Uso do método de Pontos para a Reestruturação de Objetivos Fonéticos e Oro-Musculares (PROMPT) no Transtorno do Espectro Autista: um estudo de caso / Use of the Prompts for Reestructuring Oral Muscular Phonetic Targets (PROMPT) in Autism Spectrum Disorder: a case study

RESUMO O Transtorno do Espectro Autista (TEA) é classificado pelo Manual de Diagnóstico e Estatístico de Transtornos Mentais (DSM-5) como um Transtorno do Neurodesenvolvimento, sendo caracterizado, principalmente, por alterações na comunicação social e pela presença de um repertório restrito de atividades e interesses. Na literatura, há muitos estudos sobre autismo, fala e linguagem, mas poucos correlacionando fala e autismo. Este estudo teve como finalidade realizar um estudo de caso que abordou autismo, fala e PROMPT (Pontos para a Reestruturação de Objetivos Fonéticos e Oro-Musculares) e mensurou a melhora da fala no participante com autismo, utilizando o método. Foram definidas palavras-alvo para toda a intervenção, conforme o Sistema de Observação e Análise (SOA) e Hierarquia Motora de Fala (HMF), que fazem parte da avaliação de PROMPT. Após a avaliação, o participante foi atendido por 16 sessões, uma vez semanalmente. Após análise dos dados, observou-se melhora em todos os aspectos que foram delineados de acordo com a avaliação no pré-tratamento, como controle fonatório, controle mandibular, controle lábio-facial e controle lingual, como também no movimento sequenciado, apesar deste não ser o objetivo traçado na avaliação. Também foi possível mensurar melhora no número de vocábulos adequados, número de fonemas adequados, porcentagens de consoantes corretas - revisado (PCC-R) e inteligibilidade.

ABSTRACT Autism Spectrum Disorder (ASD) is classified by Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a neurodevelopmental disorder, whose characteristics are mainly deficits in social communication and a restricted range of interests. There are several studies about autism, speech, and language in the literature, but few correlate speech and autism. This study aims to carry out a case study that will address autism, speech, and PROMPT (Restructuring Oral Muscular Phonetic Targets) and also to describe the speech improvement in the participant with autism using the method. The target words were defined for the entire intervention according to the System Analysis Observation (SAO) and Motor Speech Hierarchy (MSH), which are parts of the PROMPT evaluation. After the evaluation, the participant was attended for 16 sessions, once weekly, with the objective of improving their speech. After analyzing the data, it was possible to observe improvement in all aspects outlined according to the pre-treatment evaluation of the method such as phonatory control, mandibular control, lip-facial control and lingual control as well as in the sequenced movement although this was not the aim outlined in the evaluation. It was also possible to measure the improvement of an adequate number of words, an adequate number of phonemes, percentages of correct consonants - revised (PCC-R), and intelligibility.

Use of the Prompts for Reestructuring Oral Muscular Phonetic Targets (PROMPT) in Autism Spectrum Disorder: a case study. / Uso do método de Pontos para a Reestruturação de Objetivos Fonéticos e Oro-Musculares (PROMPT) no Transtorno do Espectro Autista: um estudo de caso.

Autism Spectrum Disorder (ASD) is classified by Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a neurodevelopmental disorder, whose characteristics are mainly deficits in social communication and a restricted range of interests. There are several studies about autism, speech, and language in the literature, but few correlate speech and autism. This study aims to carry out a case study that will address autism, speech, and PROMPT (Restructuring Oral Muscular Phonetic Targets) and also to describe the speech improvement in the participant with autism using the method. The target words were defined for the entire intervention according to the System Analysis Observation (SAO) and Motor Speech Hierarchy (MSH), which are parts of the PROMPT evaluation. After the evaluation, the participant was attended for 16 sessions, once weekly, with the objective of improving their speech. After analyzing the data, it was possible to observe improvement in all aspects outlined according to the pre-treatment evaluation of the method such as phonatory control, mandibular control, lip-facial control and lingual control as well as in the sequenced movement although this was not the aim outlined in the evaluation. It was also possible to measure the improvement of an adequate number of words, an adequate number of phonemes, percentages of correct consonants - revised (PCC-R), and intelligibility.

O Transtorno do Espectro Autista (TEA) é classificado pelo Manual de Diagnóstico e Estatístico de Transtornos Mentais (DSM-5) como um Transtorno do Neurodesenvolvimento, sendo caracterizado, principalmente, por alterações na comunicação social e pela presença de um repertório restrito de atividades e interesses. Na literatura, há muitos estudos sobre autismo, fala e linguagem, mas poucos correlacionando fala e autismo. Este estudo teve como finalidade realizar um estudo de caso que abordou autismo, fala e PROMPT (Pontos para a Reestruturação de Objetivos Fonéticos e Oro-Musculares) e mensurou a melhora da fala no participante com autismo, utilizando o método. Foram definidas palavras-alvo para toda a intervenção, conforme o Sistema de Observação e Análise (SOA) e Hierarquia Motora de Fala (HMF), que fazem parte da avaliação de PROMPT. Após a avaliação, o participante foi atendido por 16 sessões, uma vez semanalmente. Após análise dos dados, observou-se melhora em todos os aspectos que foram delineados de acordo com a avaliação no pré-tratamento, como controle fonatório, controle mandibular, controle lábio-facial e controle lingual, como também no movimento sequenciado, apesar deste não ser o objetivo traçado na avaliação. Também foi possível mensurar melhora no número de vocábulos adequados, número de fonemas adequados, porcentagens de consoantes corretas ­ revisado (PCC-R) e inteligibilidade.

Food wanting is mediated by transient activation of dopaminergic signaling in the honey bee brain.

The biological bases of wanting have been characterized in mammals, but whether an equivalent wanting system exists in insects remains unknown. In this study, we focused on honey bees, which perform intensive foraging activities to satisfy colony needs, and sought to determine whether foragers leave the hive driven by specific expectations about reward and whether they recollect these expectations during their waggle dances. We monitored foraging and dance behavior and simultaneously quantified and interfered with biogenic amine signaling in the bee brain. We show that a dopamine-dependent wanting system is activated transiently in the bee brain by increased appetite and individual recollection of profitable food sources, both en route to the goal and during waggle dances. Our results show that insects share with mammals common neural mechanisms for encoding wanting of stimuli with positive hedonic value.

Anxiety in anesthesia providers during coronavirus disease 19 pandemic: Insights into perception of harm a cross-sectional study.

Background: The influence of Coronavirus disease 2019 (COVID-19) pandemic on mental health has been widely studied; however, literature evaluating the mental health effects of the pandemic on small groups of people is scarce. We aim to evaluate the impact of the COVID-19 pandemic on anxiety levels of anesthesiology providers in an academic institution. Materials and methods: We conducted a cross-sectional study including one hundred and five participants (Faculty anesthesiologists, anesthesia residents, certified registered and student nurse anesthetists). The generalized anxiety disorder questionnaire (GAD-7) was administered to participants. Results: Approximately half of the 105 participants experienced various degrees of anxiety, with only 14.3% exhibiting moderate to severe symptoms of anxiety. Anxiety interfering with daily activities was reported in 54.9% of the participants. Anxiety-generating factors such as access to protective equipment and transmitting the disease to family members were identified. Conclusion: The COVID-19 pandemic is associated with different degrees of anxiety. The prevalence of severe anxiety is relatively low, probably due to differential individual perceptions, feelings of invulnerability, and resilience of anesthesia providers.

The short neuropeptide F (sNPF) promotes the formation of appetitive visual memories in honey bees.

Motivation can critically influence learning and memory. Multiple neural mechanisms regulate motivational states, among which signalling via specific neuropeptides, such as NPY in vertebrates and NPF and its short variant sNPF in invertebrates, plays an essential role. The honey bee (Apis mellifera) is a privileged model for the study of appetitive learning and memory. Bees learn and memorize sensory cues associated with nectar reward while foraging, and their learning is affected by their feeding state. However, the neural underpinnings of their motivational states remain poorly known. Here we focused on the short neuropeptide F (sNPF) and studied if it modulates the acquisition and formation of colour memories. Artificially increasing sNPF levels in partially fed foragers with a reduced motivation to learn colours resulted in significant colour learning and memory above the levels exhibited by starved foragers. Our results thus identify sNPF as a critical component of motivational processes involved in foraging and in the cognitive processes associated with this activity in honey bees.

The short neuropeptide F regulates appetitive but not aversive responsiveness in a social insect.

The neuropeptide F (NPF) and its short version (sNPF) mediate food- and stress-related responses in solitary insects. In the honeybee, a social insect where food collection and defensive responses are socially regulated, only sNPF has an identified receptor. Here we increased artificially sNPF levels in honeybee foragers and studied the consequences of this manipulation in various forms of appetitive and aversive responsiveness. Increasing sNPF in partially fed bees turned them into the equivalent of starved animals, enhancing both their food consumption and responsiveness to appetitive gustatory and olfactory stimuli. Neural activity in the olfactory circuits of fed animals was reduced and could be rescued by sNPF treatment to the level of starved bees. In contrast, sNPF had no effect on responsiveness to nociceptive stimuli. Our results thus identify sNPF as a key modulator of hunger and food-related responses in bees, which are at the core of their foraging activities.

Charles Henry Turner and the cognitive behavior of bees.

Social movements in several countries are stimulating a reconsideration of academic structures and historic figures and promoting reparation and recognition of marginalized and forgotten black scientists. A paradigmatic case in that sense is Charles Henry Turner (1867-1923) who was the first African American to receive a graduate degree at the University of Cincinnati and one of the first in earning a PhD degree of the University of Chicago. He performed numerous experiments on sensory perception, orientation, and mating of solitary and social bees, most of which have been unjustly forgotten despite the fact that they anticipated fundamental concepts of animal cognition. We review these studies and highlight the importance of his ideas for modern views of animal cognition and the study of bee behavior. We conclude that besides his scientific contributions, Turner is an inspiration for scientists fighting against social adversity and prejudices.

Supra-massive transfusion and interdisciplinary approach to cesarean hysterectomy due to complex placenta percreta: Case report.

Placenta accreta spectrum encompasses a group of conditions of abnormal placental infiltration of the uterine wall and surrounding tissues. It is associated with significant blood loss, perioperative morbidity, and risk of death. A coordinated interdisciplinary approach to these complex cases and early resuscitation with blood products are critical factors in the successful management of patients affected by this disease. We describe the successful management of a patient with placenta percreta who required supra-massive transfusion of blood products and interventions by different specialized teams in a tertiary care center.

Peripheral taste detection in honey bees: What do taste receptors respond to?

Understanding the neural principles governing taste perception in species that bear economic importance or serve as research models for other sensory modalities constitutes a strategic goal. Such is the case of the honey bee (Apis mellifera), which is environmentally and socioeconomically important, given its crucial role as pollinator agent in agricultural landscapes and which has served as a traditional model for visual and olfactory neurosciences and for research on communication, navigation, and learning and memory. Here we review the current knowledge on honey bee gustatory receptors to provide an integrative view of peripheral taste detection in this insect, highlighting specificities and commonalities with other insect species. We describe behavioral and electrophysiological responses to several tastant categories and relate these responses, whenever possible, to known molecular receptor mechanisms. Overall, we adopted an evolutionary and comparative perspective to understand the neural principles of honey bee taste and define key questions that should be answered in future gustatory research centered on this insect.

Genetic modifiers and phenotypic variability in neuromuscular disorders.

Neuromuscular disorders are mostly rare diseases with autosomal dominant, recessive, or X-linked inheritance. Interestingly, among patients carrying the same mutations, a range of phenotypic severity is reported. This phenotypic variability in neuromuscular disorders is still not fully understood. This review will focus on genetic modifiers and will briefly describe metabolic pathways, in which they are involved. Genetic modifiers are variants in the same or other genes that modulate the phenotype. Proteins encoded by genetic modifiers in neuromuscular diseases are taking part in different metabolic processes, most commonly in inflammation, growth and regeneration, endoplasmic reticulum metabolism, and cytoskeletal activities. Recent advances in omics technologies, development of computational algorithms, and establishing large international consortia intensified discovery sped up investigation of genetic modifiers. As more individuals affected by neuromuscular disorders are tested, it is often suggested that classic models of genetic causation cannot explain phenotypic variability. There is a growing interest in their discovery and identifying shared metabolic pathways can contribute to design targeted therapies. We provide an update on variants acting as genetic modifiers in neuromuscular disorders and strategies used for their discovery.

Degradation of an appetitive olfactory memory via devaluation of sugar reward is mediated by 5-HT signaling in the honey bee.

Conditioned taste aversion (CTA) learning induces the devaluation of a preferred food through its pairing with a stimulus inducing internal illness. In invertebrates, it is still unclear how this aversive learning impairs the memories of stimuli that had been associated with the appetitive food prior to its devaluation. Here we studied this phenomenon in the honey bee and characterized its neural underpinnings. We first trained bees to associate an odorant (conditioned stimulus, CS) with appetitive fructose solution (unconditioned stimulus, US) using a Pavlovian olfactory conditioning. We then subjected the bees that learned the association to a CTA training during which the antennal taste of fructose solution was contingent or not to the ingestion of quinine solution, which induces malaise a few hours after ingestion. Only the group experiencing contingent fructose stimulation and quinine-based malaise exhibited a decrease in responses to the fructose and a concomitant decrease in odor-specific retention in tests performed 23 h after the original odor conditioning. Furthermore, injection of dopamine- and serotonin-receptor antagonists after CTA learning revealed that this long-term decrease was mediated by serotonergic signaling as its blockade rescued both the responses to fructose and the odor-specific memory 23 h after conditioning. The impairment of a prior CS memory by subsequent CTA conditioning confirms that bees retrieve a devaluated US representation when presented with the CS. Our findings further highlight the importance of serotonergic signaling in aversive learning in the bee and uncover mechanisms underlying aversive memories induced by internal illness in invertebrates.

Microglial physiological properties and interactions with synapses are altered at presymptomatic stages in a mouse model of Huntington's disease pathology.

BACKGROUND: Huntington's disease (HD) is a dominantly inherited neurodegenerative disorder that affects cognitive and motor abilities by primarily targeting the striatum and cerebral cortex. HD is caused by a mutation elongating the CAG repeats within the Huntingtin gene, resulting in HTT protein misfolding. Although the genetic cause of HD has been established, the specific susceptibility of neurons within various brain structures has remained elusive. Microglia, which are the brain's resident macrophages, have emerged as important players in neurodegeneration. Nevertheless, few studies have examined their implication in HD. METHODS: To provide novel insights, we investigated the maturation and dysfunction of striatal microglia using the R6/2 mouse model of HD. This transgenic model, which presents with 120+/-5 CAG repeats, displays progressive motor deficits beginning at 6 weeks of age, with full incapacitation by 13 weeks. We studied microglial morphology, phagocytic capacity, and synaptic contacts in the striatum of R6/2 versus wild-type (WT) littermates at 3, 10, and 13 weeks of age, using a combination of light and transmission electron microscopy. We also reconstructed dendrites and determined synaptic density within the striatum of R6/2 and WT littermates, at nanoscale resolution using focused ion beam scanning electron microscopy. RESULTS: At 3 weeks of age, prior to any known motor deficits, microglia in R6/2 animals displayed a more mature morphological phenotype than WT animals. Microglia from R6/2 mice across all ages also demonstrated increased phagocytosis, as revealed by light microscopy and transmission electron microscopy. Furthermore, microglial processes from 10-week-old R6/2 mice made fewer contacts with synaptic structures than microglial processes in 3-week-old R6/2 mice and age-matched WT littermates. Synaptic density was not affected by genotype at 3 weeks of age but increased with maturation in WT mice. The location of synapses was lastly modified in R6/2 mice compared with WT controls, from targeting dendritic spines to dendritic trunks at both 3 and 10 weeks of age. CONCLUSIONS: These findings suggest that microglia may play an intimate role in synaptic alteration and loss during HD pathogenesis.

Utility of color flow Doppler ultrasound to identify peripheral intravenous catheter position in adult surgical patients.

OBJECTIVE: To evaluate color flow Doppler flow ultrasound compared to standard clinical techniques, to detect the intravascular position of peripheral intravenous catheters in adult surgical patients. METHODS: A prospective study was conducted in adult (>18 years old) patients scheduled to undergo elective surgery. Peripheral intravenous catheter position was evaluated with standard clinical techniques (free flow of fluid from a hanging bag, easy saline injection, and aspiration of blood), and with color flow Doppler ultrasound proximal to the insertion site to identify intravascular catheter position. Comparative test performance was carried out. RESULTS: In total, 174 patients were enrolled. The venous catheter was deemed to be intravascular in 92.53% (n = 161) and 90.23% (n = 157) based on clinical evaluation and color flow Doppler, respectively (p = 0.206). Moderate to substantial agreement between the two approaches was found. Cohen's kappa was 0.64 (95% CI 0.43-0.83). Specificity of clinical judgment to detect catheter extravascular position was only 58.82%, when the color flow Doppler technique was set as the gold standard. Free flow from a hanging bag method showed the best agreement with color flow Doppler to determine intravascular position of a catheter (p = 0.3173, kappa = 0.68), with sensitivity of 98.09% and specificity of 64.71%. CONCLUSION: Color flow Doppler is a specific tool complementary to sensitive clinical indicators to detect peripheral venous catheter infiltration. The ability of color flow Doppler to accurately determine the position of a peripheral venous catheter depends on experience and familiarity with the tool by providers, who can master the technique with education and training.

Ultrasound your NPO: Effect of body mass index on gastric volume in term pregnant women - Retrospective case series.

INTRODUCTION: A common belief has been that obese patients are prone to develop aspiration of gastric contents when general anesthesia is administered. We aimed to determine the correlation between antral cross-sectional area as a surrogate of gastric volume measured by gastric ultrasound, and body mass index (BMI) in term pregnant women scheduled for elective cesarean section. METHODS: A cross-sectional observational study was conducted on forty-two term pregnant patients scheduled for cesarean section. A preoperative qualitative and quantitative ultrasound assessment of the antral area was performed on the day of surgery. Gastric volume as a function of BMI was evaluated. RESULTS: A significant correlation was found between BMI and gastric antral area (p = 0.001), as well as with longitudinal diameter (p < 0.001). This correlation is independent of gravidity and parity. CONCLUSION: BMI is an independent predictor of antral cross sectional area and gastric volume in term pregnant patients scheduled for cesarean section. Perioperative fasting guidelines in pregnancy should be adjusted in obese and morbidly obese pregnant women.

Aversive gustatory learning and perception in honey bees.

Taste perception allows discriminating edible from non-edible items and is crucial for survival. In the honey bee, the gustatory sense has remained largely unexplored, as tastants have been traditionally used as reinforcements rather than as stimuli to be learned and discriminated. Here we provide the first characterization of antennal gustatory perception in this insect using a novel conditioning protocol in which tastants are dissociated from their traditional food-reinforcement role to be learned as predictors of punishment. We found that bees have a limited gustatory repertoire via their antennae: they discriminate between broad gustatory modalities but not within modalities, and are unable to differentiate bitter substances from water. Coupling gustatory conditioning with blockade of aminergic pathways in the bee brain revealed that these pathways are not restricted to encode reinforcements but may also encode conditioned stimuli. Our results reveal unknown aspects of honey bee gustation, and bring new elements for comparative analyses of gustatory perception in animals.

A dense cluster of D1 + cells in the mouse nucleus accumbens.

The striatum is known to be largely composed of intermingled medium-sized projection neurons expressing either the D1 or the D2 dopamine receptors. In the present study, we took advantage of the double BAC Drd1a-TdTomato/Drd2-GFP (D1 /D2 ) transgenic mice to reveal the presence of a peculiar cluster of densely-packed D1 + cells located in the shell compartment of the nucleus accumbens. This spherical cluster has a diameter of 110 µm and is exclusively composed by D1 + cells, which are all immunoreactive for the neuronal nuclear marker (NeuN). However, in contrast to other D1 + or D2 + striatal cells, those that form the accumbens cluster are devoid of calbindin (CB) and DARPP-32, two faithful markers for striatal projection neurons. Using GAD-GFP transgenic mice, we confirm the GABAergic nature of the D1 + clustered neurons. Intracellular injections from fixed brain slices indicate that these neurons are endowed with distinctive morphological features, including a small (5-6 µm), round cell body giving rise to a single primary dendrite that branches into two secondary processes. Single-neuronal injections combined to electron microscopy reveal the existence of GAP junctions linking these D1 + cells. Based on their location, morphological characteristics and neurochemical phenotype, we conclude that the D1 + accumbens cluster form a highly compact group of small neurons distinct from the larger and more diffusely distributed D1 + or D2 + striatal projection neurons that surround it. This remarkable nucleus might play a crucial role in the limbic function of the murine striatum.

Caso inusual de difteria cutánea con compromiso mucoso y síndrome del vértex orbitario / Unusual clinical presentation of cutaneous diphteria with mucosal involvement and orbital Vertex syndrome

La difteria es una enfermedad prevenible por vacunas. En la actualidad existe un brote en nuestro país que se inició en abril de 2016. Desde entonces se han descrito casos en diferentes sitios del país predominantemente de la forma faríngea. La difteria cutánea no ha sido reportada en este brote. A nivel mundial el compromiso simultáneo en piel y mucosas, no ha sido descrito. La paciente cuya enfermedad describimos aquí es un caso de difteria de presentación atípica que se inicia con expresión cutánea y evoluciona a compromiso nasal, ocular y faríngeo con complicaciones severas en la órbita ocular expresadas como un síndrome del vértex orbitario, en una paciente con diabetes mellitus tipo 2 no controlada, que tuvo una evolución tórpida que la llevó a la muerte. Se revisa la literatura(AU)

Diphtheria is a vaccine-preventable disease. Actually, there is an outbreak in Venezuela since April 2016. Cases in different parts of the country have been described, predominantly pharyngeal. Cutaneous diphtheria has not been reported in this outbreak. The simultaneous presentation of the cutaneous form with mucosal involvement has not been described in the revised literature. We present a case of diphtheria with atypical presentation that begins with cutaneous expression and evolves to nasal, ocular and pharyngeal compromise with severe complications of the orbit, expressed in an orbital vertex syndrome in a patient with type 2 diabetes mellitus, who had a torpid evolution that led her to death. The literature is reviewed(AU)

Absence of food alternatives promotes risk-prone feeding of unpalatable substances in honey bees.

The question of why animals sometimes ingest noxious substances is crucial to understand unknown determinants of feeding behaviour. Research on risk-prone feeding behaviour has largely focused on energy budgets as animals with low energy budgets tend to ingest more aversive substances. A less explored possibility is that risk-prone feeding arises from the absence of alternative feeding options, irrespectively of energy budgets. Here we contrasted these two hypotheses in late-fall and winter honey bees. We determined the toxicity of various feeding treatments and showed that when bees can choose between sucrose solution and a mixture of this sucrose solution and a noxious/unpalatable substance, they prefer the pure sucrose solution and reject the mixtures, irrespective of their energy budget. Yet, when bees were presented with a single feeding option and their escape possibilities were reduced, they consumed unexpectedly some of the previously rejected mixtures, independently of their energy budget. These findings are interpreted as a case of feeding helplessness, in which bees behave as if it were utterly helpless to avoid the potentially noxious food and consume it. They suggest that depriving bees of variable natural food sources may have the undesired consequence of increasing their acceptance of food that would be otherwise rejected.

Insulin effects on honeybee appetitive behaviour.

Worker honeybees (Apis mellifera) carry out multiple tasks throughout their adult lifespan. It has been suggested that the insulin/insulin-like signalling pathway participates in regulating behavioural maturation in eusocial insects. Insulin signalling increases as the honeybee worker transitions from nurse to food processor to forager. As behavioural shifts require differential usage of sensory modalities, our aim was to assess insulin effects on olfactory and gustatory responsiveness as well as on olfactory learning in preforaging honeybee workers of different ages. Adults were reared in the laboratory or in the hive. Immediately after being injected with insulin or vehicle (control), and focusing on the proboscis extension response, bees were tested for their spontaneous response to odours, sucrose responsiveness and ability to discriminate odours through olfactory conditioning. Bees injected with insulin have higher spontaneous odour responses. Sucrose responsiveness and odour discrimination are differentially affected by treatment according to age: whereas insulin increases gustatory responsiveness and diminishes learning abilities of younger workers, it has the opposite effect on older bees. In summary, insulin can improve chemosensory responsiveness in young workers, but also worsens their learning abilities to discriminate odours. The insulin signalling pathway is responsive in young workers, although they are not yet initiating outdoor activities. Our results show strong age-dependent effects of insulin on appetitive behaviour, which uncover differences in insulin signalling regulation throughout the honeybee worker's adulthood.