Efficacy of transcranial Direct Current Stimulation (tDCS) combined with intensive speech therapy for language production in monozygotic twins with corpus callosum dysgenesis (CCD): A sham-controlled single subject study.

The purpose of this single subject study was to investigate whether transcranial direct current stimulation (tDCS) applied to both hemispheres combined with speech therapy can improve language learning in a pair of 5-year-old twins with corpus callosum dysgenesis (CCD). The treatment protocol included anodal tDCS with simultaneous speech therapy in one of the participants (T.D.), and sham-tDCS with the same montage, and stimulation regime concomitant with speech therapy for the other twin (A.D.). Our findings show that T.D. improved in language production when treated with speech therapy in combination with tDCS. A.D. showed evidence for a relatively minor behavioral benefit from speech therapy.

The effect of transcranial photobiomodulation on cognitive function and attentional performance of older women with mild cognitive impairment: a randomized controlled trial.

Introduction: Mild cognitive impairment (MCI) is a progressive age-related condition caused by physiological and structural changes in the brain, such as neurodegeneration and hypometabolism. Transcranial photobiomodulation (tPBM) is a neuromodulation technique that improves brain metabolism and oxygenation by irradiating red to near-infrared light on a specific area of the head. This study aimed to investigate the effect of multi-session tPBM on the cognitive capacities and attentional function of older women with MCI. Material and methods: In this randomized controlled trial, 42 older women with MCI were randomly assigned to 2 equal groups: real and sham. The mini-mental state examination (MMSE) and the attentional Go/No-Go task were used to examine the patients. On the right frontal-pole of the cortex, 5 sessions of 850 nm tPBM were given. Re-examinations were conducted on the participants. For the Go/No-Go task, the reaction time to the target (RTT), the percentage of correct trials (PCT), and the efficiency score (ES) were measured. Results: The findings revealed a significant interaction between group × time for MMSE (F (1, 40) = 20, p < 0.001, h2 = 0.33), and the post-hoc paired-samples t-tests revealed a substantial rise in the mean MMSE in the real group (t = 15.9; p = 0.001; d = 9.3). Additionally, for ES (F (1, 40) = 19, p < 0.001, h2 = 0.32), RTT (F (1, 40) = 17, p < 0.001, h2 = 0.38), and PCT (F (1, 40) = 13, p < 0.001, h2 = 0.31), a significant group × time interaction was discovered, and post-hoc paired-samples t-tests revealed a significant improvement in attention performance of the real group for increases in the mean of ES (F (1,40) = 20, p < 0.001, h2 = 0.33), (t = 5.3, p < 0.001, d = 0.034), decreases in the mean of RTT (t = 4.8; p = 0.001; d = -37.4), and increases in the mean of PCT (t = 2.67; p = 0.015; d = 6.3). Conclusions: According to the findings of this study, tPBM had a positive effect on older people's attention and cognitive abilities.

Transcranial near-infrared photobiomodulation could modulate brain electrophysiological features and attentional performance in healthy young adults.

The aim of the present study was to investigate the electrophysiological effects of the photobiomodulation (PBM) by the quantitative electroencephalography (qEEG) as a diagnostic method. The neurotherapeutic potential of transcranial PBM has been recently investigated in preclinical and clinical studies. According to the PBM mechanisms of action on increasing the cerebral blood flow and the neuronal firing, a change may occur in cortical electrical activity after transcranial PBM that could be revealed in qEEG. A total of 30 participants (15 males and 15 females) were included in this experimental study in a convenience sampling method. A 19-channel EEG was obtained from subjects, before and after receiving sham or real 850-nm PBM by light emitting diode (LED) array on the right prefrontal cortex (PFC). An attentional task also was completed by the participant before and after the irradiation. Results presented that the effect of PBM on the reaction time was significant (p = 0.001) in favor of the real-treatment group (p < 0.05). For the absolute power, repeated-measures ANOVA showed a significant interaction of group × time × frequency (p = 0.04). In the real-treatment group, absolute power of delta band was significantly reduced in all electrodes (p < 0.05). Also, a similar significant interaction of group × time × frequency was seen for relative power (p = 0.04). Post-hoc analysis showed a significant decrease in delta band after PBM in the real treatment group (p < 0.05). The study presented that light irradiation with 850-nm LED source on right PFC could change brain electrical activity and has beneficial effects on attentional performance.

Phosphatidylinositol 4,5-bisphosphate clusters the cell adhesion molecule CD44 and assembles a specific CD44-Ezrin heterocomplex, as revealed by small angle neutron scattering.

The cell adhesion molecule CD44 regulates diverse cellular functions, including cell-cell and cell-matrix interaction, cell motility, migration, differentiation, and growth. In cells, CD44 co-localizes with the membrane-cytoskeleton adapter protein Ezrin that links the CD44 assembled receptor signaling complexes to the cytoskeletal actin network, which organizes the spatial and temporal localization of signaling events. Here we report that the cytoplasmic tail of CD44 (CD44ct) is largely disordered. Upon binding to the signaling lipid phosphatidylinositol 4,5-bisphosphate (PIP2), CD44ct clusters into aggregates. Further, contrary to the generally accepted model, CD44ct does not bind directly to the FERM domain of Ezrin or to the full-length Ezrin but only forms a complex with FERM or with the full-length Ezrin in the presence of PIP2. Using contrast variation small angle neutron scattering, we show that PIP2 mediates the assembly of a specific heterotetramer complex of CD44ct with Ezrin. This study reveals the role of PIP2 in clustering CD44 and in assembling multimeric CD44-Ezrin complexes. We hypothesize that polyvalent electrostatic interactions are responsible for the assembly of CD44 clusters and the multimeric PIP2-CD44-Ezrin complexes.

A randomized trial to assess the biological activity of short-term (pre-surgical) fulvestrant 500 mg plus anastrozole versus fulvestrant 500 mg alone or anastrozole alone on primary breast cancer.

INTRODUCTION: Fulvestrant shows dose-dependent biological activity. Greater estrogen-receptor (ER) blockade may feasibly be achieved by combining fulvestrant with anastrozole. This pre-surgical study compared fulvestrant plus anastrozole versus either agent alone in patients with ER-positive breast cancer. METHODS: In this double-blind, multicenter trial, 121 patients received fulvestrant 500 mg on Day 1 plus anastrozole 1 mg/day for 14 to 21 days (F + A); fulvestrant plus anastrozole placebo (F); or fulvestrant placebo plus anastrozole (A), 2 to 3 weeks before surgery. ER, progesterone-receptor (PgR) and Ki67 expression were determined from tumor biopsies before treatment and at surgery. RESULTS: A total of 103 paired samples were available (F, n = 35; F+A, n = 31; A, n = 37). All treatments significantly reduced mean ER expression from baseline (F: -41%, P = 0.0001; F + A: -39%, P = 0.0001; A: -13%, P = 0.0034). F and F + A led to greater reductions in ER versus A (both P = 0.0001); F + A did not lead to additional reductions versus F. PgR and Ki67 expression were significantly reduced with all treatments (means were -34% to -45%, and -75% to -85%, respectively; all P = 0.0001), with no differences between groups. CONCLUSIONS: In this short-term study, all treatments reduced ER expression, although F and F + A showed greater reductions than A. No significant differences were detected between the treatment groups in terms of PgR and Ki67 expression. No additional reduction in tumor biomarkers with combination treatment was observed, suggesting that F + A is unlikely to have further clinical benefit over F alone. TRIAL REGISTRATION: Clinicaltrials.gov NCT00259090.

Neural activity in self-identified claustrophobic individuals under in-vivo stimuli: A human electroencephalography dataset.

The electrocortical activity in claustrophobic situations is a very limited field of study and has recently caught researchers' attention. This article represents a set of electroencephalographic (EEG) data obtained from twenty-two participants. The volunteers include 9 participants with self-identified claustrophobia and 13 healthy controls under in-vivo stimuli. The EEG data were recorded using Mitsar 31-channel EEG system. Before cortical signal recording, Individuals were asked to identify themselves as healthy controls or claustrophobic participants. The EEG data collection process consisted of three experimental conditions. In all conditions, the participants were asked to stay calm and keep their eyes open. The first experimental condition was at seated resting state in a relatively large and well-lit laboratory (8m × 15m) area. In the second experimental condition, the subjects entered a moderately-lit chamber and repeated the previous resting situation. The final condition of the EEG data acquisition was performed in the same chamber but with reduced dimensions. For each experimental condition, duration of data collection was approximately 300 s. This data can be used to understand the brain's response in claustrophobic situations through various statistical or data-driven methods.

Development of a speech production test in Azeri Turkish speaking children.

Due to the lack of appropriate tests for the assessment of speech sounds of Azeri Turkish speaking children, the present study aimed to develop and validate a single word test. A total of 150 typically developing children were recruited in the study (30 children for investigating the name agreement and 120 children to establish construct validity). In the first step, a test with 31 items was developed in terms of suggested criteria in the literature including word frequency, word length, syllabic structure, familiarity, and picturability of words. Then, we asked the expert panel's opinion for the test items. The value of the content validity ratio for each target word was 1.00 except for one item. To administer the test, we asked the participants to name images. Name agreement of the items was determined through administrating the test. The percentages for the indices of name agreement were 87.68 and 0.17, respectively. The findings of the item-by-item test-retest and inter-rater reliability showed satisfactory values in terms of consonants in the initial and final positions. Also, the value of the internal consistency was calculated to be kr = 0.78 (p < 0.001). The psychometric properties of this scale with 31 items proved that it is appropriate for quantifying the speech sound production in Azeri Turkish typically developing children.

Pre-existing do-not-resuscitate orders are not associated with increased postoperative morbidity at 30 days in surgical patients.

OBJECTIVE: To assess the relationship between pre-existing do-not-resuscitate orders and the incidence of postoperative 30-day minor morbidity in surgical patients. DESIGN: Retrospective analysis of prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program database in patients undergoing general surgical procedures between 2005 and 2008. SETTING: All U.S. hospitals that participated in the American College of Surgeons National Surgical Quality Improvement Program, which is the nationally validated, risk-adjusted, outcomes-based program that uses a prospective, peer-controlled, validated database to quantify 30-day risk-adjusted surgical outcomes, allowing valid comparison of outcomes among all hospitals in the program. INTERVENTIONS: American College of Surgeons National Surgical Quality Improvement Program data included preoperative risk factors, intraoperative variables, and 30-day postoperative mortality and morbidity outcomes for patients undergoing major surgical procedures in both the inpatient and outpatient setting. The data were collected, validated, and submitted by a trained Surgical Clinical Reviewer at each site. Association between do-not-resuscitate status and minor and major morbidities was assessed using proportional hazards models adjusting for death as a competing risk. MEASUREMENTS AND MAIN RESULTS: Of 635,265 patients in the database, 576,745 patients were analyzed. Propensity-matched analysis successfully matched 2,199 (of 2,687 [81.8%]) patients having pre-existing do-not-resuscitate orders (DNR group) with 6,002 non-do-not-resuscitate control subjects (nonDNR group). At any time point within 30 days of surgery, DNR patients were 16% (95% confidence interval, 3-28%; p = .02) less likely to have a minor complication as compared with nonDNR patients after accounting for the competing risk of death. DNR patients were more likely to experience 30-day mortality compared with nonDNR patients (hazard ratio, 2.3; 95% confidence interval, 1.9-2.7; p < .001). However, there was no association between pre-existing do-not-resuscitate orders and occurrence of any major complication (p = .65) treating death as a competing risk event. When associations between do-not-resuscitate orders and individual minor complications were analyzed, a pre-existing do-not-resuscitate order remained independently associated only with decreased odds of superficial surgical site infection (p = .001). CONCLUSIONS: Undergoing surgery with a pre-existing do-not-resuscitate order did not increase the risk of having a postoperative minor or major morbidity at any time within the 30-day postoperative period. Results of health care in U.S. hospitals do not differ based on presence of do-not-resuscitate orders.

The neural differences of arithmetic verification performance depend on math skill: Evidence from event-related potential.

AIM: Math skill is a basic need for an individual, as a career prospect. However, little is known about early brain processes of arithmetic between individuals with different math skill. Therefore, we questioned the modulation of the amplitude of an early negative component by math skill level in an arithmetic verification paradigm using event-related potential (ERP). METHODS: Thirty-six right-handed participants were assigned in two groups of high- and low-performing students. Their electroencephalogram was recorded while they completed an arithmetic verification task. Simple arithmetic operands were made by random digits from 1 to 9. Addition and subtraction operations were equally used in correct and incorrect responses. The accuracy scores, reaction times, and peak amplitude of the negativity in 200-400 ms time window were analyzed. RESULTS: The high-performing group showed significantly higher response speeds, and they were more accurate than the low-performing group. The group × region interaction effect was significant. The high-performing group showed a significantly greater negativity, particularly in parietal region, while the low-performing group showed a significantly deeper negativity in frontal and prefrontal region. In the low-performing group, there were significant peak amplitude differences between the anterior and posterior areas. However, such differences were not detected in the high-performing group. CONCLUSION: Students with different mathematical performance showed distinct patterns in early processing of arithmetic verification, as reflected by differences in negativity at 200-400 ms at anterior and posterior. This suggests that ERPs could be used to differentiate math mastery at neural level which is beneficial in educational and clinical contexts.

Transcranial photobiomodulation changes topology, synchronizability, and complexity of resting state brain networks.

Objective. Transcranial photobiomodulation (tPBM) is a recently proposed non-invasive brain stimulation approach with various effects on the nervous system from the cells to the whole brain networks. Specially in the neural network level, tPBM can alter the topology and synchronizability of functional brain networks. However, the functional properties of the neural networks after tPBM are still poorly clarified.Approach. Here, we employed electroencephalography and different methods (conventional and spectral) in the graph theory analysis to track the significant effects of tPBM on the resting state brain networks. The non-parametric statistical analysis showed that just one short-term tPBM session over right medial frontal pole can significantly change both topological (i.e. clustering coefficient, global efficiency, local efficiency, eigenvector centrality) and dynamical (i.e. energy, largest eigenvalue, and entropy) features of resting state brain networks.Main results. The topological results revealed that tPBM can reduce local processing, centrality, and laterality. Furthermore, the increased centrality of central electrode was observed.Significance. These results suggested that tPBM can alter topology of resting state brain network to facilitate the neural information processing. On the other hand, the dynamical results showed that tPBM reduced stability of synchronizability and increased complexity in the resting state brain networks. These effects can be considered in association with the increased complexity of connectivity patterns among brain regions and the enhanced information propagation in the resting state brain networks. Overall, both topological and dynamical features of brain networks suggest that although tPBM decreases local processing (especially in the right hemisphere) and disrupts synchronizability of network, but it can increase the level of information transferring and processing in the brain network.

Electroencephalographic Activity in Patients with Claustrophobia: A Pilot Study.

BACKGROUND: Exposure to small confined spaces evokes physiological responses such as increased heart rate in claustrophobic patients. However, little is known about electrocortical activity while these people are functionally exposed to such phobic situations. The aim of this study was to examine possible changes in electrocortical activity in this population. METHOD: Two highly affected patients with claustrophobia and two healthy controls participated in this in vivo study during which electroencephalographic (EEG) activity was continuously recorded. Relative power spectral density (rPSD) was compared between two situations of being relaxed in a well-lit open area, and sitting in a relaxed chair in a small (90 cm × 180 cm × 155 cm) chamber with a dim light. This comparison of rPSDs in five frequency bands of EEG was intended to investigate possible patterns of change in electrical activity during fear-related situation. This possible change was also compared between claustrophobic patients and healthy controls in all cortical areas. RESULTS: Statistical models showed that there is a significant interaction between groups of participants and experimental situations in all frequency bands (P < 0.01). In other words, claustrophobic patients showed significantly different changes in electrical activity while going from rest to the test situation. Clear differences were observed in alpha and theta bands. In the theta band, while healthy controls showed an increase in rPSD, claustrophobic patients showed an opposite decrease in the power of electrical activity when entering the confined chamber. In alpha band, both groups showed an increase in rPSD, though this increase was significantly higher for claustrophobic patients. CONCLUSION: The effect of in vivo exposure to confined environments on EEG activity is different in claustrophobic patients than in healthy controls. Most of this contrast is observed in central and parietal areas of the cortex, and in the alpha and theta bands.

Adaptation of MC3T3 cell line to Dulbecco's Modified Eagle's medium.

Seeding cells directly into a new medium subjects the cells to stress due to certain differences in medium formulation. As a result, it seems necessary for cells to be adapted to a new medium, in order to save the properties of the cells and to achieve reliable results from the tests. The MC3T3 osteoblastic cell line is recommended to be cultured in Alpha Minimum Essential Medium (α-MEM). However, Dulbecco's Modified Eagle's medium (DMEM) is widely used for its culture. Therefore, in the present paper, two sequential methodologies were applied to adapt the MC3T3 cells to DMEM. In sequential adaptation 1, 10 vol.% DMEM was added to the original medium every day, while in sequential adaptation 2, the old medium was changed to a new medium having 20 vol.% higher DMEM content after each passage. Cells were monitored and compared to direct cell adaptation, while they were growing. The results showed that in the direct cell adaptation, increase in the number of cells was very slow. In contrast, the two sequential adaptation processes were more efficient where sequential adaptation 2 resulted in a higher number of cells in fewer days; 88 % greater than sequential adaptation 1 when it was believed that the cells were adapted. Furthermore, the statistical analysis was conducted by stepwise regression analysis and mathematical models were provided, which can predict the number of cells by day of culture.

Electroencephalographic characteristics of word finding during phonological and semantic verbal fluency tasks.

AIMS: Verbal Fluency is sensitive to brain damage and is employed to assess language abilities like the size of vocabulary and the semantic-lexical networks' integrity and executive functioning abilities particularly inhibition, working memory, and self-monitoring. Various studies revealed oscillatory changes related to word retrieval during different tasks. However, there are not enough studies on electroencephalographic characteristics of word retrieval routes (phonological or semantic pathway) during free recall. The purpose of our study was to investigate electroencephalography power relationship with semantic and phonological word finding routes during verbal fluency. METHODS: In this within-subject study, the electroencephalography of 20 healthy participants was recorded during written category and letter fluency tasks and compared with the rest state. Absolute power of the signals in delta (1-3.5 Hz), theta (4-7.5 Hz), alpha (8-12 Hz), and beta (12.5-30 Hz) was calculated in three lobes (frontal, parietal, and temporal). RESULTS: A repeated measures ANOVA showed significant interaction of condition × lobe × frequency × side (P < .001). Post hoc test for each lobe showed significant changes in the absolute power of delta, theta and beta for frontal, delta and theta for parietal, and theta and beta for temporal lobes (P-values < .05). CONCLUSION: Searching the words by phonological entries is associated with decreased beta and increased theta in left frontal lobe. These changes are not necessary for semantic word retrieval strategy.

Adaptation and validation of the Persian version of pediatric Voice Handicap Index (pVHI).

BACKGROUND AND OBJECTIVES: This study aimed to assess the reliability and validity of the Persian version of the Pediatric Voice Handicap Index (pVHI). MATERIALS AND METHODS: The questionnaire was translated into Persian and then administrated to the parents of 45 dysphonic children and parents of 135 normal children. The content validity of the questionnaire was confirmed by eight speech-language pathologists. Internal consistency and test-retest reliability were measured via Cronbach's alpha and intra-class correlation coefficient, respectively. Independent-samples t-test was used to evaluate the discriminative and clinical validity of Persian pVHI. RESULTS: Cronbach's coefficient values were excellent for the total score (α = 0.94) and physical subcomponent (α = 0.91). Moreover, these corresponding values were satisfactory for functional (α = 0.82) and emotional (α = 0.79) subcomponents. Test-retest reliability for the total score was high in both dysphonic and control groups (intra-class correlation coefficient> 0.92). There were significant differences between the control and dysphonic groups in terms of the total score and all subcomponents scores of Persian pVHI. However, no significant difference was observed in the mean total score of the Persian pVHI between the control and dysphonic group regarding gender (P < 0.001). DISCUSSION: Persian version of pVHI is a valid and reliable tool to evaluate the severity of voice disorder and its negative effects on the daily life of Persian children with voice disorder from the Parents' viewpoint.

A Randomized, Open-label, Presurgical, Window-of-Opportunity Study Comparing the Pharmacodynamic Effects of the Novel Oral SERD AZD9496 with Fulvestrant in Patients with Newly Diagnosed ER+ HER2- Primary Breast Cancer.

PURPOSE: Fulvestrant, the first-in-class selective estrogen receptor (ER) degrader (SERD), is clinically effective in patients with ER+ breast cancer, but it has administration and pharmacokinetic limitations. Pharmacodynamic data suggest complete ER degradation is not achieved at fulvestrant's clinically feasible dose. This presurgical study (NCT03236974) compared the pharmacodynamic effects of fulvestrant with AZD9496, a novel, orally bioavailable, nonsteroidal, potent SERD, in treatment-naïve patients with ER+ HER2- primary breast cancer awaiting curative intent surgery. PATIENTS AND METHODS: Patients were randomized 1:1 to receive AZD9496 250 mg twice daily from day 1 for 5-14 days, or fulvestrant 500 mg on day 1. On-treatment imaging-guided core tumor biopsies were taken between day 5 and 14 and compared with pretreatment diagnostic biopsies. The primary objective was to compare the effects of AZD9496 and fulvestrant on ER expression. Secondary objectives included changes in progesterone receptor (PR) and Ki-67 pharmacokinetic/pharmacodynamic relationships and safety. RESULTS: Forty-six women received treatment (AZD9496 n = 22; fulvestrant n = 24); 35 paired biopsies were evaluable (AZD9496 n = 15; fulvestrant n = 20). The least square mean estimate for ER H-score reduction was 24% after AZD9496 versus 36% after fulvestrant treatment (P = 0.86). AZD9496 also reduced PR H-scores (-33.3%) and Ki-67 levels (-39.9%) from baseline, but was also not superior to fulvestrant (PR: -68.7%, P = 0.97; Ki-67: -75.4%, P = 0.98). No new safety findings were identified. CONCLUSIONS: This was the first presurgical study to demonstrate that an oral SERD affects its key biological targets. However, AZD9496 was not superior to fulvestrant at the dose tested.

Proliferation and AKT Activity Biomarker Analyses after Capivasertib (AZD5363) Treatment of Patients with ER+ Invasive Breast Cancer (STAKT).

PURPOSE: The STAKT study examined short-term exposure (4.5 days) to the oral selective pan-AKT inhibitor capivasertib (AZD5363) to determine if this drug can reach its therapeutic target in sufficient concentration to significantly modulate key biomarkers of the AKT pathway and tumor proliferation. PATIENTS AND METHODS: STAKT was a two-stage, double-blind, randomized, placebo-controlled, "window-of-opportunity" study in patients with newly diagnosed ER+ invasive breast cancer. Stage 1 assessed capivasertib 480 mg b.i.d. (recommended monotherapy dose) and placebo, and stage 2 assessed capivasertib 360 and 240 mg b.i.d. Primary endpoints were changes from baseline in AKT pathway markers pPRAS40, pGSK3ß, and proliferation protein Ki67. Pharmacologic and pharmacodynamic properties were analyzed from blood sampling, and tolerability by adverse-event monitoring. RESULTS: After 4.5 days' exposure, capivasertib 480 mg b.i.d. (n = 17) produced significant decreases from baseline versus placebo (n = 11) in pGSK3ß (H-score absolute change: -55.3, P = 0.006) and pPRAS40 (-83.8, P < 0.0001), and a decrease in Ki67 (absolute change in percentage positive nuclei: -9.6%, P = 0.031). Significant changes also occurred in secondary signaling biomarker pS6 (-42.3, P = 0.004), while pAKT (and nuclear FOXO3a) also increased in accordance with capivasertib's mechanism (pAKT: 81.3, P = 0.005). At doses of 360 mg b.i.d. (n = 5) and 240 mg b.i.d. (n = 6), changes in primary and secondary biomarkers were also observed, albeit of smaller magnitude. Biomarker modulation was dose and concentration dependent, and no new safety signals were evident. CONCLUSIONS: Capivasertib 480 mg b.i.d. rapidly modulates key biomarkers of the AKT pathway and decreases proliferation marker Ki67, suggesting future potential as an effective therapy in AKT-dependent breast cancers.

Short-term Effects of Transcranial Near-Infrared Photobiomodulation on Motor Performance in Healthy Human Subjects: An Experimental SingleBlind Randomized Clinical Trial.

Introduction: Transcranial near-infrared photobiomodulation (NIR-PBM) is a new noninvasive procedure which transcranially applies a near-infrared wavelength to the scalp with a laser or a light-emitting diode (LED) source. Improvement in the neurological or psychological symptoms has been reported following light irradiation. However, to our knowledge, there is no study to investigate the effects of transcranial NIR-PBM on motor performance directly. Therefore, the objective of this study was to investigate the short-term effects of transcranial NIR-PBM on motor performance in healthy human subjects. Methods: In this experimental single-blind randomized clinical trial study, 56 right-handed healthy participants, whose ages ranged from 18 to 30, were randomly assigned to (1) Real transcranial NIR-PBMC3 group (n=14), (2) Sham transcranial NIR-PBMC3 group (n=14), (3) Real transcranial NIR-PBMC4 group (n=14), and (4) Sham transcranial NIR-PBMC4 group (n=14). We applied the 808 nm laser with irradiation energy density of 60 J/cm2 and power density of 200 mw/cm2 to the C3 or C4 points of the scalp. The number of finger taps as an indicator of motor performance was assessed by the finger-tapping test (FTT) before and after irradiation of transcranial NIR-PBM on the corresponding points of the scalp for 5 minutes. Results: The results showed that the number of finger taps in both right and left hands following the use of transcranial NIR-PBM in the real transcranial NIR-PBMC3 group significantly increased (P<0.05). Conclusion: We concluded that using transcranial NIR-PBM with a laser source on C3 point of the motor cortex in right-handed healthy people can increase the number of finger taps in both hands as an indicator of motor performance improvement.

Septic shock in the postoperative patient: three important management decisions.

The medical consultant should have a high index of suspicion for sepsis. Early goal-directed therapy is recommended and includes early, aggressive fluid resuscitation, antibiotics, and vasoactive agents, if needed. CVO2 may be helpful in guiding therapy, but targeting supranormal levels of oxygen delivery is not necessary. Empiric use of steroids and early use of activated protein C also need to be considered. Vasopressin should be considered if hypotension persists or if the situation requires escalating doses of norepinephrine.