Neural signature of attention impairment in allergic asthma: an ERP study.

Background Cognitive impairments are linked to poor treatment response and disease control in allergic asthma. However, there are no studies exploring attention-related functional brain alterations in allergic asthma. Here, we explore attention deficit and its association with clinical characteristics and common neuropsychiatric disorders in patients with allergic asthma.Methods We recruited 38 participants, equally distributed into healthy and asthma groups. Behavioral, neurophysiological, and lung function assessment tools were used in this study.Results Our behavioral data show that allergic asthma induces attention impairment. Additionally, the event-related potentials (ERP) analysis reveals that this attention deficit is associated with a disruption in cognitive processing capability in frontal brain areas. These behavioral and neurophysiological abnormalities were strongly correlated with disease severity and neuropsychiatric comorbidities of asthmatic patients.Conclusion Together, here we propose that disrupted neurophysiological responses in frontal brain areas might lead to attention impairments in patients with allergic asthma. These findings could help characterizing the neuro-pathophysiology of cognitive disorders in allergic asthma, possibly opening the way for development of novel treatment strategies.

Asthma induces psychiatric impairments in association with default mode and salience networks alteration: A resting-state EEG study.

Asthma is a chronic inflammatory disease associated with a high prevalence of psychiatric disorders. There are specific brain networks responsible for emotional processes, including two important networks associated with psychiatric problems: the default mode network (DMN), which is more active in the resting state, and the salience network (SN), which is structurally connected to DMN. Although previous studies suggested that neuro-phenotypes of asthma may be recognizable by the neural activity of brain circuits, an association between the brain's functional alterations and psychiatric impairments induced by asthma remains unknown. We aimed to assess DMN and SN activity and its association with psychiatric indices and clinical parameters in asthmatic patients. Electroencephalography was recorded during the resting state with an awake and eyes-open condition in thirty-eight sex and age-matched subjects (19 atopic asthma patients and 19 healthy participants). Power spectrum and functional connectivity were computed for DMN and SN. We examined psychiatric disorders (including depression, anxiety, and stress) and pulmonary function using the DASS questionnaire and spirometry test, respectively. The results showed that DASS scores were significantly higher in asthmatic patients compared to healthy subjects. Asthmatic patients also demonstrate a significant enhancement in power and functional connectivity in the two networks. Notably, these power enhancements of the networks were correlated with psychiatric problems scores, pulmonary function, asthma duration, and poor asthma control. These results introduce new evidence for the association between altered brain activity, the existence of psychiatric disorders, and asthma-related features, including pulmonary function. Also, we provide new insights into asthma-induced inflammatory response and the importance of developing novel interventions and therapeutic strategies for managing allergic inflammation patients who suffer from concurrent psychiatric disorders.

ACC-BLA functional connectivity disruption in allergic inflammation is associated with anxiety.

Allergic asthma is a chronic inflammatory respiratory disease. Psychiatric disorders, including anxiety are associated with poorer treatment response and disease control in asthmatic patients. To date, there is no experimental evidence describing the role of peripheral inflammation on the oscillatory activities in the anterior cingulate cortex (ACC) and basolateral amygdala (BLA), two major brain structures modulating anxiety. In the present work we evaluated lung and brain inflammatory responses, anxiety-like behavior, in association with oscillatory features of the ACC-BLA circuit in an animal model of allergic inflammation. Our data showed that allergic inflammation induced anxiety-like behavior and reactivation of microglia and astrocytes in ACC and BLA. Allergic inflammation also enhanced neuronal activities and functional connectivity of the ACC-BLA circuit which were correlated with the level of anxiety. Together, we suggest that disruption in the dynamic oscillatory activities of the ACC-BLA circuit, maybe due to regional inflammation, is an underlying mechanism of allergic asthma-induced anxiety-like behavior. Our findings could pave the way for better understanding the neuro-pathophysiology of the psychiatric disorders observed in asthmatic patients, possibly leading to develop novel treatment strategies.

Nasal Air Puff Promotes Default Mode Network Activity in Mechanically Ventilated Comatose Patients: A Noninvasive Brain Stimulation Approach.

OBJECTIVES: Coma state and loss of consciousness are associated with impaired brain activity, particularly gamma oscillations, that integrate functional connectivity in neural networks, including the default mode network (DMN). Mechanical ventilation (MV) in comatose patients can aggravate brain activity, which has decreased in coma, presumably because of diminished nasal airflow. Nasal airflow, known to drive functional neural oscillations, synchronizing distant brain networks activity, is eliminated by tracheal intubation and MV. Hence, we proposed that rhythmic nasal air puffing in mechanically ventilated comatose patients may promote brain activity and improve network connectivity. MATERIALS AND METHODS: We recorded electroencephalography (EEG) from 15 comatose patients (seven women) admitted to the intensive care unit because of opium poisoning and assessed the activity, complexity, and connectivity of the DMN before and during the nasal air-puff stimulation. Nasal cavity air puffing was done through a nasal cannula controlled by an electrical valve (open duration of 630 ms) with a frequency of 0.2 Hz (ie, 12 puff/min). RESULTS: Our analyses demonstrated that nasal air puffing enhanced the power of gamma oscillations (30-100 Hz) in the DMN. In addition, we found that the coherence and synchrony between DMN regions were increased during nasal air puffing. Recurrence quantification and fractal dimension analyses revealed that EEG global complexity and irregularity, typically seen in wakefulness and conscious state, increased during rhythmic nasal air puffing. CONCLUSIONS: Rhythmic nasal air puffing, as a noninvasive brain stimulation method, opens a new window to modifying the brain connectivity integration in comatose patients. This approach may potentially influence comatose patients' outcomes by increasing brain reactivity and network connectivity.

Allergen-induced anxiety-like behavior is associated with disruption of medial prefrontal cortex - amygdala circuit.

Anxiety is prevalent in asthma, and is associated with disease severity and poor quality of life. However, no study to date provides direct experimental evidence for the effect of allergic inflammation on the structure and function of medial prefrontal cortex (mPFC) and amygdala, which are essential regions for modulating anxiety and its behavioral expression. We assessed the impact of ovalbumin (OVA)-induced allergic inflammation on the appearance of anxiety-like behavior, mPFC and amygdala volumes using MRI, and the mPFC-amygdala circuit activity in sensitized rats. Our findings exhibited that the OVA challenge in sensitized rats induced anxiety-like behavior, and led to more activated microglia and astrocytes in the mPFC and amygdala. We also found a negative correlation between anxiety-like behavior and amygdala volume. Moreover, OVA challenge in sensitized rats was associated with increases in mPFC and amygdala activity, elevation of amygdala delta-gamma coupling, and the enhancement of functional connectivity within mPFC-amygdala circuit - accompanied by an inverted direction of information transferred from the amygdala to the mPFC. We indicated that disrupting the dynamic interactions of the mPFC-amygdala circuit may contribute to the induction of anxiety-related behaviors with asthma. These findings could provide new insight to clarify the underlying mechanisms of allergic inflammation-induced psychiatric disorders related to asthma.

A 40-year-old man with testicular torsion and large bilateral spermatoceles.

Testicular torsion is a rare disease that mostly involves children. Peak incidence is in infancy and in adolescence. Testicular torsion is rarely seen in men over 40 years of age and has only once been accompanied with spermatocele. We report the case of a 40-year-old man with testicular pain one day prior to visiting our clinic. The patient's visit to the clinic was delayed due to history of occasional testicular pain related to his bilateral spermatoceles. On arrival, a color Doppler ultrasound test was performed, which revealed heterogeneous echo in the right testis with no vascular flow, suggestive of torsion, as well as two cystic lesions in the right and left scrotums indicating spermatoceles. The patient was immediately transferred to the operating room where the bilateral spermatoceles were resected and after detorting, the right testis was saved. After four months, a normal left testis along with partial right testicular atrophy was observed. It is highly recommended to educate patients with spermatocele who have no indication for surgical treatment to visit their physician in case any new testicular pain is experienced. Furthermore, testicular pain regardless of the co-existing pathology may always be treated as an indicator of suspected torsion.

Lung inflammation changes and oxidative stress induced by cigarette smoke exposure in guinea pigs affected by Zataria multiflora and its constituent, carvacrol.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an epidemic and progressive health problem which is mainly a consequence of cigarette smoking, and associated with lung inflammation. Anti-inflammatory property of Zataria multiflora (Z. multiflora) and its constituent, carvacrol was shown in various inflammatory disorders previously. Therefore, in the present study, the effects of the plant and its constituent, carvacrol, on lung inflammation changes and oxidative stress, in guinea pigs model of COPD were evaluated. METHODS: Nine groups of animals including control, COPD, COPD + drinking water containing three concentrations of extract of Z. multiflora (0.4, 0.8, and 1.6 mg/mL), COPD + drinking water containing three concentrations of carvacrol (60, 120, and 240 µg/mL), and COPD + dexamethasone (50 µg/mL) were studied. For inducing COPD, animals were exposed to cigarette smoke for 3 months. Thiol groups, IL-8, total and differential WBC were measured in broncho-alveolar lavage fluid (BALF) (n = 6 for each group). RESULTS: Total WBC, eosinophils, and neutrophils counts as well as the levels of IL-8 in BALF were significantly increased but thiol group was decreased in COPD compared to the control group (p < 0.05 to p < 0.001). Total WBC and IL-8 in all treated COPD groups, thiol group, eosinophils and neutrophils counts in treated groups with dexamethasone and two higher concentrations of the Z. multiflora and carvacrol were significantly improved compared to non-treated COPD group (p < 0.05 to p < 0.001). Lymphocyte count in treated groups with dexamethasone, highest concentration of Z. multiflora, and two higher concentration of carvacrol was also significantly higher than non-treated group (p < 0.05 to p < 0.001). CONCLUSIONS: A preventive effect of Z. multiflora extract and its constituent carvacrol on lung inflammation changes and oxidative stress in animal model of COPD was suggested.

A 14-Year-Old Boy with Torsion of the Epididymal Cyst.

Epididymal cyst is a benign mass in the scrotum that is relatively common in adults but it is rare in children. In routine experience the treatment of such cysts is conservative. Torsion of these cysts is extremely rare and the diagnosis is made by exploration of the scrotum. Our patient was a 14-year-old boy who has been referred to hospital with scrotal pain followed by a minor trauma 3 days ago. Exploration of the scrotum to rule out testicular rupture was performed and a large black cyst connected to the head of the epididymis with 720-degree rotation was found. The cyst was resected and pathologic examination revealed an acquired epididymal cyst (spermatocele). The patient has normal physical exam after 3 months' follow-up.

Colonic perforation during percutaneous nephrolithotomy: An 18-year experience.

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large, extracorporeal lithotripsy failure stones and those in the inferior calyx. Despite the development of new techniques and the increasing experience in recent decades, complications may still occur. Colonic perforation is one of the most dangerous and rare complications of PCNL, which may lead to peritonitis and sepsis. We present our 18-year experience on the diagnosis and management of colonic perforation during PCNL. METHODS: We retrospectively reviewed the data of 5260 PCNL procedures performed between May1995 and August 2013. Preoperative and operative factors, such as age, sex, history of previous ipsilateral stone intervention, stone side, stone location, site of skin puncture and punctured calyx, were reviewed in patients with colonic injury. RESULTS: Colonic perforation was found in 11 patients (5 males and 6 females) and the mean age was 40.4 ± 22.2 years (range: 4 to 71). All injuries were retroperitoneal. The left side was affected in 5 patients and the right side was injured in 6 cases. Conservative management was the treatment planned for all patients. It included withdrawal of the nephrostomy tube outside the kidney to the colon as a percutaneous colostomy, insertion of a double-J ureteral stent, intravenous broad-spectrum antibiotics, bowel rest and total parenteral nutrition. Under this conservative management, complete healing of the colon was achieved in all patients. CONCLUSION: Early diagnosis and conservative management of colonic perforation can minimize patient morbidity and mortality and result in excellent healing of the fistulous tract without any serious complications.