Comparing the cognitive performance of action video game players and age-matched controls following a cognitively fatiguing task: A stage 2 registered report

Recent work demonstrates that those who regularly play action video games (AVGs) consistently outperform non-gamer (NG) controls on tests of various cognitive abilities. AVGs place high demands on several cognitive functions and are often engaged with for long periods of time (e.g., over 2 h), predisposing players to experiencing cognitive fatigue. The detrimental effects of cognitive fatigue have been widely studied in various contexts where accurate performance is crucial, including aviation, military, and sport. Even though AVG players may be prone to experiencing cognitive fatigue, this topic has received little research attention to date. In this study, we compared the effect of a cognitively fatiguing task on the subsequent cognitive performance of action video game players and NG control participants. Our results indicated AVGs showed superior spatial working memory and complex attention abilities while showing no difference from NGs on simple attention performance. Additionally, we found that our cognitive fatigue and control interventions did not differentially affect the cognitive performance of AVGs and NGs in this study. This pre-registered study provides evidence that AVGs show superior cognitive abilities in comparison to a non-gaming population, but do not appear more resilient to cognitive fatigue.

Emergency Physician-performed Transesophageal Echocardiography in Simulated Cardiac Arrest

Introduction

Transesophageal echocardiography (TEE) is a well-established method of evaluating cardiac pathology. It has many advantages over transthoracic echocardiography (TTE), including the ability to image the heart during active cardiopulmonary resuscitation. This prospective simulation study aims to evaluate the ability of emergency medicine (EM) residents to learn TEE image acquisition techniques and demonstrate those techniques to identify common pathologic causes of cardiac arrest.

Methods

This was a prospective educational cohort study with 40 EM residents from two participating academic medical centers who underwent an educational model and testing protocol. All participants were tested across six cases, including two normals, pericardial tamponade, acute myocardial infarction (MI), ventricular fibrillation (VF), and asystole presented in random order. Primary endpoints were correct identification of the cardiac pathology, if any, and time to sonographic diagnosis. Calculated endpoints included sensitivity, specificity, and positive and negative predictive values for emergency physician (EP)-performed TEE. We calculated a kappa statistic to determine the degree of inter-rater reliability.

Results

Forty EM residents completed both the educational module and testing protocol. This resulted in a total of 80 normal TEE studies and 160 pathologic TEE studies. Our calculations for the ability to diagnose life-threatening cardiac pathology by EPs in a high-fidelity TEE simulation resulted in a sensitivity of 98%, specificity of 99%, positive likelihood ratio of 78.0, and negative likelihood ratio of 0.025. The average time to diagnose each objective structured clinical examination case was as follows: normal A in 35 seconds, normal B in 31 seconds, asystole in 13 seconds, tamponade in 14 seconds, acute MI in 22 seconds, and VF in 12 seconds. Inter-rater reliability between participants was extremely high, resulting in a kappa coefficient across all cases of 0.95.

Conclusion

EM residents can rapidly perform TEE studies in a simulated cardiac arrest environment with a high degree of precision and accuracy. Performance of TEE studies on human patients in cardiac arrest is the next logical step to determine if our simulation data hold true in clinical practice.

New method for detection of a bronchopleural fistula: direct instillation of Tc-99m DTPA into the pleural space via a thoracostomy tube

A 65-year-old man who had undergone a right upper lobectomy for squamous cell carcinoma developed a persistent air space in the right superior thorax. Because a bronchopleural fistula was suspected, a new technique to demonstrate the fistula was used. Five mCi of Tc-99m DTPA was instilled through a pigtail catheter into the cavity. Radiotracer activity extended into the remaining right bronchial tree, trachea, and left bronchial tree on the 10 minute delayed image confirming the presence of a bronchopleural fistula. Using bronchoscopic guidance, the fistula was sealed with a fibrin plug. A repeat examination 4 days later revealed no extension of tracer from the cavity up to 60 minutes after instillation, indicating successful sealing of the fistula. This technique offers a rapid, inexpensive, and portable diagnosis of bronchopleural fistula.

Clinically unsuspected epiglottitis detected by indium-111-white blood cell scintigraphy

A 62-yr-old woman with a history of mental retardation, paranoid psychosis and agitated depression presented with deterioration in her baseline mental status and fever. No obvious source of fever was found on clinical exam or on initial laboratory studies. An 111In-white blood cell (111In-WBC) study was performed 1 wk after hospital admission, which revealed increased uptake in the anterior neck and oral cavity. Subsequent laryngoscopy revealed a red, swollen epiglottis compatible with epiglottitis. While not advocating 111In-WBC scintigraphy as part of the workup of epiglottitis, this case is presented to emphasize the possible milder presentation of epiglottitis in adults compared to children.

Correlation of thallium-201 single photon emission computed tomography and survival after treatment failure in patients with glioblastoma multiforme

After initial radiotherapy for an intracranial malignant glioma, the majority of patients return at a later date with a recurrent, enhancing mass on computed tomography or magnetic resonance imaging. This mass represents either recurrent tumor, radionecrosis, or a combination of the two. The relative proportion of live versus dead tumor cells is difficult to determine from surgical specimens of another biopsy, although this has been the preferred method of assessing such "failed" patients. Recently, attention has turned to tomographic images of metabolic markers, i.e., positron emission tomography and thallium-201 (Tl-201) single photon emission computed tomography, as noninvasive methods of assessing relative tumor viability. To assess whether Tl-201 uptake in vivo can be used as a prognostic indicator in patients with glioblastoma multiforme, we measured the ratio of Tl-201 uptake in tumor to Tl-201 uptake in myocardium (T/C ratio) in 16 patients at the point of treatment "failure" and followed all the patients until they died. All patients died of neurological causes, and 11 of the 16 patients had documented viable tumor recurrence. There was a significant negative correlation between the T/C ratio at failure and the time interval between failure and death (r = -0.602, P = 0.014). Patients with T/C ratios of less than 0.3 lived an average of 13 months, whereas patients with T/C ratios of more than 0.3 lived an average of only 4 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Indium-111 monoclonal antibody B72.3 scintigraphy in colorectal cancer. Correlation with computed tomography, surgery, histopathology, immunohistology, and human immune response

As part of an open-labeled nonrandomized multi-institutional Phase III study, the authors compared the results of In-111 (In-111) B72.3 glycyl-tyrosyl-n-diethylenetriaminepentaacetic acid lysine (GYK-DTPA) monoclonal antibody scintigraphy with computed tomography (CT), surgery, histopathology, immunohistology, and human antibody response in 23 patients with primary colorectal carcinoma. There were no significant adverse reactions to 1 mg of In-111-labeled antibody. Planar imaging identified 16 of 23 primary colon lesions, whereas single photon emission computer tomography (SPECT) imaging identified 21. SPECT also correctly identified lymphatic involvement in four patients. (There were two false-positive results.) Liver metastases were identified with SPECT imaging. Twenty-six percent of patients developed human anti-mouse antibody (HAMA). These preliminary results demonstrate that In-111 B72.3 GYK-DTPA is a safe monoclonal antibody conjugate that has a high sensitivity for identifying primary colorectal cancer. Regional lymphatic and distant liver metastases also can be imaged, but false-positive results can occur.

Scrotal scintigraphy in testicular torsion

Testicular torsion is a surgical emergency that requires prompt diagnosis and treatment to maximize testicular survival. When the clinical diagnosis is uncertain, testicular scintigraphy can be performed to evaluate testicular perfusion. This noninvasive imaging study is widely validated and highly accurate in predicting nontorsion, which excludes the need for exploration.

Hepatobiliary imaging

A patient's clinical presentation should prompt an imaging evaluation that is cost effective for accurate diagnosis and leads to appropriate treatment of gallbladder inflammatory disease. In the setting of recurrent biliary colic, chronic cholecystitis is the main diagnostic consideration. Imaging hallmarks include gallstones and gallbladder wall thickening for which ultrasonography is uniquely suited. When a patient appears more toxic with right upper quadrant pain, one would more strongly consider acute cholecystitis. Because the morbidity and mortality of acute cholecystitis are reduced with early cholecystectomy, it is incumbent upon the clinician to make the diagnosis promptly and accurately. Hepatobiliary imaging with an IDA derivative has proven superior sensitivity, specificity, and accuracy for this condition. The examination has validity because it detects cystic duct obstruction, the primary pathophysiologic event responsible for most acute calculous and acalculous disease. Utilizing morphine augmentation when delayed filling is present has reduced the total examination time to less than 2 hours. Use of ancillary findings including gallbladder hyperemia and the "hot rim" sign help predict complicated cholecystitis, enabling more urgent intervention. The bulk of data presented in this review supports hepatobiliary imaging as the modality of first choice in the evaluation of acute cholecystitis. In the intensive care setting, where acalculous disease and atypical presentations are common, hepatobiliary imaging also plays a major role. We recommend liberal use of Sincalide pretreatment, morphine augmentation, and delayed images to promote gallbladder filling. If the gallbladder is nonvisualizing despite these maneuvers, sonography is often added as an aid to detect secondary signs of acute cholecystitis and help confirm the diagnosis with greater certainty prior to high-risk surgery.

Ventilation-perfusion scintigraphy

Ventilation-perfusion scintigraphy remains an important diagnostic tool in the evaluation of patients suspected of having PE. It is important for the emergency physician to be able to use the information from a lung scan appropriately in the diagnostic management of this elusive and life-threatening disorder. This requires a clear knowledge of how these scans are interpreted as well as a consultative approach between the physician ordering the lung scan and the nuclear medicine physician interpreting it. Each can ultimately contribute to the development of an effective management plan. It is important for the clinician to understand that a low-probability lung scan does not rule out PE, but in fact can have up to a 40% probability of PE when clinical suspicion is high.

Lung uptake on Tc-99m albumin colloid liver spleen scan and on Ga-67 scan in angiotropic lymphoma

Lung uptake of Tc-99m sulfur colloid has been reported in various hepatic and extrahepatic diseases, and lung uptake of gallium-67 may occur in patients with various interstitial lung disease without radiographic abnormality. This may be the first case of Tc-99m albumin colloid and Ga-67 lung uptake in a patient with angiotropic lymphoma of the liver, spleen, and uterus.

Osteoporosis in women with eating disorders: comparison of physical parameters, exercise, and menstrual status with SPA and DPA evaluation

Osteoporosis has been reported in anorexia nervosa (AN), but not in other eating disorders. Thirty-three patients, 8 AN, 17 bulimia nervosa (BN), and 8 eating disorder not otherwise specified (EDNOS), were evaluated by bone densitometry (radius, spine, femur) to determine the prevalence and distribution of osteoporosis and the role of physical parameters, exercise and estrogen. All three diagnostic subgroups had evidence of decreased bone density, worst in the EDNOS subgroup and least in the BN subgroup. The most affected site was the femur, least the spine; the radius was intermediate. Age, body surface area, age of onset, and length of illness weakly correlated with the femur and spine density in the BN and EDNOS subgroups. Exercise was related to bone density in the AN subgroup in the femur, moderate exercise having a protective effect and strenuous exercise being detrimental. No significant correlation of bone density measurements with estradiol levels and/or history of amenorrhea was identified. Eating disorder patients are at risk for osteoporosis, which has multiple contributing factors including physical parameters and exercise. Estrogen deficiency by itself may not be a major causative factor.

Molecular detection of deletions involving band q14 of chromosome 13 in retinoblastomas

DNA fragments from a locus spanning 29 kilobases within chromosome band 13q14 detected deletions in 3 retinoblastomas out of 37 such tumors examined. Somatically occurring, homozygous deletions spanning at least 25 kilobases were detected in retinoblastomas from two unrelated patients. These deletions are bounded by the esterase D locus proximally. In a third patient, both tumor cells and leukocytes have a deletion of one chromosome 13 homolog, with one end of the deletion localized to a 1.55-kilobase fragment within the cloned region. It is likely that the cloned locus is within a few hundred kilobases of the retinoblastoma gene (i.e., the locus governing predisposition to such tumors) and that the deletions detected also involve the retinoblastoma gene. Further, it may be possible to base a successful approach to the isolation of the retinoblastoma gene on this assumed physical proximity of the two loci.

Disuse osteoporosis: mimic of neoplastic disease

Disuse osteoporosis, a common sequela to immobilization, consists of bony changes that may mimic neoplastic disease. This paper describes the different types of cortical and medullary demineralization that can be manifested radiologically and the histopathologic basis for these alterations. Six cases are included that exemplify these changes, and comparison is made with multiple myeloma.

Metaphyseal cortical irregularities in children: a new perspective on a multi-focal growth variant

The occurrence of metaphyseal cortical irregularities in adolescents in many different bones indicates a commonality of these lesions as a variation of normal growth, rather than a stress or avulsive by-product. The histologically recognized incomplete nature of the metaphysial cortex in children offers an attractive explanation for this phenomenon.