Significant Increase In Duration Research Articles

The effect of neurofeedback and somatosensory exercises on balance and physical performance of older adults: a parallel single-blinded randomized controlled trial

This study examines the effects of a 5-week program of neurofeedback combined with somatosensory exercises on balance and physical performance in older adults, with the goal of addressing age-related declines in sensory processing and motor function. Sixty older adult men with balance disorders were randomly assigned to one of three groups: neurofeedback combined with somatosensory training, somatosensory training alone, or a control group. The interventions were administered over 5 weeks, with participants attending three sessions per week. Assessments were conducted both before and after the intervention period, including measurements of static balance using the Stork test, dynamic balance using the Timed Up and Go (TUG) test, and physical performance using the Continuous Scale Physical Functional Performance-10 (CS-PFP-10) test. The findings revealed significant improvements in balance and physical performance among participants who received either neurofeedback combined with somatosensory training or somatosensory training alone. Specifically, the Stork test (with both open and closed eyes) showed significant increases in duration, while the TUG test indicated reductions in completion times for both intervention groups (p = 0.001), suggesting enhanced balance and mobility. Additionally, the CS-PFP-10 test results demonstrated a significant difference following the interventions (p = 0.001). These findings suggest that incorporating neurofeedback training into somatosensory exercises may provide additional benefits for older adults in improving balance and mobility.

Characteristics of gait function in hemiparetic patients with subacute period of ischemic stroke: a single-center retrospective study

BACKGROUND: Gait disorders are common among 80% of stroke patients. Its consequences include increased risk of falls and functional limitations, which can significantly reduce the quality of life. AIM: To investigate the functional profile of hemiparesis resulting from subacute ischemic stroke. MATERIALS AND METHODS: This observational, retrospective, one-stage, single-center study analyzed primary biomechanical gait parameters in 31 patients and 34 healthy controls. Spatial, temporal, kinematic, and electromyographic characteristics were recorded. A statistical assessment and inter-group and intra-group comparison of the collected data were performed to identify the pathognomonic features of hemiplegic gait in patients with subacute stroke. RESULTS: Changes in gait biomechanics typical for hemiparetic patients who have suffered from ischemic stroke were described: slight asymmetry of step cycle, normal duration of support period on the paretic side, significant increase in duration of support period on the healthy side, and shortening of single support period on the paretic side. Additionally, the asymmetry of the walking function was characterized by changes in reciprocity, that is, a harmonious sequence of step cycles. The function of the hip and knee joints was reduced and altered, and the amplitude of the ankle joint was increased. Decrease and change in the bioelectric activity profile of muscles were detected. Moreover, the quadriceps femoris function was least affected. CONCLUSION: The main changes in walking function are characterized by an asymmetry of spatiotemporal parameters, a decrease in movement amplitudes of the hip and knee joints on the paretic side, an increase in ankle joint amplitude, a decrease in the bioelectric activity of muscles, and a shift in the phases of their activity. The results contribute to a better understanding of the mechanisms behind hemiplegic gait and provide a valuable tool for developing more personalized and targeted rehabilitation plans for patients suffering from hemiparesis as a result of subacute ischemic stroke.

Prevalence of intra-abdominal adhesions in patients undergoing repeat cesarean section: An observational retrospective study

: To study the prevalence of intraabdominal adhesion in repeat CS and evaluate the maternal and fetal outcome.: CS is a lifesaving procedure for the mother and fetus, but have multiple complications like adhesions, abdominal pain, prolonged duration of surgery, postoperative bleeding, and identification of these can help improve maternal and fetal outcome and care.: This retrospective study reviewed 70 pregnant women undergoing repeat CS. Data was tabulated and analyzed and adhesions were scored based on a system into dense and flimsy, and its dimensions. Chi Square test was used to observe association. P-value<0.05 was taken as significant.: Adhesions were noted in 30(42.9%) of the subjects and 40(57.1%) patients had no adhesions. Dense adhesions were noted in 19(27.1%) and flimsy in 11(15.7%) patients. Among those with adhesions – 6(20%) had atonic postpartum hemorrhage (PPH). No association was noted with fetal outcome. There was a statistically significant increase in duration of surgery in those with adhesions – 126.83 minutes +/- 19.85 than in those without adhesions – 82.35 minutes +/-12.82. Those patients with dense adhesions, the duration of surgery was – 132.63 minutes +/-21.88 and with flimsy adhesions – 116.82 minutes +/-82.: Repeat CS with adhesions increased the duration of surgery, increased the chances of PPH and had no statistically significant effect on neonatal outcome. Furthermore, duration of surgery was prolonged with dense adhesions. Further research can be done including post operative complications, details of prior CS and interpregnancy interval and thereby adhesion prevalence.

Efficacy of preoxygenation administration in volunteers, in extending the end-expiration breath-hold duration for application to abdominal radiotherapy

End expiration breath hold (EEBH) is the preferred motion management method for abdominal Stereotactic Ablative Body Radiotherapy (SABR) treatments. However, multiple short EEBHs are required to complete a single treatment session. The study aimed to determine the efficacy of preoxygenation with hyperventilation in extending an EEBH duration.We randomised 10 healthy participants into two arms, each included breathing room air and oxygen at a rate of 10 L per minute (l/min) without hyperventilation for four minutes, and normally for four minutes and with hyperventilation for one minute at a rate of 20 breaths/minute for hyperventilation. The type of gas was blinded from the participants for each test. EEBH durations were then recorded, as well as systolic blood pressure, SpO2 and heart rate. A discomfort rating was also recorded after each breath hold.A significant increase in duration of almost 50% was observed between normal breathing of room air and breathing oxygen normally followed by hyperventilation. Vital signs remained consistent between the 4 tests. The tests were well tolerated with 75% of participants recording none or minimal discomfort.Preoxygenation with hyperventilation could be used to increase the EEBH duration for abdominal SABR patients which would assist in the accuracy of these treatments and possibly resulting in a reduction of overall treatment times.

Comparison of Bupivacaine (0.5%) and Bupivacaine (0.5%) with Dexmedetomide for Spinal Anesthesia in Lower Abdominal and Pelvic Surgery

Background: Dexmedetomiodine has also been used intrathecally to enhance the duration of motor and sensory blockade produced by hyperbaric bupivacaine. By increasing the dose of intrathecal dose of intrathecal dexmedetomidine it has been found that there is a significant increase in duration of motor and sensory blockade produced by intrathecal hyperbaric bupivacaine. Purpose of this study was to evaluate whether addition of dexmedetomidine changes the characteristics of bupivacaine 0.5% analgesia and other effects when injected intrathecally. Materials & Methods: This prospective, double-blind, randomized, controlled study was conducted in 100 patients of ASA PS I-II, aged between 20-60 yrs, of either sex, scheduled for elective lower abdominal and pelvic surgery were chosen and divided into two groups. Patients were randomly allocated to receive intrathecally either 3ml of 0.5% hyperbaric bupivacaine plus 1ml normal saline (group X) or 3ml of 0.5% hyperbaric bupivacaine plus dexmedetomidine 4 µg in 1 ml (group Y). The time taken to achieve peak sensory (T10 dermatome) and motor blockade (Bromage score 3), duration of block, recovery characteristics and hemodynamic changes were recorded. Any adverse symptoms like nausea, vomiting, shivering, pruritis, and sedation etc were noted.Results: The mean time of sensory block to reach T10 dermatome was 5.56±1.23 minutes in Group Y, 6.48±1.18 minutes in Group X.The mean time to reach Bromage 3 scale was 8.94±1.62 minutes in Group Y and 11.88±1.42 minutes in Group X. The regression time to Bromage 0 was 291.7±30.2 minutes for Group Y and 144.8 ±10.5 minutes for Group X. Onset and regression of sensory and motor block were highly significant ( p<0.0001). The mean time for 2 segment regression was 111.1±14.96 for group Y and 89.2±9.11 for group X (p<0.0001).
 Conclusion: The onset of sensory and motor blockade was shortened by dose of dexmedetomidine. The duration of sensory and motor block was also prolonged. Therefore it can be concluded that dexmedetomidine has effect on sensory and motor block when used as an adjuvant to bupivacaine in spinal anaesthesia

Oral hygiene with chlorhexidine and increase in time of hospitalization in an Intensive Care Unit

Objective: to evaluating the effect of an oral hygiene routine with chlorhexidine solution in the length of stay of intensive care patients, comparing the number of days of permanence in the intensive care unit before and after protocol implementation. Methods: this is a quasi-experimental study held in 2020, which analyzed 126 medical records, which were divided into two groups (63 each) according to the use of chlorhexidine 0.12% in an oral hygiene routine: before use (2004-2010) and after use (2011-2020). The selection of patients was based on pairing by sex, age, underlying disease and comorbidities. Results: the mean age was 55 years old (±18,76). The median length of stay before and after the new oral care routine were 3.0 and 5.0 days, respectively, and a significant increase in duration of hospitalization after routine implementation was observed (OR=2.82; CI95%=1.06-4.87; p=0.033). Conclusion: after implementing the oral hygiene routine using a chlorhexidine, the length of stay of patients in the intensive care unit significantly increased.

The impact of childhood sexual abuse and its associated stigma on depressed women in Egypt

Abstract Background Depression is common in women, childhood sexual abuse and its related stigma in our culture are expected to increase the severity of depression, and it may be a strong risk factor for the presence of suicidal ideations in women. This study aimed to look at the relationship of childhood history of sexual abuse and its related stigma to depression and suicidal ideations in depressed women. Methods A consecutive sample of 160 depressed women was enrolled in this study. The structured clinical interview for DSM-5 was used to diagnose depression, and the Beck Depression Inventory, second edition was used to quantify its severity. The Scale for Suicidal Ideations was used to evaluate suicidal ideations, and history taking was used to assess previous suicidal attempts. The history of childhood sexual abuse was evaluated using a self-report questionnaire, the questions of this questionnaire were derived from the National Population Survey, and a Canadian survey of sexual abuse and its related stigma was assessed using a scale for stigma of sexual abuse. Results The findings showed that 11.8% of depressed women had a history of childhood sexual abuse under age of 15 years. There was a significant decrease in age of onset of depression, a significant increase in duration of depression, number of hospital admission, the Beck Depression Inventory, second edition BDI-II, the Beck Hopelessness Scale (BHS) mean scores, number of patients with suicidal ideations, and previous suicidal attempts in depressed women with a history of childhood sexual abuse in comparison to those without that history. History of childhood sexual abuse and its related stigma were the most significant predictors for the presence of depression and current suicidal ideations. Conclusions The history of sexual abuse in childhood and its related stigma were associated with increased severity of depression and the presence of suicidal ideations in depressed women. Identification of childhood sexual abuse and its related stigma in depressed women is highly important for proper management of depression.

Severity of oEsophageal Anastomotic Leak in patients after oesophagectomy: the SEAL score.

Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score. This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally. Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification. The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.

Supraclavicular Brachial Plexus Block with or without Dexamethasone

Aim: To assess the effect of supraclavicular brachial plexus block in patients with or without dexamethasone. Study design: Double blind randomized controlled trial Place and duration of study: Department of Anesthesia and Critical Care, The Indus Hospital a free of cost tertiary care hospital in Karachi from 9th May 2019 to 19th February 2020. Methodology: Sixty patients were enrolled with 30 patients in each intervention group. Patients who came for elective or emergency surgery of the upper limb below shoulder were included in the study. Block performed on patients lying supine at 45 degree. The dexamethasone group received 0.25% plain bupivacaine 18 ml with 2ml dexamethasone (0.4mg/ml) and control group received 0.25% plain bupivacaine 18 ml with 2 ml normal saline. Results: The age of the group B patients was higher than the group A patients such as 43.4±15.7 years vs 38.6±14.2 years. The ASA level presented higher scoring than II in patients from Group B with 63.3% those patients who called for pain. In this study the intra operative vital signs showed an insignificant variance in both groups.However, a significant increase in duration of analgesia was observed in group A. Conclusion: Perineural administration of dexamethasone with clinical bupivacaine concentration can prolong the duration of anesthesia. Keywords: Supraclavicular, Brachial plexus block, Dexamethasone

Discriminating speech traits of Alzheimer's disease assessed through a corpus of reading task for Spanish language

It is estimated that between 50% and 75% of all cases of dementia are due to Alzheimer's disease (AD), the most common neurodegenerative disease among World population. However, a long preclinical period of AD makes it difficult to differentiate between people with Mild Cognitive Impairment (MCI) that would progress to dementia from people with MCI that would not. One of the most promising solutions to detect MCI which will evolve to dementia (preAD) comes from the field of automatic speech analysis. Speech is a complex physiological and neurocognitive language-mediated process, which can be significantly altered in pathological aging and exhibit high levels of sensitivity for the diagnosis of neurological diseases. The purpose of this research is to offer a detailed perspective on the speech changes in MCI and mild AD when compared to healthy aging (HA), that would allow to detect pathological processes prior to the clinical expression of AD. Based on our previous research record on speech in HA, MCI and AD, we provide a global review of dementia-related speech traits and propose a reading-based protocol for assessing ongoing neurodegenerative processes in the elderly. We report the results of speech analysis in elderly people with different cognitive profiles, who performed a standardized reading task and were further analyzed for correlations between neurocognitive assessment indicative of cognitive impairment stage (HA, MCI or AD) and acoustic, temporal and prosodic traits in speech. We show that evolution from HA to AD exhibits a steady pattern of speech changes in parallel to the cognitive decline, which consists in significant increase in duration and phonation time, extension of pauses and voice breaks, intensification of variation in syllabic production, and decrease in speech energy and intensity leading to dysphony. In doing so, we prove that a standardized reading task is a very useful type of stimuli for detecting dementia-related speech traits and, in view of this, we discuss the relevance of reading for preclinical automated diagnosis of AD. The main contribution of this paper is a corpus of recordings of the standardized reading task performed by healthy elderly people and people with MCI and AD in Spanish language, and which can be used for further research purposes. In this respect, our work fills an important gap existing in corpora-based studies of speech and language impairments related to progression to dementia.

P 26. Ipsilateral silent period in multiple sclerosis and healthy controls depends on stimulus intensity

Background. In patients with multiple sclerosis (MS) lesions of the corpus callosum can be found even at early disease stages. With transcranial magnetic stimulation (TMS) the transcallosal interhemispheric inhibition can be investigated using the ipsilateral silent period (ISP). Various studies revealed differences in the duration of ISP in MS-patients compared to healthy controls (HC), both as increased (Schmierer et al. 2002) or decreased (Lenzy et al., 2007), presumably because of methodological differences in stimulus intensities. Therefore this study aimed to investigate the influence of stimulus intensities on the ISP in MS compared to HC.Methods: 20 MS (13 females, age: 44.6 ± 10.6) and 15 HC (9 females, age: 41.4 ± 10.0) matched by age and sex received a structural cranial MRI to perform MR-navigated TMS of the motor cortex. In total 40 TMS pulses were applied and durations of ISP were estimated in each participant. To examine to which extent the intensity of the TMS pulses modulate the duration, measurements were repeated at four stimulus intensities (state 1 to 4, 10 stimuli per state) calculated by the individuals resting motor threshold (RMT; 1.2 RMT/1.5 RMT/1.75 RMT/2 RMT). Results. rmANOVA revealed an effect for ISP-duration (RMT intensities; p < 0.05) but no significant group effect (MS, HC; n.s.). Post hoc analyses for RMT showed significant increase in duration between 1.2 and 1.5 RMT (p < 0.05). Conclusion. Our data provide evidence that the intensity of TMS may have an impact on the resulting duration of ISP in both MS and HC, which might explain the somewhat contradictory results in the literature so far. Future studies in patient cohorts should use different stimulus intensities in ISP. References Schmierer et al., 2002. Neurology 59: 1218-24. Lenzy et al., 2007. Hum Brain Mapp 28: 636-44.

A COMPARATIVE STUDY OF CAUDAL BLOCK AND ULTRASOUND-GUIDED TRANSVERSUS ABDOMINIS PLANE BLOCK WITH LEVOBUPIVACAINE AND DEXAMETHASONE AS ADDITIVE IN EXTRAPERITONEAL LOWER ABDOMINAL SURGERIES IN PEDIATRICS

Objective: The objective of the study was to evaluate the efficacy of ultrasound-guided transversus abdominis plane (TAP) block versus caudal block for post-operative analgesia with levobupivacaine and dexamethasone as additive in extraperitoneal lower abdominal surgeries in pediatrics as there is no available literature showing the same.&#x0D; Methods: This is a randomized control study carried out between two groups among 50 children (1–8 years of age), both sexes, posted for elective extraperitoneal lower abdominal surgeries after taking informed consent from parents. Fifty children were randomly allocated into two groups, 25 in each group. Caudal epidural (CE) group received general anesthesia and caudal block with 1 ml/kg of 0.2% levobupivacaine and 0.1 mg/kg dexamethasone. TAP group received general anesthesia and ultrasound-guided TAP block with 0.5 ml/kg of 0.2% levobupivacaine and 0.1 mg/kg dexamethasone. Data were collected by means of pre-designed format with pre-/post-operative assessment with standardized scores.&#x0D; Results: The mean age of the patients was 4.84 (SD=2.29). Mean face, legs, activity, cry, and consolability score was low and non-significant before shifting the patient (&lt;2 h post-operative [post-op]) in both the groups. Thereafter from 2 to 12 h, the mean score increased to 4.92 (SD=2.72) in the CE group and 2.92 (SD=2.17) in the TAP group and the difference was statistically significant at 2 h, 4 h, 6 h, and 12 h postoperatively. Mean time to rescue analgesia in the CE group was 4.96 h (SD=4.32) and 5.52 h (SD=7.53) in the TAP group and difference was statistically significant (p=0.000). Mean total rescue analgesic requirement for the CE and TAP groups was 298.40 mg (SD=170.70) and 111.40 mg (SD=138.81) and the difference was also significant. Post-operative complications such as urinary retention and motor blockade were seen in 28% of CE patients, while none of the patients experienced post-operative nausea/vomiting.&#x0D; Conclusions: Our study showed significant increase in duration of post-operative analgesia among TAP patients with reduced requirement of rescue analgesics and lesser post-operative complications as compared to CE patients

Changes in International Students’ Dietary Habits, Physical Activity and BMI During Their First Year After Relocating to the U.S.

ObjectivesTo identify changes in diet, physical activity and BMI after 3–6 months of relocation among international students in Georgia, USA. MethodsData were collected from 74 international students attending 2 urban universities in the Southeast. Students were interviewed within 10 days of arrival in the U.S and again 3–6 months later. Participants completed an interviewer-administered questionnaire that included a 26-item food frequency questionnaire, and questions on weekly physical activity, daily screen-time usage, sleep duration, and anthropometric measurements (body weight, height, and waist circumference), each measured twice and then averaged. Student t-test, Chi square and ANOVA analysis was done for participants who completed both waves (n = 74). ResultsParticipants reported consistent food consumption within 3–6 months (mean difference < 0.5 times per week). Physical activity frequency remained consistent (mean difference < 0.5), but duration of almost all activities was increased. Participants reported increased hiking frequency and a significant increase in duration (frequency mean 0.05 to 0.09 times/week, 95% CI of (0.02–0.08) to (0.02–0.16), duration mean 21.1 to 117 minutes/week, 95% CI (14.1–28.0) to (94.7–138.5)). Screen time significantly increased (mean 4.2 to 7.0 hours/day, 95% CI (3.6–4.9) to (6.2–7.8)). Mean weight slightly increased (62.7 kg to 62.9 kg, 95% CI (60.5–65.0)), as did mean BMI (22.4 to 22.6, 95% CI (21.6–23.2)). However, around 37% of participants gained > 10% of their baseline weight, while 32% lost > 10% of their baseline weight. Almost half of participants (44.5%) reported that they had gained weight and 77% reported a decrease in their overall health. ConclusionsFollow-up data suggests International students’ body weights changed drastically in a short time period which could potentially lead to negative health outcomes. Funding SourcesNone.

Analysis of Dexmedetomidine added to Ropivacaine in Supraclavicular Brachial Plexus block

Aim: To evaluate the effect of Dexmedetomidine added to Ropivacaine in Supraclavicular Brachial Plexus block. Material and Methods: This study was performed in the Department of Anaesthesia, Mahatma Gandhi Missions Institute of Health Sciences, Navi Mumbai, Maharashtra after approval by the Institute Ethics Committee. After getting written informed consent from patients, this study was carried out as a controlled, randomized (chit method), double blind, prospective study in 60 patients. Sensory and motor blockade of radial, median, musculocutaneous and ulnar nerves were recorded at regular intervals (at each min till complete blockade) after drug injection. Following observations were noted intra and post operatively. The duration of analgesia or first request for analgesic defined as the time to attain a Visual Analogue Score (VAS) of 4 or >4 after Ropivacaine administration. The VAS was recorded post-operatively every 30min till the score of 4 or >4. Results: Duration of sensory block was significantly longer in group RD as compared to group R (p < 0.001). It was found that duration of motor block increased more with Dexmedetomidine addition (407.33±53.09 min) than with Ropivacaine alone (278.66±44.77 min). There was significant increase in duration of analgesia in group RD (685.33±90.02 min) than with group R (344.00±52.06 min). In RD group 2 patients developed haematoma and only 1 patient develop blood in aspiration due to arterial puncture, and in R group 1 patient develop haematoma and 2 patients developed blood in aspiration. Conclusion: We conclude that Dexmedetomidine is a good adjuvant in supraclavicular brachial plexus block for upper limb surgeries.

Base Editing Mediated Generation of Point Mutations Into Human Pluripotent Stem Cells for Modeling Disease.

Human pluripotent stem cells (hPSCs) are a powerful platform for disease modeling and drug discovery. However, the introduction of known pathogenic mutations into hPSCs is a time-consuming and labor-intensive process. Base editing is a newly developed technology that enables facile introduction of point mutations into specific loci within the genome of living cells. Here, we design an all-in-one episomal vector that expresses a single guide RNA (sgRNA) with an adenine base editor (ABE) or a cytosine base editor (CBE). Both ABE and CBE can efficiently introduce mutations into cells, A-to-G and C-to-T, respectively. We introduce disease-specific mutations of long QT syndrome into hPSCs to model LQT1, LQT2, and LQT3. Electrophysiological analysis of hPSC-derived cardiomyocytes (hPSC-CMs) using multi-electrode arrays (MEAs) reveals that edited hPSC-CMs display significant increases in duration of the action potential. Finally, we introduce the novel Brugada syndrome-associated mutation into hPSCs, demonstrating that this mutation can cause abnormal electrophysiology. Our study demonstrates that episomal encoded base editors (epi-BEs) can efficiently generate mutation-specific disease hPSC models.

Impact of Reduced ASIC2 and Pregnancy on Seizure Susceptibility in Mice

RationalePreeclampsia, a hypertensive disorder of pregnancy, can advance to eclampsia with the occurrence of new‐onset seizures in the mother. What induces this progression is unknown. Previous research found that utero‐placental ischemia, modeled by reducing uterine perfusion pressure (RUPP) in the rat, reduced latency to drug‐induced seizures. While acid sensing ion channels (ASICs) have been implicated in reducing seizure longevity and severity, the role ASICs have in seizure susceptibility in the context of pregnancy or placental ischemia has not been investigated.HypothesisIn this study, we tested the hypothesis that placental ischemia reduces hippocampal ASIC2 expression and that reduced ASIC2 increases seizure severity and longevity in pregnancy.MethodsUtero‐placental ischemia was induced in female C57BL/6 mice by ligating the uterine arteries between the ovaries and the first pup at day 13.5 post coitus. Hippocampi (SHAM=6, RUPP=5) were harvested on day 18.5 and processed for Western blot analysis to assess ASIC2a expression. Using Image Lab software, ASIC2a expression was normalized to total protein on the Western blot. The role of ASIC2 in seizure activity was assessed by inducing seizures using pentylenetetrazol (PTZ, 40mg/kg, i.p.) in pregnant and non‐pregnant ASIC2 wild type (WT) and heterozygous (HET) transgenic mice (n=4–11). After injection, mice were video monitored for 30 minutes. Using Observer XT software, seizure behavior was scored using a modified Racine Scale with scores ranging from 0 to 7, where 0 indicates normal behavior and 7 indicates respiratory arrest. Seizure activity was determined based on the following: latency to first seizure behavior, duration of all seizures, highest seizure severity score, and duration of seizure behavior associated with grand mal seizures (scores 4–7). Unpaired t‐test was used to analyze ASIC2a expression, and 2‐way ANOVA using a Sidak’s multiple comparison test was used to assess seizure behavior (factors: genotype and pregnancy status).ResultsHippocampal ASIC2a expression was reduced in RUPP (0.47±0.088) compared to SHAM (1±0.19; p= 0.021) mice. In WT mice, pregnancy increased latency to first seizure (116±43.3 vs 50±10.5s; p=0.057), decreased seizure duration (1026±142 vs.1643±44s; p=0.053), and decreased duration of grand‐mal associated seizure scores (23.5±23.5 vs1092±205s; p=0.018) compared to non‐pregnant mice. There was no effect of pregnancy on any of the seizure activity measures within the HET mice (p&gt;0.05). However, there was a significant increase in duration of grand‐mal associated seizures in HET (1065±238s) vs WT pregnant mice (23.5±23.5; p=0.038). No significant difference in highest seizure severity score or survival was observed with pregnancy or reduced ASIC2.ConclusionOur finding of reduced hippocampal ASIC2 in placental ischemic mice and the absence of improved seizure latency and severity with pregnancy in HET mice, support the hypothesis that reduced ASIC2 contributes to increased seizure severity and longevity in placental ischemia.SignificanceASIC2a is a potential novel therapeutic target for the treatment of seizures in pregnancy as occurs in eclampsia.Support or Funding InformationNIH R00HL129192 and R00HL129192‐S1

Impact of maintenance rituximab on duration of response in primary central nervous system lymphoma.

The role of maintenance immunotherapy with anti-CD20 monoclonal antibody rituximab in primary central nervous system lymphoma (PCNSL) is unclear. We retrospectively reviewed the medical records of all immunocompetent adults with newly diagnosed PCNSL treated at our institution between1996 and 2017. We identified 66 patients who attained complete response (CR) after completion of first-line regimen; 20 received maintenance therapy (maintenance therapy group) and 46 were observed with serial MRI scans without maintenance therapy (no-maintenance therapy group). Compared to the surveillance group, there was a significant increase in duration of survival (HR 0.27, 95% CI 0.08-0.98, P = 0.046) in the maintenance therapy group while the reduction in the risk of progression was not significant (HR: 0.61, 95% CI 0.26-1.43, P = 0.259). We are evaluating the effectiveness of maintenance immunotherapy in PCNSL in a prospective multicenter randomized clinical trial.

Blood transfusion and lung surgeries in pediatric age group: A single center retrospective study.

Background:Blood transfusion is not without harm, and recent studies suggest association between transfusion and poor outcome in critically ill patients. Although it is prescribed for many reasons based on the firm belief that blood transfusion improves oxygen carrying capacity, it carries notable adverse hazards. Importantly, lung surgeries are counted as moderate to high-risk operations and take a significant risk of blood loss.Aim:This study aims to reveal the association between blood transfusion and poor clinical outcomes and characterize the epidemiology of blood transfusion after pediatric chest surgery.Settings and Design:Retrospective cohort study, done throughout 3 years.Materials and Methods:A total of 248 patients who underwent open thoracotomy and lung surgery and aged ≤18 years were classified according to the need of intraoperative or postoperative blood transfusion into two groups: Group I (non-transfused = 130) and Group II (transfused = 118).Statistical Analysis:SPSS v25 was used for analysis.Results:Transfusion probability ranged between 42.8% and 50% according to type of surgery. As regard to postoperative variables, there was no significant difference between both groups regarding the duration of analgesia, allergic reactions, need of re-operation and in-hospital mortality. However, transfused group showed significant increase in duration of antibiotic, persistent postoperative fever, time to remove chest drains, ICU stays, hospital stay and pneumonia. Incidence of pneumonia had a relative risk 1.82 with transfused compared to non-transfused group.Conclusion:Transfusion group in pediatrics undergoing lung surgeries in our study was more prone to adverse outcomes such as pneumonia, delayed time to remove chest drains, prolonged ICU stay, and hospital stay.

Evaluating the potential of drug eluting contact lenses for treatment of bacterial keratitis using an ex vivo corneal model.

Corneal infections are treated by multiple instillations of eye drops each day. This study aims to investigate the effectiveness of ofloxacin-loaded contact lenses as prolonged release devices for the treatment of bacterial keratitis. Two silicone hydrogel contact lenses (SHCLs) Senofilcon A (ACUVUE OASYS®) and Narafilcon A (ACUVUE TRUEYE®) were modified by incorporation of ofloxacin alone or with vitamin E (VE). The drug uptake and in vitro release kinetics were investigated and the antibacterial efficacy was assessed against Staphylococcus aureus and Pseudomonas aeruginosa in an ex vivo rabbit corneal model. The in vitro studies showed a higher uptake (p ≤ 0.05) and longer duration of release by Narafilcon A lenses compared to the Senofilcon A lenses. The addition of VE led to a significant increase in duration of release (p < 0.05) for both lenses. The ex vivo studies confirmed the effectiveness of the ofloxacin-loaded lenses in the reduction of bacterial load to clinically insignificant levels and ofloxacin-vitamin E-loaded Narafilcon A lenses in the reduction of bacteria on the corneas to undetectable levels. Antibiotic-loaded lenses are effective in the treatment of ocular infections. Incorporation of vitamin E will sustain this effect and eliminate the need for multiple instillations of eye drops.

Association between adenosine receptor gene polymorphism and response to caffeine citrate treatment in apnea of prematurity; An Egyptian single-center study

BackgroundCaffeine citrate is the methyl-xanthine of choice used in controlling apnea of prematurity (AOP). Caffeine central effect is mediated via non-selective (A1) and selective (A2a) adenosine receptors antagonism. Variability in caffeine response had been frequently noticed in AOP, suggesting underlying genetic predisposition. Aim of the studyWe evaluated the role of adenosine receptor A1 [ADORA1] and adenosine receptor A2a [ADORA2a] gene polymorphisms in the variability of caffeine response among Egyptian preemies with AOP. Patient and methodsIn this case-control study, 43 preterm neonates with AOP were eligible as cases and 43 preterm babies free from apnea were taken as controls. Preterm neonates with AOP were further divided according to response to caffeine treatment into caffeine responder (n = 18) and caffeine non-responders (n = 25). ADORA1 [716 T > G] and ADORA2a [1976C > T] gene polymorphisms were genotyped by mean of PCR-based RFLP-assay. ResultsThere were significant increase in frequency distribution of ADORA2a [1976C > T] CT (62.7% vs 23.3%), TT (14% vs 4.7%) genotypes and T allele (34.3% vs 16.3%) in cases compared to controls with significant increased risk of AOP development with OR (95%CI); P-value of 8.37(3.03–23.1), P = 0.000; 9.3(1.61–53.61), P = 0.005 and 4.27(2.09–8.70), P = 0.000 respectively. Further, caffeine non-responders were associated with significant increase frequency of ADORA2a CT (80% vs 38.9%) and TT (16% vs 11.1%) genotypes and T allele (56% vs 30.6%) with OR (95%CI) and P-value of 21.38 (2.31–197.8), P = 0.001; 18 (1.24–260.9); P = 0.005 and 2.89(1.17–7.13), P = 0.019 respectively, when compared to caffeine responders. Patients with AOP who had ADORA2a CT and TT genotypes were associated with significant increase in duration of hospital stay and poor outcome. Genotype distribution frequency of studied polymorphisms did not deviate from Hardy Weinberg (HW) equilibrium among controls. ConclusionADORA2a [1976C > T] polymorphism has a significant role in AOP development and variation in caffeine response among preterm babies.