Prolonged Peak Research Articles

Auditory function and motor proficiency in type 1 diabetic children: A case-control study

ObjectivesThe aim of the study was to evaluate the auditory and motor functions in children with insulin dependent diabetes mellitus (IDDM). MethodsThis case-control study, 65 diabetic children, receiving care in Diabetes Center of 17 Sharivar Hospital, were enrolled. 130 controls were matched to cases by age and sex. The authors performed audio-vestibular tests, including pure tone audiometry (PTA), distortion product otoacoustic emission (DPOAE), auditory brainstem response (ABR), bedside head-impulse test and dynamic visual acuity test. Motor function was evaluated using of Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2). ResultsThe results showed higher thresholds of air conduction PTA and a prolonged peak latency of wave V (ABR) in diabetic children as compared to controls (all Ps < 0.001). The odds of normal response in DPOAE of cases decreased by 0.44–0.82 - fold. Although clinical vestibular outcomes were worse in cases, differences were not significant. In BOT-2, the cases had statistically significant lower scores (standard score = −0.58, P < 0.05) than the controls for the Total Motor Composite. Also diabetic girls had more skill motor impairment compared to boys with IDDM. ConclusionBased on our study, metabolic disturbances present in Type I diabetes cause disturbances in different parts of auditory and balance functions.

Lateral Leg Pain in an Avid Hiker After a Fall

HISTORY: A 62-year-old female with a history of hip OA and low back discomfort presents with left lateral leg pain that started after a fall onto her back 11 months ago. Pain is described as a constant throbbing in the left lateral calf, ankle, and dorsal foot. Pain worsens with ambulation and is relieved by rest. Noninvasive vascular studies ruled out claudication. Prior treatments included left L5 nerve root block, lumbar ESI, SI joint injection, chiropractic treatment, pain medications, and therapy with limited success. She presents to our sports medicine clinic for a diagnostic ultrasound of the left lateral leg region. PHYSICAL EXAMINATION: Guarded gait favoring weight bearing on right lower extremity. Mild tenderness over the proximal tibiofibular joint. No focal area of tenderness noted at lateral knee joint line or distal iliotibial band. Range of motion about the knee and ankle were both full without pain and strength was intact. Allodynia noted to light touch over left anterolateral leg, ankle, and dorsal foot. Straight leg raise and lumbar facet challenge were negative. Lumbar Spurling’s was positive on the left. DIFFERENTIAL DIAGNOSIS: 1. Superficial peroneal neuropathy 2. Common peroneal neuropathy 3. Lumbar radiculopathy TEST AND RESULTS: -MRI lumbar spine: Mild multilevel DJD without significant stenosis. -MRI left tibia-fibula: Subtle edema in the peroneal muscle area. Diffuse symmetric atrophy in both muscles. -EMG/NCV: Decreased amplitude in left superficial peroneal response (4 mV vs 12 mV on contralateral side) and mildly prolonged peak latency. No signs of lumbar radiculopathy. -Left lateral leg/knee ultrasound: Swollen superficial peroneal nerve at the site of penetration through peroneus longus muscular fascia (0.08 cm proximally and 0.22 cm distally). FINAL WORKING DIAGNOSIS: Left superficial peroneal neuropathy TREATMENT AND OUTCOMES: 1. Sonographically guided superficial peroneal nerve hydrodissection (HD) x 2 resulted in improvement in painless walking distance and decrease in pain scale by 50-60%. 2. Repeat elective EMG/NCV 2 months later demonstrated signs of re-innervation of the left superficial peroneal nerve evidenced by normalized and symmetric sensory response amplitude (8 mV) and peak latency measures with polyphasic motor unit potentials seen in the fibularis longus.

Characterizing spring emergence of adult Halyomorpha halys using experimental overwintering shelters and commercial pheromone traps

AbstractTo improve our understanding of adult Halyomorpha halys (Stål) (Hemiptera: Pentatomidae) overwintering biology and to better inform models of its population dynamics, its temporal pattern of spring emergence was investigated using experimental overwintering shelters in screened cages within protective structures. In 2012, plastic shelters containing 100 adults were deployed in unheated, unlighted buildings, and adjacent woodlots in Virginia, USA. In 2013 and 2014, wooden shelters containing 300 paint‐marked adults were deployed in pairs in six woodlots across Virginia, West Virginia, and Maryland, USA; one in a closed cage and one in a cage with the top removed, enabling emerged adults to be counted or to disperse, respectively. In 2013 and 2014, pheromone‐baited and non‐baited pyramid traps encircled the shelters at each site. Regular counts of adults that emerged into the closed cage and of marked and ‘wild’ (unmarked) adults captured in traps were conducted from February or March through early July. In 2012, emergence patterns from shelters in buildings and woodlots were very similar and matched those recorded from woodlots in 2013 and 2014. In all years, a small peak of emergence occurred in about mid‐April, a larger and more prolonged peak was observed between mid‐May and early June, and emergence ended by early July. Of the 449 H. halys adults captured in traps between 2013 and 2014, only three were marked individuals from shelters in the open cage, suggesting that adults emerging from overwintering sites may require a dispersal flight before responding to pheromone‐baited traps. In 2013 and 2014, respectively, 98 and 93% of captures were in pheromone‐baited traps, but there was no correlation between the weekly number of adults that emerged from shelters in the closed cages and captures in traps.

Associations between hand anthropometric measurements, and degree of severity of carpal tunnel syndrome in Suez Canal area, Egypt

Background: Carpal tunnel syndrome (CTS) is considered as the most commonly reported peripheral nerve entrapment syndrome resulting from compression of the median nerve at the wrist level. Many studies have investigated the association between anthropometric characteristics and the degree of severity of the disease. Most literature supports a causal association between overweight and CTS; moreover, there is strong evidence that anatomical characteristics of the hand-wrist system may change the risk, and perhaps the severity of CTS. The aim of this study was to investigate the association between hand anthropometric measurements in patients with CTS and severity of the disease. Methodology: A cross-sectional study was conducted among patients with CTS (n = 600). For this purpose, a brief questionnaire and physical examination were done; hand dominance also was recorded. Body and hand anthropometric measurements were performed and recorded followed by electrodiagnostic testing at the same visit. Results: Patients had significantly prolonged distal latency, prolonged peak latency, lower compound muscle action potential and sensory nerve action potential amplitudes, and slower sensory nerve conduction velocity. Patients had significantly higher wrist depth, higher wrist ratio (WR), shorter palm length, shorter hand length, and lower hand ratio. Correlations of WR and wrist depth were also found. Conclusion: Anthropometric characteristics of the wrist and hand are significantly correlated with CTS. These measurements could be used in certain occupations to screen for those individuals who have increased liability to develop CTS.

Melatonin-loaded silica coated with hydroxypropyl methylcellulose phthalate for enhanced oral bioavailability: Preparation, and in vitro-in vivo evaluation

Melatonin (MLT) is a small molecule with low water solubility and high permeability. According to the Biopharmaceutics Classification System, MLT is a class II drug exhibiting a very short half-life and minimal and variable bioavailability. This work aimed to establish a delivery system composed of an enteric MLT nanosphere with favorably controlled and sustained release characteristics superior to those of raw MLT. The nanosphere was composed of hydroxypropyl methylcellulose phthalate (HP55) and silica (SiO2) with MLT. As a carrier, SiO2 contains numerous surface pores with high adsorption capacity advantageous for permeability and slow release. HP55 is a good enteric coating material. MLT-loaded SiO2 was obtained through adsorption in acetone solution. A MLT-loaded SiO2 coated with HP55 (MLT-SiO2-HP55) nanosphere was prepared via desolvation. The characteristics of this nanosphere were analyzed through transmission electron microscopy, Brunauer–Emmett–Teller surface area analysis, diffuse reflectance infrared Fourier transform spectroscopy, X-ray diffraction, differential scanning calorimetry, and thermogravimetric analysis. Results show that MLT was loaded mostly in the pores of SiO2. HP55 was coated on a large portion of MLT-SiO2. In vitro release studies revealed that the release rate of MLT from MLT-SiO2 was higher than that of raw MLT in simulated gastric fluid (SGF). The amount of MLT released from MLT-SiO2-HP55 in SGF was lower than that released from simulated intestinal fluid because of HP55 coated on MLT-SiO2. In vivo evaluation demonstrated the controlled drug release of MLT-SiO2-HP55 in rats. Compared with raw MLT, MLT-SiO2-HP55 prolonged peak time (Tmax) from 15min to 30min and increased peak concentration (Cmax) from 168.86ng/mL to 383.71ng/mL. The corresponding area under the curve (AUC) of MLT-SiO2-HP55 was 3.5 times higher than that of raw MLT. This finding illustrated the sustained release of MLT-SiO2-HP55. Our in vitro release and in vivo absorption studies indicated that the proposed preparation of MLT-SiO2-HP55 is an effective method to facilitate the controlled and sustained release of MLT with enhanced bioavailability.

Impact of mild traumatic brain injury on auditory brain stem dysfunction in mouse model.

The auditory brainstem response (ABR) is an electrophysiological test that examines the functionality of the auditory nerve and brainstem. Traumatic brain injury (TBI) can be detected if prolonged peak latency is observed in ABR measurements, since latency measures the neural conduction time in the brainstem, and an increase in latency can be a sign of pathological lesion at the auditory brainstem level. The ABR is elicited by brief sounds that can be used to measure hearing sensitivity as well as temporal processing. Reduction in peak amplitudes and increases in latency are indicative of dysfunction in the auditory nerve and/or central auditory pathways. In this study we used sixteen young adult mice that were divided into two groups: sham and mild traumatic brain injury (mTBI), with ABR measurements obtained prior to, and at 2, 6, and 14 weeks after injury. Abnormal ABRs were observed for the nine TBI cases as early as two weeks after injury and the deficits lasted for fourteen weeks after injury. Results indicated a significant reduction in the Peak 1 (P1) and Peak 4 (P4) amplitudes to the first noise burst, as well as an increase in latency response for P1 and P4 following mTBI. These results are the first to demonstrate auditory sound processing deficits in a rodent model of mild TBI.

Deaths at high altitude: Reducing the risk. A preliminary field study.

Altitude-related medical literature provides very few simple clinical studies relating to those on 'adventure holidays'. Systemic blood pressure has seldom been studied closely in relation to altitude. This study aimed to address both these issues and to assist GPs approached by patients for pre-trek advice. A total of 17 hillwalkers, evenly distributed for gender and age, trekked gradually from moderate to extreme altitude on Mera Peak in the Himalaya, noting any altitude sickness symptoms. Heart rate, blood pressure, oxygen saturation, peak expiratory flow and core temperature were measured daily. Altitude was double-checked hourly and synchronised with each set of measurements. On each day, two individuals wore 24-h ambulatory blood pressure monitors for assessment of altitude effects. Two principal findings emerged. Firstly, none of our 17 developed altitude-related symptoms below 4000 m, consistent with the recognised protective effect of slow rate of ascent; at 3500-4000 m all showed a sharp fall on O2sat and above 4500 m symptoms arose unpredictably. Secondly, hourly blood pressure monitoring showed no altitude effect below 3500 m, but above 5000 m a marked yet asymptomatic rise with delayed and prolonged peak. There may be a critical altitude above which extra vigilance is required; blood pressure here needs further research.

Temporal and Spatial Variation in Riparian Vegetation and Floodplain Aquifers on the Regulated Dolores River, Southwest Colorado, USA

The importance of flow variability and floodplain water table recharge for the establishment and long-term survival of riparian vegetation has been well-documented. However, temporal and spatial variation in floodplain aquifers has received less attention, although native species can have narrow tolerances for groundwater decline. Our observations of decreased cottonwood cover on floodplains and increased willow cover on river banks since dam completion on the Dolores River led to comparisons between three long-term study sites above and below McPhee Dam. We summarize 5 years (2010–2014) of shallow groundwater well data from transects of three wells per site. Vegetation cover data were collected from quadrats and line-intercept transects. In the willow zone, groundwater well levels mirror in-channel flows and rarely drop below 0.6 m from ground surface. Willow cover and stem counts on point bars are higher at dammed sites. Wells in the cottonwood zone indicate that alluvial recharge happens only during prolonged peak discharge during spring snowmelt or dam release. Years with no dam spill reduced connectivity between surface flows and groundwater, and groundwater depth dropped to between 2 and >2.5 m. Long-term data below the dam indicate that canopy cover of the dominant cottonwoods has declined over time (48% in 1995, 19% in 2003), especially in the wake of severe drought. Mature cottonwood cover is significantly higher at the undammed site (p = 0.025). Our results indicate that floodplain habitats below dams exist under artificially extreme drought and inform how biologically diverse riparian systems will be impacted by a drying climate. Copyright © 2016 John Wiley & Sons, Ltd.

Native Magnetic Resonance T1-Mapping Identifies Diffuse Myocardial Injury in Hypothyroidism.

Background and AimHypothyroidism (HT) is characterized by thyroid hormone deficiencies, which can lead to diffuse myocardial interstitium lesions in patients with HT. Myocardial longitudinal relaxation time (T1) mapping is a potential diagnostic tool for quantifying diffuse myocardial injury. This study aimed to assess the usefulness of T1 mapping in identifying myocardial involvement in HT, and determine the relationship between T1 values and myocardial function.MethodsA cross-sectional study was conducted with 30 untreated HT patients alongside 23 age- and sex-matched healthy controls. All subjects underwent cardiac magnetic resonance (CMR) with non-contrast (native) T1 mapping using a modified Look-Locker inversion-recovery (MOLLI) sequence to assess the native T1 values of myocardium and cardiac function.ResultsNative myocardial T1 values were significantly increased in HT patients, especially those with pericardial effusion (p < 0.05), compared with healthy controls. In addition, significantly reduced peak filling rate (PFR) and prolonged peak filling time (PFT) were obtained (p < 0.05) in HT patients compared with controls. Furthermore, stroke volume (SV) and cardiac index (CI) were significantly lower in HT patients than controls (all p < 0.05). Interestingly, native T1 values were negatively correlated with free triiodothyronine (FT3), PFR, SV and CI (all p < 0.05).ConclusionDiffuse myocardial injuries are common in HT patients, and increased T1 values are correlated with FT3 and cardiac function impairment. These findings indicate that T1 mapping might be useful in evaluating myocardial injuries in HT patients.

Aging augments the impact of influenza respiratory tract infection on mobility impairments, muscle-localized inflammation, and muscle atrophy.

Although the influenza virus only infects the respiratory system, myalgias are commonly experienced during infection. In addition to a greater risk of hospitalization and death, older adults are more likely to develop disability following influenza infection; however, this relationship is understudied. We hypothesized that upon challenge with influenza, aging would be associated with functional impairments, as well as upregulation of skeletal muscle inflammatory and atrophy genes. Infected young and aged mice demonstrated decreased mobility and altered gait kinetics. These declines were more prominent in hind limbs and in aged mice. Skeletal muscle expression of genes involved in inflammation, as well as muscle atrophy and proteolysis, increased during influenza infection with an elevated and prolonged peak in aged mice. Infection also decreased expression of positive regulators of muscle mass and myogenesis components to a greater degree in aged mice. Gene expression correlated to influenza-induced body mass loss, although evidence did not support direct muscle infection. Overall, influenza leads to mobility impairments with induction of inflammatory and muscle degradation genes and downregulation of positive regulators of muscle. These effects are augmented and prolonged with aging, providing a molecular link between influenza infection, decreased resilience and increased risk of disability in the elderly.

Eph-B4 mediates vein graft adaptation by regulation of endothelial nitric oxide synthase

Vein graft adaptation is characterized by loss of expression of the tyrosine kinase receptor Eph-B4, the embryonic determinant of venous identity, without increased expression of its ligand ephrin-B2, the embryonic determinant of arterial identity. Endothelial nitric oxide synthase (eNOS) is an important mediator of vessel remodeling. We hypothesized that the mechanism of action of Eph-B4 during vein graft adaptation might be through regulation of downstream eNOS activity. Mouse lung endothelial cells were stimulated with ephrin-B2/Fc, without and with preclustering, without and with the eNOS inhibitor Nω-nitro-l-arginine methyl ester hydrochloride or the Eph-B4 inhibitor NVP-BHG712, and assessed by Western blot and immunofluorescence for eNOS and Eph-B4 phosphorylation. Nitric oxide (NO) production was assessed using an NO-specific chemiluminescence analyzer. Cell migration was assessed using a Transwell assay. Human and mouse vein graft specimens were examined for eNOS activity by Western blot, and vessel remodeling was assessed in vein grafts in wild-type or eNOS knockout mice. Ephrin-B2/Fc stimulated both Eph-B4 and eNOS phosphorylation in a bimodal temporal distribution (n= 4; P< .05), with preclustered ephrin-B2/Fc causing prolonged peak Eph-B4 and eNOS phosphorylation as well as altered subcellular localization (n= 4; P< .05). Ephrin-B2/Fc increased NO release (n= 3; P< .01) as well as increased endothelial cell migration (n= 6; P< .05) in an eNOS-dependent fashion. Both human and mouse vein grafts showed increased eNOS phosphorylation compared with normal veins (n= 3; P< .05). Vein grafts from eNOS knockout mice showed less dilation and less wall thickening compared with wild-type vein grafts (n= 7; P< .05). eNOS is a mediator of vein graft adaptation to the arterial environment. Eph-B4 stimulates eNOS phosphorylation in vitro and may mediate vein graft adaptation by regulation of eNOS activity in vivo.

Relationship of the Acoustic Startle Response and Its Modulation to Emotional and Behavioral Problems in Typical Development Children and Those with Autism Spectrum Disorders.

Auditory hyper-reactivity is a common sensory-perceptual abnormality in autism spectrum disorders (ASD), which interrupts behavioral adaptation. We investigated acoustic startle response (ASR) modulations in 17 children with ASD and 27 with typical development (TD). Compared to TD, children with ASD had larger ASR magnitude to weak stimuli and more prolonged peak startle-latency. We could not find significant difference of prepulse inhibition (PPI) or habituation in ASD children compared to TD. However, habituation and PPI at 70-dB prepulses were negatively related to several subscales of Social Responsiveness Scale and the Strengths and Difficulties Questionnaire, when considering all children. Comprehensive investigation of ASR and its modulation might increase understanding of the neurophysiological impairments underlying ASD and other mental health problems in children.

Eph-B4 Mediates Vein Graft Adaptation By Regulation of eNOS

Vein graft adaptation is characterized by loss of expression of the tyrosine kinase receptor ephrin type-B receptor 4 (Eph-B4), the embryonic determinant of venous identity, without increased expression of its ligand ephrin-B2, the embryonic determinant of arterial identity. Endothelial nitric oxide synthase (eNOS) is an important mediator of vessel remodeling. We hypothesized that the mechanism of action of Eph-B4 during vein graft adaptation might be via regulation of downstream eNOS activity. Human and mouse vein graft specimens were examined for eNOS activity by Western blot, and vessel remodeling was assessed in vein grafts in wild-type (WT) or eNOS-knockout (KO) mice. Mouse endothelial cells (EC) were stimulated with ephrin-B2/Fc without and with preclustering, without and with L-NAME (1 mM), and assessed by Western blot and immunofluorescence for eNOS and Eph-B4 phosphorylation. NO production was assessed using a NO-specific chemiluminescence analyzer. Cell migration was assessed using a transwell assay. Human and mouse vein grafts both showed increased eNOS phosphorylation compared with normal veins (n = 3; P < .05). Vein grafts from eNOS-KO mice showed less dilation and less wall thickening compared with WT vein grafts (n = 7; P < .05). Ephrin-B2/Fc stimulated both Eph-B4 and eNOS phosphorylation in a bimodal temporal distribution (n = 4; P < .05), with preclustered ephrin-B2/Fc causing prolonged peak Eph-B4 and eNOS phosphorylation as well as altered subcellular localization (n = 4; P < .05). Ephrin-B2/Fc increased NO release from ECs (n = 3; P < .01) as well as a trend towards increased EC migration (n = 6; P = .11) in an eNOS-dependent fashion. eNOS is a mediator of vein graft adaptation to the arterial environment. Eph-B4 stimulates eNOS phosphorylation and mediates vein graft adaptation by regulation of eNOS activity.

Alterations in brain-stem auditory evoked potentials among drug addicts. A cross-sectional study.

Objective:To compare the absolute latencies, the interpeak latencies, and amplitudes of different waveforms of brainstem auditory evoked potentials (BAEP) in different drug abusers and controls, and to identify early neurological damage in persons who abuse different drugs so that proper counseling and timely intervention can be undertaken.Methods:In this cross-sectional study, BAEP’s were assessed by a data acquisition and analysis system in 58 male drug abusers in the age group of 15-45 years as well as in 30 age matched healthy controls. The absolute peak latencies and the interpeak latencies of BAEP were analyzed by applying one way ANOVA and student t-test. The study was carried out at the GGS Medical College, Faridkot, Punjab, India between July 2012 and May 2013.Results:The difference in the absolute peak latencies and interpeak latencies of BAEP in the 2 groups was found to be statistically significant in both the ears (p<0.05). However, the difference in the amplitude ratio in both the ears was found to be statistically insignificant.Conclusion:Chronic intoxication by different drugs has been extensively associated with prolonged absolute peak latencies and interpeak latencies of BAEP in drug abusers reflecting an adverse effect of drug dependence on neural transmission in central auditory nerve pathways.

Brainstem auditory evoked potentials in traffic policemen occupationally exposed to vehicular emission

Background and Aim: It is a well-known fact that traffic policemen in Delhi are exposed to immense vehicular pollution particularly at crowded intersections. These pollutants affect various systems of the body including nervous system in due course of time. Realizing these facts, we recorded absolute and inter peak latencies (IPLs) of brainstem auditory evoked potentials (BAEPs) in traffic policemen exposed to enormous vehicular emission and compared with the normal controls living in the residential areas in Delhi. Methods: Totally, 60 subjects all males and nonsmokers between 30 and 50 years of age were studied, 30 belonged to exposed group comprised of traffic policemen and 30 nonexposed controls. Their BAEPs were recorded using MEB 5200 Neuropack II plus evoked potential recorder (Nihon Kohden, Japan) and evaluation of anthropometric and neuro-psychiatric parameters was done. To compare BAEP results, Student's t -test was used. Results: Significantly prolonged absolute peak latencies I, II, III, IV, V and IPL I-III in exposed group were observed as compared to controls. Conclusion: Findings suggest prolongation of peripheral and central auditory conduction time in exposed subjects. The prolonged latencies in exposed group may be attributed to occupational exposure to vehicular emission.

Auditory brainstem gap responses start to decline in mice in middle age: a novel physiological biomarker for age-related hearing loss.

The auditory function of the CBA/CaJ mouse strain is normal during the early phases of life and gradually declines over its lifespan, much like human age-related hearing loss (ARHL) but within the "time frame" of a mouse life cycle. This pattern of ARHL is similar to that of most humans: difficult to diagnose clinically at its onset and currently not treatable medically. To address the challenge of early diagnosis, we use CBA mice to analyze the initial stages and functional onset biomarkers of ARHL. The results from Auditory Brainstem Response (ABR) audiogram and Gap-in-noise (GIN) ABR tests were compared for two groups of mice of different ages, namely young adult and middle age. ABR peak components from the middle age group displayed minor changes in audibility but had a significantly higher prolonged peak latency and decreased peak amplitude in response to temporal gaps in comparison with the young adult group. The results for the younger subjects revealed gap thresholds and recovery rates that were comparable with previous studies of auditory neural gap coding. Our findings suggest that age-linked degeneration of the peripheral and brainstem auditory system begins in middle age, allowing for the possibility of preventative biomedical or hearing protection measures to be implemented in order to attenuate further damage to the auditory system attributable to ARHL.

Constipation Predominant Irritable Bowel Syndrome (IBS-C) With Positive Lactulose Breath Test (LBT) Can Be Treated With Polyethylene Glycol (PEG) in Lieu of Antibiotics

Introduction: Small intestinal bacterial overgrowth (SIBO) has been increasingly recognized as a pathophysiological link to irritable bowel syndrome (IBS). Different groups of bacteria in the intestine produce methane (CH4), hydrogen (H2) and carbon dioxide (CO2), which are tested in lactulose breath test (LBT). An early peak at 60 minutes is diagnostic of SIBO and a later prolonged peak at 120 minutes corresponds to colon bacteria. Studies have demonstrated the effectiveness of polyethylene glycol (PEG) in treating constipation predominant IBS (IBS-C). When compared with antibiotics, PEG is economically preferable and has fewer side effects. Aim: compare the effect of PEG and antibiotics in treating LBT positive IBS-C patients. Methods: Total of 36 patients were diagnosed as IBS-C based on Rome-III criteria with a positive LBT after reviewing medical records at our gastrointestinal center from 2011 to 2013. Ten patients received PEG and 12 received antibiotics for 14 days. LBT results of those patients were obtained prior and 2 weeks after treatment. H2, CH4 and CO2 levels at baseline, 60 minutes, and 120 minutes after ingestion of lactulose were collected. The mean levels of change were calculated and the extents of changes were compared with student t test in patients treated with PEG versus antibiotics. Results: For the patients who received PEG, prior to treatment they had mean H2 increase of 17.6 ppm and mean CH4 increase of 25.4 ppm at 60min. After PEG treatment, they had mean H2 increase of 9.2 ppm and CH4 decrease of 24 ppm at 60 min. For the patient who received antibiotics, prior to treatment they had mean H2 increase of 12 ppm at and mean CH4 increase of 33 ppm at 60 min. After antibiotics treatment, they had mean H2 increase of 8.4 ppm and mean CH4 decrease of 1.03 ppm at 60 min. There is H2 decrease after treatment at 60 min in both PEG and antibiotic treatment group. The extent of changes of H2 levels in those 2 groups were compared statistically using student T test, p value was >0.05. There is also CH4 decrease after treatment at 60 minutes in both PEG and antibiotic treatment groups. The extent of changes of CH4 levels in those 2 groups were compared statistically using student T test, p value was <0.05. Conclusion: PEG provides similar effect of H2 production in small bowel as antibiotic treatment in IBS-C LBT positive patients. PEG can reduce more CH4 production in small intestine with statistical significance which could be secondary to effect on different bacteria groups. Thus PEG could be used in lieu of antibiotics to treat LBT positive IBS-C patients. Future studies with larger sample size and with investigation of symptom improvement are needed.

Disinhibitory shift of recovery curve of somatosensory-evoked response in elderly: A magnetoencephalographic study

ObjectiveThe aim of the study was to investigate the functional differences between N20m and P30m components of somatosensory-evoked magnetic cortical field (SEF) in young and senior subjects. MethodsTwenty-nine healthy subjects, 13 younger (mean age: 21.8years) and 16 senior (63.8years), participated. Magnetic fields were measured using a 160-channel, whole head MEG. Single- and paired-pulse stimulations of 200 artifact-free MEG signal epochs were averaged separately. We calculated how aging affects recovery function of SEFs. ResultsThe senior showed a prolonged N20m peak latency compared to the younger, although the P30m peak latency was not significantly different between groups. The N20m ratios at 60 and 80ms in the senior were significantly increased compared to the ratios in the younger (60ms: P<0.05, 80ms: P<0.001). The P30m ratios at inter-stimulus interval (ISI) of 80 and 100ms showed even disinhibition in the senior than in the younger (P<0.05). The younger also showed a significantly negative correlation between P30m and N20m components’ recovery curves (R=0.72, P<0.05). ConclusionAging-related changes that occurred in recovery functioning were the decrease in N20m component suppression and the increase in P30m component recovery, indicating that the N20m and P30m components have different functions in aging-related recovery changes. SignificanceOur results show that the N20m ratio at an ISI of 80ms was significantly increased in the senior group, indicating that the second stimulus-evoked SEF was less inhibited by the initial stimulus at this ISI, suggesting less refractory effect or increased disinhibition.

Clinical usefulness of measuring prothrombin time and soluble fibrin levels in Japanese patients with atrial fibrillation receiving rivaroxaban

BackgroundRivaroxaban is currently used to prevent stroke in patients with atrial fibrillation. Measuring coagulation function may help clinicians to understand the effects of this drug and the associated risk of bleeding. Methods and resultsRivaroxaban was given to 136 patients with non-valvular atrial fibrillation. Mean age was 74.5±9.0 years (men: 63.2%) and mean CHADS2 score (±SD) was 1.8±1.2. Prothrombin times (PTs) and plasma soluble fibrin (SF) levels were examined in 84 out of 136 patients at baseline and at least 2 weeks thereafter. In 48 patients we were able to collect blood at exact times, namely just before and 3h after rivaroxaban administration, corresponding to the trough and peak concentrations. Mean peak PT in 48 patients was 17.1±3.6s and median peak SF level was 1.46μg/mL. Multiple regression analysis showed that female sex, high brain natriuretic peptide, and high dose were independent factors prolonging the peak PT. Patients with peak PTs ≥20s experienced significantly more bleeding events. Among 29 of 46 patients newly treated with rivaroxaban without any previous anticoagulant, we examined coagulation function at the exact trough and peak times. In 29 patients, peak PT was significantly more prolonged than the baseline or trough PT (p<0.001 for both), whereas trough PT was comparable to the baseline PT. In contrast, both trough and peak SF levels in these newly treated patients were significantly reduced than at baseline (p=0.003 and p<0.001, respectively). ConclusionsIn Japanese patients with non-valvular atrial fibrillation receiving rivaroxaban, a prolonged peak PT (≥20s) could indicate increased risk of bleeding, and both trough and peak SF levels were reduced relative to baseline. PT and SF are both valuable measures of coagulation status in patients receiving rivaroxaban, regardless of prior anticoagulant history.

Reduced automatic frontal response to auditory deviance in Huntington’s disease as indexed by magnetic mismatch negativity

Huntington’s disease (HD) is a neurodegenerative disorder accompanied by a degradation of dopaminergic receptors. It is evident that dopaminergic dysfunction leads to attention deterioration. However, little is known about the functional integrity of involuntary attention processing in patients with HD. The present study aimed to investigate whether patients with HD exhibit a deficit in automatic deviance detection that can be indexed by magnetic mismatch responses. Magnetoencephalographic responses during a passive oddball task were recorded to examine automatic neural activation to auditory deviants in patients with symptomatic HD and age and sex-matched healthy volunteers. The mean amplitude and peak latency of magnetic mismatch responses were calculated from the waveforms in each hemisphere. Furthermore, minimum current estimate (MCE) was applied to estimate the source strength of temporal and frontal mismatch responses. Compared with healthy participants, patients with HD exhibited a decreased waveform amplitude and a prolonged peak latency of magnetic mismatch responses in the left temporal lobe. The MCE analysis also revealed significantly lower activation of the bilateral frontal mismatch responses in patients. In conclusion, the frontal underactivation to occasional auditory deviance suggests a deficit of involuntary attention switching in HD.