Reconsidering the olfactory and brain structures in Kallmann's syndrome: New findings in the analysis of volumetry.

OBJECTIVE: Kallmann's syndrome (KS) is characterized by hypogonadotropic hypogonadism and olfactory disorders. The complementary exams for evaluating of patients with hypogonadotrophic hypogonadism are important for the diagnosis and management of these patients. PATIENTS: We performed a well-established olfactory Sniffin' Stick test (SST) on 17 adult patients with KS and brain magnetic resonance imaging (MRI) to evaluate olfactory structures and further analysis by Freesurfer, a software for segmentation and volumetric evaluation of brain structures. We compared the Freesurfer results with 34 healthy patients matched for age and sex and performed correlations between the data studied. RESULTS: More than half of the patients with KS reported preserved smell but had olfactory disorders in the SST. In the MRI, 16 patients showed changes in the olfactory groove, the olfactory bulb-tract complex was altered in all of them and 52% had symmetrical structural changes. Interestingly, the pituitary gland was normal in only 29%. Regarding correlations, symmetrical changes in the olfactory structures were related to anosmia in 100%, while asymmetric changes induced anosmia in only 50% (p = .0294). In Freesurfer's assessment, patients with KS, compared to controls, had lower brainstem volume. In those with aplastic anterior olfactory sulcus, the brainstem volume was lower than in hypoplasia (p = .0333). CONCLUSIONS: Olfactory assessment and MRI proved to be important auxiliary tools for the diagnosis and management of patients with KS. New studies are needed to confirm the decrease in brainstem volume found by the Freesurfer software in patients with KS. Further studies are needed to confirm the decrease in brainstem volume found by the Freesurfer software in patients with KS.

Tear proteomic profile in three distinct ocular surface diseases: keratoconus, pterygium, and dry eye related to graft-versus-host disease.

BACKGROUND: Diseases of the anterior segment of the eye may present different mechanisms, intensity of symptoms, and impact on the patients' quality of life and vision. The tear film is in direct contact with the ocular surface and cornea and can be easily accessed for sample collection, figuring as a promising source of potential biomarkers for diagnosis and treatment control. This study aimed to evaluate tear proteomic profile in 3 distinct ocular diseases: keratoconus (corneal ectasia), severe dry eye related to graft-versus-host-disease (tear film dysfunction and ocular inflammatory condition) and pterygium (conjunctival fibrovascular degenerative disease). METHODS: Tear samples were collected from patients of each condition and a control group. By using mass spectrometric analysis combined with statistics and bioinformatics tools, a detailed comparison of protein profile was performed. RESULTS: After Student's t-test analyses comparing each condition to the control group, we found the following number of differentially expressed proteins: 7 in keratoconus group, 29 in pterygium group, and 79 in GVHD group. Following multivariate analyses, we also report potential candidates as biomarkers for each disease. CONCLUSIONS: We demonstrated herein that mass spectrometry-based proteomics was able to indicate proteins that differentiate three distinct ocular conditions, which is a promising tool for the diagnosis of ocular diseases.

Whole-Body Vibration on Performance of Quadriceps After ACL Reconstruction: A Blinded Randomized Controlled Trial.

CONTEXT: Whole-body vibration (WBV) has been widely used in clinical and sport practice. These devices produce constant vibrations, originating symmetrical waves that move along the vertical axis. It is suggested that mechanical stimuli produced by high vibration can be an alternative to improve neuromuscular performance and balance in different populations. However, there is still a lack of consensus in the literature regarding neurophysiological responses in the skeletal muscle immediately after the use of WBV, specifically in individuals subjected to anterior cruciate ligament reconstruction. OBJECTIVE: To investigate the immediate effects of WBV on neuromuscular performance of the quadriceps femoris and postural oscillation of individuals subjected to anterior cruciate ligament reconstruction. DESIGN: This is a blinded randomized controlled trial. SETTING: University laboratory. PARTICIPANTS: Forty-four men. INTERVENTION: Participants were randomized into 2 groups: control group (n = 22, exercise protocol on the vibrating platform turned off) and WBV group (n = 22, exercises on the vibrating platform turned on, at a frequency of 50 Hz and amplitude of 4 mm). MAIN OUTCOME MEASURES: The volunteers underwent a dynamometric evaluation of the quadriceps femoris and electromyographic activity of vastus lateralis and vastus medialis muscles, in addition to oscillation of the center of pressure at 2 different moments: before and immediately after the intervention protocol. RESULTS: The intragroup comparison evidenced differences between preassessments and postassessments for the variables of laterolateral amplitude, peak torque, and total work. However, no significant difference was observed in the intergroup comparison after WBV protocol. CONCLUSION: The use of WBV did not immediately alter the performance of the quadriceps femoris and the electromyographic activity of vastus lateralis and vastus medialis muscles. In addition, it also did not interfere with pressure center oscillation of individuals subjected to anterior cruciate ligament reconstruction.

Visceral fat increase and signals of inflammation in adipose tissue after administration of titanium dioxide nanoparticles in mice.

Titanium dioxide nanoparticles (TiO2 NP) are present in several daily use products, and the risks associated with their bioaccumulation must be stablished. Thus, an evaluation of several toxicological-related effects was conducted after intraperitoneal injection of TiO2 NPs in mice. Mice were divided into two groups, which received 2 mg kg-1 day-1 of TiO2 NPs or vehicle saline. Assessments of body and organ weight as well as biochemical, hematological, and histopathological analyses were performed in order to evaluate adverse effects. The results showed that treatment resulted in an increased visceral and abdominal fat deposition, as well as a mononuclear inflammatory infiltrates in the abdominal fat tissue. The TiO2 NPs induced significant decrease in the weight gain and splenomegaly. Additionally, TiO2 NP-treated mice showed altered hematological parameters and significant liver injuries, which were characterized by histopathological and biochemical changes. Our results also indicated that TiO2 NPs were absorbed and significantly accumulated in the spleen, liver, and kidney. These results showed the ability of TiO2 NPs to infiltrate different organs and to induce inflammation and liver and spleen damage with visceral fat accumulation. The data obtained are useful for the governmental authorities to legislate and implement regulations concerning the use and the production of this kind of material that might be hazardous to the living beings, as well as to the environment.

Effects of Whole Body Vibration on the Neuromuscular Amplitude of Vastus Lateralis Muscle.

The aim of this study was to investigate the effects of whole-body vibration (WBV) on vastus lateralis (VL) surface electromyographic (sEMG) amplitude during an isometric semi-squat exercise, using two different frequencies, and to verify the influence of additional filters on the analyzed sEMG signal's characteristics. Forty physically active women were randomly divided into two groups with 20 members each: one group performed an isometric semi-squat exercise at 30 Hz - while the other group performed the same exercise protocol at 50 Hz. The sEMG amplitude of the VL muscle was recorded during the exercise protocols in two conditions: with and without vibration. After removing vibration-induced artifacts using digital filters, sEMG amplitude of VL increased significantly (p < 0.05) without differences between the frequencies. The results of this study suggest that WBV at 30 Hz and 50 Hz increased the sEMG amplitude of the VL muscle during an isometric semi-squat exercise. Furthermore, applying sEMG filters during signal processing of WBV is necessary, because motion artifacts from the vibration frequencies may contribute to the contamination of the sEMG amplitude.

Assessment of the Halogen Content of Brazilian Inhalable Particulate Matter (PM10) Using High Resolution Molecular Absorption Spectrometry and Electrothermal Vaporization Inductively Coupled Plasma Mass Spectrometry, with Direct Solid Sample Analysis.

Halogens in the atmosphere play an important role in climate change and also represent a potential health hazard. However, quantification of halogens is not a trivial task, and methods that require minimum sample preparation are interesting alternatives. Hence, the aim of this work was to evaluate the feasibility of direct solid sample analysis using high-resolution continuum source molecular absorption spectrometry (HR-CS MAS) for F determination and electrothermal vaporization-inductively coupled plasma mass spectrometry (ETV-ICP-MS) for simultaneous Cl, Br, and I determination in airborne inhalable particulate matter (PM10) collected in the metropolitan area of Aracaju, Sergipe, Brazil. Analysis using HR-CS MAS was accomplished by monitoring the CaF molecule, which was generated at high temperatures in the graphite furnace after the addition of Ca. Analysis using ETV-ICP-MS was carried out using Ca as chemical modifier/aerosol carrier in order to avoid losses of Cl, Br, and I during the pyrolysis step, with concomitant use of Pd as a permanent modifier. The direct analysis approach resulted in LODs that were proven adequate for halogen determination in PM10, using either standard addition calibration or calibration against a certified reference material. The method allowed the quantification of the halogens in 14 PM10 samples collected in a northeastern coastal city in Brazil. The results demonstrated variations of halogen content according to meteorological conditions, particularly related to rainfall, humidity, and sunlight irradiation.

Bromine isotope ratio measurements in seawater by multi-collector inductively coupled plasma-mass spectrometry with a conventional sample introduction system.

A simple and accurate methodology for Br isotope ratio measurements in seawater by multi-collector inductively coupled plasma-mass spectrometry (MC-ICP-MS) with pneumatic nebulization for sample introduction was developed. The Br(+) signals could be measured interference-free at high mass resolution. Memory effects for Br were counteracted using 5 mmol L(-1) of NH4OH in sample, standard, and wash solutions. The major cation load of seawater was removed via cation exchange chromatography using Dowex 50WX8 resin. Subsequent Br preconcentration was accomplished via evaporation of the sample solution at 90 °C, which did not induce Br losses or isotope fractionation. Mass discrimination was corrected for by external correction using a Cl-matched standard measured in a sample-standard bracketing approach, although Sr, Ge, and Se were also tested as potential internal standards for internal correction for mass discrimination. The δ(81)Br (versus standard mean ocean bromide (SMOB)) values thus obtained for the NaBr isotopic reference material NIST SRM 977 and for IRMM BCR-403 seawater certified reference material are in agreement with literature values. For NIST SRM 977, the (81)Br/(79)Br ratio (0.97291) was determined with a precision ≤0.08‰ relative standard deviation (RSD).

Low-level laser therapy reduces the fatigue index in the ankle plantar flexors of healthy subjects.

Low-level laser therapy (LLLT) has been suggested as a resource capable of increasing resistance to fatigue and enhancing muscle performance through its metabolic and photochemical effects. This study evaluated the immediate effects of the application of LLLT on neuromuscular performance of the plantar ankle flexors in healthy subjects through a fatigue-induced protocol. This is a randomized controlled clinical trial, attended by 60 young and physically active volunteers of both genders. The subjects were randomly assigned into three groups, control, placebo, and laser, and underwent a preliminary evaluation of the isokinetic performance of plantar flexors and electromyographic activity of the soleus muscle to ensure homogeneity between groups. After the application of the respective intervention protocols, participants were induced to fatigue by performing 100 isokinetic concentric contractions of ankle plantar flexors at a speed of 90°/s. The dynamometric fatigue index (DFI) and median frequency were recorded during the fatigue protocol for comparison between groups. The group receiving the laser application showed significantly lower dynamometric fatigue index (p = 0.036) when compared to control and placebo groups. In relation to the median frequency during the fatigue test, there was a decrease in all groups, however with no differences between them. We suggest that LLLT being applied prior to exercise can reduce the fatigue index in the ankle plantar flexors of healthy subjects.

Phytochemicals, Monosaccharides and Elemental Composition of the Non-Pomace Constituent of Organic and Conventional Grape Juices (Vitis labrusca L.): Effect of Drying on the Bioactive Content.

Grape and grape derivatives contain a variety of antioxidants that have gain increasing interest for functional foods applications. The chemical composition of grapes is mainly related to grape variety and cultivation factors, and each grape constituent exhib its unique characteristics regarding its bioactive properties. This study investigated the chemical composition and the effect of drying on the bioactive content of the non-pomace constituent obtained in the processing of organic and conventional grape juices from V. labrusca L. The non-pomace samples were analyzed for polyphenols, monosaccharides, antioxidant activity and elemental composition and the effect of drying on the bioactive composition was evaluated in samples subjected to lyophilization and drying with air circulation. The analyses revealed high concentrations of proanthocyanidins, flavanols and anthocyanins, and high antioxidant capacity of the organic and conventional samples. The drying processes reduced significantly (P < 0.05) the total phenolic content that ranged from 13.23 to 36.36 g/kg. Glucose, xylose, and mannose were the predominant monosaccharides, whereas K, Ca and Mg were the most abundant minerals. Variations in the chemical composition of organic and conventional samples were associated with cultivation factors. Nevertheless, this non-pomace constituent is a promising source of nutrients and polyphenols with bioactive potential.

The sound of silence: Quantification of typical absence seizures by sonifying EEG signals from a custom-built wearable device.

OBJECTIVE: To develop and validate a method for long-term (24-h) objective quantification of absence seizures in the EEG of patients with childhood absence epilepsy (CAE) in their real home environment using a wearable device (waEEG), comparing automatic detection methods with auditory recognition after seizure sonification. METHODS: The waEEG recording was acquired with two scalp electrodes. Automatic analysis was performed using previously validated software (Persyst® 14) and then fully reviewed by an experienced clinical neurophysiologist. The EEG data were converted into an audio file in waveform format with a 60-fold time compression factor. The sonified EEG was listened to by three inexperienced observers and the number of seizures and the processing time required for each data set were recorded blind to other data. Quantification of seizures from the patient diary was also assessed. RESULTS: Eleven waEEG recordings from seven CAE patients with an average age of 8.18 ± 1.60 years were included. No differences in the number of seizures were found between the recordings using automated methods and expert audio assessment, with significant correlations between methods (ρ > .89, p < .001) and between observers (ρ > .96, p < .001). For the entire data set, the audio assessment yielded a sensitivity of .830 and a precision of .841, resulting in an F1 score of .835. SIGNIFICANCE: Auditory waEEG seizure detection by lay medical personnel provided similar accuracy to post-processed automatic detection by an experienced clinical neurophysiologist, but in a less time-consuming procedure and without the need for specialized resources. Sonification of long-term EEG recordings in CAE provides a user-friendly and cost-effective clinical workflow for quantifying seizures in clinical practice, minimizing human and technical constraints.

Acceptance and commitment therapy versus cognitive behavioral therapy for insomnia: A randomized controlled trial.

OBJECTIVE: To compare the effectiveness of an acceptance and commitment therapy (ACT)-based protocol and cognitive behavior therapy (CBT) for insomnia in adults. METHOD: The participants comprised 227 adults with insomnia. They were randomized to six weekly group sessions consisting of acceptance and commitment therapy for insomnia (n = 76), cognitive behavioral therapy for insomnia (n = 76), or waitlist (WL; n = 75). RESULTS: Both treatment modalities significantly reduced insomnia severity with large effect sizes in the posttreatment phase. These results were maintained during the follow-up period with large effect sizes. CBT was superior to ACT in reducing the Insomnia Severity Index at posttreatment and follow-up, with a small effect size. ACT was superior to WL at posttreatment and at follow-up, with a moderate effect size. The treatment response and remission ratios were higher with CBT at posttreatment and similar at 6-month follow-up for both therapies, as ACT made further gains in response and remission. ACT had a significantly higher proportion of response and remission than WL in both periods (posttreatment and follow-up). Both therapies improved daytime functioning at both posttreatment and follow-up, with few differential changes across the groups. CONCLUSIONS: Both cognitive behavior therapy and acceptance and commitment therapy are effective, with CBT showing superiority and ACT showing delayed improvement. ACT has proven to be an effective therapy, especially in the long term, even in the absence of behavioral techniques such as stimulus control and sleep restriction, and it is a viable option for those who have difficulties adhering to behavioral techniques. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Electromyography as a tool to motion analysis for people with Amyotrophic Lateral Sclerosis: A protocol for a systematic review.

Biomechanical analysis of human movement plays an essential role in understanding functional changes in people with Amyotrophic Lateral Sclerosis (ALS), providing information on muscle impairment. Studies suggest that surface electromyography (sEMG) may be able to quantify muscle activity, identify levels of fatigue, assess muscle strength, and monitor variation in limb movement. In this article, a systematic review protocol will analyze the psychometric properties of the sEMG regarding the clinical data on the skeletal muscles of people with ALS. This protocol uses the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodological tool. A specific field structure was defined to reach each phase. Nine scientific databases (PubMed, Web of Science, Embase, Elsevier, IEEE, Google Scholar, SciELO, PEDro, LILACS E CENTRAL) were searched. The framework developed will extract data (i.e. study information, sample information, sEMG information, intervention, and outcomes) from the selected studies using a rigorous approach. The data will be described quantitatively using frequency and trend analysis methods, and heterogeneity between the included studies will be assessed using the I2 test. The risk of bias will be summarized using the most recent prediction model risk of bias assessment tool. Be sure to include relevant statistics here, such as sample sizes, response rates, P values or Confidence Intervals. Be specific (by stating the value) rather than general (eg, "there were differences between the groups"). This protocol will map out the construction of a systematic review that will identify and synthesize the advances in movement analysis of people with ALS through sEMG, using data extracted from articles.

Honey bee stressor networks are complex and dependent on crop and region.

Honey bees play a major role in crop pollination but have experienced declining health throughout most of the globe. Despite decades of research on key honey bee stressors (e.g., parasitic Varroa destructor mites and viruses), researchers cannot fully explain or predict colony mortality, potentially because it is caused by exposure to multiple interacting stressors in the field. Understanding which honey bee stressors co-occur and have the potential to interact is therefore of profound importance. Here, we used the emerging field of systems theory to characterize the stressor networks found in honey bee colonies after they were placed in fields containing economically valuable crops across Canada. Honey bee stressor networks were often highly complex, with hundreds of potential interactions between stressors. Their placement in crops for the pollination season generally exposed colonies to more complex stressor networks, with an average of 23 stressors and 307 interactions. We discovered that the most influential stressors in a network-those that substantively impacted network architecture-are not currently addressed by beekeepers. Finally, the stressor networks showed substantial divergence among crop systems from different regions, which is consistent with the knowledge that some crops (e.g., highbush blueberry) are traditionally riskier to honey bees than others. Our approach sheds light on the stressor networks that honey bees encounter in the field and underscores the importance of considering interactions among stressors. Clearly, addressing and managing these issues will require solutions that are tailored to specific crops and regions and their associated stressor networks.

Environmental metagenetics unveil novel plant-pollinator interactions.

Honey bees are efficient pollinators of flowering plants, aiding in the plant reproductive cycle and acting as vehicles for evolutionary processes. Their role as agents of selection and drivers of gene flow is instrumental to the structure of plant populations, but historically, our understanding of their influence has been limited to predominantly insect-dispersed flowering species. Recent metagenetic work has provided evidence that honey bees also forage on pollen from anemophilous species, suggesting that their role as vectors for transmission of plant genetic material is not confined to groups designated as entomophilous, and leading us to ask: could honey bees act as dispersal agents for non-flowering plant taxa? Using an extensive pollen metabarcoding dataset from Canada, we discovered that honey bees may serve as dispersal agents for an array of sporophytes (Anchistea, Claytosmunda, Dryopteris, Osmunda, Osmundastrum, Equisetum) and bryophytes (Funaria, Orthotrichum, Sphagnum, Ulota). Our findings also suggest that honey bees may occasionally act as vectors for the dispersal of aquatic phototrophs, specifically Coccomyxa and Protosiphon, species of green algae. Our work has shed light on the broad resource-access patterns that guide plant-pollinator interactions and suggests that bees could act as vectors of gene flow, and potentially even agents of selection, across Plantae.

Effects of a self-care educational program via telerehabilitation on quality of life and caregiver burden in amyotrophic lateral sclerosis: a single-blinded randomized clinical trial protocol.

Introduction: The implementation of a telerehabilitation protocol for self-care in the routine of caregivers of individuals with amyotrophic lateral sclerosis (ALS) has been associated with reduced levels of stress and improved quality of life. Moreover, it may reduce the difficulty of traveling to perform physical or other self-care activities. Thus, this study designed a clinical trial protocol to investigate the effects of a self-care education program via telerehabilitation on the burden and quality of life of caregivers of individuals with ALS. Methods: This single-blinded randomized clinical trial will recruit 26 caregivers and randomly allocate them to the experimental (EG = 13) or control group (CG = 13). The EG will receive an informative booklet and participate in a 6-week synchronous telerehabilitation program with a neuropsychologist, nutritionist, and physiotherapist to discuss physical and mental health. The CG will receive an informative booklet on self-care and physical activity and weekly phone calls for 6 weeks to solve questions about the booklet. Outcomes will include the caregiver burden (Zarit scale), quality of life (World Health Organization Quality of Life BREF), pain (McGill Pain Questionnaire), stress (Perceived Stress Scale), and depression (Beck Depression Inventory), which will be evaluated at the baseline after the six-week program and 30 days after the program. Additionally, we will assess daily the nocturnal awakenings, sleep patterns, level of physical activity, and heart rate variability. Discussion: This study aimed to investigate the effectiveness of telerehabilitation for caregivers of individuals with ALS. If effective, this program could be disseminated among health professionals, increasing the possibility of remotely monitoring individuals with difficulty performing physical activities. Trial registration number: NCT05884034 (clinicaltrials.gov).

Identifying biomarkers for tDCS treatment response in Alzheimer's disease patients: a machine learning approach using resting-state EEG classification.

Background: Transcranial direct current stimulation (tDCS) is a promising treatment for Alzheimer's Disease (AD). However, identifying objective biomarkers that can predict brain stimulation efficacy, remains a challenge. The primary aim of this investigation is to delineate the cerebral regions implicated in AD, taking into account the existing lacuna in comprehension of these regions. In pursuit of this objective, we have employed a supervised machine learning algorithm to prognosticate the neurophysiological outcomes resultant from the confluence of tDCS therapy plus cognitive intervention within both the cohort of responders and non-responders to antecedent tDCS treatment, stratified on the basis of antecedent cognitive outcomes. Methods: The data were obtained through an interventional trial. The study recorded high-resolution electroencephalography (EEG) in 70 AD patients and analyzed spectral power density during a 6 min resting period with eyes open focusing on a fixed point. The cognitive response was assessed using the AD Assessment Scale-Cognitive Subscale. The training process was carried out through a Random Forest classifier, and the dataset was partitioned into K equally-partitioned subsamples. The model was iterated k times using K-1 subsamples as the training bench and the remaining subsample as validation data for testing the model. Results: A clinical discriminating EEG biomarkers (features) was found. The ML model identified four brain regions that best predict the response to tDCS associated with cognitive intervention in AD patients. These regions included the channels: FC1, F8, CP5, Oz, and F7. Conclusion: These findings suggest that resting-state EEG features can provide valuable information on the likelihood of cognitive response to tDCS plus cognitive intervention in AD patients. The identified brain regions may serve as potential biomarkers for predicting treatment response and maybe guide a patient-centered strategy. Clinical Trial Registration: https://classic.clinicaltrials.gov/ct2/show/NCT02772185?term=NCT02772185&draw=2&rank=1, identifier ID: NCT02772185.

Dielectric barrier discharge-assisted determination of methylmercury in particulate matter by atomic absorption spectrometry.

Particulate matter (PM) impregnated with methlymercury (MeHg+) was analyzed using atomic absorption spectrometry coupled to a customized dielectric barrier discharge (DBD) device. Chemical vapor generation (CVG) was applied to generate methylmercury hydride and the DBD device promoted bond cleavage with subsequent release of free Hg atoms to the gas phase. Hydride generation was carried out using a lab-made syringe-based device in batch mode using argon as a carrier gas. Optimized conditions included the use of 1.0 mL of a 0.05% m/v NaBH4 solution and 1.0 mL of a 10% v/v HCl solution. This system was coupled to the DBD device, designed to operate in "plasma jet" configuration. Assessment of the designed device for methylmercury detection was established based on an on-off switch, which promptly demonstrated that Hg signals could only be detected upon activation of the plasma discharge. In parallel, adsorption of MeHg+ to PM-loaded glass fiber filters was investigated. Direct analysis of methylmercury-impregnated PM resulted in significant signal suppression compared to the same mass of analyte from an aqueous standard, which suggests that methylmercury is efficiently adsorbed on PM. This was later confirmed by repeating the same experiment with "blank" (PM-free) glass fiber filters. Hence, extraction of methylmercury to a liquid phase was required for quantification. In order to demonstrate the feasibility of the proposed setup to carry out methylmercury detection in the presence oh Hg2+, recovery tests were conducted by mixing MeHg+ with Hg2+ at three distinct concentration levels (100 : 1, 10 : 1 and 1 : 1 MeHg+ : Hg2+). Recoveries better than 91% were obtained for MeHg+ under these conditions, which demonstrates that the device is efficient for MeHg+ determination by simply modulating the plasma (switching on-off). Limits of detection and quantification were established as 6 ng and 19 ng, respectively.

Visual word form area hyperexcitability associated with focal epileptiform activity in a case of reading epilepsy

Reading epilepsy recruits critical language-related areas, with synchronization and subsequent spreading of excitation in response to the epileptogenic stimulus. The mechanism by which possible generalized discharges result in the expression of bilateral or unilateral clinical symptoms remains controversial. The cortical and subcortical areas involved may constitute part of the normal reading network, such as the visual word form area (VWFA). A right-handed, 59-year-old man was diagnosed with epilepsy at the age of 15 after tonic-clonic seizures. Later, the patient described myoclonic jerks of the masticatory and perioral muscles while reading. A multimodal approach with magnetic resonance imaging and ambulatory and video-electroencephalogram was used for seizure characterization and source analysis. A left hemisphere spontaneous occipital-temporal epileptic focus, activated by reading, was observed, spreading broadly throughout frontal and temporal language networks. There was an abnormally increased cortical response to visual word presentation in comparison to pseudowords. Spatial localization of spike sources suggested a close association between the primary epileptic focus and the VWFA. This epileptiform activity seems to be selectively triggered at an early stage of lexical processing, with a functional connection between the epileptic network and the VWFA. This multimodal and functional connectivity approach could be helpful in determining the epileptic network in reading epilepsy.

Early Mobilization Prescription in Patients Undergoing Cardiac Surgery: Systematic Review.

INTRODUCTION: Early mobilization of patients in the postoperative period of cardiac surgery who are hospitalized in the intensive care unit (ICU) is a practice that has a positive impact. METHODS: This is a systematic review of studies published until September 2020 in the Medical Literature Analysis and Retrieval System Online (or MEDLINE®), Embase, Physiotherapy Evidence Database (or PEDro), Scientific Electronic Library Online (or SciELO), and Latin American and Caribbean Health Sciences Literature (or LILACS) databases. Randomized clinical trials describing mobilization protocols performed early in ICU patients after cardiac surgery were included. RESULTS: According to the eligibility criteria, only 14 of the 1,128 articles found were included in the analysis. Early mobilization protocols were initiated in the immediate postoperative period or first postoperative day. The resources and technics used were progressive mobilization, cycle ergometer, early bed activities, walking protocols, resistance exercise, and virtual reality. Intensity of the mobilization activities was determined using the Borg scale and heart rate. CONCLUSION: Early mobilization protocols are generalist (not individual), and low-intensity exercises are used, through progressive mobilization, with two daily physical therapy sessions, during 10 to 30 minutes.

A plethora of ocular surface manifestations in a multidisciplinary ocular graft-versus-host disease unit.

To describe the experience in a recently created ocular graft-versus-host disease unit in a tertiary hospital and to detail ocular surface features and complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). This retrospective study included all patients who underwent allo-HSCT, with or without chronic GVHD and were being monitored in the Hematopoietic Stem Cell Transplantation Unit in the UNICAMP Clinical Hospital (Campinas, Sao Paulo, Brazil) from 2015 to 2020. Patients were concomitantly evaluated by hematology and ophthalmology teams of the Ocular GVHD Unit. Hematologists performed a comprehensive systemic evaluation searching and grading mouth, skin, lungs, gastrointestinal tract, liver and genitalia GVHD. While ophthalmologists evaluated ocular symptoms through specific questionnaire (Ocular Surface Disease Index-OSDI) and a protocol of distinct ocular surface parameters for dry eye disease (1) and ocular complications, which encompassed meniscometry, non-invasive tear break-up time (NITBUT) measurement, conjunctival hyperemia quantification, meibography, fluorescein and lissamine staining and Schirmer's test. Patients were diagnosed with chronic GVHD using the National Institutes of Health (NIH) Consensus Criteria for Chronic Graft-versus-Host Disease. The International Chronic Ocular GVHD Consensus Group (ICOGCG) score was obtained at the onset of ocular disease presentation or afterwards. A total of 82 patients underwent allo-HSCT (97.6% full matched and 2.4% haploidentical), mainly for cases of leukemia and 73.2% had chronic GVHD. Mean onset time for chronic GVHD was 232 ± 7.75 days. The mouth, skin, and eyes were the main organs involved (63%, 50%, and 48%, respectively). Symptom scores and all ocular surface parameters differ in patients with and without chronic GVHD and along different timepoints of the follow-up. Ocular complications mostly involved were severe DED and meibomian gland dysfunction, conjunctival scarring, cataract and infections resulting in keratitis and corneal perforation. As therapeutic strategies, 73% patients received preservative-free lubricants, 27% autologous serum, 48% topical steroids, 27% oral tetracycline derivatives, 22% mucolytic eye drops and 3 patients needed bandage contact lens. Ocular GVHD is a complex and challenging disease with varied manifestations, resulting in a broad range of ocular test endpoints, and inconsistent treatment responses. The main ocular presentations were dry eye, meibomian gland dysfunction and cataracts. The therapeutic approach often involves topical steroids and autologous serum tears. It is important to monitor these patients closely, so the ocular GVHD Unit may improve the care, providing prompt identification of ocular manifestations and faster treatment of complications.