Resting State Functional MR Imaging of Language Function.

Resting state functional MR imaging methods can provide localization of the language system; however, presurgical functional localization of the language system with task-based functional MR imaging is the current standard of care before resection of brain tumors. These methods provide similar results and comparing them could be helpful for presurgical planning. We combine information from 3 data resources to provide quantitative information on the components of the language system. Tables and figures compare anatomic information, localization information from resting state fMR imaging, and activation patterns in different components of the language system expected from commonly used task fMR imaging experiments.

Allergic and nonallergic asthma in children: are they distinct phenotypes?

The aim of current study is to describe clinical similarities and differences between atopic and non-atopic asthma in children. In a cross-sectional study, 95 asthmatic children (75 allergics and 20 nonallergics) were included in the study. Demographic, clinical, and familial history were compared between two groups. There was no significant differences between variables like sex, age of onset (p=0.75), severity (p=0.70), and family history among the two groups (p=0.42). Patients with allergic asthma were significantly older than those with non- allergic asthma (11.28 ± 3.19 and 9.75 ± 2.35 years, respectively, p=0.02). The controversy lingers over the presence of a completely distinct phenotype of non-atopic asthma in children. Our study suggested that phenotypes of allergic and non-allergic asthma in children were not entirely distinct.

Risk factors for increased multiple sclerosis susceptibility in the Iranian population.

Multiple sclerosis (MS) is a complex autoimmune disease with increasing prevalence. Many factors have been assessed in relation to its development and its worldwide geographical and racial distribution. Therefore, we decided to conduct a nationwide case-control matched study to estimate the possible influence of putative risk factors on MS status in an Iranian MS population. Between January 2008 and September 2013, 1403 patients diagnosed with MS according to the Poser or McDonald criteria and 883 controls were studied. Of all patients, there were 921 women and 296 men (ratio 3.1:1) with a mean age of 32.6 ± 8.7 years. In the multivariate model adjusted for sex and age (±2years), we found associated risk factors of MS to be: history of any allergic condition (Odds ratio (OR): 1.92, 95% Confidence interval (CI): 1.55-2.47, p<0.001), and smoking (OR: 1.93, 95% CI: 1.31-2.73, p<0.001). Sunlight exposure ⩾ 3 hours was found to be associated with a reduced risk of MS (OR: 0.23, 95% CI: 0.15-0.31, p<0.001). As expected, cases were more likely to have a positive family history of MS than controls (OR: 1.91, 95% CI: 1.33-2.75, p<0.001). A significant association was found between family history of other autoimmune diseases and MS risk (OR: 1.57, 95% CI: 1.18-2.09, p=0.002). These results support the hypothesis that sun exposure is associated with a decreased risk of MS while smoking, autoimmune family history, MS family history, and personal allergy history are risk factors for MS susceptibility.

A new method to make 24-hour urine collection more convenient: a validity study.

Background and Objectives. This study proposes a novel urine collection device that can divide each urine collection into 20 parts and store and cool just one part. The aim of the current study is to compare measured biomarkers from the proposed urine collection device to those of conventional 24-hour sampling method. We also hypothesized that the new method would significantly increase patients' adherence to the timed urine collection. Methods. Two 24-hour urine samples with the conventional method and with the new automated urine collection device that uses just one-twentieth of each void were obtained from 40 healthy volunteers. Urine parameters including volume, creatinine, and protein levels were compared between the two methods and the agreement of two measurements for each subject was reported through Bland-Altman plots. Results. Our results confirmed that for all three variables, there is a positive correlation (P < 0.001) between the two measurements and high degree of agreement could be seen in Bland-Altman plots. Moreover, more subjects reported the new method as "more convenient" for 24-hour urine collection. Conclusions. Our results clearly indicate that a fixed proportion of each void may significantly reduce the urine volume in timed collections and this, in turn, may increase subjects' adherence to this difficult sampling.

Oral l-citrulline malate in patients with idiopathic pulmonary arterial hypertension and Eisenmenger Syndrome: a clinical trial.

BACKGROUND AND PURPOSE: Citrulline is an amino acid which is produced by the urea cycle and also a precursor for NO, that is, a vasodilator for normal function of pulmonary vasculature. Thereby, enhancing l-citrulline malate in patients with idiopathic pulmonary arterial hypertension and those with congenital heart disease identified as Eisenmenger Syndrome results in reduction of pulmonary hypertension. METHODS AND SUBJECTS: In this clinical trial before and after study, we assigned 25 patients with arterial pulmonary hypertension (idiopathic or Eisenmenger Syndrome) to receive l-citrulline malate 1g three times daily for two weeks. The primary measurement was the change in exercise capacity, as considered as a result of the total distance walked in six minutes, from baseline to week 2. We also assessed mean pulmonary artery pressure, the change in the quality of life, and the change in pro-brain natriuretic peptide (BNP) level. The study was not powered to evaluate mortality. RESULTS: The mean walking distance in six minutes was significantly increased by about 44m (p=0.005) after receiving l-citrulline malate. Mean pulmonary artery pressure significantly reduced from 83.34mmHg before receiving l-citrulline malate to 79.1mmHg after that (p=0.01). All dimensions of the quality of life had statistical differences after receiving l-citrulline malate except limit due to physical health, limit due to emotional health and social functioning (p>0.05). Finally, pro-BNP difference was not statistically significant (p=0.9). CONCLUSION: l-Citrulline malate improves the distance walk in six minutes and also the quality of life of patients with idiopathic arterial pulmonary hypertension and Eisenmenger Syndrome and also reduced mean arterial pulmonary hypertension.

Uterine Doppler velocimetry of the uterine arteries in the second and third trimesters for the prediction of gestational outcome.

PURPOSE: The aim of this longitudinal study was to investigate the value of uterine artery Doppler sonography during the second and third trimesters in the prediction of adverse pregnancy outcome in low-risk women. METHODS: From July 2011 to August 2012, a total of 205 singleton pregnant women presenting at our antenatal clinic were enrolled in this prospective study and were assessed for baseline demographic and obstetric data. They underwent ultrasound evaluation at the time of second and third trimesters, both included Doppler assessment of bilateral uterine arteries to determine the values of the pulsatility index (PI) and resistance index (RI) and presence of early diastolic notch. The endpoint of this study was assessing the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Doppler ultrasonography of the uterine artery, for the prediction of adverse pregnancy outcomes including preeclampsia, stillbirth, placental abruption and preterm labor. RESULTS: The mean age of cases was 26.4±5.11. The uterine artery PI and RI values for both second (PI: 1.1±0.42 versus 1.53±0.59, p=0.002; RI: 0.55±0.09 versus 0.72±0.13, p=0.000 respectively) and third-trimester (PI: 0.77±0.31 versus 1.09±0.46, p=0.000; RI: 0.46±0.10 versus 0.60±0.14, p=0.010 respectively) evaluations were significantly higher in patients with adverse pregnancy outcome than in normal women. Combination of PI and RI >95th percentile and presence of bilateral notch in second trimester get sensitivity and specificity of 36.1 and 97% respectively, while these measures were 57.5 and 98.2% in third trimester. CONCLUSIONS: According to our study, it seems that uterine artery Doppler may be a valuable tool for the prediction of a variety of adverse outcomes in second and third trimesters.

Doplervelocimetria da arteria uterina no segundo e terceiro trimestres para predicao dos resultados gestacionais / Uterine Doppler velocimetry of the uterine arteries in the second and third trimesters for the prediction of gestational outcome

OBJETIVO: O objetivo do presente estudo longitudinal foi avaliar o valor da ultrassonografia Doppler das artérias uterinas no segundo e terceiro trimestres de gestação para a predição de desfecho adverso da gravidez em mulheres de baixo risco. MÉTODOS: De julho de 2011 até agosto de 2012, 205 gestantes de feto único atendidas em nossa clínica de pré-natal foram incluídas no presente estudo prospectivo e avaliadas em termos de dados demográficos e obstétricos. As pacientes foram submetidas à avaliação de ultrassom durante o segundo e terceiro trimestres, incluindo avaliação Doppler das artérias uterinas bilaterais, visando determinar os valores do índice de pulsatilidade (IP) e do índice de resistência (IR), bem como a presença de incisura diastólica precoce. O desfecho do presente estudo foi a avaliação da sensibilidade, especificidade, valor preditivo positivo (VPP) e valor negativo preditivo (VNP) da ultrassonografia Doppler das artérias uterinas para a predição de desfechos adversos da gravidez, incluindo pré-eclâmpsia, natimortalidade, descolamento prematuro da placenta e trabalho de parto prematuro. RESULTADOS: A média de idade das gestantes foi de 26,4±5,11 anos. Os valores de IP e IR das artérias uterinas para o primeiro (IP: 1,1±0,42 versus 1,53±0,59, p=0,002; IR: 0,55±0,09 versus 0.72±0.13, p=0,000, respectivamente) e para o terceiro trimestre (IP: 0,77±0,31 versus 1,09±0,46, p=0,000; IR: 0,46±0,10 versus 0,60±0,14, p=0,010, respectivamente) foram significativamente maiores em pacientes com desfecho adverso da gravidez em relação às mulheres com desfecho normal. A combinação de IP e IR > percentil 95 e a presença de incisura bilateral apresentou sensibilidade e especificidade de ...

PURPOSE: The aim of this longitudinal study was to investigate the value of uterine artery Doppler sonography during the second and third trimesters in the prediction of adverse pregnancy outcome in low-risk women. METHODS: From July 2011 to August 2012, a total of 205 singleton pregnant women presenting at our antenatal clinic were enrolled in this prospective study and were assessed for baseline demographic and obstetric data. They underwent ultrasound evaluation at the time of second and third trimesters, both included Doppler assessment of bilateral uterine arteries to determine the values of the pulsatility index (PI) and resistance index (RI) and presence of early diastolic notch. The endpoint of this study was assessing the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Doppler ultrasonography of the uterine artery, for the prediction of adverse pregnancy outcomes including preeclampsia, stillbirth, placental abruption and preterm labor. RESULTS: The mean age of cases was 26.4±5.11. The uterine artery PI and RI values for both second (PI: 1.1±0.42 versus 1.53±0.59, p=0.002; RI: 0.55±0.09 versus 0.72±0.13, p=0.000 respectively) and third-trimester (PI: 0.77±0.31 versus 1.09±0.46, p=0.000; RI: 0.46±0.10 versus 0.60±0.14, p=0.010 respectively) evaluations were significantly higher in patients with adverse pregnancy outcome than in normal women. Combination of PI and RI >95th percentile and presence of bilateral notch in second trimester get sensitivity and specificity of 36.1 and 97% respectively, while these measures were 57.5 and 98.2% in third trimester. CONCLUSIONS: According to our study, it seems that uterine artery Doppler may be a valuable tool for the prediction of a variety of adverse outcomes in second and third trimesters. .

Predictive ability of C-reactive protein for early mortality after ischemic stroke: comparison with NIHSS score.

We aimed to compare the association of high-sensitivity C-reactive protein (CRP) and National Institutes of Health Stroke Scale (NIHSS) score with mortality risk and to determine the optimal threshold of CRP for prediction of mortality in ischemic-stroke patients. A series of 162 patients with first-ever ischemic-stroke admitted within 24 h after onset of symptoms was enrolled. CRP and NIHSS score were estimated on admission and their predictive abilities for mortality at 7 days were determined by logistic-regression analyses. Receiver-Operating Characteristic (ROC) curves were depicted to identify the optimal cut-off of CRP, using the maximum Youden-index and the shortest-distance methods. Deceased patients had higher levels of CRP and NIHSS on admission (8.87 ± 7.11 vs. 2.20 ± 4.71 mg/l for CRP, and 17.31 ± 6.36 vs. 8.70 ± 4.85 U for NIHSS, respectively, P < 0.01). CRP and NIHSS were correlated with each other (r (2) = 0.39, P < 0.001) and were also independently associated with increased risk of mortality [odds ratios (95 % confidence interval) of 1.16 (1.05-1.28) and 1.20 (1.07-1.35) for CRP and NIHSS, respectively, P < 0.01]. The areas under the ROC curves of CRP and NIHSS for mortality were 0.82 and 0.84, respectively. The CRP value of 2.2 mg/l was identified as the optimal cut-off value for prediction of mortality within 7 days (sensitivity: 0.81, specificity: 0.80). Thus, CRP as an independent predictor of mortality following ischemic-stroke is comparable with NIHSS and the value of 2.2 mg/l yields the optimum sensitivity and specificity for mortality prediction.

Orthotopic heart transplant for treatment-resistant cardiomyopathy in Kawasaki syndrome: report of a successful case.

Kawasaki disease is a systemic vascular inflammatory disorder of yet unknown cause that is associated with critical cardiovascular complications. Several long-term medical therapies, coronary revascularization, and heart transplant have been introduced to treat coronary artery lesions. This report describes a 20-year-old man with Kawasaki disease manifesting as intermittent chest pain and nausea who had advanced decompensated cardiomyopathy (ejection fraction, 15%) diagnosed. Coronary artery bypass surgery and implantation of a cardioverter defibrillator had been performed, although no significant clinical improvement was observed. Finally, a successful orthotopic bicaval heart transplant was performed. Follow-up examination after 1 year revealed normal cardiac function with no evidence of organ rejection. This experience demonstrated that heart transplant might be a successful method of treating permanent ischemic cardiomyopathy in patients with Kawasaki syndrome.

Prevalence of smoking in 15-64 years old population of north of Iran: meta-analysis of the results of non-communicable diseases risk factors surveillance system.

Smoking is known as a major cause of chronic obstructive pulmonary disease (COPD) and hence immediate and effective interventions are required for its elimination. This study aimed to collect valid data with regard to cigarette smoking in adult population of north of Iran for policy making by a meta-analysis of the documents of national non-communicable disease risk factors surveillance system. We investigated relevant evidences by searching in published and non-electronic databases. Data were extracted based on variables such as year of the study, sex, age group and prevalence of smoking habit. Based on results of heterogeneity, we applied fixed or random effects model to estimate the overall prevalence of cigarette smoking. All analyses were performed using STATA 11 software. A total of 20747 subjects (10381 males and 10366 females) in five age groups 15-24, 25-34, 35-44, 45-54 and 55-64 years were interviewed. Meta-analysis in men and women showed prevalence of 19.2% (15.8-22.6%) and 0.3% (0.2-0.5%) respectively. Results of the present meta-analysis showed as much as one fifth of male population of north of Iran are smoker. Subgroup analysis also revealed that the rate of smoking was higher among the middle-aged men.

Successful surgical intervention in an unusual case of Aspergillus endocarditis with acute myeloid leukemia.

Endocarditis due to Aspergillus infection is a rare complication in patients with hematological malignancies. Here, we present a case of aspergillus endocarditis in a patient with acute myeloid leukemia (AML) successfully treated with antifungal therapy and surgical treatment. The patient was a 51 years old male, a known case of AML who was admitted to our medical center for evacuating his valvular vegetations and repairing his atrial septal defect. He underwent an open heart surgery to relinquish his thromboses and also received an antifungal regimen. The patient tolerated the procedure well and eight months after his surgery, the patient remains asymptomatic. Successful treatment of this severe case of aspergillus endocarditis justifies a multidisciplinary method to be as a safe and effective approach to manage these patients.

Cigarette smoking and associated risk of multiple sclerosis in the Iranian population.

Exposure to cigarette smoke is emerging as an environmental risk factor for multiple sclerosis (MS). We investigated the possible association between environmental tobacco smoke, its cumulative exposure, and MS risk. We used data from the Iranian Multiple Sclerosis Registry to identify a case-control of 662 patients who had MS and a comparison group of 394 patients. Information regarding current smoking status, including the number of cigarettes smoked per day, duration, and smoking pack-years indicative of cumulative dose of tobacco smoked was obtained. We analyzed the incidence of MS among ever-smokers who had been smokers during their disease course and prior to disease onset in comparison with never-smokers who had never been exposed by calculating the odds ratio (OR) with a 95% confidence interval (CI) employing logistic regression. Of the 662 MS patients, there were 523 women (79.0%) and 139 men (21.0%), with a mean age of 31 ± 10.0 years at disease onset. The risk for MS was increased among ever-smokers (OR = 1.78, 95% CI = 1.22-2.59, p = 0.03) compared to never-smokers. As compared with never smokers, the OR for patients with 6-10 pack years was 2.91 for men (95% CI = 1.11-9.47, p = 0.03) and 1.69 for women (95% CI = 1.02-6.45, p = 0.04). Our results demonstrate that cigarette smoking is significantly associated with an increased risk for MS. The risk effects of smoking were more noticeable in male patients and at higher tobacco doses.

Conventional forceps or hot biopsy: comparative study of two methods in diagnosis of endobronchial lesions.

BACKGROUND: It is suggested that hot electrocoagulation-enabled forceps (hot biopsy) may reduce hemorrhage risk after the biopsy in endobronchial tumors. The main concern in this method is possible reduction of the specimen's quality. OBJECTIVES: To compare the procedure related hemorrhage with hot biopsy and conventional forceps biopsy and the diagnostic quality of the obtained specimens with either technique. METHODS: In this prospective study, assessment of the biopsy samples and quantity of hemorrhage were done in a blind fashion. At first, for each patient a definite clinical diagnosis was made based on pathologic examination of all available samples, clinical data, and imaging findings. Then, second pathologist reviewed all samples to evaluate the quality of the samples. RESULTS: A total of 36 patients with endobronchial lesions were included in this study. Definite diagnosis was made in 83% of the patients. Diagnostic yield of the two methods were not statistically different, while the mean hemorrhage grades of all hot biopsy protocols were significantly lower as compared to that of conventional biopsy (p=0.003, p<0.001 and p<0.001 for 10,20and40 voltages respectively). No significant difference was detected between the qualities of specimens obtained by hot biopsy methods in comparison with conventional biopsy (p>0.05 for all three voltages). CONCLUSIONS: Hot biopsy can be a valuable alternative to forceps biopsy in evaluating endobronchial lesions.

A case of cardiac hydatidosis: role for transesophageal echocardiography in evaluating bilateral pulmonary nodules.

Echinococcusis is a zoonotic disease, which is endemic in sheep-raising areas such as Iran. Cardiac involvement of the hydatidosis is rare and mostly asymptomatic, but it could lead to lethal complications. Thus, early diagnosis with accurate treatment would be life-saving. Here we report a 17-year-old female with nonspecific pulmonary presentations and a positive history of pulmonary hydatid cysts. Transesophageal echocardiography showed multiple cardiac hydatid cysts in the right ventricle. Patient underwent the bypass surgery to remove cardiac cysts. Postoperatively patient was on Albendazole and Praziquantel for two years. In a two-year-follow up, the patient had no complications.

Cytometric profiling in various clinical forms of multiple sclerosis with respect to CD21+, CD32+, and CD35+ B and T cells.

BACKGROUND: We aimed to evaluate the frequency of various types of B and T cells expressing CD21, CD32, and CD35 in multiple sclerosis (MS) clinical courses. METHODS: Peripheral blood mononuclear cell from 30 MS patients (17 relapsing remitting [RRMS], six secondary progressive [SPMS], and seven primary progressive MS [PPMS]) and 18 healthy subjects were analyzed. All patients were in acute attack. Healthy controls were matched for age and gender ratio. The frequencies of various subsets of B and T cells were determined using flow cytometry. RESULTS: The frequency of CD4+T cells was lower in MS patients compared to control subjects (41.14 ± 9.45% vs. 46.88 ± 6.98%, respectively, P < 0.05). The CD32+ fraction of CD4+T cells and the CD21+ fraction of CD8+T cells were higher in MS patients (2.85 ± 3.72% vs. 1.06 ± 0.62% for CD32+CD4+T cells, 2.71 ± 1.86% vs. 1.16 ± 0.99% for CD21+CD8+T cells in MS patients and control subjects, respectively, P < 0.05). After dividing subjects by type of MS course, higher values of these two T cell subsets were found in SPMS patients compared to control subjects (P < 0.05). Further, RRMS patients had lower levels of CD32+CD4+T cells than SPMS patients and also they had lower levels of CD32+CD8+T cells than PPMS patients (P < 0.05). However, neither the expression of CD35 on T cells nor the various B cell subsets were statistically different between the compared groups. CONCLUSIONS: Our findings demonstrate that T cell subsets expressing CD21 and CD32 may differ with respect to the presence or clinical forms of MS disease. By contrast, CD35+T cells and different subsets of B cells are not altered in various MS clinical courses.

Atypical language lateralization: an fMRI study in patients with cerebral lesions.

Differences in the lateralization of language processes between healthy subjects and patients with neurological complaints other than epilepsy have been less documented than those between healthy subjects and epilepsy patients. Moreover, the contribution of factors such as the location and type of lesion in determining interhemispheric shift of language function is poorly understood. Sixty-seven patients who underwent presurgical evaluations at the Medical Imaging Center of the Imam Khomeini University Hospital, Tehran, and the same number of healthy controls, were recruited. The laterality index (LI) of language activation, calculated from two separate functional magnetic resonance imaging tasks, was compared between the patients and the age-/gender-/handedness-matched controls. Chi square testing showed that the percentages of subjects with "typical" and "atypical" language dominance in the patient group were significantly different from the percentages recorded in the matched healthy controls for both tasks (p<0.005). Lesion type, lesion location, lesion hemisphere, presenting symptom and patient gender had no statistically significant effect on the hemispheric LI (p>0.05). In a logistic regression model including all potential determinants of atypical LI, age emerged as the only independent predictor (p<0.05, odds ratio=0.9). Abnormal language lateralization is found in patients with a variety of cerebral lesions and with a diversity of clinical manifestations. In our selected population, symptom duration, lesion hemisphere and anatomical site of the lesion were not found to impact significantly on the development of an abnormal LI while patient age can independently predict the presence of an atypical LI.

Methodological considerations in conducting an olfactory fMRI study.

The sense of smell is a complex chemosensory processing in human and animals that allows them to connect with the environment as one of their chief sensory systems. In the field of functional brain imaging, many studies have focused on locating brain regions that are involved during olfactory processing. Despite wealth of literature about brain network in different olfactory tasks, there is a paucity of data regarding task design. Moreover, considering importance of olfactory tasks for patients with variety of neurological diseases, special contemplations should be addressed for patients. In this article, we review current olfaction tasks for behavioral studies and functional neuroimaging assessments, as well as technical principles regarding utilization of these tasks in functional magnetic resonance imaging studies.

Risk factors affecting the survival rate in patients with symptomatic pericardial effusion undergoing surgical intervention.

OBJECTIVES: The optimal management and treatment of pericardial effusion are still controversial. There is limited data related to the risk factors affecting survival in these patients. The aim of this study was to determine the risk factors affecting the survival rate of patients with symptomatic pericardial effusion who underwent surgical interventions. METHODS: From 2004 to 2011, we retrospectively analysed 153 patients who underwent subxiphoid pericardial window as their surgical intervention to drain pericardial effusions at the National Research Institute of Tuberculosis and Lung diseases (NRITLD). To determine the effects of risk factors on survival rate, demographic data, clinical records, echocardiographic data, computed tomographic and cytopathological findings and also operative information of patients were recorded. Patients were followed annually until the last clinical follow-up (August 2011). To determine the prognostic factors affecting survival, both univariate analysis and multivariate Cox proportional hazards model were utilized. RESULTS: There were 89 men and 64 women with a mean age of 50.3 ± 15.5 years. The most prevalent symptom was dyspnoea. Concurrent malignancies were present in 66 patients. Lungs were the most prevalent primary site for malignancy. The median duration of follow-up was 15 (range 1-85 months). Six-month, 1-year and 18-month survival rates were 85.6, 61.4 and 36.6%, respectively. In a multivariate analysis, positive history of lung cancer (hazard ratio [HR] 2.894, 95% confidence interval [CI] 1.362-6.147, P = 0.006) or other organ cancers (HR 2.315, 95% CI 1.009-50311, P = 0.048), presence of a mass in the computed tomography (HR 1.985, 95% CI 1.100-3.581, P = 0.023), and echocardiographic findings compatible with tamponade (HR 1.745, 95% CI 1.048-2.90 P = 0.032) were the three independent predictors of postoperative death. CONCLUSIONS: In the surgical management of pericardial effusion, patients with underlying malignant disease, especially with lung cancer, patients with a detectable invasion of thorax in computed tomography and those with positive echocardiographic findings compatible with tamponade have a poor survival. Therefore, minimally invasive therapies could be considered as a more acceptable alternative for these high-risk patients.

Modulation of cold pain perception by transcranial direct current stimulation in healthy individuals.

OBJECTIVES: The aim of the current study was to evaluate the effect of transcranial direct current stimulation (tDCS) on cold pain perception in healthy individuals. METHODS: Anodal, cathodal (2 mA), or sham tDCSs were applied on the primary motor cortex of 22 healthy subjects in a random order. A cold pressor test was performed ten minutes after initiation of stimulation. Pain threshold and tolerance were defined as time latencies to the onset of pain perception and to the withdrawal from cold stimulus, respectively. Furthermore, pain intensity (on a scale from 0 to 10) was rated at tolerance. RESULTS: Time latencies to pain threshold and tolerance were altered by the type of stimulation (p < 0.05). Pairwise post hoc analysis revealed that anodal tDCS led to increment in pain threshold and tolerance compared with sham stimulation (13.3 ± 7.4 vs. 10.9 ± 6.0 sec for the comparison of pain threshold and 54.6 ± 26.0 vs. 45.3 ± 17.9 for the comparison of pain tolerance following anodal and sham stimulations, respectively, p < 0.05 for both comparisons). However, cathodal stimulation did not alter pain perception in comparison to anodal and sham stimulations (p > 0.05). Furthermore, pain intensity score at tolerance was not significantly affected by the type of stimulation (p > 0.05). CONCLUSION: Anodal stimulation of the primary motor area can be utilized to alleviate cold pain perception in healthy individuals.

Surgical management of traumatic rupture of aortic isthmus: a 25-year experience.

OBJECTIVE: Traumatic rupture of the thoracic aorta is a surgical emergency with a high mortality rate. This condition requires prompt diagnosis and expeditious evaluation to improve patient survival. The aim of this study is to evaluate the outcomes of early and late management of traumatic rupture of aortic isthmus in patients with blunt thoracic trauma. METHODS: Between February 1980 and June 2005, 64 patients sustained blunt thoracic trauma underwent open surgical repair for traumatic rupture of the aortic isthmus (7 women, 57 men, and mean age 38 ± 14.3 years). Clinical signs of diagnostic principles in our series of patients were: chest pain and dyspnea (48.5 %), hemoptysis (23.5 %), and hypotension (15.5 %). All patients underwent a left posterolateral thoracotomy through the fourth or fifth intercostal space or median sternotomy. Extracorporeal circulation for spinal cord protection was installed in all patients. RESULTS: Of the 64 patients identified over the 25-year study period, 15 (23.5 %) underwent direct suture, 48 (75 %) underwent interposition graft repair, and 1 (1.5 %) experienced patch aortoplasty repair. The overall hospital mortality rate for the entire patient was 3 % due to multiple organ failure and myocardial infarction. No paraplegia occurred postoperatively. Three patients died during the follow-up period, two from myocardial infarction, and one from acquired immunodeficiency syndrome. CONCLUSIONS: Traumatic aortic rupture remains a potentially lethal injury and an ongoing therapeutic challenge. Open surgical technique to repair the traumatic rupture of aorta is a safe procedure: postoperative outcome was excellent and the complications observed that were with aortic endoprosthetic stent-grafts were avoided.