The Treatment of Nonepileptic Seizures: Historical Perspectives and Future Directions

Summary:  Nonepileptic seizures (NES) are neuropsychiatric disorders presenting with a combination of neurologic signs and underlying psychological conflicts. For more than a century, the medical community has accumulated data and insights about the phenomenology, epidemiology, risks, comorbidities, and prognosis of NES. However, we have not progressed much beyond anecdotal reports of treatments for NES, and no randomized, controlled trials of treatment for the disorder have been conducted. We review the diagnosis and treatment of NES and suggest directions for future research in these areas.     

VDT对操作人员健康的影响

本文报道了VDT的卫生学调查,观察到VDT组(67例)眼疲劳感、视物模糊、眼酸、乏力等主诉率显著高于对照组;有明显的视疲劳与作业能力下降;尿5—HIAA含量亦显著高于对照组。结果表明VDT作业对视功能、作业能力和5—HT能神经元的代谢存在一定程度的职业性影响,其原因可能与工作环境、心理压力和功效学等因素的联合作用有关。     

The influence of future gaze orientation upon eye-head coupling during saccades

Mammals with foveas (or analogous retinal specializations) frequently shift gaze without moving the head, and their behavior contrasts sharply with afoveate mammals, in which eye and head movements are strongly coupled. The ability to move the eyes without moving the head could reflect a gating mechanism that blocks a default eye-head synergy when an attempted head movement would be energetically wasteful. Based upon such considerations of efficiency, we predicted that for saccades to targets lying within the ocular motor range, the tendency to generate a head movement would depend upon a subjects expectations regarding future directions of gaze. We tested this hypothesis in two experiments with normal human subjects instructed to fixate sequences of lighted targets on a semicircular array. In the target direction experiment, we determined whether subjects were more likely to move the head during a small gaze shift if they expected that they would be momentarily required to make a second, larger shift in the same direction. Adding the onward-directed target increased significantly the distribution of final head positions (customary head orientation range, CHOR) observed during fixation of the primary target from 16.6±4.9° to 25.2±7.8°. The difference reflected an increase in the probability, and possibly the amplitude, of head movements. In the target duration experiment, we determined whether head movements were potentiated when subjects expected that gaze would be held in the vicinity of the target for a longer period of time. Prolonging fixation increased CHOR significantly from 53.7±18.8° to 63.2±15.9°. Larger head movements were evoked for any given target eccentricity, due to a narrowing in the gap between the x-intercepts of the head amplitude:target eccentricity relationship. The results are consistent with the idea that foveate mammals use knowledge of future gaze direction to influence the coupling of saccadic commands to premotor circuitry of the head. While the circuits ultimately mediating the coupling may lie within the brainstem, our results suggest that the cerebrum plays a supervisory role, since it is a likely seat of expectation regarding target behavior. Eye-head coupling may reflect separate gating and scaling mechanisms, and changes in head movement tendencies may reflect parametric modulation of either mechanism.     

'Honoring tradition, accepting new ways': development of a hepatitis B control intervention for Vietnamese immigrants

Background. Chronic hepatitis B infection rates among Vietnamese‐American adults range from 7 to 14%. Carriers of HBV are over 200 times more likely to develop liver cancer than non‐carriers, and Vietnamese males have the highest liver cancer incidence rate of any ethnic group in the USA (41.8 per 100,000). Culturally and linguistically appropriate interventions are necessary to increase hepatitis B knowledge, serologic testing, and vaccination rates among Vietnamese immigrants.

Methods. The authors engaged in qualitative data collection to inform the development of intervention materials including a video, pamphlet, and barrier‐specific counseling guidelines. Bilingual research assistants conducted 25 open‐ended qualitative interviews and six focus groups focusing on hepatitis B and liver cancer with a convenience sample of Vietnamese‐American men and women living in the Seattle area.

Results. Qualitative findings include beliefs about liver illness and health influenced by traditional Vietnamese and traditional Chinese medicine theory; beliefs about hepatitis B transmission and causes embedded in personal experiences and socio‐historical circumstances; and the value of health and a positive attitude. The video portrays a Vietnamese immigrant family struggling with the new knowledge that their healthy‐appearing son is a hepatitis B carrier. Print materials address knowledge resources and misconceptions about hepatitis B revealed in the qualitative data.

Discussion. Qualitative research provides valuable insight into unanticipated issues influencing health beliefs and behaviors relevant to specific populations and is essential to the development of effective health education materials, which necessarily draw upon local social and cultural contexts. The methods used in this study to develop culturally informed hepatitis B intervention materials for Vietnamese‐Americans translate well for the development of education outreach programs targeting Vietnamese and other immigrants elsewhere.     

Influence of time pressure and verbal provocation on physiological and psychological reactions during work with a computer mouse

The overall aim of this study was to investigate whether time pressure and verbal provocation has any effect on physiological and psychological reactions during work with a computer mouse. It was hypothesised that physiological reactions other than muscle activity (i.e. wrist movements, forces applied to the computer mouse) would not be affected when working under stressful conditions. Fifteen subjects (8 men and 7 women) participated, performing a standardised text-editing task under stress and control conditions. Blood pressure, heart rate, heart rate variability, electromyography, a force-sensing computer mouse and electrogoniometry were used to assess the physiological reactions of the subjects. Mood ratings and ratings of perceived exertion were used to assess their psychological reactions. The time pressure and verbal provocation (stress situation) resulted in increased physiological and psychological reactions compared with the two control situations. Heart rate, blood pressure and muscle activity in the first dorsal interosseus, right extensor digitorum and right trapezius muscles were greater in the stress situation. The peak forces applied to the button of the computer mouse and wrist movements were also affected by condition. Whether the increases in the physiological reactions were due to stress or increased speed/productivity during the stress situation is discussed. In conclusion, work with a computer mouse under time pressure and verbal provocation (stress conditions) led to increased physiological and psychological reactions compared to control conditions. Electronic Publication     

Indocyanine green video angiographies help to identify burns requiring operation

The key decision in the treatment of thermal injuries is the determination of the depth of the burn wound and the resultant decision on treatment options. The trend in the treatment of deep dermal and full thickness burns is toward very early excision and grafting to reduce the risk of infection, decrease scar formation, shorten hospital stay, and thereby reducing costs. Traditionally, this has involved serial clinical examinations, which involves primarily subjective judgment. Various objective examination techniques, supplementing the clinical diagnosis, have been suggested, but none has yet achieved widespread clinical acceptance. It has frequently been postulated that the blood flow in injured tissue indicates the extent of tissue damage. In this study, the clinical and scientific impact of indocyanine green (ICG) video angiography was tested in 20 patients. A wide range of depth of injury and etiology was included and analyzed. In all cases considered, video angiography was possible. The measurements and observations correlated well with the actual burn depth, which was assessed clinically (pre- and intraoperative assessment) and histologically (biopsies). In conclusion, ICG video angiography seems to be a practical method to describe vascular patency in a burn wound. The results indicate that ICG fluorescence angiography is a practical, accurate, and effective adjunct to clinical methods for estimating burn wound depth and thereby to assist in the rational assessment of treatment options. Furthermore, it allows an objective, qualitative and quantitative observation of the dynamic changes in burn wound depth, which are observed during the acute post-burn period, thereby indicating optimal timing of the first operation.     

'A day in the life': advancing a methodology for the cultural study of development and learning in early childhood

This paper explores the methodology of an ecological investigation of aspects of culture in the interactional construction of early childhood in diverse global communities: Peru, Italy, Canada, Thailand, and the United Kingdom. Regarding culture as a dynamic dimension of the child's socialisation, the approach taken was to film a 'day in the life' of a two-and-a-half-year-old girl in each location. The principal investigators viewed these five 'days' and selected clips were made into a compilation tape, to be interrogated and interpreted by the local investigators and the child's family. These latter reflections were also taped and then applied to a growing appreciation of the child in cultural context. Other inter-researcher techniques were used to elucidate and explore events and values further. Reflexive concerns as to the interplay between aims and methods in interpretive research are critical components of this endeavour to develop new cultural understandings of the girls in context.     

前庭诱发肌源性电位预测突聋患者疗效的临床价值

目的 分析单侧突发性耳聋患者的疗效,探讨前庭功能与预后的关系。 方法 回顾性分析59例(59耳)突发性耳聋患者的临床资料,观察临床疗效,根据前庭功能结果探讨对预后的影响。 结果 59例突发性耳聋患者在治疗前共进行了183项前庭功能检查,眼性前庭诱发肌源性电位(oVEMP)和颈性前庭诱发肌源性电位(cVEMP)异常的突聋患者显示出更低的治疗总有效率;oVEMP和cVEMP正常的突聋患者受损频率听力提高更明显。冷热试验(Caloric Test)和视频头脉冲试验(vHIT)的正常与否对突聋患者的总有效率和受损听力的提高无影响。cVEMP和oVEMP都异常的患者治疗无效率比仅其中一项异常的患者高,受损听力恢复程度也比仅其中一项异常的患者差。 结论 oVEMP和cVEMP异常的突聋患者疗效较差,oVEMP和cVEMP正常的突聋患者有更好的听力恢复。oVEMP和cVEMP功能可能是预测突发性聋患者预后的有效指标。前庭功能异常提示突发性聋患者的内耳病变范围较大、程度较重。     

Video-assisted thoracoscopic surgery tracheal resection and carinal reconstruction for tracheal adenoid cystic carcinoma

We report a case of video-assisted thoracoscopic surgery (VATS) tracheal resection and carinal reconstruction in a patient with tracheal tumor. The patient presented with adenoid cystic carcinoma (ACC) of the distal trachea, extending along the right main bronchus with carinal invasion. The reconstruction procedure was assisted with cross-field ventilation. Postoperative clinical course of this case was good. The forced expiratory volume in the first second (FEV₁) improved from 0.461 L (17% pred.) to 2.31 L (87% pred.) 1 month after the operation. VATS tracheal resection and carinal reconstruction is a feasible option for patients with tracheal tumor with carina involvement.