Neuroimaging determinants of cognitive impairment in the memory clinic: how important is the vascular burden?

While neurodegenerative and vascular neurocognitive disorder (NCD) often co-occur, the contribution of vascular lesions, especially stroke lesions identified on MRI, to global cognition in a real-life memory clinic population remains unclear. The main objective of this retrospective study was to determine NCD neuroimaging correlates: the GM atrophy pattern and vascular lesions (especially stroke lesion localization by voxel-based lesion-symptom mapping, VLSM) in a memory clinic. We included 336 patients with mild or major NCD who underwent cerebral MRI and a neuropsychological assessment. The GM atrophy pattern (obtained by voxel-based morphometry, VBM) and the stroke lesion localization (obtained by VLSM) associated with G5 z-score (a global cognitive score), were included as independent variables with other neuroimaging and clinical indices in a stepwise linear regression model. The mean age was 70.3 years and the mean MMSE score 21.3. On MRI, 75 patients had at least one stroke lesion. The G 5 z-score was associated with GM density in the pattern selected by the VBM analysis (R2 variation = 0.166, p < 0.001) and the presence of a stroke lesion in the region selected by the VSLM analysis (mainly in the right frontal region; R2 variation = 0.018, p = 0.008). The interaction between the two factors was insignificant (p = 0.374). In conclusion, in this first study combining VBM and VLSM analysis in a memory clinic, global cognition was associated with a specific GM atrophy pattern and the presence of a stroke lesion mainly in the right frontal region.

[Foot injuries in the emergency room : three lesions that should not be missed]. / Traumatismes du pied aux urgences : attention à trois lésions pièges.

Urgent consultations for foot injuries are common. Trauma injuries are often obvious, such as displaced or open fractures, dislocations, or tissue breakdown. However, they can also have a subtle presentation and still hide severe structural damage. This is the case of «benign¼ Lisfranc sprains, compartment syndrome or even tendon sections through an apparently benign wound. The purpose of this article is to help the primary care physician to be aware of these subtle and sometimes hidden injuries, to assist him in the diagnosis and to provide the keys to appropriate treatment.

Les consultations en urgence pour une blessure du pied sont fréquentes. Les lésions consécutives aux traumatismes sont souvent évidentes et on ne passera certainement pas à côté d'une fracture déplacée, voire ouverte, d'une luxation articulaire ou d'un délabrement de l'enveloppe tissulaire. Toutefois, les lésions peuvent aussi se présenter de manière subtile et cacher quand même une atteinte structurelle sévère. C'est le cas des entorses « bénignes ¼ du Lisfranc, du syndrome des loges ou encore des sections tendineuses à travers une plaie d'apparence anodine. Le but de cet article est de rendre le médecin de premier recours attentif à ces atteintes parfois cachées, de l'aider dans sa démarche diagnostique et de lui donner les clés du traitement adéquat.

A Blue-Enriched Light Intervention Counteracts the Alertness Decrement Among Mine Workers on Extended 12-Hour Night Shift Periods.

OBJECTIVE: The aim of the study is to assess whether a blue-enriched light intervention improves nocturnal alertness and daytime sleep of night workers. METHODS: Thirteen miners performing 12-hour night shifts for 12 consecutive nights were exposed to a baseline and a blue-enriched light condition. All subjects wore an actigraph and completed a Psychomotor Vigilance Task at the beginning and at the end of each shift. Data were analyzed with linear mixed models. RESULTS: In the blue-enriched light condition, the daily increase in median reaction time (RT), mean RT, slowest 10% of RT, and fastest 10% of RT was lower than that observed in the baseline condition between day 1 and 12 ( P ≤ 0.05). CONCLUSIONS: The addition of blue-enriched light during a long period of extended night shifts counteracts most of the daily decline in nocturnal alertness observed in the standard lighting condition, irrespectively of sleep duration and sleep efficiency.

Effect of Manikin and Virtual Simulation on Clinical Judgment.

BACKGROUND: Evidence suggests competency in clinical judgment may be lacking in new graduate nurses. Graduates from accelerated baccalaureate nursing (ABSN) programs have even less time to develop clinical judgment competency. Various simulation modalities, including high-fidelity manikin and virtual reality, have been used to develop clinical judgment in prelicensure students. However, the outcomes of these simulation modalities on clinical judgment in ABSN students is not well understood. METHOD: An integrative literature review was conducted using five databases with primary research that examined the effect of manikin or virtual simulation on clinical judgment in BSN students. RESULTS: Fourteen studies were included in this review. The findings were organized using Tanner's Clinical Judgment Model. CONCLUSION: Findings from this review were mixed, with a lack of evidence comparing the two modalities. Future research should include comparison studies aimed at examining the effects of these modalities with ABSN students. [J Nurs Educ. 2022;61(12):693-699.].

Breast Reconstruction: Economic Impact Swiss Health Insurance System.

BACKGROUND: Considering present concerns about healthcare costs and the lack of evidence and published articles on breast reconstruction costs in Switzerland, we retrospectively investigated charges to the Swiss healthcare system for different breast reconstruction procedures at the Centre Hospitalier Universitaire Vaudois. METHODS: We selected all hospitalized patients at the University Hospital who underwent a "total" delayed breast reconstruction from January 2012 to December 2015. Analysis included 72 women who underwent autologous or implant-based reconstructions. Three main breast reconstruction techniques were included: Deep Inferior Epigastric Perforator (n = 46) autologous flap reconstruction, Tissue Expander followed by Implant (n = 12) and pedicled Latissimus Dorsi (n = 12) flap with or without tissue expander and implant (n = 7). For all different groups, the global costs of reconstruction and total number of required operations were statistically compared. RESULTS: Global costs for Deep Inferior Epigastric Perforator reconstruction were 29,728 ± 1892 CHF (avg ± Std. Error of Mean), while Tissue Expander reconstruction showed a significantly higher global cost, reaching an average of 44,313 ± 5553 CHF (avg ± Std. Error of Mean). LD showed a similar cost, compared to the Deep Inferior Epigastric Perforator reconstruction (29,813 ± 3637 CHF), increasing when including an implant (37,688 ± 4840 CHF). No significant differences in the number of interventions were detected. CONCLUSION: These data show that autologous breast reconstruction (DIEP) delivers the best cost ratio, with lower overall costs. Implant-based reconstructions showed a greater likelihood of complications and re-intervention, globally creating superior costs when compared to autologous reconstructions.

Base-editing-mediated dissection of a γ-globin cis-regulatory element for the therapeutic reactivation of fetal hemoglobin expression.

Sickle cell disease and ß-thalassemia affect the production of the adult ß-hemoglobin chain. The clinical severity is lessened by mutations that cause fetal γ-globin expression in adult life (i.e., the hereditary persistence of fetal hemoglobin). Mutations clustering ~200 nucleotides upstream of the HBG transcriptional start sites either reduce binding of the LRF repressor or recruit the KLF1 activator. Here, we use base editing to generate a variety of mutations in the -200 region of the HBG promoters, including potent combinations of four to eight γ-globin-inducing mutations. Editing of patient hematopoietic stem/progenitor cells is safe, leads to fetal hemoglobin reactivation and rescues the pathological phenotype. Creation of a KLF1 activator binding site is the most potent strategy - even in long-term repopulating hematopoietic stem/progenitor cells. Compared with a Cas9-nuclease approach, base editing avoids the generation of insertions, deletions and large genomic rearrangements and results in higher γ-globin levels. Our results demonstrate that base editing of HBG promoters is a safe, universal strategy for treating ß-hemoglobinopathies.

Timely use of in-car dim blue light and blue blockers in the morning does not improve circadian adaptation of fast rotating shift workers.

Circadian adaptation to night work usually does not occur in naturalistic conditions, largely due to exposure to low levels of light during the night and light in the morning on the way home. This leads to circadian misalignment, which has documented deleterious effects on sleep and functioning during waking hours. Chronic circadian misalignment is also being increasingly associated with long-term health comorbidities. As the circadian system is mostly sensitive to short wavelengths (i.e., blue light) and less sensitive to long wavelengths (i.e., red light), shaping light exposure in a "wavelength-wise" manner has been proposed to promote partial adaptation to night shifts, and, therefore, alleviate circadian rhythms disruption. This report presents results from two cross-over designed studies that aimed to investigate the effects of three different light conditions on circadian phase, sleepiness, and alertness of police patrol officers on a rotating shift schedule. The first study took place during summer (n = 15) and the second study (n = 25) during winter/early spring. In both studies, all participants went through three conditions composed of four consecutive night shifts: 1) in-car dim blue light exposure during the night shift and wearing of blue-blocking glasses (BBG) in the morning after 05:00 h; 2) in-car red light exposure during the night shift and wearing of BBG in the morning after 05:00 h; 3) a control condition with no intervention. To assess circadian phase position, salivary melatonin was collected hourly the night before and the night after each condition. Sleep was monitored by wrist actigraphy. Also, a 10-min Psychomotor Vigilance-Task was administered at the beginning and end of each night shift and the Karolinska Sleepiness Scale was completed every 2 h during each night shift. In the summer study, no difference was found in alertness and sleepiness between conditions. Participants though exhibited greater (≈3 h) phase delay after four consecutive night shifts in the control condition (in which morning light exposure was expected to prevent phase delay) than after the blue and red conditions (≈2 h) (in which wearing BBG were expected to promote phase delay). In the second study performed during the winter/early spring, a comparable ≈2 h phase delay was found in each of the three conditions, with no difference in alertness and sleepiness between conditions. In conclusion, participants in both studies exhibited modest phase delay across the four night shifts, even during the control conditions. Still, re-entrainment was not fast enough to produce partial circadian adaptation after four night shifts. A greater number of consecutive night shifts may be necessary to produce enough circadian alignment to elicit benefits on sleepiness and alertness in workers driving a motorized vehicle during night shifts. In-car dim blue light exposure combined with the wearing of BBG in the morning did not show the expected benefits on circadian adaptation, sleepiness, and alertness in our studies. Higher levels of light may be warranted when implementing light intervention in a motorized vehicle setting.

Chronotype, Light Exposure, Sleep, and Daytime Functioning in High School Students Attending Morning or Afternoon School Shifts: An Actigraphic Study.

Adolescent maturation is associated with delays of the endogenous circadian phase. Consequently, early school schedules may lead to a mismatch between internal and external time, which can be detrimental to adolescent sleep and health. In parallel, chronotype is known to play a role in adolescent health; evening chronotype adolescents are at higher risk for sleep problems and lower academic achievement. In the summer of 2008, Kénogami High School (Saguenay, Canada) was destroyed by fire. Kénogami students were subsequently relocated to Arvida High School (situated 5.3 km away) for the 2008-2009 academic year. A dual school schedule was implemented, with Arvida students attending a morning schedule (0740-1305 h) and Kénogami students an afternoon schedule (1325-1845 h). This study aimed to investigate the effects of such school schedules and chronotype on sleep, light exposure, and daytime functioning. Twenty-four morning and 33 afternoon schedule students wore an actigraph during 7 days to measure sleep and light exposure. Academic achievement was obtained from school. Subjects completed validated questionnaires on daytime sleepiness, psychological distress, social rhythms, school satisfaction, alcohol, and chronotype. Overall, afternoon schedule students had longer sleep duration, lower sleepiness, and lower light exposure than morning schedule students. Evening chronotypes (E-types) reported higher levels of sleepiness than morning chronotypes (M-types) in both morning and afternoon schedules. Furthermore, M-types attending the morning schedule reported higher sleepiness than M-types attending the afternoon schedule. No difference was found between morning and afternoon schedule students with regard to academic achievement, psychological distress, social rhythms, school satisfaction, and alcohol consumption. However, in both schedules, M-type had more regular social rhythms and lower alcohol consumption. In summary, this study emphasizes that an early school schedule is associated with detrimental effects in terms of sleep deprivation and daytime sleepiness, even for M-types. Furthermore, irrespective of school schedule, E-type adolescents face an increased risk for poor daytime functioning.

Investigating the contribution of short wavelengths in the alerting effect of bright light.

INTRODUCTION: Short-wavelengths can have an acute impact on alertness, which is allegedly due to their action on intrinsically photosensitive retinal ganglion cells. Classical photoreceptors cannot, however, be excluded at this point in time as contributors to the alerting effect of light. The objective of this study was to compare the alerting effect at night of a white LED light source while wearing blue-blockers or not, in order to establish the contribution of short-wavelengths. MATERIALS AND METHODS: 20 participants stayed awake under dim light (< 5 lx) from 23:00 h to 04:00 h on two consecutive nights. On the second night, participants were randomly assigned to one light condition for 30 min starting at 3:00 h. Group A (5M/5F) was exposed to 500 µW/cm(2) of unfiltered LED light, while group B (4M/6F) was required to wear blue-blocking glasses, while exposed to 1500 µW/cm(2) from the same light device in order to achieve 500 µW/cm(2) at eye level (as measured behind the glasses). Subjective alertness, energy, mood and anxiety were assessed for both nights at 23:30 h, 01:30 h and 03:30 h using a visual analog scale (VAS). Subjective sleepiness was assessed with the Stanford Sleepiness Scale (SSS). Subjects also performed the Conners' Continuous Performance Test II (CPT-II) in order to assess objective alertness. Mixed model analysis was used to compare VAS, SSS and CPT-II parameters. RESULTS: No difference between group A and group B was observed for subjective alertness, energy, mood, anxiety and sleepiness, as well as CPT-II parameters. Subjective alertness (p < 0.001), energy (p < 0.001) and sleepiness (p < 0.05) were, however improved after light exposure on the second night independently of the light condition. CONCLUSIONS: The current study shows that when sleepiness is high, the alerting effect of light can still be triggered at night in the absence of short-wavelengths with a 30 minute light pulse of 500 µW/cm(2). This suggests that the underlying mechanism by which a brief polychromatic light exposure improves alertness is not solely due to short-wavelengths through intrinsically photosensitive retinal ganglion cells.

Day and night shift schedules are associated with lower sleep quality in Evening-types.

Eveningness has been suggested as a facilitating factor in adaptation to shift work, with several studies reporting evening chronotypes (E-types) as better sleepers when on night shifts. Conversely, eveningness has been associated with more sleep complaints during day shifts. However, sleep during day shifts has received limited attention in previous studies assessing chronotypes in shift workers. Environmental light exposure has also been reported to differ between chronotypes in day workers. Activity is also known to provide temporal input to the circadian clock. Therefore, the aim of this study was to compare objective sleep, light exposure and activity levels between chronotypes, both during the night and day shifts. Thirty-nine patrol police patrol officers working on a fast rotating shift schedule (mean age ± SD: 28.9 ± 3.2 yrs; 28 males) participated in this study. All subjects completed the Morningness-Eveningness Questionnaire (MEQ). Sleep and activity were monitored with actigraphy (Actiwatch-L; Mini-Mitter/Respironics, Bend, OR) for four consecutive night shifts and four consecutive day shifts (night work schedule: 00:00 h-07:00 h; day work schedule: 07:00 h-15:00 h). Sleep and activity parameters were calculated with Actiware software. MEQ scores ranged from 26 to 56; no subject was categorized as Morning-type. E-types (n = 13) showed significantly lower sleep efficiency, longer snooze time and spent more time awake after sleep onset than Intermediate-types (I-types, n = 26) for both the night and day shifts. E-types also exhibited shorter and more numerous sleep bouts. Furthermore, when napping was taken into account, E-types had shorter total sleep duration than I-types during the day shifts. E-types were more active during the first hours of their night shift when compared to I-types. Also, all participants spent more time active and had higher amount of activity per minute during day shifts when compared to night shifts. No difference was found regarding light exposure between chronotypes. In conclusion, sleep parameters revealed poorer sleep quality in E-types for both the night and day shifts. These differences could not be explained by sleep opportunity, light exposure or activity levels. This study challenges the notion that E-types adapt better to night shifts. Further studies must verify whether E-types exhibit lower sleep quality than Morning-types.

Relationship of chronotype to sleep, light exposure, and work-related fatigue in student workers.

Students who work during the school year face the potential of sleep deprivation and its effects, since they have to juggle between school and work responsibilities along with social life. This may leave them with less time left for sleep than their nonworking counterparts. Chronotype is a factor that may exert an influence on the sleep of student workers. Also, light and social zeitgebers may have an impact on the sleep-related problems of this population. This study aimed to document sleep, light exposure patterns, social rhythms, and work-related fatigue of student workers aged 19-21 yrs and explore possible associations with chronotype. A total of 88 student workers (mean ± SD: 20.18 ± .44 yrs of age; 36 males/52 females) wore an actigraph (Actiwatch-L; Mini-Mitter/Respironics,Bend, OR) and filled out the Social Rhythm Metric for two consecutive weeks during the school year. Also, they completed the Morningness-Eveningness Questionnaire (MEQ), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and Occupational Fatigue Exhaustion/Recovery Scale (OFER). Repeated and one-way analyses of variance (ANOVAs), Pearson's chi-square tests, and correlation coefficients were used for statistical comparisons. Subjects slept an average of 06:28 h/night. Actigraphic sleep parameters, such as sleep duration, sleep efficiency, wake after sleep onset, and sleep latency, did not differ between chronotypes. Results also show that evening types (n = 17) presented lower subjective sleep quality than intermediate types (n = 58) and morning types (n = 13). Moreover, evening types reported higher levels of chronic work-related fatigue, exhibited less regular social rhythms, and were exposed to lower levels of light during their waking hours (between 2 and 11 h after wake time) as compared to intermediate types and morning types. In addition, exposure to light intensities between 100 and 500 lux was lower in evening types than in intermediate types and morning types. However, bright light exposure (≥ 1000 lux) did not differ between chronotypes. In conclusion, results suggest that student workers may constitute a high-risk population for sleep deprivation. Evening types seemed to cope less well with sleep deprivation, reporting poorer sleep quality and higher levels of work-related fatigue than intermediate types and morning types. The higher chronic work-related fatigue of evening types may be linked to their attenuated level of light exposure and weaker social zeitgebers. These results add credence to the hypothesis that eveningness entails a higher risk of health-impairing behaviors.

Clinical, ultrasonographic, and laboratory findings in 12 llamas and 12 alpacas with malignant round cell tumors.

Clinical signs, duration of illness, clinicopathologic findings, and ultrasonographic findings were evaluated in 12 llamas and 12 alpacas with malignant round cell tumors (MRCT). All but 1 animal died or was euthanized. Common clinical findings were anorexia, recumbency or weakness, and weight loss or poor growth. Peripheral lymphadenomegaly occurred in only 7 animals and was detected more often at necropsy than during physical examination. Common clinicopathologic abnormalities were hypoalbuminemia, acidosis, azotemia, anemia, hyperglycemia, and neutrophilia. Ultrasonography detected tumors in 4/6 animals. Cytologic evaluation of fluid or tissue aspirates or histopathology of biopsy tissue was diagnostic in 5/6 cases. A clinical course of 2 wk or less prior to death or euthanasia was more common in animals ≤ 2 y of age (9/11) than in older animals (6/13). Regular examination of camelids to include clinical pathology and evaluation of peripheral lymph nodes may result in early detection of MCRT.

Prevalence of neoplasia in llamas and alpacas (Oregon State University, 2001-2006).

Prevalence and type of neoplastic disease were determined in 551 camelid submissions (368 alpacas [Lama pacos], 180 llamas [Lama glama], and 3 cases in which species was not identified) over a 5-year period. Forty neoplasms were identified in 38 animals (6.9%). Prevalence of neoplasia in llamas was higher (11%) than in alpacas (4.9%). Mean age of camelids with neoplasia was 9.42 +/- 4.9 years. Mean age of alpacas with neoplasia (5.48 +/- 3.7 years) was significantly less than of llamas with neoplasia (12.53 +/- 3.2 years; P < 0.001). Cutaneous and mucocutaneous fibroma/fibropapilloma was most common (10 animals), followed by cutaneous and mucocutaneous squamous cell carcinoma (6 animals), disseminated lymphoma (5 animals), and fibrosarcoma (4 animals). Four of 5 animals with lymphoma were alpacas, aged 0.21 to 4 years. Lymphoma occurred in 1 aged llama (15 years). Disseminated carcinoma and adenocarcinoma occurred in 4 llamas and 2 alpacas, and included biliary (2), gastrointestinal (2), mammary gland (1), and unknown (1) origin. Mean age of camelids with any type of carcinoma or adenocarcinoma (12.36 +/- 2.8 years) was significantly greater than that of camelids with lymphoma (4.24 +/- 6.2 years; P = 0.02). Results indicate that neoplasia is relatively common in camelids and that there are differences between llamas and alpacas as regards prevalence of neoplasia, tumor types, and age at diagnosis.

Cervical cancer survival by socioeconomic status, race/ethnicity, and place of residence in Texas, 1995-2001.

OBJECTIVE: The current study explored whether socioeconomic status (SES), race/ethnicity, and rural residence may be linked to poorer cervical cancer survival by stage at diagnosis. METHODS: Data from 7,237 cervical cancer cases reported to the Texas Cancer Registry from 1995-2001 were used to address the association by stage at diagnosis and cause of death. Zip code-level census data were used to classify residence and to develop a composite variable for SES. Multilevel Cox proportional hazards modeling was used to estimate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS: Late stage at diagnosis was a strong predictor of cervical cancer mortality (HR = 6.2, 95% CI 5.5-7.2). SES and race/ethnicity were independently associated with stage at diagnosis. Women residing in areas with lower SES had significantly shorter survival times when diagnosed at an early stage (HR = 3.0, 95% CI 2.1-4.3). Hispanic women had a lower probability of dying from cervical cancer during the follow-up period (HR = 0.7, 95% CI 0.6- 0.8) after adjusting for confounders. The association between lower SES and poorer survival was consistent across all racial/ethnic groups, suggesting the effect of SES may be more important than race. CONCLUSIONS: SES and race/ethnicity were independently associated with poorer cervical cancer survival in this large Texas sample. Further research is needed to investigate the role of optimal treatment and comorbid conditions in the association between SES and cervical cancer survival.

Car seat challenges: where are we in implementation of these programs?

Premature infants and infants with special needs are being discharged home at smaller weights and earlier postconceptional ages. This presents a challenge to safely transporting these infants in car seats. Car seat technology has not kept abreast of advances experienced in neonatal medical technology. Several studies have demonstrated that preterm infants are at risk for apnea, bradycardia, and oxygen desaturations while being transported in traditional car seats. The American Academy of Pediatrics issued policy statements recommending that all infants less than 37 weeks of gestational age be monitored in a car seat safety test prior to discharge. This article reviews current literature on implementing car seat safety testing in hospitals and the results of a research survey of newborn nursery and neonatal intensive care units across the United States to evaluate the status of these facilities in implementing car seat safety testing programs. The results show that many level II and level III units have begun to implement car seat safety programs despite the lack of literature and guidelines available on how to develop a program. Although most programs monitored the same criteria, there were variations in length of testing, which infants were tested, and recommendations for the infants who failed the testing.