Effect of Music Tempo on Pattern Reversal Visual Evoked Potential in Young Adults-Multisensory Stochastic Resonance: A Pilot Study

Stochastic resonance (SR) is a phenomenon in which an intermediate level of noise enhances the response of a weak input signal. This phenomenon is experimentally used for rehabilitation and treatment of visuomotor disorders associated with low amplitude and higher latency P100 VEPs. We presupposed that shortly it will be possible to develop and design new devices that enable multisensory SR in the audio-visual modality for human sensorimotor enhancement and rehabilitation purposes. This study was newer in which the auditory noise was used in the form of song of different tempos and their amplitude and latency of P100 PRVEP (pattern reversal visual evoked potential) was compared. Whether the different tempos song may affects the PRVEP. This study was conducted on 57 healthy volunteers in AIIMS Bhopal. The subjects were placed in front of a computer displaying a checkerboard 8x8 size. Electrodes were pasted on their scalp. The average latencies and amplitudes of the PRVEP were recorded at resting, then with the stimulus of acoustic noise in the form of low and high tempo song. The PRVEP were recorded for each event. We found that low- and high-tempo songs do not affect the latency component of PRVEP, while it significantly affects amplitude. Music therapy can help with vision rehabilitation, especially in patients with low amplitude PRVEP. A more significant number of samples for further study in this field in multisensory SR with visual evoked potentials (VEP) are necessary. We can also conclude that a sound-free environment is essential during VEP recording.

Dilated Optic Nerve Sheath in Mucopolysaccharidosis I: Common and Not Necessarily High Intracranial Pressure

Hydrocephalus is one of the earliest manifestations of mucopolysaccharidosis I-Hurler syndrome, and delayed treatment of hydrocephalus can lead to neurocognitive delay or even death. Optic nerve sheath diameter has been established as a noninvasive measurement to detect elevated intracranial pressure. This study aimed to establish correlations between optic nerve sheath diameter and opening pressure. Forty-nine MR images and opening pressures in patients with mucopolysaccharidosis I-Hurler syndrome were retrospectively reviewed from 2008 to 2020. The optic nerve sheath diameter was measured 3 mm posterior to the posterior margin of the globe (retrobulbar) and 10 mm anterior to the optic foramen (midpoint segment), and the average was taken between the 2 eyes. Opening pressure was measured with the patient in the lateral decubitus position with controlled end-tidal CO2 on the same day as the MR imaging. The average retrobulbar optic nerve sheath diameter was 5.33 mm, higher than the previously reported measurement in healthy controls, in patients with idiopathic intracranial hypertension, and there was a positive correlation between age and the optic nerve sheath diameter measured at the retrobulbar or midpoint segment (retrobulbar segment, R 2 = 0.27, P < .01; midpoint segment, R 2 = 0.20, P < .01). However, there was no correlation between retrobulbar or midpoint segment optic nerve sheath diameter and opening pressure (retrobulbar segment, R 2 = 0.02, P = .17; midpoint segment, R 2 = 0.03, P < .12). This study shows a higher average optic nerve sheath diameter in patients with mucopolysaccharidosis I-Hurler syndrome than in healthy controls regardless of the location of the measurement. However, the degree of optic nerve sheath dilation does not correlate with opening pressure, suggesting that increased optic nerve sheath diameter is an ocular manifestation of mucopolysaccharidosis I-Hurler syndrome itself rather than a marker of elevated intracranial pressure.

A sinister needle in an enormous haystack: A clinician survey regarding Acute Aortic Syndrome diagnostic practice in United Kingdom Emergency Departments

Acute Aortic Syndrome (AAS) is a life-threatening condition associated with high diagnostic uncertainty. This results in an unacceptable number of missed cases, which contributes to its high mortality. We designed and distributed a survey to Emergency Departments (EDs) across the United Kingdom to establish the standard practice for investigation and diagnosis of AAS across the UK. 56 EDs across the UK responded. The majority of these did not have a formal work-up pathway for AAS. The estimated CT scanning rates and missed cases of AAS were highly variable between departments. This suggests variation in practice and diagnostic uncertainty. Given its time sensitive nature, the need for a more standardised diagnostic pathway for AAS in EDs is evident. This may aid clinicians rule out AAS more safely and reduce the number of missed cases, which would in turn reduce the high morbidity and mortality associated with AAS.

Collision-System and Beam-Energy Dependence of Anisotropic Flow Fluctuations

Elliptic flow measurements from two-, four-, and six-particle correlations are used to investigate flow fluctuations in collisions of U+U at sqrt[s_{NN}]=193  GeV, Cu+Au at sqrt[s_{NN}]=200  GeV and Au+Au spanning the range sqrt[s_{NN}]=11.5-200  GeV. The measurements show a strong dependence of the flow fluctuations on collision centrality, a modest dependence on system size, and very little if any, dependence on particle species and beam energy. The results, when compared to similar LHC measurements, viscous hydrodynamic calculations, and trento model eccentricities, indicate that initial-state-driven fluctuations predominate the flow fluctuations generated in the collisions studied.

Unilateral sacral erector spinae plane block for lower limb surgery in children

The erector spinae plane block is a versatile regional anaesthesia technique used for a variety of truncal surgeries. A novel variation is the sacral erector spinae plane block which is gaining popularity for perineal and anorectal procedures. Local anaesthetic injected at this level blocks the sacral dermatomes and has the potential for more proximal spread to involve lumbar nerve fibres via spread to the lumbar plexus or the epidural space. The advantage of a sacral erector spinae plane block over a neuraxial block is that it is less invasive and may have a better safety profile: there is a reduced risk of epidural haematoma, epidural abscess, haemodynamic instability and motor weakness of the lower extremities. Until now, this approach has been used for midline surgical procedures when the local anaesthetic was injected bilaterally. Its application for lower limb procedures with a single unilateral injection has not been described. We report the use of a unilateral sacral erector spinae plane block at the level of the S2 median crest in two children undergoing lower limb procedures of the hip and thigh. The block was found to provide effective peri-operative analgesia with minimal need for any opioid analgesics and without any significant adverse effects.

Effect of aerobic exercises and therapeutic pain neuroscience education on disability, pain, head posture and QOL in migraine patients

Migraine is a type of primary headache with a high degree of associated disability that can present with a variety of indications and co-morbidities. The role of physical therapy treatment in migraine management is largely obscure. To investigate the combine effect of aerobic exercises and therapeutic pain neuroscience education on disability, pain pressure threshold, head posture and quality of life (QoL) in patients having migraine. Subjects were screened by using Migraine Disability Assessment (MIDAS) and after screening total sample of 50 subjects were randomly assigned into two groups: Group A (Experimental, n=25) and Group B (Control, n=25). Migraine disability assessment, pressure algometer, craniovertebral angle (CVA) and migraine specific quality of life were examined before and after 6 weeks of the intervention. Group A were given aerobic exercises and therapeutic pain neuroscience education along with conventional treatment for 45 min 3 days/week for 6 weeks, whereas participants in the Group B performed conventional exercises alone for 20 min 3 days/week for 6 weeks. Significant differences were observed in migraine disability score (P=0.003) and pain pressure threshold (P=0.039, P=0.030 and P=0.025) and improvement in forward head posture (P=0.001) between the groups after the intervention period, signifying greater improvement in the group A. QoL also improved in both the groups after intervention. Main findings of the present study suggest that the therapeutic pain neuroscience education and aerobic exercises combined with conventional treatment together maybe helpful to give better quality of life, reduced disability, increased pain pressure threshold and increased CVA to patients with migraine.

Survey of the American Society of Neuroradiology Membership on the Use and Value of Extracranial Carotid Vessel Wall MRI

BACKGROUND AND PURPOSE

Extracranial vessel wall MRI (EC-VWI) contributes to vasculopathy characterization. This survey study investigated EC-VWI adoption by American Society of Neuroradiology (ASNR) members and indications and barriers to implementation.

MATERIALS AND METHODS

The ASNR Vessel Wall Imaging Study Group survey on EC-VWI use, frequency, applications, MR imaging systems and field strength used, protocol development approaches, vendor engagement, reasons for not using EC-VWI, ordering provider interest, and impact on clinical care was distributed to the ASNR membership between April 2, 2019, to August 30, 2019.

RESULTS

There were 532 responses; 79 were excluded due to minimal, incomplete response and 42 due to redundant institutional responses, leaving 411 responses. Twenty-six percent indicated that their institution performed EC-VWI, with 66.3% performing it ≤1-2 times per month, most frequently on 3T MR imaging, with most using combined 3D and 2D protocols. Protocols most commonly included pre- and postcontrast T1-weighted imaging, TOF-MRA, and contrast-enhanced MRA. Inflammatory vasculopathy (63.3%), plaque vulnerability assessments (61.1%), intraplaque hemorrhage (61.1%), and dissection-detection/characterization (51.1%) were the most frequent applications. For those not performing EC-VWI, the reasons were a lack of ordering provider interest (63.9%), lack of radiologist time/interest (47.5%) or technical support (41.4%) for protocol development, and limited interpretation experience (44.9%) and knowledge of clinical applications (43.7%). Reasons given by 46.9% were that no providers approached radiology with interest in EC-VWI. If barriers were overcome, 51.1% of those not performing EC-VWI indicated they would perform it, and 40.6% were unsure; 48.6% did not think that EC-VWI had impacted patient management at their institution.

CONCLUSIONS

Only 26% of neuroradiology groups performed EC-VWI, most commonly due to limited clinician interest. Improved provider and radiologist education, protocols, processing techniques, technical support, and validation trials could increase adoption.

1716 Why do emergency department clinicians miss acute aortic syndrome? A case series and descriptive analysis

Aims, Objectives and Background

Acute aortic syndrome (AAS) is a rare, life-threatening emergency affecting approximately 4000 people per year in the UK, has an ED misdiagnosis rate as high as 38% and around one quarter of cases are not diagnosed until 24 hours after presenting to the ED.

It presents in many atypical ways, posing a significant diagnostic conundrum for the emergency department (ED) clinician and risk of litigation. We sought to understand the reasons why AAS was missed in ED by conducting a case series review of patients with misidentified AAS presenting to three UK EDs over a 10-year period.

Method and Design

We identified missed diagnoses of AAS using searches of ED morbidity and mortality records, post-mortem reports, complaints, Electronic Patient Records (EPRs) and Radiology records from three UK EDs.

Results and Conclusion

Between 1.1.2011–31.12.2020, 43 cases were identified across three EDs (1.4 cases/yr/dept).

The most common diagnosis was Type A aortic dissection (22; 51%).

The most common incorrect presumed diagnoses made were acute coronary syndrome (ACS, 12; 28%), pulmonary embolism (PE, 5; 12%) and ‘non-specific chest pain’ (5; 12%).

In 31 of the 43 cases (72%) there was no evidence from the notes of consideration of AAS in the differential diagnosis. In 10 of the 43 cases (23%), AAS was clearly considered, but the clinician appears to have been falsely reassured by clinical findings, normal chest x-ray, or atypical or resolved symptoms.

Only 63% (27/43) presented with chest pain and 16% (7/43) had no pain. 65% (28/43) documented sudden onset of symptoms.

This case series reinforces the RCEM/RCR recommendation that ‘All clinicians working in the emergency department should be made aware of the difficulties in excluding the diagnosis of thoracic aortic dissection.’ Further research is required to improve ED diagnostic pathways for this group of patients.

Heterogeneity of management practices surrounding operable gallbladder cancer - results of the OMEGA-S international HPB surgical survey

BACKGROUND

Gallbladder cancer (GBC) is an aggressive, uncommon malignancy, with variation in operative approaches adopted across centres and few large-scale studies to guide practice. We aimed to identify the extent of heterogeneity in GBC internationally to better inform the need for future multicentre studies.

METHODS

A 34-question online survey was disseminated to members of the European-African Hepatopancreatobiliary Association (EAHPBA), American Hepatopancreatobiliary Association (AHPBA) and Asia-Pacific Hepatopancreatobiliary Association (A-PHPBA) regarding practices around diagnostic workup, operative approach, utilization of neoadjuvant and adjuvant therapies and surveillance strategies.

RESULTS

Two hundred and three surgeons responded from 51 countries. High liver resection volume units (>50 resections/year) organised HPB multidisciplinary team discussion of GBCs more commonly than those with low volumes (p < 0.0001). Management practices exhibited areas of heterogeneity, particularly around operative extent. Contrary to consensus guidelines, anatomical liver resections were favoured over non-anatomical resections for T3 tumours and above, lymphadenectomy extent was lower than recommended, and a minority of respondents still routinely excised the common bile duct or port sites.

CONCLUSION

Our findings suggest some similarities in the management of GBC internationally, but also specific areas of practice which differed from published guidelines. Transcontinental collaborative studies on GBC are necessary to establish evidence-based practice to minimise variation and optimise outcomes.

Predictors of Seizures and Associated Functional Outcome in a Cerebral Venous Thrombosis Cohort: An Ambispective Cohort Study

Background and Purpose

We aimed to explore the characteristics, clinical features, predictors of seizure, and associated clinical outcomes in patients with cerebral venous thrombosis (CVT).

Methods

We enrolled patients with CVT from January 2014 to July 2020. Prospectively patients were recruited from December 2018. We analyzed predictors of seizures and associated good functional outcomes (modified Rankin Scale, mRS: 0-2) using multivariable logistic regression.

Results

We enrolled 153 patients with CVT in which 77 (50%) had presented with a seizure. The median age was 31 years (IQR 16-46), and the majority were men (73.2%). Focal to bilateral tonic-clonic was the most common seizure type (27%), followed by generalized seizures (22%). None of the patients had status epilepticus. Antiseizure medications (ASM) were used in 71% of patients at diagnosis, 42% having received them prophylactically. Supratentorial parenchymal involvement was seen in 72% of seizure patients compared to 38% in those without, and superior sagittal sinus was most commonly involved. Percentage of patients who achieved good clinical outcome (mRS 0-2) at 3 months did not vary significantly between both groups. The only predictor for seizures with CVT was the presence of a parenchymal lesion (OR-3.75, 95% CI 1.79-7.85), whereas seizure occurrence (OR- 12.55, 95% CI- 1.53-102.59) was associated with statistically significant risk for recurrent seizures, by multiple logistic regression analysis. Seizure occurrence was not associated with adverse functional outcomes.

Conclusion

Seizures at presentation occurred in 50% of patients with CVT which was associated with a parenchymal lesion in the brain. There was no association between seizure at presentation and clinical outcome.

Understanding the Effect of an Amorphous Surface on the Ultrafast Dynamics of a Heterogeneous Photoinduced Reaction: CD3I Photoinduced Reaction on Amorphous Cerium Oxide Films

In this work, to understand how an amorphous surface influences the dynamics of surface photoinduced reactions, pump-probe spectroscopy in conjunction with mass spectrometry is employed to track the ultrafast evolution of intermediates and final products with time, mass, and energy resolution. As a model system, the photoinduced reaction of CD₃I adsorbed on amorphous cerium oxide films is investigated. A fraction of the first intermediates produced on a freshly prepared surface is trapped to passivate the surface. After the A-band excitation, the minimum dissociation time of CD₃I indicates that CD₃I adsorption geometries with either CD₃ or I facing the gas phase exist; however, the transient data suggest that most molecules are adsorbed with the I atom facing the surface. CD₃ and I are consumed to form I₂ and reform CD₃I, which are produced at a steady rate only after the intermediates have lost the excess translational energy released from photodissociation.

Even-Denominator Fractional Quantum Hall State at Filling Factor ν=3/4

Fractional quantum Hall states (FQHSs) exemplify exotic phases of low-disorder two-dimensional (2D) electron systems when electron-electron interaction dominates over the thermal and kinetic energies. Particularly intriguing among the FQHSs are those observed at even-denominator Landau level filling factors, as their quasiparticles are generally believed to obey non-Abelian statistics and be of potential use in topological quantum computing. Such states, however, are very rare and fragile, and are typically observed in the excited Landau level of 2D electron systems with the lowest amount of disorder. Here we report the observation of a new and unexpected even-denominator FQHS at filling factor ν=3/4 in a GaAs 2D hole system with an exceptionally high quality (mobility). Our magnetotransport measurements reveal a strong minimum in the longitudinal resistance at ν=3/4, accompanied by a developing Hall plateau centered at (h/e^{2})/(3/4). This even-denominator FQHS is very unusual as it is observed in the lowest Landau level and in a 2D hole system. While its origin is unclear, it is likely a non-Abelian state, emerging from the residual interaction between composite fermions.

Caregiver willingness to give TPT to children living with drug-resistant TB patients

BACKGROUND Pediatric household contacts (HHCs) of patients with multidrug-resistant TB (MDR-TB) are at high risk of infection and active disease. Evidence of caregiver willingness to give MDR-TB preventive therapy (TPT) to children is limited.METHODS This was a cross-sectional study of HHCs of patients with MDR-TB to assess caregiver willingness to give TPT to children aged <13 years.RESULTS Of 743 adult and adolescent HHCs, 299 reported caring for children aged <13 years of age. The median caregiver age was 35 years (IQR 27-48); 75% were women. Among caregivers, 89% were willing to give children MDR TPT. In unadjusted analyses, increased willingness was associated with TB-related knowledge (OR 5.1, 95% CI 2.3-11.3), belief that one can die of MDR-TB (OR 5.2, 95% CI 1.2-23.4), concern for MDR-TB transmission to child (OR 4.5, 95% CI 1.6-12.4), confidence in properly taking TPT (OR 4.5, 95% CI 1.6-12.6), comfort telling family about TPT (OR 5.5, 95% CI 2.1-14.3), and willingness to take TPT oneself (OR 35.1, 95% CI 11.0-112.8).CONCLUSIONS A high percentage of caregivers living with MDR- or rifampicin-resistant TB patients were willing to give children a hypothetical MDR TPT. These results provide important evidence for the potential uptake of effective MDR TPT when implemented.

Culture media, DMSO and efflux affect the antibacterial activity of cisplatin and oxaliplatin

Cisplatin was originally discovered through its antibacterial action and subsequently has found use as a potent broad-spectrum anticancer agent. This study determines the effect of growth media and solvent on the antibacterial activity of cisplatin and its analogue, oxaliplatin. Escherichia coli MG1655 or MG1655 ΔtolC was treated with the platinum compounds under different conditions and susceptibility was determined. Our results showed that DMSO reduced the activity of cisplatin by fourfold (MIC 12·5 mg l-1 ) compared with 0·9% NaCl-solubilized cisplatin (MIC 3·12 mg l-1 ) when tested in MOPS. Surprisingly, complete loss of activity was observed in Mueller-Hinton Broth II (MHB II). By supplementing MOPS with individual components of MHB II such as the sulphur-containing amino acids, l-cysteine and l-methionine, individually or in combination reduced activity by ≥8-fold (MIC ≥25 mg l-1 ). Oxaliplatin was less active against E. coli (MIC 100 mg l-1 ) but exhibited similar inactivation in the presence of DMSO, MHBII or MOPS spiked with l-cysteine and l-methionine (MIC ≥400 mg l-1 ). Our data suggest that the antibacterial activity of cisplatin and oxaliplatin is modulated by both choice of solvent and composition of growth media. We demonstrate that this is primarily due to sulphur-containing amino acids cysteine and methionine, an essential component of the recommended media for testing antimicrobial susceptibility, MHBII.

Current Research on Zinc Oxide Nanoparticles: Synthesis, Characterization, and Biomedical Applications

Zinc oxide nanoparticles (ZnO-NPs) have piqued the curiosity of researchers all over the world due to their extensive biological activity. They are less toxic and biodegradable with the capacity to greatly boost pharmacophore bioactivity. ZnO-NPs are the most extensively used metal oxide nanoparticles in electronic and optoelectronics because of their distinctive optical and chemical properties which can be readily modified by altering the morphology and the wide bandgap. The biosynthesis of nanoparticles using extracts of therapeutic plants, fungi, bacteria, algae, etc., improves their stability and biocompatibility in many biological settings, and its biofabrication alters its physiochemical behavior, contributing to biological potency. As such, ZnO-NPs can be used as an effective nanocarrier for conventional drugs due to their cost-effectiveness and benefits of being biodegradable and biocompatible. This article covers a comprehensive review of different synthesis approaches of ZnO-NPs including physical, chemical, biochemical, and green synthesis techniques, and also emphasizes their biopotency through antibacterial, antifungal, anticancer, anti-inflammatory, antidiabetic, antioxidant, antiviral, wound healing, and cardioprotective activity. Green synthesis from plants, bacteria, and fungus is given special attention, with a particular emphasis on extraction techniques, precursors used for the synthesis and reaction conditions, characterization techniques, and surface morphology of the particles.

Association of 25 (OH) Vitamin D and Leptin in Individuals with Insulin Resistance

Introduction

Asian-Indian individuals with diabetes have been shown to have low vitamin D levels. Whether this hypovitamonisis D is associated with hyperleptinaemia is unclear. Also, whether this association is different in those with and without insulin resistance has not been ascertained. The present study aimed to investigate the association of 25-hydroxy vitamin D [25(OH) vitamin D] and leptin in individuals with and without insulin resistance.

Methods

Ninety two individuals were recruited in two study groups (n = 46 each group). First group included individuals with insulin resistance (homeostasis model assessment of insulin resistance [HOMA-IR] ≥2.0). Second group included those without insulin resistance (HOMA-IR <2.0). Comparison of 25(OH) vitamin D, leptin, anthropometry, and biochemical parameters was done between two groups and correlations between 25(OH) vitamin D, leptin, and HOMA-IR were studied.

Results

Individuals with insulin resistance were of simiar age (39.6 ± 5.3 years) and body mass index (24.4 ± 3.2 kg/m2) as those without (39.5 ± 5.2 years and 23.6 ± 3.2 kg/m2). Individuals with insulin resistance showed significantly lower 25(OH) vitamin D (17.8 ± 7.1 vs. 22.3 ± 11.6 ng/mL, P = .03) and significantly higher leptin levels (16.9 ± 15.8 vs. 9.6 ± 9.3 ng/mL, P = .09) compared to those without. Significant negative correlation was observed between 25(OH) vitamin D and leptin levels overall (r = -0.3, P = .008). HOMA-IR showed significantly negative correlation with 25(OH) vitamin D levels in individuals with insulin resistance (r = -0.33, P = .027).

Conclusion

The present study found higher circulating leptin levels and lower 25(OH) vitamin D levels in individuals with insulin resistance. 25(OH) vitamin D levels were inversely associated with leptin levels particularly in women.