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Invited Commentary on "Optimizing Diffusion-Tensor Imaging Acquisition for Spinal Cord Assessment," with Response from Dr Martín Noguerol et al.
Smith SA
(2020) Radiographics 40: 428-431
MeSH Terms: Diffusion Tensor Imaging, Physical Examination, Spinal Cord
Added March 30, 2020
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3 MeSH Terms
In-Hospital Pediatric Stroke Alert Activation.
Barry M, Le TM, Gindville MC, Jordan LC
(2018) Pediatr Neurol 88: 31-35
MeSH Terms: Adolescent, Child, Child, Preschool, Emergency Service, Hospital, Female, Hemorrhage, Humans, Infant, Magnetic Resonance Imaging, Male, Neurologic Examination, Stroke, Time Factors, Tomography Scanners, X-Ray Computed, Young Adult
Show Abstract · Added March 24, 2020
BACKGROUND - Pediatric stroke alerts or "code strokes" allow for rapid evaluation, imaging, and treatment of children presenting with stroke-like symptoms. In a previous study of emergency department-initiated pediatric stroke alerts, 24% of children had confirmed strokes. The purpose of this study was to characterize in-hospital pediatric stroke alerts.
METHODS - Demographic and clinical information was obtained from a quality improvement database and medical records for children (zero to 20 years) at a single institution for whom a stroke alert was activated after hospital admission between April 2011 and December 2016. Stroke alert activation criteria included a new focal neurological defect occurring within 48 hours. A neurologist evaluated the patient within 15 minutes and rapid magnetic resonance imaging was available.
RESULTS - Medical personnel activated in-hospital stroke alerts for 56 children (median age 6.5 years, interquartile range 1 to 13, 52% male). Stroke was the final diagnosis of 25 (45%), 72% ischemic, and 28% hemorrhagic strokes. Other diagnoses included neurological urgencies: seizure (21%), posterior reversible encephalopathy syndrome (7%), transient ischemic attack (5%), and acute disseminated encephalomyelitis (4%). Of the stroke diagnoses, 68% were stroke alerts called in the pediatric intensive care unit or pediatric cardiac intensive care unit. Rapid neuroimaging was completed in 91%; magnetic resonance imaging brain was the first image in 55%.
CONCLUSIONS - Of in-hospital pediatric stroke alerts, 45% were stroke while 38% were other neurological conditions requiring urgent evaluation. In-hospital stroke alerts were commonly activated for children with complicated medical histories. Rapid neurological evaluation facilitated care. No child underwent thrombolysis or thrombectomy.
Copyright © 2018. Published by Elsevier Inc.
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MeSH Terms
Cognitive functioning over 2 years after intracerebral hemorrhage in school-aged children.
Murphy LK, Compas BE, Gindville MC, Reeslund KL, Jordan LC
(2017) Dev Med Child Neurol 59: 1146-1151
MeSH Terms: Adolescent, Cerebral Hemorrhage, Child, Cognition Disorders, Comprehension, Female, Humans, Intelligence, Intelligence Tests, Longitudinal Studies, Male, Memory, Short-Term, Neurologic Examination, Neuropsychological Tests, Outcome Assessment, Health Care
Show Abstract · Added March 24, 2020
AIM - Previous research investigating outcomes after pediatric intracerebral hemorrhage (ICH) has generally been limited to global and sensorimotor outcomes. This study examined cognitive outcomes after spontaneous ICH in school-aged children with serial assessments over 2 years after stroke.
METHOD - Seven children (age range 6-16y, median 13; six males, one female; 57% white, 43% black) presenting with spontaneous ICH (six arteriovenous malformations) were assessed at 3 months, 12 months, and 24 months after stroke. The Pediatric Stroke Outcome Measure (PSOM) quantified neurological outcome and Wechsler Intelligence Scales measured cognitive outcomes: verbal comprehension, perceptual reasoning, working memory, and processing speed.
RESULTS - PSOM scales showed improved neurological function over the first 12 months, with mild to no sensorimotor deficits and moderate overall deficits at 1- and 2-year follow-ups (median 2-year sensorimotor PSOM=0.5, total PSOM=1.5). Changes in cognitive function indicated a different trajectory; verbal comprehension and perceptual reasoning improved over 24 months; low performance was sustained in processing speed and working memory. Age-normed centile scores decreased between 1- and 2-year follow-ups for working memory, suggesting emerging deficits compared with peers.
INTERPRETATION - Early and serial cognitive testing in children with ICH is needed to assess cognitive functioning and support children in school as they age and cognitive deficits become more apparent and important for function.
WHAT THIS PAPER ADDS - In children with intracerebral hemorrhage (ICH), motor function improved between 3 months and 24 months. Improvements in cognitive function were variable between 3 months and 24 months. Working memory centiles declined, suggesting emerging deficits compared with peers. Processing speed improved but remained significantly below the 50th centile. Cognitive impact of ICH may increase with age in children.
© 2017 Mac Keith Press.
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Bypass of DNA-Protein Cross-links Conjugated to the 7-Deazaguanine Position of DNA by Translesion Synthesis Polymerases.
Wickramaratne S, Ji S, Mukherjee S, Su Y, Pence MG, Lior-Hoffmann L, Fu I, Broyde S, Guengerich FP, Distefano M, Schärer OD, Sham YY, Tretyakova N
(2016) J Biol Chem 291: 23589-23603
MeSH Terms: Amination, Amino Acid Sequence, Base Sequence, DNA Adducts, DNA Replication, DNA-Directed DNA Polymerase, Guanine, Humans, Molecular Dynamics Simulation, Oxidation-Reduction, Peptides, Proteins, Recombinant Proteins
Show Abstract · Added March 14, 2018
DNA-protein cross-links (DPCs) are bulky DNA lesions that form both endogenously and following exposure to bis-electrophiles such as common antitumor agents. The structural and biological consequences of DPCs have not been fully elucidated due to the complexity of these adducts. The most common site of DPC formation in DNA following treatment with bis-electrophiles such as nitrogen mustards and cisplatin is the N7 position of guanine, but the resulting conjugates are hydrolytically labile and thus are not suitable for structural and biological studies. In this report, hydrolytically stable structural mimics of N7-guanine-conjugated DPCs were generated by reductive amination reactions between the Lys and Arg side chains of proteins/peptides and aldehyde groups linked to 7-deazaguanine residues in DNA. These model DPCs were subjected to in vitro replication in the presence of human translesion synthesis DNA polymerases. DPCs containing full-length proteins (11-28 kDa) or a 23-mer peptide blocked human polymerases η and κ. DPC conjugates to a 10-mer peptide were bypassed with nucleotide insertion efficiency 50-100-fold lower than for native G. Both human polymerase (hPol) κ and hPol η inserted the correct base (C) opposite the 10-mer peptide cross-link, although small amounts of T were added by hPol η. Molecular dynamics simulation of an hPol κ ternary complex containing a template-primer DNA with dCTP opposite the 10-mer peptide DPC revealed that this bulky lesion can be accommodated in the polymerase active site by aligning with the major groove of the adducted DNA within the ternary complex of polymerase and dCTP.
© 2016 by The American Society for Biochemistry and Molecular Biology, Inc.
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13 MeSH Terms
Generalized onset seizures with focal evolution (GOFE) - A unique seizure type in the setting of generalized epilepsy.
Linane A, Lagrange AH, Fu C, Abou-Khalil B
(2016) Epilepsy Behav 54: 20-9
MeSH Terms: Adolescent, Anticonvulsants, Brain, Child, Child, Preschool, Disease Progression, Electroencephalography, Epilepsies, Partial, Epilepsy, Generalized, Female, Humans, Male, Neurologic Examination, Risk Factors, Seizures
Show Abstract · Added March 14, 2018
PURPOSE - We report clinical and electrographic features of generalized onset seizures with focal evolution (GOFE) and present arguments for the inclusion of this seizure type in the seizure classification.
METHODS - The adult and pediatric Epilepsy Monitoring Unit databases at Vanderbilt Medical Center and Children's Hospital were screened to identify generalized onset seizures with focal evolution. We reviewed medical records for epilepsy characteristics, epilepsy risk factors, MRI abnormalities, neurologic examination, antiepileptic medications before and after diagnosis, and response to medications. We also reviewed ictal and interictal EEG tracings, as well as video-recorded semiology.
RESULTS - Ten patients were identified, 7 males and 3 females. All of the patients developed generalized epilepsy in childhood or adolescence (ages 3-15years). Generalized onset seizures with focal evolution developed years after onset in 9 patients, with a semiology concerning for focal seizures or nonepileptic events. Ictal discharges had a generalized onset on EEG, described as either generalized spike-and-wave and/or polyspike-and-wave discharges, or generalized fast activity. This electrographic activity then evolved to focal rhythmic activity most commonly localized to one temporal or frontal region; five patients had multiple seizures evolving to focal activity in different regions of both hemispheres. The predominant interictal epileptiform activity included generalized spike-and-wave and/or polyspike-and-wave discharges in all patients. Taking into consideration all clinical and EEG data, six patients were classified with genetic (idiopathic) generalized epilepsy, and four were classified with structural/metabolic (symptomatic) generalized epilepsy. All of the patients had modifications to their medications following discharge, with three becoming seizure-free and five responding with >50% reduction in seizure frequency.
CONCLUSION - Generalized onset seizures may occasionally have focal evolution with semiology suggestive of focal seizures, leading to a misdiagnosis of focal onset. This unique seizure type may occur with genetic as well as structural/metabolic forms of epilepsy. The identification of this seizure type may help clinicians choose appropriate medications, avoiding narrow spectrum agents known to aggravate generalized onset seizures.
Copyright © 2015 Elsevier Inc. All rights reserved.
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15 MeSH Terms
Disgust proneness and associated neural substrates in obesity.
Watkins TJ, Di Iorio CR, Olatunji BO, Benningfield MM, Blackford JU, Dietrich MS, Bhatia M, Theiss JD, Salomon RM, Niswender K, Cowan RL
(2016) Soc Cogn Affect Neurosci 11: 458-65
MeSH Terms: Adult, Body Mass Index, Brain Mapping, Cerebral Cortex, Eating, Emotions, Female, Food, Food Contamination, Functional Laterality, Humans, Hunger, Hyperphagia, Magnetic Resonance Imaging, Male, Neuropsychological Tests, Obesity, Photic Stimulation
Show Abstract · Added February 15, 2016
Defects in experiencing disgust may contribute to obesity by allowing for the overconsumption of food. However, the relationship of disgust proneness and its associated neural locus has yet to be explored in the context of obesity. Thirty-three participants (17 obese, 16 lean) completed the Disgust Propensity and Sensitivity Scale-Revised and a functional magnetic resonance imaging paradigm where images from 4 categories (food, contaminates, contaminated food or fixation) were randomly presented. Independent two-sample t-tests revealed significantly lower levels of Disgust Sensitivity for the obese group (mean score = 14.7) compared with the lean group (mean score = 17.6, P = 0.026). The obese group had less activation in the right insula than the lean group when viewing contaminated food images. Multiple regression with interaction analysis revealed one left insula region where the association of Disgust Sensitivity scores with activation differed by group when viewing contaminated food images. These interaction effects were driven by the negative correlation of Disgust Sensitivity scores with beta values extracted from the left insula in the obese group (r = -0.59) compared with a positive correlation in the lean group (r = 0.65). Given these body mass index-dependent differences in Disgust Sensitivity and neural responsiveness to disgusting food images, it is likely that altered Disgust Sensitivity may contribute to obesity.
© The Author (2015). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.
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18 MeSH Terms
Functional brain imaging in survivors of critical illness: A prospective feasibility study and exploration of the association between delirium and brain activation patterns.
Jackson JC, Morandi A, Girard TD, Merkle K, Graves AJ, Thompson JL, Shintani AK, Gunther ML, Cannistraci CJ, Rogers BP, Gore JC, Warrington HJ, Ely EW, Hopkins RO, VISualizing Icu SurvivOrs Neuroradiological Sequelae (VISIONS) Investigation
(2015) J Crit Care 30: 653.e1-7
MeSH Terms: Aged, Brain, Cognition Disorders, Cohort Studies, Critical Illness, Delirium, Feasibility Studies, Female, Functional Neuroimaging, Humans, Intensive Care Units, Linear Models, Magnetic Resonance Imaging, Male, Memory, Short-Term, Middle Aged, Patient Discharge, Physical Examination, Pilot Projects, Prospective Studies, Survivors, Time Factors
Show Abstract · Added September 23, 2015
PURPOSE - We undertook this pilot prospective cohort investigation to examine the feasibility of functional magnetic resonance imaging (fMRI) assessments in survivors of critical illness and to analyze potential associations between delirium and brain activation patterns observed during a working memory task (N-back) at hospital discharge and 3-month follow-up.
MATERIALS AND METHODS - At hospital discharge and 3 months later, fMRI assessed subjects' functional activity during an N-back task. Multiple linear regression was used to examine associations between duration of delirium and brain activity, and elastic net regression was used to assess the relationship between brain activation patterns at 3 months and cognitive outcomes at 12 months.
RESULTS - Of 47 patients who underwent fMRI at discharge, 38 (80%) completed the protocol; of 37 who underwent fMRI at 3 months, 34 (91%) completed the protocol. At discharge, the mean (SD) percentage of correct responses on the most challenging version (the N2 version) of the N-back task was 70.4 (23.2; range of 20-100) compared with 76 (23.4; range of 33-100) at 3 months. No association was observed between delirium duration in the hospital and brain region activity in any brain region at discharge or 3 months after adjusting for relevant covariates (P values across all 11 brain regions of interest were >.25).
CONCLUSIONS - Our data support the feasibility of using fMRI in survivors of critical illness at 3-month follow-up but not at discharge. In this small study, delirium was not associated with distinct or abnormal brain activation patterns, although overall performance on a cognitive task of working memory was poorer than observed in other cohorts of individuals with medically related executive dysfunction, mild cognitive impairment, and mild traumatic brain injury.
Copyright © 2015. Published by Elsevier Inc.
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22 MeSH Terms
Are fourth-year medical students as prepared to manage unstable patients as they are to manage stable patients?
McEvoy MD, Dewaay DJ, Vanderbilt A, Alexander LA, Stilley MC, Hege MC, Kern DH
(2014) Acad Med 89: 618-24
MeSH Terms: Analysis of Variance, Angina, Stable, Checklist, Clinical Competence, Computer Simulation, Diagnosis, Differential, Education, Medical, Undergraduate, Electrocardiography, Female, Humans, Male, Myocardial Infarction, Physical Examination, Students, Medical, Young Adult
Show Abstract · Added October 17, 2015
PURPOSE - To evaluate the fourth-year medical student's assessment and management of an unstable patient.
METHOD - The authors compared the performance of fourth-year medical students in a clinical performance examination (CPX) across a spectrum of simulated stable conditions as compared with a case of ST-elevation myocardial infarction (STEMI). All fourth-year medical students at the Medical University of South Carolina participated in an eight-station CPX. Student performance was graded as the percentage of correct steps performed according to checklists developed through a modified Delphi technique. Repeated analysis of variance was performed to compare performance on different stations. Data are reported as mean (standard deviation), and P < .05 was considered significant.
RESULTS - A total of 143 fourth-year medical students participated in the study. The percentage of correct actions performed in the STEMI station was 47.8 (9.5), which was significantly lower than all other stations (P < .001). There was no difference in overall performance between any of the other stable encounters. Students performed significantly worse in the physical and management/treatment components of the STEMI station, as compared with history, differential diagnosis, labs/tests, and diagnosis.
CONCLUSIONS - Fourth-year medical students were less prepared to manage a simulated STEMI case compared with a range of nonacute conditions. Given the prevalence of coronary artery disease and the necessity of interns to be equipped to handle emergent situations, this deficiency should be addressed in undergraduate medical curricula.
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15 MeSH Terms
Bioelectrical impedance self-measurement protocol development and daily variation between healthy volunteers and breast cancer survivors with lymphedema.
Ridner SH, Bonner CM, Doersam JK, Rhoten BA, Schultze B, Dietrich MS
(2014) Lymphat Res Biol 12: 2-9
MeSH Terms: Adult, Aged, Arm, Breast Neoplasms, Electric Impedance, Feasibility Studies, Female, Healthy Volunteers, Humans, Lymphedema, Middle Aged, Patient Compliance, Pilot Projects, Self-Examination, Survivors
Show Abstract · Added March 13, 2014
BACKGROUND - A significant percentage of breast cancer survivors are at risk for lymphedema for which lifelong self-care is required. Previous studies suggest that less than 50% of breast cancer survivors with lymphedema (BCS-LE) perform prescribed self-care tasks and that even wearing a compression sleeve, the most commonly reported self-care activity, is done irregularly. Reasons for poor self-care adherence include perceived lack of results from self-care (no available arm volume data) and perceived inability to manage the condition.
METHODS AND RESULTS - A two-part pilot study was conducted to: 1) develop and determine the feasibility of a self-measurement protocol using a single frequency bioelectrical impedance device; and 2) examine daily variation in extracellular volume in healthy and lymphedematous limbs. Healthy and BCS-LE volunteers were recruited to refine and test a self-measurement protocol. Volunteers were trained in the use of the device and measured for 5 consecutive days in a laboratory setting. They were then given the device to use at home for an additional 5 consecutive days of self-measurement. All volunteers completed each scheduled home measurement. Daily variability in both groups was noted.
CONCLUSIONS - Home self-measurement using bioelectrical impedance is feasible, acceptable, and captures change. This has implications for both self-care support and for the possibility of incorporating self-measurement using bioelectrical impedance in future clinical trials examining effectiveness of lymphedema treatment.
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15 MeSH Terms
Assessment of external lymphedema in patients with head and neck cancer: a comparison of four scales.
Deng J, Ridner SH, Dietrich MS, Wells N, Murphy BA
(2013) Oncol Nurs Forum 40: 501-6
MeSH Terms: Aged, Cross-Sectional Studies, Female, Head and Neck Neoplasms, Humans, Lymph Node Excision, Lymphatic Irradiation, Lymphedema, Male, Middle Aged, Nursing Assessment, Physical Examination, Postoperative Complications, Prevalence, Severity of Illness Index
Show Abstract · Added March 7, 2014
PURPOSE/OBJECTIVES - To compare available grading and staging scales that measure external lymphedema in patients with head and neck cancer (HNC) and to assess problems and gaps related to these tools.
DESIGN - Cross-sectional.
SETTING - A comprehensive cancer center in Tennessee.
SAMPLE - 103 participants post-HNC treatment.
METHODS - Four scales were used to evaluate study participant external lymphedema status, including the Common Terminology Criteria for Adverse Events (CTCAE) Lymphedema Scale (version 3.0), American Cancer Society Lymphedema Scale, Stages of Lymphedema (Földi's Scale), and the CTCAE Fibrosis Scale (version 3.0).
MAIN RESEARCH VARIABLES - Occurrence rate, severity of lymphedema, and components and descriptors of each scale.
FINDINGS - The prevalence and severity of external lymphedema differed based on the tools. Each tool had an identified limitation. Current theory postulates a continuum between lymphedema and fibrosis, but only the Földi's Scale adequately reflected that concept.
CONCLUSIONS - None of the available scales clearly captured all the important characteristics of external lymphedema in patients with HNC. A need exists to develop a clearly defined and validated scale of external lymphedema in the HNC population.
IMPLICATIONS FOR NURSING - Oncology nurses should take an active role in addressing issues related to lymphedema assessment in patients post-HNC treatment; however, new assessment tools need to be developed for clinical use.
KNOWLEDGE TRANSLATION - Early identification and accurate documentation of head and neck lymphedema are critically important to prevent lymphedema progress. However, existing grading criteria failed to capture important characteristics of external head and neck lymphedema. More research efforts need to be made to address this under-recognized issue.
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15 MeSH Terms