Impaired self-awareness after traumatic brain injury: a systematic review. Part 1: Assessment,clinical aspects and recovery

BackgroundImpaired self-awareness (ISA) has frequently been found to be both frequent and deleterious in patients with moderate to severe traumatic brain injury (TBI).ObjectivesThe present paper is the first of a two-part systematic review of ISA after traumatic brain injury (TBI), focusing on assessment methods, clinical aspects and recovery.MethodsFollowing the PRISMA guidelines, 95 articles meeting the inclusion criteria were included.ResultsISA occurs in 30% to 50% of patients with moderate to severe TBI, although it tends to improve with time. There is no one single gold-standard measure of ISA. Self-proxy discrepancy scores, with scales such as the Patient Competency Rating Scale or the Awareness Questionnaire, or a structured interview such as the Self Awareness of Deficits Interview, are the most frequently used assessment methods, with adequate psychometric properties. Scores on these different scales correlate only moderately with each other, which suggests that they may address different aspects of self-awareness. ISA mainly concerns cognitive and behavioral problems rather than physical or sensory impairments and may concern different areas of functioning, such as anticipatory, emergent or meta-cognitive awareness.ConclusionISA is a complex and multifaceted issue that should be systematically assessed in rehabilitation settings using a range of relatively well-validated tools. The consequences and predictors of ISA after TBI will be addressed in a companion paper.     

Intérêt de l’échographie pour la prise en charge des syndromes douloureux chroniques

Recently, there has been significant interest in the utilization of ultrasound for chronic pain management procedures. Traditional visualization techniques for these procedures include fluoroscopy and computed tomography, and even MRI. With fluoroscopic guided procedures, the initial extrapolation of the position of soft tissues (i.e. muscles, blood vessels, and nerves) is based on their anatomic relationship to viewed bony structures. The interest in the use of ultrasound for chronic pain management procedures has grown from certain visualization advantages including the ability to see muscle layers, nerves and blood vessels. Ultrasound allows for the elimination or reduction of radiation exposure for both the patient and physician. Additionally, real time needle advancement can be visualized with ultrasound, as well as the diffusion of the injected solution. Limitations to current ultrasound technology exist, — i.e acoustic shadow artefact, narrow image windows — which result in the inability to view structures deep to bony obstruction, but techniques are rapidly progressing, allowing to extend and increase the indications in the field of pain medicine.     

Effects of hemodynamic conditions and valve sizing on leaflet bending stress in self-expanding transcatheter aortic valve: An in vitro study

Transcatheter aortic valve (TAV) replacement has become a viable alternative to surgery for high and intermediate risk patients with severe aortic stenosis. This technology may extend to the younger and lower risk patients. In this population, long-term durability of the TAV is key. Increased leaflet mechanical stress is one of the main determinants of valve structural deterioration. This in vitro study aims at evaluating leaflet bending stress (LBS) in the self-expanding TAV for different valve sizes, stroke volumes (SV), and degrees of valve oversizing (OS). Three different sizes (23, 26, and 29 mm) of CoreValve (CV) were tested on a pulse duplicator in annulus size ranging from 17 to 26 mm. Leaflet bending stress and bending of the leaflet coaptation line in diastole pinwheeling index (PI) were measured using high-speed camera imaging (1000 images/s). For each given CV and annulus size, geometric orifice area (GOA) increased significantly with OS (P < .001) and SV (P = .001). LBS decreased with increasing prosthesis size and aortic annulus (AA) size while increasing with SV (P < .03). The largest value of peak LBS (3.79 MPa) was obtained with the CV 23 mm in AA of 17 mm (%OS = 35%), SV 90 mL and the smallest value (0.99 MPa) for the CV 29 mm in AA of 26 mm (%OS = 12%), SV 30 mL. On multivariable analysis, LBS increased independently with larger OS, smaller AA size and higher SV. The PI increased with decreasing AA size and increasing OS. Moderate valve OS, such as generally used for transcatheter aortic valve implantation, is associated with increased LBS during valve opening and closing, especially in small annuli. Hence, TAV OS may negatively impact long-term valve durability.     

Liver regeneration and recanalization time course following reversible portal vein embolization

BACKGROUND/AIMS: Permanent portal vein embolization (PVE) is a widely practised technique. The use of an absorbable material would be safer in clinical situations in which the embolized liver is not resected. We evaluated the efficiency of reversible PVE in terms of liver regeneration and analyzed the precise time course of portal recanalization. METHODS: Nine monkeys underwent PVE of the left and right anterior portal branches using powdered absorbable material. Repeated portograms were carried out until complete revascularization of the embolized liver. Hepatocyte proliferation rates were assessed by BrdU incorporation. Liver segment volumes were determined by CT scans performed before embolization, then 1month and 1year after embolization. RESULTS: Reversible PVE induced significant hepatocyte proliferation in the non-embolized segments (13.5+/-1.0%, 10.5+/-0.8% and 9.1+/-2.0% of cells on days 3, 5 and 7, respectively). One month after the embolization, the non-embolized liver volume had increased from 38.4+/-1.3% to 54.8+/-0.5% of total liver volume. Proximal and complete revascularization occurred 6-8 and 12-16days, respectively. CONCLUSIONS: Reversible PVE efficiently induces liver regeneration. The use of absorbable material avoids long-term liver scarring. Such material may be suitable for several clinical indications, including cell transplantation.     

Comparative effects of adaptation on layers II–III and V–VI neurons in cat V1

V1 is fundamentally grouped into columns that descend from layers II–III to V–VI. Neurons inherent to visual cortex are capable of adapting to changes in the incoming stimuli that drive the cortical plasticity. A principle feature called orientation selectivity can be altered by the presentation of non‐optimal stimulus called ‘adapter’. When triggered, LGN cells impinge upon layer IV and further relay the information to deeper layers via layers II–III. Using different adaptation protocols, neuronal plasticity can be investigated. Superficial neurons in area V1 are well acknowledged to exhibit attraction and repulsion by shifting their tuning peaks when challenged by a non‐optimal stimulus called ‘adapter’. Layers V–VI neurons in spite of partnering layers II–III neurons in cortical computation have not been explored simultaneously toward adaptation. We believe that adaptation not only affects cells specific to a layer but modifies the entire column. In this study, through simultaneous multiunit recordings in anesthetized cats using a multichannel depth electrode, we show for the first time how layers V–VI neurons (1000–1200 μm) along with layers II–III neurons (300–500 μm) exhibit plasticity in response to adaptation. Our results demonstrate that superficial and deeper layer neurons react synonymously toward adapter by exhibiting similar behavioral properties. The neurons displayed similar amplitude of shift and maintained equivalent sharpness of Gaussian tuning peaks before and the following adaptation. It appears that a similar mechanism, belonging to all layers, is responsible for the analog outcome of the neurons’ experience with adapter.     

What do you mean by aortic valve area: geometric orifice area, effective orifice area, or gorlin area?

Aortic valve area can be measured by cardiac catheterization, Doppler echocardiography, or imaging planimetry to assess aortic stenosis severity. These diagnostic techniques provide the Gorlin area, the effective orifice area (EOA) and the geometric orifice area (GOA), respectively. The differences between these three parameters depend mainly on the valve inflow shape and cross-sectional area of the ascending aorta. Because the values obtained may differ noticeably in the same patient, they may lead to different estimations of stenosis severity depending on the measurement method used. It is therefore essential to be aware of the underlying fundamentals on which these parameters are based. The aim of this state-of-the-art report was to clarify these hemodynamic concepts and to underline their clinical implications. Because planimetry only provides GOA and does not characterize the flow property, this method should preferably not be used to assess stenosis severity. The most appropriate parameters for this purpose are the Gorlin area and the energy loss coefficient (E(L)Co), which corresponds to the EOA adjusted for aortic cross-sectional area. From a hemodynamic viewpoint, Doppler E(L)Co and Gorlin area both reflect the fluid energy loss induced by aortic stenosis, and describe better the increased overload imposed on the left ventricle. Although the Gorlin area and Doppler E(L)Co are equivalent, the latter parameter has the advantage of being measurable non-invasively using Doppler echocardiography.     

Biological effects of particles from the paris subway system

Particulate matter (PM) from atmospheric pollution can easily deposit in the lungs and induce recruitment of inflammatory cells, a source of inflammatory cytokines, oxidants, and matrix metalloproteases (MMPs), which are important players in lung structural homeostasis. In many large cities, the subway system is a potent source of PM emission, but little is known about the biological effects of PM from this source. We performed a comprehensive study to evaluate the biological effects of PM sampled at two sites (RER and Metro) in the Paris subway system. Murine macrophages (RAW 264.7) and C57Bl/6 mice, respectively, were exposed to 0.01-10 microg/cm2 and 5-100 microg/mouse subway PM or reference materials [carbon black (CB), titanium dioxide (TiO2), or diesel exhaust particles (DEPs)]. We analyzed cell viability, production of cellular and lung proinflammatory cytokines [tumor necrosis factor alpha (TNFalpha), macrophage inflammatory protein (MIP-2), KC (the murin analog of interleukin-8), and granulocyte macrophage-colony stimulating factor (GM-CSF)], and mRNA or protein expression of MMP-2, -9, and -12 and heme oxygenase-1 (HO-1). Deferoxamine and polymixin B were used to evaluate the roles of iron and endotoxin, respectively. Noncytotoxic concentrations of subway PM (but not CB, TiO2, or DEPs) induced a time- and dose-dependent increase in TNFalpha and MIP-2 production by RAW 264.7 cells, in a manner involving, at least in part, PM iron content (34% inhibition of TNF production 8 h after stimulation of RAW 264.7 cells with 10 microg/cm2 RER particles pretreated with deferoxamine). Similar increased cytokine production was transiently observed in vivo in mice and was accompanied by an increased neutrophil cellularity of bronchoalveolar lavage (84.83+/-0.98% of polymorphonuclear neutrophils for RER-treated mice after 24 h vs 7.33+/-0.99% for vehicle-treated animals). Subway PM induced an increased expression of MMP-12 and HO-1 both in vitro and in vivo. PM from the Paris subway system has transient biological effects. Further studies are needed to better understand the pathophysiological implications of these findings.     

On‐line conversion monitoring of the solution polymerization of methyl methacrylate using near‐infrared spectroscopy

Fiber‐optic near‐infrared (NIR) spectroscopy was successfully used to monitor the conversion of monomer during the solution polymerization of methyl methacrylate (MMA) carried out in a lab‐scale reactor. NIR spectra were recorded during 18 batch and semi‐continuous reactions using an in‐situ transmission probe. An empirical model was generated using partial least‐squares regression (PLS) to relate the NIR spectral data to the conversion measured off line by gravimetry. The obtained calibration was characterized by a correlation coefficient of 99.45% and a standard error of calibration (SEC) equal to 1.95%. The measurements were then validated for various operating conditions and for both batch and semi‐continuous modes. The conversion was measured with a standard error below 2.6%, in the worst case scenario. The on‐line NIR measurement of conversion was demonstrated to be accurate, robust, and suitable for versatile use in the polymerization plant.

Validation of the on‐line measurement of MMA conversion during the semi‐continuous Runs V2 and V3.