Disease spread through contiguity and axonal tracts in primary lateral sclerosis

Our goal in this report was to determine whether symptom progression in primary lateral sclerosis (PLS) was consistent with disease spread through axonal pathways or contiguous cortical regions. The date of symptom onset in each limb and cranial region was obtained from 45 PLS patient charts. Each appearance of symptoms in a new body region was classified as axonal, contiguous, possibly contiguous, or unrelated, according to whether the somatotopic representations were adjacent in the cortex. Of 152 spread events, the first spread event was equally divided between axonal (22) and contiguous (23), but the majority of subsequent spread events were classified as contiguous. Symptom progression in PLS patients is consistent with disease spread along axonal tracts and by local cortical spread. Both were equally likely for the first spread event, but local cortical spread was predominant thereafter, suggesting that late degeneration does not advance through long axonal tracts. Muscle Nerve 49 :439–441, 2014     

Fewer intensive care unit refusals and a higher capacity utilization by using a cyclic surgical case schedule

PURPOSE: Mounting health care costs force hospital managers to maximize utilization of scarce resources and simultaneously improve access to hospital services. This article assesses the benefits of a cyclic case scheduling approach that exploits a master surgical schedule (MSS). An MSS maximizes operating room (OR) capacity and simultaneously levels the outflow of patients toward the intensive care unit (ICU) to reduce surgery cancellation. MATERIALS AND METHODS: Relevant data for Erasmus MC have been electronically collected since 1994. These data are used to construct an MSS that consisted of a set of surgical case types scheduled for a period or cycle. This cycle was executed repetitively. During such a cycle, surgical cases for each surgical department were scheduled on a specific day and OR. The experiments were performed for the Erasmus University Medical Center and for a virtual hospital. RESULTS: Unused OR capacity can be reduced by up to 6.3% for a cycle length of 4 weeks, with simultaneous optimal leveling of the ICU workload. CONCLUSIONS: Our findings show that the proposed cyclic OR planning policy may benefit OR utilization and reduce surgical case cancellation and peak demands on the ICU.     

Procalcitonin in the recognition of complications in critically ill surgical patients

Background

Procalcitonin (PCT) is a relatively new, promising indirect parameter for infection. In the intensive care unit (ICU) it can be used as a marker for sepsis. However, in the ICU there is a need for reliable markers for clinical deterioration in the critically ill patients. This study determines the clinical value of PCT concentrations in recognizing surgical complications in a heterogeneous group of general surgical patients in the ICU.

Material and methods

We prospectively collected PCT concentration data from April 2010 to June 2012 for all general surgical patients admitted to the ICU. Both the relationships between PCT levels and events (diagnostic and therapeutic interventions) as well as between PCT levels and surgical complications (abscesses, bleeding, perforation, ischemia, and ileus) were studied.

Results

PCT concentrations were lower in patients who developed complications than those who did not develop complications on the same day, although not significant (P = 0.27). A 10% increase in PCT levels resulted in a 2% higher complication odds, but again this was not significant (odds ratio [OR], 1.020; 95% confidence interval [CI], 0.961–1.083; P = 0.51). Even a 20% or 30% increase in PCT concentrations did not result in higher complication probability (OR, 1.039; 95% CI, 0.927–1.165 and OR, 1.057; 95% CI, 0.897–1.246). Furthermore, an increase in PCT levels did not show an increase or a reduction in the number of diagnostic and therapeutic interventions.

Conclusions

An increase in PCT levels does not help to predict surgical complications in critically ill surgical patients.     

The role of impaired esophageal and gastric motility in end-stage lung diseases and after lung transplantation

Today, many questions persist regarding the causal relationship of gastroesophageal reflux disease (GERD) to promote aspiration and its potential to induce both pulmonary and allograft failure. Current hypotheses, which have identified GERD as a nonimmune risk factor in inducing pulmonary and allograft failure, center on the role of GERD-induced aspiration of gastroduodenal contents. Risk factors of GERD, such as impaired esophageal and gastric motility, may indirectly play a role in the aspiration process. In fact, although impaired esophageal and gastric motility is not independently a cause of lung deterioration or allograft failure, they may cause and or exacerbate GERD. This report seeks to review present research on impaired esophageal and gastric motility in end-stage lung disease to characterize prevalence, etiology, pathophysiology, and current treatment options within this special patient population.     

Timing the fearful brain: unspecific hypervigilance and spatial attention in early visual perception

Numerous studies suggest that anxious individuals are more hypervigilant to threat in their environment than nonanxious individuals. In the present event-related potential (ERP) study, we sought to investigate the extent to which afferent cortical processes, as indexed by the earliest visual component C1, are biased in observers high in fear of specific objects. In a visual search paradigm, ERPs were measured while spider-fearful participants and controls searched for discrepant objects (e.g. spiders, butterflies, flowers) in visual arrays. Results showed enhanced C1 amplitudes in response to spatially directed target stimuli in spider-fearful participants only. Furthermore, enhanced C1 amplitudes were observed in response to all discrepant targets and distractors in spider-fearful compared with non-anxious participants, irrespective of fearful and non-fearful target contents. This pattern of results is in line with theoretical notions of heightened sensory sensitivity (hypervigilance) to external stimuli in high-fearful individuals. Specifically, the findings suggest that fear facilitates afferent cortical processing in the human visual cortex in a non-specific and temporally sustained fashion, when observers search for potential threat cues.     

Setbacks,pleasant surprises and the simply unexpected: brainwave responses in a language comprehension task

This event-related potential (ERP) study explored the behaviour of N400 and post-N400 frontal positivities (pN400FP) during the processing of emotionally biased and unbiased sentences that randomly led to highly expected or unexpected word outcomes. Unexpected outcomes (as determined by sentence completion written tests) elicited significantly larger N400 and pN400FP responses than did highly expected outcomes. Emotionally neutral outcomes triggered a significant N400 expectancy effect across all scalp locations, including frontal sites, whereas emotionally biased outcomes elicited a significant N400 effect localized to posterior scalp regions. The subsequent pN400FP effect was significant only when emotional expectations were violated and not when emotionally neutral sentences led to unexpected outcomes. This frontal effect, linked to the processing of lexically unexpected but plausible words, showed larger amplitudes for unexpected pleasant surprises than for unexpected setbacks. Our results support the view that the pN400FP response to unexpected verbal outcomes entails more than a generic reaction to a lexical ‘misprediction’. Rather, they favour the hypothesis that the affective content of the sentence being processed influences the effort needed to override a lexical prediction, such that more effort is needed to override a pessimistic prediction than an optimistic one.     

Training of goal directed arm movements with motion interactive video games in children with cerebral palsy – A kinematic evaluation

Objective: The main aim of this study was to evaluate the quality of goal-directed arm movements in 15 children with cerebral palsy (CP) following four weeks of home-based training with motion interactive video games. A further aim was to investigate the applicability and characteristics of kinematic parameters in a virtual context in comparison to a physical context.

Method: Kinematics and kinetics were captured while the children performed arm movements directed towards both virtual and physical targets.

Results: The children’s movement precision improved, their centre of pressure paths decreased, as did the variability in maximal shoulder angles when reaching for virtual objects. Transfer to a situation with physical targets was mainly indicated by increased movement smoothness.

Conclusion: Training with motion interactive games seems to improve arm motor control in children with CP. The results highlight the importance of considering both the context and the task itself when investigating kinematic parameters.     

The effect of training in an interactive dynamic stander on ankle dorsiflexion and gross motor function in children with cerebral palsy

Objective: To study the effect of active stretching of ankle plantarflexors using an interactive dynamic stander in children with cerebral palsy (CP).

Methods: Six children in Gross Motor Function Classification System classes I–III, aged 4–10 years, trained intensive active dorsiflexion in an interactive dynamic stander using ankle movement to play custom computer games following a 10-week control period. Gross Motor Function Measure Item Set, gait performance and passive and active dorsiflexion with extended and flexed knee were chosen as outcome parameters.

Results: Median active and passive ankle dorsiflexion increased significantly (5 and 10 degrees, respectively) with extended knee. There was a small but clinically significant increase in gross motor function. The intervention had no effect on temporospatial gait parameters.

Conclusion: In spite of the low number of participants, these results may indicate that intensive active stretching in an interactive dynamic stander could be an effective new conservative clinical treatment of ankle plantarflexor contracture in children with CP.