Overt and imagined singing of an Italian aria

Activation maps of 16 professional classical singers were evaluated during overt singing and imagined singing of an Italian aria utilizing a sparse sampling functional magnetic imaging (fMRI) technique. Overt singing involved bilateral primary and secondary sensorimotor and auditory cortices but also areas associated with speech and language production. Activation magnitude within the gyri of Heschl (A1) was comparable in both hemispheres. Subcortical motor areas (cerebellum, thalamus, medulla and basal ganglia) were active too. Areas associated with emotional processing showed slight (anterior cingulate cortex, anterior insula) activation. Cerebral activation sites during imagined singing were centered on fronto-parietal areas and involved primary and secondary sensorimotor areas in both hemispheres. Areas processing emotions showed intense activation (ACC and bilateral insula, hippocampus and anterior temporal poles, bilateral amygdala). Imagery showed no significant activation in A1. Overt minus imagined singing revealed increased activation in cortical (bilateral primary motor; M1) and subcortical (right cerebellar hemisphere, medulla) motor as well as in sensory areas (primary somatosensory cortex, bilateral A1). Imagined minus overt singing showed enhanced activity in the medial Brodmann's area 6, the ventrolateral and medial prefrontal cortex (PFC), the anterior cingulate cortex and the inferior parietal lobe. Additionally, Wernicke's area and Brocca's area and their homologues were increasingly active during imagery. We conclude that imagined and overt singing involves partly different brain systems in professional singers with more prefrontal and limbic activation and a larger network of higher order associative functions during imagery.     

Comparison of the AVPU Scale and the Pediatric GCS in Prehospital Setting

Objective: The pediatric Glasgow coma scale (pGCS) is a consciousness score that, although widely applied, requires skill to apply. The AVPU scale uses four simple categories (Alert; Verbal response; response to Pain; Unresponsive), but has not been studied in a large pediatric population. We compared the performance of the AVPU and pGCS scales in a large pediatric cohort in an acute, prehospital setting. Methods: In a six-month-long prospective cohort study, AVPU and pGCS scores were determined by emergency physicians in children less than 10 years of age at their first prehospital encounter. Results: We included 302 children (median age 2.3 years) with a broad spectrum of diagnoses. Data were complete for 287 children. AVPU and pGCS scores showed good a correlation in the extreme categories A and U (positive predictive values of 98% and 100%, respectively). Corresponding pGCS scores for each AVPU category were as follows: 11–15 for A; 5–15 for V; 4–12 for P; and 3–5 for U. The positive predictive value to detect patients with pGCS ≥ 8 for AVPU category V was 100%. Conclusions: We demonstrated good correlation of simple and fast consciousness AVPU scoring to the standard pGCS in a large cohort of pediatric patients in a prehospital setting. The AVPU category “V” identifies patients with a pGCS of or exceeding 8 and, therefore, identifies children at low risk requiring more invasive procedures or intensive care treatment.     

Effects of inhaled nitric oxide on right ventricular function in severe acute respiratory distress syndrome

Objective To compare the effects of inhaled nitric oxide (NO) and an infusion of prostacyclin (PGI₂) on right ventricular function in patients with severe acute respiratory distress syndrome (ARDS).Design Randomized prospective short-term study.Setting: Post-surgical ICU in an university hospital.Patients 10 patients with severe ARDS referred to our hospital for intensive care.Interventions In random sequence the patients inhaled NO at a concentration of 18 parts per million (ppm) followed by 36 ppm, and received an intravenous infusion of PGI₂ (4 ng·kg^–1·min^–1).Measurement and results Inhalation of 18 ppm NO reduced the means (±SE) pulmonary artery pressure (PAP) from 33±2 to 28±1 mmHg (p=0.008), increased right ventricular ejection fraction (RVEF), as assessed by thermodilution technique, from 28±2 to 32±2% (p=0.005), decreased right ventricular end-diastolic volume index from 114±6 to 103±8 ml·m^–2 (p=0.005) and right ventricular end-systolic volume index from 82±4 to 70±5 ml·m^–2 (p=0.009). Mean arterial pressure (MAP) and cardiac index (CI) did not change significantly. The effects of 36 ppm NO were not different from the effects of 18 ppm NO. Infusion of PGI₂ reduced PAP from 34±2 to 30±2 mmHg (p=0.02), increased RVEF from 29±2 to 32±2% (p=0.02). Right ventricular end-diastolic and end-systolic volume indices did not change significantly. MAP decreased from 80±4 to 70±5 mmHg (p=0.03), and CI increased from 4.0±0.5 to 4.5±0.5 l·min^–1·m^–2 (p=0.02).Conclusions Using a new approach to selective pulmonary vasodilation by inhalation of NO, we demonstrate in this groups of ARDS patients that an increase in RVEF is not necessarily associated with a rise in CI. The increase in CI during PGI₂ infusion is probably related to the systemic effect of this substance.Supported by DFG Fa 139/1-2/2-2     

Sonographische Funktionsbeurteilung von H?modialysefisteln

Zusammenfassung Hintergrund und Ziel:   Für die Hämodialyse und verwandte Verfahren wird ein stabiler Gefäßzugang benötigt, wobei die Brescia-Cimino-Fistel am nicht dominierenden Unterarm die beste Form darstellt. Die apparative Diagnostik von Fisteldysfunktionen erfolgt heute in erster Linie mit der farbkodierten Duplexsonographie. Der Wert der dopplersonographischen Widerstandsindex-( RI-)Messung am zuführenden Gefäß für die Vorhersage des Stromzeitvolumens der Fistel sollte beurteilt werden. Patienten und Methodik:   Bei 47 Patienten mit Dialysefisteln wurden morphologische und funktionelle Untersuchungen des Fistelarms einschließlich Stromzeitvolumenbestimmung mittels farbkodierter Duplexsonographie durchgeführt. Es erfolgten RI-Messungen proximal und distal der Fistel sowie am kontralateralen Arm an den gleichen Ableitorten mit Hilfe der bidirektionalen CW-Doppler-Sonographie. Die systolischen Fingerarteriendrücke am zweiten und dritten Finger beider Hände wurden dopplersonographisch ermittelt. Es wurden Untersuchungen zur Feststellung eines Zusammenhangs zwischen dem proximalen RI und dem Stromzeitvolumen durchgeführt. Ergebnisse:   Am Fistelarm lagen proximal und distal niedrigere RI-Werte vor als am kontralateralen Arm. Die systolischen Fingerarteriendrücke waren am Fistelarm niedriger. Die Stromzeitvolumina waren bei Oberarmfisteln höher als bei Unterarmfisteln, bedingt durch die größeren Gefäßdurchmesser. Eine lineare Korrelation zwischen dem proximalen RI und dem Stromzeitvolumen der Fistel ließ sich nicht belegen. 50% der Unterarmfisteln mit einem proximalen RI 0,53 wiesen ein Stromzeitvolumen < 400 ml/min auf. Schlussfolgerung:   Die Bestimmung des RI an der fistelspeisenden Arterie bei Unterarmfisteln eignet sich zur Identifizierung von Unterarmfisteln mit für eine effektive Hämodialyse zu geringen Stromzeitvolumina. In diesen Fällen ist eine weitere Untersuchung der betreffenden Fisteln indiziert. Viele Einflüsse, vor allem auf die Bestimmung der Stromzeitvolumina, sind zu beachten. Empfehlenswert sind intraindividuelle Längsschnittuntersuchungen mit der CW-Doppler-Sonographie zur Evaluation der Dynamik der Dialysefisteln, um bessere Möglichkeiten für die Überwachung der funktionstüchtigen Fisteln zur Verfügung zu haben.     

Correspondence of DNA Methylation Between Blood and Brain Tissue and Its Application to Schizophrenia Research

Given the difficulty of procuring human brain tissue, a key question in molecular psychiatry concerns the extent to which epigenetic signatures measured in more accessible tissues such as blood can serve as a surrogate marker for the brain. Here, we aimed (1) to investigate the blood-brain correspondence of DNA methylation using a within-subject design and (2) to identify changes in DNA methylation of brain-related biological pathways in schizophrenia.We obtained paired blood and temporal lobe biopsy samples simultaneously from 12 epilepsy patients during neurosurgical treatment. Using the Infinium 450K methylation array we calculated similarity of blood and brain DNA methylation for each individual separately. We applied our findings by performing gene set enrichment analyses (GSEA) of peripheral blood DNA methylation data (Infinium 27K) of 111 schizophrenia patients and 122 healthy controls and included only Cytosine-phosphate-Guanine (CpG) sites that were significantly correlated across tissues.Only 7.9% of CpG sites showed a statistically significant, large correlation between blood and brain tissue, a proportion that although small was significantly greater than predicted by chance. GSEA analysis of schizophrenia data revealed altered methylation profiles in pathways related to precursor metabolites and signaling peptides.Our findings indicate that most DNA methylation markers in peripheral blood do not reliably predict brain DNA methylation status. However, a subset of peripheral data may proxy methylation status of brain tissue. Restricting the analysis to these markers can identify meaningful epigenetic differences in schizophrenia and potentially other brain disorders.Key words: DNA methylation, cross-tissue, blood, brain, correlation, schizophrenia     

Central nervous tuberculosis in patients non-VIH: seven case reports

PURPOSE: Tuberculosis involving the central nervous system (CNS) is rarely observed in non immuno-compromised hosts. We report herin the various clinical, biological and radiological manifestations observed in 7 patients with CNS tuberculosis. METHODS: Clinical and biological records of 7 patients with CNS tuberculosis were retrospectively studied. All patients had encephalic CT-scan and MRI in the course of the disease. RESULTS: 5 women and 2 men with a mean age of 38.4 years initially initially presented with headache (n = 6), fever (n = 5), meningeal irritation (n = 3), localizing neurological signs (n = 1). Lumbar punction revealed lymphocytic meningitis (n = 6/7). Mycobacterium tuberculosis or bovis was isolated in 3 patients only. Cerebral tomodensitography or magnetic resonance imaging were initially normal in most of cases (n = 4/7), but discovered in the course of disease basilar meningitis (n = 6), hydrocephalus (n = 6), abcess or tuberculoma (n = 4). In all the patients, initiation of the treatment was complicated by clinical and/or biological deterioration, called paradoxal reaction, leading in all cases to glucocorticoid adjunction, with various final results. Indeed, 4 patients developed neurological sequelae. No patient died. CONCLUSION: CNS tuberculosis is a rare disease in non immunocompromised patients whose diagnostic may be difficult due to the absence of specific clinical symptoms, negative initial radiological examination, as well as delayed and often negative bacterial isolation. Paradoxal reaction appeared to be frequent despite specific antibiotherapy and underlines the beneficial effects of addictive corticosteroids.     

Manifestations cardiaques au cours la granulomatose de Wegener : à propos de quatre observations et revue de la littérature

Introduction

Discordance exists between the results of post-mortem studies and the low number of clinical reported cases of cardiac involvements in Wegener's granulomatosis.

Case reports

Data from four patients were studied retrospectively. Three patients had associated airway localization and three had kidney involvement. All patients had positive test for anti-PR3 antineutrophil antibodies. Two patients presented with dilated cardiomyopathy (one with terminal cardiac failure), another patient with complete atrioventricular block and pericarditis, and the remaining one with myopericarditis. One patient was asymptomatic. For three of these patients, the cardiac manifestations were contemporary of the diagnosis of Wegener's granulomatosis and had a severe disease course.

Conclusion

Cardiac events in Wegener's granulomatosis are probably underestimated, given the various type of heart damage and the clinical presentation. Cardiac involvement seems to be associated with a poor prognosis. Thus, we recommend systematic and regular cardiac assessment in the follow-up of patients with Wegener's granulomatosis.     

Syndrome d’encéphalopathie postérieure réversible induit par un décongestionnant nasal contenant de la pseudo-éphédrine

Introduction

Posterior reversible encephalopathy syndrome is a clinico-radiological entity characterized by neurologic symptoms in association with usually reversible bilateral posterior hemispheric oedema on neuroimaging. Many pathological conditions and treatments have been associated with this syndrome.

Case report

We report a 19-year-old woman, followed-up for hypocomplementemic urticarial vasculitis, who presented with a posterior reversible encephalopathy syndrome induced by the intake of an over-the-counter cold remedy containing pseudoephedrine. Clinical manifestations and radiological abnormalities resolved after anti-hypertensive therapy and withdrawal of sympathomimetic drug.

Conclusion

The diagnosis of posterior reversible encephalopathy syndrome should be considered in patients with compatible clinical and radiological presentation because of its potential reversibility with an appropriate management. Intake of drugs, including over-the-counter cough and cold drugs, should be looked for in the history as well as autoimmune disorders.