Conscious State Research Articles

Emergency department triaging using ChatGPT based on emergency severity index principles: a cross-sectional study

Erroneous and delayed triage in an increasingly crowded emergency department (ED). ChatGPT is an artificial intelligence model developed by OpenAI® and is being trained for use in natural language processing tasks. Our study aims to determine the accuracy of patient triage using ChatGPT according to the emergency severity index (ESI) for triage in EDs. In our cross-sectional study, 18 years and over patients who consecutively presented to our ED within 24 h were included. Age, gender, admission method, chief complaint, state of consciousness, and comorbidities were recorded on the case form, and the vital signs were detected at the triage desk. A five-member expert committee (EC) was formed from the fourth-year resident physicians. The investigators converted real-time patient information into a standardized case format. The urgency status of the patients was evaluated simultaneously by EC and ChatGPT according to ESI criteria. The median value of the EC decision was accepted as the gold standard. There was a statistically significant moderate agreement between EC and ChatGPT assessments regarding urgency status (Cohen’s Kappa = 0.659; P < 0.001). The accuracy between these two assessments was calculated as 76.6%. There was a high degree of agreement between EC and ChatGPT for the prediction of ESI-1 and 2, indicating high acuity (Cohen’s Kappa = 0.828). The diagnostic specificity, NPV, and accuracy of ChatGPT were determined as 95.63, 98.17 and 94.90%, respectively, for ESI high acuity categories. Our study shows that ChatGPT can successfully differentiate patients with high urgency. The findings are promising for integrating artificial intelligence-based applications such as ChatGPT into triage processes in EDs.

Обзор российского шанкароведения начала XXI века

The analytical review examines the most signifi cant publications of Russian researchers devoted to Śaṁkara (VII–VIII centuries), issued since 2000. The review is divided into parts devoted to individual authors, and their works are evaluated according to their contribution to Russian Śaṁkara studies, the criterion of which is the author’s translations of Śaṁkara’s texts from Sanskrit into Russian, and their conceptual interpretations. The “calling card” of V.K. Shokhin’s works is the inclusion of Śaṁkara’s discourse within the discussion of topical issues of philosophical Indology, theoretical philosophy and religious studies. The review examines the monograph “Stratifi cation of Reality in the Ontology of Advaita-Vedānta” and a number of articles; it explicates the methods by which Śaṁkara “fi ts” into the history of world philosophy. In S.L. Burmistrov’s publications, Śaṁkaraa’s texts are also used not only to solve special historical and philosophical problems, but also to solve topical problems of philosophy. The article “The Concept of Consciousness in the Philosophy of Śaṁkara” makes a completely reasonable conclusion on the decisive role of Śaṁkara in the formation of the Vedāntist concept of consciousness. In the article “Religious Consciousness in Classical Advaita-Vedānta”, Śaṁkara’s interpretations of Ātman are placed in the context of modern discussions on the forms of religious consciousness. N.V. Isaeva’s publication “The Teachings of Śaṁkara – Brahman as a Look and a Tail ...” contains interesting material that contributes to Śaṁkara’s understanding of Brahman as “full of bliss” (ānandamaya), and an assessment of the importance of the philosopher’s ideas in the development of Vedānta concepts. In V.G. Lysenko’s article “Sleep and Dreaming as States of Consciousness...”, structured as a “slow reading of the text”, two versions of Śaṁkara’s topology of consciousness are considered. The researcher reveals ambiguity of Vedāntist terminology, leading to different models of consciousness. Y.V. Predtechenskaya in her article “Defi nitions of Brahman in the Upaniṣads: Apophatic and Cataphatic Approaches ...” quite productively draws Śaṁkara’s comment to the solution of the religious problem of contrasting apophatic and cataphatic approaches to the defi nition of the Absolute. The book by R.V. Pshu “Vedārthasaṁgraha by Rāmānuja and the Formation of Viśiṣṭā-dvaita-vedānta” brings some new information of the infl uence of Śaṁkara’s ideas on t he Vedānta movement. The author notes that the Vedāntists lived after Śaṁkara did not consider his ideas as fundamental to them, and they did not develop them, but Śaṁkara’s teachings provoked their criticism, and they formulated their conceptions as antitheses to Śaṁkara’s ideas. There in the book, the reader can also fi nd useful information on the history of world Śaṁkara Studies.

A Network Analytic Approach to Dissociation: New Insights from Clinical Data

ABSTRACT The transdiagnostic construct of dissociation, characterized by a disintegration of specific psychological functions such as consciousness, memory, identity, perception, body representation, and behavior, remains elusive to a unified conceptualization. Specifically, its dimensionality is a matter of ongoing controversy. Empirical approaches applying factor analyses to the Dissociative Experiences Scale (DES) have yielded inconsistent findings. This study adopts a novel methodological approach, utilizing Exploratory Graph Analysis (EGA) to address this issue. In a sample of 668 day-hospital patients undergoing psychotherapy for a variety of mental disorders, a Gaussian graphical model was estimated for the 28 items of the DES. Additionally, the stability of the results was ensured by bootstrap procedures. While both the original EGA and the bootstrap EGA suggested four dimensions, the structural consistency of this solution was low due to an instability of 12 items. After excluding 10 of these unstable items, re-analyses again revealed a four-factor structure, but boot EGA indicated that one factor had unsatisfactory structural consistency due to the multidimensionality of its two items. Upon removing these, our final network consisted of 16 items mapping onto 3 dimensions. Our study, using data from a diagnostically heterogeneous sample, replicates and extends previous findings on the dimensionality of dissociation as captured by the DES. The three dimensions identified correspond to segregated processes, derealization/depersonalization, and absorption. This solution aligns with a bipartite model of dissociation with two broader categories referring to either altered states of consciousness (often named detachment) or to non-integrated mental modules (labeled as compartmentalization).

Мир объективного знания и социально-экономическая реальность (К. Поппер &amp; К. Маркс)

The growing specialization and formalization of economic knowledge threatens to break away from the general scientific base that forms the worldview of the researcher. An urgent task is presented in the reintegration of basic methodological principles and categories of science into modern social science and economic theory. The article conducts a comparative analysis of the works of K. Marx and K. Popper, who made revolutionary changes in the methodology and ideological attitudes (conceptual frameworks) of scientific knowledge. Marx’s contribution focuses on dialectical and historical materialism, the doctrine of the economic basis of society and the change of socio-economic formations; Popper’s contribution focuses on his trial and error method with falsifying interpretation of results and the concept of successive three worlds of the universe. Popper’s criticisms of Marxist doctrine (essentialism, elements of mythology, teleologism) and the counterarguments of consistent Marxists are evaluated. The paper characterizes Popper’s positions on the realism of scientific knowledge, the world of predispositions, flexible management in animate and inanimate nature, the world of mental states of consciousness and the world of the objective content of thinking. Their commonality with the provisions of dialectical and historical materialism (the material nature of objective reality, the theory of reflection, the role of objective mental forms and ideological social relations) in the formation of the ‘world of objective knowledge’ is shown. The insufficiency of Popper’s epistemology for the study of the economic basis of social life is revealed. Based on a structural and logical analysis of the methodological principles and theoretical positions of Marx and Popper, the paper outlines the paths to the development of a system of concepts that brings together the complementary results of their apparently opposing research programs. Also presented are sources showing the relevance of the ideas of Marx and Popper in modern methodological and socio-economic literature. It is concluded that the world of objective knowledge (the key category of Popper’s social science) is part of the socio-economic life of society (in its Marxist interpretation), which, in turn, is incomplete without taking into account the realities of this world and needs additional study from the appropriate angle.

Association of glycemic variability and prognosis in patients with traumatic brain injury: A retrospective study from the MIMIC-IV database

BackgroundElevated glycemic variability (GV) often occurs in intensive care unit (ICU) patients and is associated with patient prognosis. However, the association between GV and prognosis in ICU patients with traumatic brain injury (TBI) remains unclear. MethodClinical data of ICU patients with TBI were obtained from the Medical Information Mart for Intensive Care (MIMIC) -IV database. The coefficient of variation (CV) was utilized to quantify GV, while the Glasgow Coma Scale (GCS) was employed to evaluate the consciousness status of TBI patients. Pearson linear correlation analysis, linear regression, COX regression and restricted cubic spline (RCS) were used to investigate the relationship between CV and consciousness impairment, as well as the risk of in-hospital mortality. ResultA total of 1641 ICU patients with TBI were included in the study from the MIMIC-IV database. Pearson linear correlation and restricted cubic spline (RCS) analysis results showed a negative linear relationship between CV and the last GCS (P = 0.002) with no evidence of nonlinearity (P for nonlinear = 0.733). Multivariable linear regression suggested a higher CV was associated with a lower discharge GCS [β (95 %CI) = −1.86 (−3.08 ∼ −0.65), P = 0.003]. Furthermore, multivariable COX regression indicated that CV ≥ 0.3 was a risk factor for in-hospital death in TBI patients [HR (95 %CI) = 1.74 (1.15–2.62), P = 0.003], and this result was also consistent across sensitivity and subgroup analyses. ConclusionHigher GV is related to poorer consciousness outcomes and increased risk of in-hospital death in ICU patients with TBI. Additional research is needed to understand the logical relationship between GV and TBI progression.

The Pupillary Light-Off Reflex in Acute Disorders of Consciousness.

In intensive care patients with disorders of consciousness, the pupillary light reflex is a measure of pupillary parasympathetic function. By contrast, the pupillary light-off reflex leads to pupil dilation in response to an abrupt change from light to darkness ("light-off") and reflects combined parasympathetic and sympathetic pupillary function. To our knowledge, this reflex has not been systematically investigated in patients with disorders of consciousness. We hypothesized that the pupillary light-off reflex correlates with consciousness levels after acute brain injury. From November 2022 to March 2023, we enrolled 100 study participants: 25 clinically unresponsive (coma or unresponsive wakefulness syndrome) and 25 clinically low-responsive (minimally conscious state or better) patients from the intensive care units of a tertiary referral center, and 50 age-matched and sex-matched healthy controls. Exclusion criteria were active or chronic eye disease. We used automated pupillometry to assess the pupillary light-off reflex and the pupillary light reflex of both eyes under scotopic conditions in all study participants. The pupillary light-off reflex was strongly correlated with consciousness levels (r = 0.62, p < 0.001), the increase in pupillary diameters being smallest in unresponsive patients (mean ± standard deviation 20% ± 21%), followed by low-responsive patients (mean ± standard deviation 47% ± 26%) and healthy controls (mean ± standard deviation 67% ± 17%; p < 0.001). Similar yet less pronounced patterns were observed for the pupillary light reflex. Twenty-one of 25 (84%) unresponsive patients had preserved pupillary light reflexes, but only seven (28%) had fully preserved pupillary light-off reflexes (p < 0.0001). Of these 7 patients, five (71%) regained awareness. The pupillary light-off reflex may be more sensitive to consciousness levels than the pupillary light reflex. The clinical implications of this finding seem worthy of further investigation, particularly regarding possible benefits for neuromonitoring and prognostication after brain injury.

The ethical ‘boundary’ in psychopharmacology

Man's encounter with substances capable of producing changes in his state of consciousness, behaviour and emotional sphere is an ancient experience, dating back to the earliest forms of civilisation on our planet.

DOCTer: a novel EEG-based diagnosis framework for disorders of consciousness.

Objective. Accurately diagnosing patients with disorders of consciousness (DOC) is challenging and prone to errors. Recent studies have demonstrated that EEG (electroencephalography), a non-invasive technique of recording the spontaneous electrical activity of brains, offers valuable insights for DOC diagnosis. However, some challenges remain: (1) the EEG signals have not been fully used; and (2) the data scale in most existing studies is limited. In this study, our goal is to differentiate between minimally conscious state (MCS) and unresponsive wakefulness syndrome (UWS) using resting-state EEG signals, by proposing a new deep learning framework.Approach. We propose DOCTer, an end-to-end framework for DOC diagnosis based on EEG. It extracts multiple pertinent features from the raw EEG signals, including time-frequency features and microstates. Meanwhile, it takes clinical characteristics of patients into account, and then combines all the features together for the diagnosis. To evaluate its effectiveness, we collect a large-scale dataset containing 409 resting-state EEG recordings from 128 UWS and 187 MCS cases.Main results. Evaluated on our dataset, DOCTer achieves the state-of-the-art performance, compared to other methods. The temporal/spectral features contributes the most to the diagnosis task. The cerebral integrity is important for detecting the consciousness level. Meanwhile, we investigate the influence of different EEG collection duration and number of channels, in order to help make the appropriate choices for clinics.Significance. The DOCTer framework significantly improves the accuracy of DOC diagnosis, helpful for developing appropriate treatment programs. Findings derived from the large-scale dataset provide valuable insights for clinics.

On Tesla-inspired Extended Quantum-Holographic Framework for Reprogramming Macro-Quantum Correlations of Individual and Collective Consciousness

Nikola Tesla's visions and inventions realized in his controlled altered states of consciousness were considered previously as manifestations of his meditative insights within extended framework of quantum-holographic macroquantum correlations of individual &amp; collective consciousness. This Tesla-inspired paper now focuses on some related psychosomatice aspects of quantum entropy &amp; entanglement, and consequences on the usually observablebiological arrow of time &amp; spiritual-informational time reversal. Finally we discuss some spiritual-informational implicationson free will &amp; individual and collective consciousness reprogramming.

Psychedelic research at a crossroads

There is an urgent need to develop better treatments for mental health conditions that affect one in every eight people in the world. To combat this concern, psychedelic drugs have been combined with psychotherapy and studied in clinical trials in the United States and Europe. Psychedelics are hallucinogenic drugs that alter brain activity and facilitate altered states of consciousness. The proposed benefits of psychedelic-assisted therapy (PAT) include relatively short treatment times and stronger effects compared to other treatments. Although results of trials using MDMA for trauma or psilocybin for depression are promising, PAT is controversial because many questions about its safety and effectiveness are unanswered. This is evident in the recent ruling by the US Food and Drug Administration against the approval of MDMA therapy for post-traumatic stress disorder and the retraction of several papers about MDMA trials owing to unethical conduct by study therapists and data integrity, among other concerns. This field is at a crossroads, and the research community must address several obstacles to transition from exploratory trials to established, evidence-based treatments while avoiding pitfalls that can hinder advancement.

Autonomic nervous system activity correlates with peak experiences induced by DMT and predicts increases in well-being.

Non-ordinary states of consciousness induced by psychedelics can be accompanied by so-called "peak experiences," characterized at the emotional level by their intensity and positive valence. These experiences are strong predictors of positive outcomes following psychedelic-assisted therapy, and it is therefore important to better understand their biology. Despite growing evidence that the autonomic nervous system (ANS) plays an important role in mediating emotional experiences, its involvement in the psychedelic experience is poorly understood. The aim of this study was to investigate to what extent changes in the relative influence of the sympathetic (SNS) and parasympathetic nervous systems (PNS) over cardiac activity may reflect the subjective experience induced by the short-acting psychedelic N,N-Dimethyltryptamine (DMT). We derived measures of SNS and PNS activity from the electrocardiograms of 17 participants (11 males, mean age = 33.8 years, SD = 8.3) while they received either DMT or placebo. Results show that the joint influence of SNS and PNS ("sympathovagal coactivation") over cardiac activity was positively related to participants' ratings of "Spiritual Experience" and "Insightfulness" during the DMT experience, while also being related to improved well-being scores 2 weeks after the session. In addition, we found that the state of balance between the two ANS branches ("sympathovagal balance") before DMT injection predicted scores of "Insightfulness" during the DMT experience, as well as subsequent sympathovagal coactivation. These findings demonstrate the involvement of the ANS in psychedelic-induced peak experiences and may pave the way to the development of biofeedback-based tools to enhance psychedelic therapy.

Conventional structural magnetic resonance imaging in differentiating chronic disorders of consciousness

BACKGROUND: Differential diagnosis of chronic disorders of consciousness remains one of the most difficult problems even for experienced clinicians. AIM: To evaluate the inter-expert consistency and capacity of the researcher-developed structural scale based on magnetic resonance imaging to differentiate chronic disorders of consciousness, named, DOC-MRIDS, on a larger sample of patients. MATERIALS AND METHODS: Sixty patients with a clinically stable status diagnosed with consciousness disorders (vegetative state, n=32; minimally conscious state, n=28) were enrolled. The revised coma recovery scale (CRS-R) was included in the clinical assessment. All patients underwent structural magnetic resonance imaging with 3.0-T Siemens scanners including T2 and T1 sequences. Structural changes were assessed using the DOC-MRIDS scale and included the following features: diffuse cortical atrophy, ventricular enlargement, gyri dilatation, leukoaraiosis, brainstem and/or thalamic degeneration, corpus callosum degeneration, and focal corpus callosum lesions. A total score was calculated. Magnetic resonance imaging data were analyzed by three neuroradiologists, and inter-observer agreement (Krippendorf’s alpha) was assessed. RESULTS: A high inter-examiner agreement of the DOC-MRIDS scale score was found, with α=0.806 (95% confidence interval 0.757–0.849). The vegetative state group had a higher DOC-MRIDS score than the minimally conscious state group (p 0.005). A negative correlation was obtained between CRS-R and DOC-MRIDS scale scores (ρ=–0.457, p 0.0001), individual clinical scale domains, and magnetic resonance imaging features. CONCLUSION: When assessing structural changes in patients with chronic consciousness disorders, the use of the DOC-MRIDS scale helps differentiate the type of such disorders with sufficient specificity, sensitivity, and inter-rater agreement. This scale can be used in clinical practice as an additional differential diagnostic tool.

Effect of Virtual Reality on Trunk Control in Children with Developmental Delays

Background: Developmental delays affect motor function and trunk control in children, impacting their overall development and daily activities. Virtual reality (VR) interventions have the potential to enhance motor abilities through engaging, personalized therapies.Objective: This study aimed to determine the effectiveness of virtual reality-based neurodevelopmental treatment with trunk control exercises (VR-NDT-TCE) in improving trunk control and cognitive functions in children with developmental delays.Methods: A single-blinded randomized controlled trial was conducted with 22 children aged 2-8 years diagnosed with developmental delays. Participants were randomly assigned to Group A (NDT-TCE) or Group B (VR-NDT-TCE) for a six-week intervention, three times per week. Trunk control was measured using the Trunk Control Measurement Scale (TCMS), and cognition was assessed through the Hammersmith Infant Neurological Examination (HINE) Performa. Data analysis was performed using SPSS version 27 with paired t-tests and Mann-Whitney tests.Results: Significant improvements were observed in trunk control (TCMS score: 20.18 ± 2.40 in Group A vs. 24.18 ± 4.67 in Group B, p = 0.017). Group B showed notable gains in cognitive parameters, including conscious state (p &lt; 0.001), emotional state (p = 0.012), and social orientation (p = 0.031).Conclusion: VR-NDT-TCE significantly improved trunk control and cognitive outcomes, offering an effective intervention for children with developmental delays.

Can You Stop Your Mind and Your Daily Activities?

The paper investigates meditation as a state of consciousness that isolates an individual from the attitude of everyday life and the perspective of practical actions. It is an “ethnography of the mind” instead of the place. The paper analyses self-reports from meditators’ self-observations as part of hatha yoga practice and data from semi-structured interviews with hatha yoga teachers. Elements that distract or help people meditate were analysed and interpreted. The features of the meditative state during the practice of sitting meditation are also reconstructed. Attention is paid to three essential aspects that are related to each other when entering the meditative state: emerging thoughts, body sensations, and emotions. The analysis focuses on how practitioners deal with these obstacles; what tactics do they employ to eliminate barriers or redirect attention and include them in the background of the concentration point? What is the role of teaching meditation? What are the effects of meditation from a practitioner’s point of view? Empirical materials obtained from the first-person perspective of the researcher, the author of this article, and his collaborators in the study were also analysed.

Perturbational complexity index in assessing responsiveness to rTMS treatment in patients with disorders of consciousness: a cross-over randomized controlled trial study

BackgroundDisorders of Consciousness (DoC) caused by severe brain injuries represent a challenging clinical entity, which is easy to misdiagnosis and lacks effective treatment options. Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive neuroelectric stimulation method that shows promise in improving consciousness for DoC, especially in minimally conscious state (MCS). However, there is little evidence of its effectiveness, especially in RCT studies.MethodsTwenty MCS patients participated in a double-blind, randomized, crossover, sham-controlled clinical study to evaluate the safety and efficacy of rTMS for MCS. Subjects were randomized into two groups: one group received rTMS-active for 10 consecutive days (n = 10), and the other group received rTMS-sham for 10 consecutive days (n = 10). After a 10-day washout period, the two groups were crossed over and received the opposite treatment. the rTMS protocol consisted of 2,000 pulses per day in the left dorsolateral prefrontal cortex (L-DLPFC), sent at 10 Hz. The stimulation intensity was 90% of the resting motor threshold. Coma Recovery Scale Revised (CRS-R), the main evaluation index, was evaluated before and after each phase in a double-blind manner. Meanwhile RS-EEG and TMS-EEG data were acquired and relative alpha power (RAP), and perturbational complexity index based on state transitions (PCIst) were caculated.ResultsOne-way ANOVA revealed significantly higher scores in rTMS-active treatment compared to rTMS-sham across various measures, including CRS-R total score, RAP, PCIst (all P < 0.05). Among the 20 MCS patients, 7 (35%) were identified as responders following rTMS treatment. Compared to rTMS-sham, responder scores for CRS-R, RAP, and PCIst (all P < 0.05) were significantly elevated after rTMS-active treatment. Conversely, there was no significant difference observed in non-responders. Furthermore, post-hoc analysis revealed that baseline PCIst was significantly higher in responders than non-responders. Upon a 6-month follow-up, CRS-R scores significantly increased in all 20 patients (P = 0.026). However, the responder group exhibited a more favorable prognosis compared to the non-responder group (P = 0.031).ConclusionsApplying 10 Hz rTMS to L-DLPFC significantly increased consciousness level in MCS patients. PCIst is a neurophysiological index that has the potential to evaluate and predict therapeutic efficacy.Trial registrationwww.ClinicalTrials.gov, identifier: NCT05187000.

Investigating EFL Students' Civic Consciousness

Civic consciousness serves as a pivotal impetus for societal advancement and development, embodying individuals' cognition, attitudes, and sense of responsibility across social, political, economic, and cultural domains. Contemporary college students, as the forthcoming leaders of society, constitute a vital segment of Chinese citizenship and play crucial roles as participants and stewards in national political development and social construction. Their civic consciousness directly impacts the construction of material, spiritual, and political civilization within China. Educating EFL students on civic consciousness is instrumental in fostering accurate ideological concepts, empowering them to fulfill their duties as social citizens, igniting creativity and intellectual curiosity, enhancing comprehensive cultural literacy and cross-cultural communication awareness, nurturing critical thinking skills, and enabling students to internalize civic virtues as their behavioral norms through natural infiltration, thereby establishing a foundation for their future roles as global citizens and contributing to sustainable development. However, the civic consciousness of EFL students is confronted with significant challenges due to the interplay of international and domestic factors. Notable issues include a deficient awareness of the rule of law and an inadequate understanding of rights. This study initiates with the concept and significance of civic consciousness, elucidating its definition, connotation, and importance within college education. Through questionnaire surveys and interviews, the current state of civic consciousness among students in ZYU(Zhejiang Yuexiu University) is analyzed, identifying prevailing problems and challenges. Subsequently, effective countermeasures within the context of English as a Foreign Language (EFL) learning are proposed to address these concerns.

Study of a precise treatment protocol for patients with consciousness disorders based on the brain network analysis of functional magnetic resonance imaging.

How to conduct objective and accurate individualized assessments of patients with disorders of consciousness (DOC) and carry out precision rehabilitation treatment technology is a major rehabilitation problem that needs to be solved urgently. In this study, a multi-layer brain network was constructed based on functional magnetic resonance imaging (fMRI) to analyze the structural and functional brain networks of patients with DOC at different levels and to find regulatory targets (imaging markers) with recovery potential for DOC. Then repeated transcranial magnetic stimulation (rTMS) was performed in DOC patients to clinically validate. The brain network connectivity of DOC patients with different consciousness states is different, and the most obvious brain regions appeared in the olfactory cortex and precuneus. rTMS stimulation could effectively improve the consciousness level of DOC patients and stimulate the occipital lobe (specific regions found in this study) and the dorsolateral prefrontal cortex (DLPFC), and both parts had a good consciousness recovery effect. In clinical work, personalized stimulation regimen treatment combined with the brain network characteristics of DOC patients can improve the treatment effect.

Pain anticipation is a new behavioural sign of minimally conscious state.

Probing cognition and consciousness in the absence of functional communication remains an extremely challenging task. In this perspective, we imagined a basic clinical procedure to explore pain anticipation at bedside. In a series of 61 patients with a disorder of consciousness, we tested the existence of a nociceptive anticipation response by pairing a somaesthetic stimulation with a noxious stimulation. We then explored how nociceptive anticipation response correlated with (i) clinical status inferred from Coma Recovery Scale-Revised scoring, (ii) with an EEG signature of stimulus anticipation-the contingent negative variation-and (iii) how nociceptive anticipation response could predict consciousness outcome at 6 months. Proportion of nociceptive anticipation response differed significantly according to the state of consciousness: nociceptive anticipation response was present in 5 of 5 emerging from minimally conscious state patients (100%), in 10 of 11 minimally conscious state plus patients (91%), but only in 8 of 17 minimally conscious state minus patients (47%), and only in 1 of 24 vegetative state/unresponsive wakefulness syndrome patients (4%) (χ 2 P < 0.0001). Nociceptive anticipation response correlated with the presence of a contingent negative variation, suggesting that patients with nociceptive anticipation response were more prone to actively expect and anticipate auditory stimuli (Fisher's exact test P = 0.05). However, nociceptive anticipation response presence did not predict consciousness recovery. Nociceptive anticipation response appears as a new additional behavioural sign that can be used to differentiate minimally conscious state from vegetative state/unresponsive wakefulness syndrome patients. As most behavioural signs of minimally conscious state, the nociceptive anticipation response seems to reveal the existence of a cortically mediated state that does not necessarily reflect residual conscious processing.

The effect of cranioplasty on outcomes and complications of unresponsive wakefulness syndrome and minimally responsive state.

Background Studies that have shown neurological improvement following cranioplasty (CP) after decompressive craniectomy (DC) in patients with unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) did not include control groups. The aim of this study was to assess the justification of CP for these patients. Methods Data were collected from medical records of inpatients with UWS and MCS admitted between 2002 and 2018. Results Of the 144 participants (mean age 40 years, 76% males, 75% in UWS), 37% had CP following DC. The Loewenstein Communication Scale (LCS) gain was 12±17 and 16±17 for the control and study patients, respectively. The corresponding consciousness recovery rate (based on Coma Recovery Scale-Revised scores) was 51% and 53%, respectively. One-year survival rates were 0.80 and 0.93, and 5-year survival rates were 0.67 and 0.73, respectively. Mean outcome values were higher for the study group, but the differences between the groups did not reach statistical significance. Conclusions The study did not demonstrate that CP increases brain recovery or survival. Nevertheless, it showed that CP did not decrease them either, and it did not increase complications rate. The findings, therefore, support offering CP to patients with UWS and MCS as CP does not increase risks and can achieve additional goals for these patients.

A real-world disproportionality analysis of baloxavir marboxil: post-marketing pharmacovigilance data

ABSTRACT Objective Baloxavir marboxil (hereafter referred to as baloxavir) is the only cap-dependent endonuclease inhiabitor approved for the treatment and prevention of influenza. However, as a new drug marketed in 2018, the long-term safety of baloxavir in large sample population was unclear. This study aims to evaluate baloxavir-associated adverse events (AEs) through data mining of the international pharmacovigilance database of US FDA Adverse Event Reporting System (FAERS). Methods Disproportionality analysis was conducted to assess the association between baloxavir and its AEs. Data were collected from FAERS from March 2018 to June 2023. After standardizing the data, signal quantification techniques including ROR, PRR, BCPNN and MGPS were used for analysis. Results A total of 49 significant baloxavir-related preferred terms (PTs) in 20 system organ classes (SOCs) were identified in our data analysis. Compared to baloxavir’s FDA label, some new PTs emerged, with the top 10 being pneumonia, loss of consciousness, rhabdomyolysis, seizure, altered state of consciousness, hepatic function abnormal, delirium, depressed level of consciousness, encephalopathy and cardio-respiratory arrest. Conclusion In clinical application of baloxavir, attention should be paid to the new AE signals in addition to the those recorded in the labels, so as to ensure the safety of the patients.