Differential effects of left parietal theta-burst stimulation on order and quantity processing

Numbers can be used to represent different meanings, including order information (‘Steve lives at house number 24’) and quantity (‘Steve is paid 24 pounds’). The few previous neuroimaging studies that investigated order and quantity processing reported conflicting evidence as to whether same or partially overlapping brain systems are engaged in these processes. Such inconsistencies may be related to the use of neuroimaging techniques which do not allow causal inference regarding brain-behaviour relationships. To overcome this problem, the present study employed continuous theta-burst stimulation (TBS) to investigate whether interference to either the left or right parietal regions affected order and quantity in similar or different ways. Results revealed that following TBS to the left intraparietal sulcus, quantity processing was impaired and order facilitated; TBS to the contralateral brain region led to no specific effects in either order or quantity processing. These findings suggest that there are at least partially different neuronal populations involved in order and quantity processing, and that the left parietal cortex is critical for both processes.     

The AMC Linear Disability Score (ALDS): a cross-sectional study with a new generic instrument to measure disability applied to patients with peripheral arterial disease

Background  

The AMC Linear Disability Score (ALDS) is a calibrated generic itembank to measure the level of physical disability in patients with chronic diseases. The ALDS has already been validated in different patient populations suffering from chronic diseases. The aim of this study was to assess the clinimetric properties of the ALDS in patients with peripheral arterial disease.     

Temporomandibular region metastasis from cystosarcoma phyllodes: a case report and review of the literature.

A rare breast tumour (Cystosarcoma phyllodes) in a 58-year-old female metastasizing to the temporomandibular region and infra-temporal fossa, presenting as temporomandibular pain dysfunction syndrome is reported, along with a literature review.     

Dobutamine Antagonizes Epinephrine's Biochemical and Cardiotonic Effects: Results of an In Vitro Model Using Human Lymphocytes and a Clinical Study in Patients Recovering from Cardiac Surgery

Background: Patients may receive more than one positive inotropic drug to improve myocardial function and cardiac output, with the assumption that the effects of two drugs are additive. The authors hypothesized that combinations of dobutamine and epinephrine would produce additive biochemical and hemodynamic effects.

Methods: The study was performed in two parts. Phase 1 used human lymphocytes in an in vitro model of cyclic adenosine monophosphate (cAMP) generation in response to dobutamine (10-8 to 10-4 M) or epinephrine (10-9 M to 10-5 M), and dobutamine and epinephrine together. Phase 2 was a clinical study in patients after aortocoronary artery bypass in which isobolographic analysis compared the cardiotonic effects of dobutamine (1.25, 2.5, or 5 [micro sign]g [middle dot] kg-1 [middle dot] min-1) or epinephrine (10, 20, or 40 ng [middle dot] kg-1 [middle dot] min-1), alone or in combination.

Results: In phase 1, dobutamine increased cAMP production 41%, whereas epinephrine increased cAMP concentration [almost equal to] 200%. However, when epinephrine (10-6 M) and dobutamine were combined, dobutamine reduced cAMP production at concentrations between 10-6 to 10-4 M (P = 0.001). In patients, 1.25 to 5 [micro sing]g [middle dot] kg-1 [middle dot] min-1 dobutamine increased the cardiac index (CI) 15-28%. Epinephrine also increased the CI with each increase in dose. However, combining epinephrine with the two larger doses of dobutamine (2.5 and 5 [micro sign]g [middle dot] kg-1 [middle dot] min-1) did not increase the CI beyond that achieved with epinephrine and the lowest dose of dobutamine (1.25 [micro sign]g [middle dot] kg-1 [middle dot]-1 min (-1)). In addition, the isobolographic analysis for equieffective concentrations of dobutamine and epinephrine suggests subadditive effects.     

Con: Calcium is not routinely indicated during separation from cardiopulmonary bypass

Severe hypocalcemia is uncommon in adult cardiac surgery patients; the nearly ubiquitous mild hypocalcemia does not impair myocardial performance. Clinicians should recognize that in certain circumstances, calcium may interact negatively with catecholamines such as epinephrine or dobutamine. Lastly, evidence suggests that calcium influx during ischemia-reperfusion contributes to myocardial dysfunction after CPB. Therefore, there appears to be no justification for the practice of routinely administering large doses of calcium salts to adult cardiac surgery patients after CPB.     

Manganese toxicity,dopaminergic dysfunction and hepatic encephalopathy

Patients with chronic liver disease manifest a high incidence (>75%) of pallidal signal hyperintensity on T₁-weighted Magnetic Resonance Imaging (MRI), the intensity of which correlates with blood manganese levels and the presence of extrapyramidal symptoms. A major cause of pallidal hyperintensity on T₁-weighted MRI is manganese deposition; chronic manganese intoxication in the absence of liver disease results in pallidal MR signal hyperintensity, in extrapyramidal symptoms and in selective effects on the dopaminergic neurotransmitter system in basal ganglia. Direct measurements in globus pallidus obtained at autopsy from patients with chronic liver disease who died in hepatic coma reveal 2 to 7-fold increases of pallidal manganese and a concomitant loss of dopamine D₂ binding sites. Liver transplantation results in normalization of pallidal MR signals and of blood manganese levels. These findings suggest that (1) pallidal MR signal hyperintensity in patients with chronic liver disease is the result of manganese deposition and (2) alterations of dopaminergic function due to the toxic effects of manganese may contribute to the extrapyramidal symptoms in these patients.