (TSC). Here we examined excitatory and inhibitory synaptic currents in human tissue samples obtained from a TSC patient with no discernible cortical tubers and acute neocortical brain slices from a mouse featuring synapsin-driven conditional deletion of a TSC1 gene. These studies were designed to assess whether TSC gene inactivation alters excitability. METHODS: We used visualized patch-clamp (human and mouse) and extracellular field (mouse) recordings. Additional mice were processed for immunohistochemistry or Western blot analysis. RESULTS: Detailed anatomic studies in brain tissue sections from synapsin-TSC1 conditional knock-out mice failed to uncover gross anatomic defects, loss of lamination, or frank tuber formation. However, regions of abnormal and potentially activated neocortex were shown using antibodies to nonphosphorylated neurofilaments (SMI-311) and immediate early genes (c-Fos). Extracellular recordings from neocortical slices, examining synaptic activity in these regions, demonstrated clear differences in excitability between conditional knock-out and age-matched control mice. Whole-cell patch-clamp recordings demonstrated excitatory synaptic currents with strikingly long duration and epileptiform discharge patterns, similar to waveforms observed in our human tissue samples. These events were 1-amino-3-hydroxy-5-methyl-4-isoxazolepropionate (AMPA) receptor mediated and were most prominent in neocortex. Normal-appearing inhibitory postsynaptic currents (human) and intrinsic neuronal firing patterns (mouse) were also recorded. INTERPRETATION: This combination of human and mouse tissue studies suggests, for the first time, that synaptic excitation is altered in a direction that favors seizure generation in TSC brain tissue regardless of cortical tubers.     

Development of the Manchester framework for the evaluation of emergency department pharmacy services

International Journal of Clinical Pharmacy - Many countries, including the United Kingdom, have established Emergency Department (ED) pharmacy services where some ED pharmacists now work as...