Brain temperature regulation in poor-grade subarachnoid hemorrhage patients – A multimodal neuromonitoring study

Elevated body temperature (T_core) is associated with poor outcome after subarachnoid hemorrhage (SAH). Brain temperature (T_brain) is usually higher than T_core. However, the implication of this difference (T_delta) remains unclear. We aimed to study factors associated with higher T_delta and its association with outcome. We included 46 SAH patients undergoing multimodal neuromonitoring, for a total of 7879 h of averaged data of T_core, T_brain, cerebral blood flow, cerebral perfusion pressure, intracranial pressure and cerebral metabolism (CMD). Three-months good functional outcome was defined as modified Rankin Scale ≤2. T_brain was tightly correlated with T_core (r = 0.948, p < 0.01), and was higher in 73.7% of neuromonitoring time (T_delta +0.18°C, IQR −0.01 – 0.37°C). A higher T_delta was associated with better metabolic state, indicated by lower CMD-glutamate (p = 0.003) and CMD-lactate (p < 0.001), and lower risk of mitochondrial dysfunction (MD) (OR = 0.2, p < 0.001). During MD, T_delta was significantly lower (0°C, IQR −0.2 – 0.1; p < 0.001). A higher T_delta was associated with improved outcome (OR = 7.7, p = 0.002). Our study suggests that T_brain is associated with brain metabolic activity and exceeds T_core when mitochondrial function is preserved. Further studies are needed to understand how T_delta may serve as a surrogate marker for brain function and predict clinical course and outcome after SAH.     

Chronic kidney disease–mineral bone disorder: an update on the pathology and cranial manifestations

Chronic kidney disease–mineral bone disorder (CKD‐MBD) is a syndrome encompassing skeletal and extra skeletal changes associated with chronic kidney disease. It progresses silently until an advanced clinical stage when complications impact on the quality of life and survival rates of patients. The maxillofacial manifestations are unique and may play an important role in the early identification of changes which could influence the management of these patients. The goal of this review is to highlight the maxillofacial features, pathology, and principles of management of CKD‐MBD.     

Risk and obligation: Health professionals and the risk of AIDS

Abstract

This essay deals with the question of risk-taking by physicians and other health professionals when confronted with AIDS patients. The duty to take risks, and consequently to treat patients who have AIDS, is examined (a) from a historical perspective; (b) by considering fear and courage in the medical setting; (c) by considering views of community, justice, and the social contract; and (d) in light of notions of professionalism and obligation. It is concluded that health professionals have a historically grounded obligation to assume “reasonable” risks in dealing with such patients, that “reasonable” is defined by the community, and that this modifiable obligation emerges from views of community, justice, and professionalism.     

Plasmablastic lymphomas with light chain restriction – plasmablastic extramedullary plasmacytomas?

J Oral Pathol Med (2010) 39 : 435–439 Background: It is diagnostically difficult to differentiate plasmablastic lymphomas (PBLs) from plasma cell neoplasms with plasmablastic differentiation. Plasmablastic lymphomas are currently classified as ‘PBL of the oral mucosa’ and ‘PBL with plasmacytic differentiation’. Methods: Forty‐five cases of PBL were retrieved from the Departments of Oral Pathology of the Universities of Pretoria and Limpopo, South Africa. Clinical features and HIV status were recorded and each case was classified as ‘PBL of the oral mucosa type’ or as ‘PBL with plasmacytic differentiation’. Immunohistochemistry included: CD45, CD3, CD20, CD79a, CD38, CD138, MUM1, Ki‐67 and kappa and lambda light chains. Positivity was recorded based on the percentage of positive staining cells as focal (5–20%); intermediate (20–70%) or diffuse (>70%). In situ hybridization was performed for Epstein–Barr virus (EBV) and HHV‐8. Results were recorded as positive or negative. Results: All cases showed some degree of plasmacytic differentiation. All were negative for CD20 with reactive T cells detected with CD3. Diffuse and strong positive staining was found with Ki‐67 and MUM1, but variable immunoreactivity was found with CD79a, CD45, CD38 and CD138. Twenty cases (47%) showed light chain restriction. Epstein–Barr virus was detected in 44/45 cases and HHV‐8 in none. Conclusions: The morphological classification of PBLs is not valid as all cases showed some degree of plasmacytic differentiation. We propose that PBLs with light chain restriction be reclassified as ‘plasmablastic extramedullary plasmacytomas’ and managed accordingly. The rest represents true PBLs. The true nature of these neoplasms as an entity should be further investigated with molecular and genetic studies.     

Short and long term adaptation of variability during walking using unstable (Mbt) shoes

BackgroundThe purpose of the study was to compare the variability of biomechanical variables during treadmill walking using unstable shoes (Masai Barefoot Technology, MBT, Roggwil, Switzerland) and conventional shoes, before and after a 10 week (wk) training period.MethodsCycle characteristics, plantar pressure distribution, whole body 3D kinematics, and electromyographic signals of selected leg muscles during ground contact were recorded on 12 Sport Science students while walking on a treadmill with both conventional and unstable shoes before and after a 10 wk training intervention. The intervention consisted of more than 4 h use of unstable shoes during daily activity. The standard deviation of 15 consecutive cycles in each analyzed variable was taken as the measure for variability.FindingsThe main pattern was marked by a 35% (SD 10%) higher variability with the unstable shoes at pretest when compared with the conventional shoes, but decreased 30% (SD 12%) (both P < 0.05) during the training intervention to almost equal variability in between the two shoe situations. This was especially true with regard to variables representing within gait characteristics (peak foot force, joint angles, etc.), whereas in variables describing the overall gait cycle (e.g. cycle rate, impulse of total force, etc.) no difference between MBT and conventional shoes at pre and post tests were found.InterpretationThe current study supports the idea that the unstable shoe serves as a motor constraint applicable during everyday activity, provoking increased variability during walking. In addition, a decrease in movement variability on the MBT shoes during the training intervention to the level of conventional shoes was observed.