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Minimally conscious

Michele Torrisi, Adriana Piccolo, Rosaria De Luca, Matteo Berenati, Antonella Olivo, Giuseppa Maresca, Antonino Naro, Rocco Salvatore Calabrò
Disorder of consciousness (DOC) can be either an acute and reversible condition or a chronic condition, including vegetative state or minimally conscious state. Herein, we describe a patient who has unexpectedly recovered consciousness after being in a misdiagnosed vegetative state for a long period. A 63-year-old woman was admitted to our rehabilitation center in vegetative state (Coma Recovery Scale-Revised score, 6) and treated with a standard rehabilitation program, including physical therapy and multisensory stimulation, besides psychoactive drugs...
April 2018: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
Hanna M Butler-Struben, Samantha M Brophy, Nasira A Johnson, Robyn J Crook
Cephalopod molluscs are among the most behaviorally and neurologically complex invertebrates. As they are now included in research animal welfare regulations in many countries, humane and effective anesthesia is required during invasive procedures. However, currently there is no evidence that agents believed to act as anesthetics produce effects beyond immobility. In this study we demonstrate, for the first time, that two of the most commonly used agents in cephalopod general anesthesia, magnesium chloride and ethanol, are capable of producing strong and reversible blockade of afferent and efferent neural signal; thus they are genuine anesthetics, rather than simply sedating agents that render animals immobile but not insensible...
2018: Frontiers in Physiology
Sharon J Parish, Rossella E Nappi, Sheryl Kingsberg
OBJECTIVE: This narrative review strives to give healthcare providers (HCPs) who care for menopausal women better tools and skills to initiate discussions with women about menopause and hormone therapy (HT), communicate complex concepts and data, and promote shared decision-making. METHODS: We review relevant studies on HT, barriers to treatment of menopausal symptoms, and effective communication strategies. We also provide recommendations for communicating with patients about HT based on the medical literature and our own professional experience...
March 5, 2018: Menopause: the Journal of the North American Menopause Society
Alan Y Chiang, Brian D Guth, Michael K Pugsley, C Michael Foley, Jennifer M Doyle, Michael J Engwall, John E Koerner, Stanley T Parish, R Dustan Sarazan
INTRODUCTION: The sensitivity of a given test to detect a treatment-induced effect in a variable of interest is intrinsically related to the variability of that variable observed without treatment and the number of observations made in the study (i.e. number of animals). To evaluate test sensitivity to detect drug-induced changes in myocardial contractility using the variable LVdP/dtmax , a HESI-supported consortium designed and conducted studies in chronically instrumented, conscious dogs using telemetry...
March 2, 2018: Journal of Pharmacological and Toxicological Methods
Gillian Loomes
The right to active participation by disabled people in academic research has been discussed at length in recent years, along with the potential for such research to function as a tool in challenging oppression and pursuing disability rights. Significant ethical, legal and methodological dilemmas arise, however, in circumstances where a disabled person loses the capacity to provide informed consent to such participation. In this article, I consider disability politics and academic research in the context of the Mental Capacity Act (MCA) 2005, which sets out in Anglo-Welsh law the circumstances and requirements for research participation by individuals lacking the capacity to provide informed consent...
March 3, 2018: Journal of Medical Ethics
Tadashi Tsubouchi, Takeshi Kunimatsu, Shinji Tsujimoto, Akihiko Kiyoshi, Yasunori Katsura, Seiko Oku, Kazuhiro Chihara, Yukiko Mine, Toru Yamada, Isao Shimizu, Kiyoko Bando
The pharmacological activity of DSP-6952, a novel compound was investigated, compared to that of clinically efficacious gastrointestinal (GI) prokinetic 5-hydroxytryptamine4 (5-HT4 ) receptor agonists. DSP-6952 had a strong affinity of Ki=51.9nM for 5-HT4(b) receptor, and produced contraction in the isolated guinea pig colon with EC50 of 271.6nM and low intrinsic activity of 57%, similar to tegaserod and mosapride. In the development of the 5-HT4 receptor agonists, cardiovascular risk was deliberately evaluated, because some related prokinetics were reported to cause with cardiovascular adverse events, such as ventricular arrhythmias or ischemia...
March 1, 2018: European Journal of Pharmacology
Berno U H Overbeek, Henk J Eilander, Jan C M Lavrijsen, Raymond T C M Koopmans
Visual pursuit (VP) and visual fixation (VF) have been recognized as the first signs of emerging consciousness and, therefore, are considered indicative of the minimally conscious state (MCS). However, debate exists about their status as they are considered either conscious reactions or reflexes. The aim of this study is to review the evidence of the definition, operationalization, and assessment of VP and VF in unconscious patients. PubMed and EMBASE were searched for relevant papers between May 26, 1994 and October 1, 2016...
February 28, 2018: Journal of Neurology
Eleonora Tobaldini, Edgar Toschi-Dias, Pietro Davide Trimarchi, Nicola Brena, Angela Comanducci, Silvia Casarotto, Nicola Montano, Guya Devalle
OBJECTIVES: Patients with chronic disorders of consciousness (DOC) may show alterations of autonomic function; however, in this clinical population, no data are available on the specific effects of nociceptive stimuli on cardiac autonomic control. Thus, we aimed at investigating the effects of a noxious stimulation on heart rate variability (HRV) in a population of patients with chronic DOC, taking into account different states of consciousness (vegetative state/unresponsive wakefulness syndrome, VS/UWS and minimally conscious state, MCS)...
February 14, 2018: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Emilio Portaccio, Azzurra Morrocchesi, Anna Maria Romoli, Bahia Hakiki, Maria Pia Taglioli, Elena Lippi, Martina Di Renzone, Antonello Grippo, Claudio Macchi
OBJECTIVE: To assess the prognostic utility of the Coma Recovery Scale-Revised (CRS-R) in rehabilitation of patients surviving from severe brain injury. METHODS: In this prospective cohort study, all patients consecutively admitted to an Italian Intensive Rehabilitation Unit, with a diagnosis of unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS) due to acquired brain injury, underwent clinical evaluations using the Italian version of the CRS-R...
February 26, 2018: Brain Injury: [BI]
Iacopo Cappellini, Fabio Picciafuochi, Daniele Ostento, Ginevra Danti, Angelo Raffaele De Gaudio, Chiara Adembri
BACKGROUND: The extensive use of neuromuscular blocking agents (NMBAs) during surgical procedures still leads to potential residual paralyzing effects in the postoperative period. Indeed, neuromuscular monitoring in an intra-operative setting is strongly advocated. Acetylcholinesterase inhibitors can reverse muscle block, but their short half-life may lead to residual curarization in the ward, especially when intermediate or long-acting NMBAs have been administered. Sugammadex is the first selective reversal drug for steroidal NMBAs; it has been shown to give full and rapid recovery of muscle strength, thus minimizing the occurrence of residual curarization...
February 21, 2018: Trials
Antonino Naro, Antonino Chillura, Simona Portaro, Alessia Bramanti, Rosaria De Luca, Placido Bramanti, Rocco Salvatore Calabrò
The assessment of behavioral responsiveness in patients suffering from chronic disorders of consciousness (DoC), including Unresponsive Wakefulness Syndrome (UWS) and Minimally Conscious State (MCS), is challenging. Even if a patient is unresponsive, he/she may be covertly aware in reason of a cognitive-motor dissociation, i.e., a preservation of cognitive functions despite a solely reflexive behavioral responsiveness. The approach of an external stimulus to the peripersonal space (PPS) modifies some biological measures (e...
2018: Frontiers in Neurology
Emilio Portaccio, Azzurra Morrocchesi, Anna Maria Romoli, Bahia Hakiki, Maria Pia Taglioli, Elena Lippi, Martina Di Renzone, Antonello Grippo, Claudio Macchi
OBJECTIVES: to evaluate the prognostic utility of serial assessment on the Coma Recovery Scale-Revised (CRS-R) during the first 4 weeks of intensive rehabilitation in patients surviving from severe brain injury DESIGN: prospective cohort study PARTICIPANTS: Patients consecutively admitted to the Intensive Rehabilitation Unit at the IRCCS Don Gnocchi Foundation (Florence, Italy). Inclusion criteria were diagnosis of unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS) due to acquired brain injury, age older than 18 years...
February 8, 2018: Archives of Physical Medicine and Rehabilitation
Sauid Ishaq, Haleema Sultan, Keith Siau, Toshio Kuwai, Chris J Mulder, Helmut Neumann
Zenker's diverticulum (ZD), or pharyngeal pouch, is an anatomical defect characterized by herniation of the posterior pharyngeal wall through Killian's dehiscence, and may result in dysphagia and regurgitation. Multiple therapeutic modalities including surgery, rigid and flexible endoscopy have been developed to manage ZD. Although surgical management with open and endoscopically assisted techniques have historically been the mainstay of ZD treatment, minimally invasive flexible endoscopic techniques, carried out under conscious sedation, are increasingly favored...
February 9, 2018: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
Antonino Naro, Rocco Salvatore Calabrò, Antonino Leo, Margherita Russo, Demetrio Milardi, Antonino Cannavò, Alfredo Manuli, Antonio Buda, Carmela Casella, Placido Bramanti, Alberto Cacciola, Alessia Bramanti
Advanced functional neuroimaging approaches dealing with motor imagery have disclosed covert cognitive processes in patients with disorders of consciousness (DoC). However, motor impairment and cognitive-motor dissociation can bias such approaches. Fourteen patients with post-traumatic DoC and ten healthy controls (HC) were provided with three motor tasks related to mirror neuron system (MNS) activation (movement observation, movement execution, and passive motor imagery of a movement) while recording electroencephalographic (EEG) metrics [EEG power and Granger Casualty Index (GCI)] to detect residual signs of conscious awareness...
February 7, 2018: Brain Topography
Lionel Naccache
No abstract text is available yet for this article.
February 5, 2018: Brain: a Journal of Neurology
Tim Bayne, Jakob Hohwy, Adrian M Owen
No abstract text is available yet for this article.
February 5, 2018: Brain: a Journal of Neurology
Christina Tan, Larry S Dean
As indications for TAVR continue to grow, experienced centers strive to adopt further minimally invasive techniques and continue to improve outcomes. Meta-analysis of the available data demonstrate that conscious sedation is associated with decreased ICU and hospitalization time, and is not associated with decreased procedural efficacy or safety. Randomized Controlled clinical Trial data will be needed to confirm observational findings suggesting decreased mortality with conscious sedation versus general anesthesia...
February 1, 2018: Catheterization and Cardiovascular Interventions
Emily M Wong, William F Walby, Dennis W Wilson, Fern Tablin, Edward S Schelegle
BACKGROUND: Particulate matter (PM) and ozone (O3) are dominant air pollutants that contribute to development and exacerbation of multiple cardiopulmonary diseases. Mature adults with cardiovascular disease (CVD) are particularly susceptible to air pollution-related cardiopulmonary morbidities and mortalities. OBJECTIVES: The aim was to investigate the biologic potency of ultrafine particulate matter (UFPM) combined with O3 in the lungs of mature adult normotensive and spontaneously hypertensive Wistar-Kyoto rats...
January 31, 2018: Toxicological Sciences: An Official Journal of the Society of Toxicology
Stephanie M Pywell
The two titles of the judgment on which this commentary is based reflect the fact that its scope was wider than resolving the legal matter at issue between two parties. It records the reasons for Jackson J's decision on a set of facts, it clarifies whether legal proceedings were necessary and the form that they should take, and it explains why the Court of Protection appointed a patient's mother as her litigation friend. The case arose from a request for a declaration that it would be lawful to withdraw clinically assisted nutrition and hydration from a woman with Huntingdon's disease who had been in a minimally conscious state for about one year...
January 29, 2018: Medical Law Review
Zuliang Feng, Michael P Feng, David P Feng, Mark J Rice, Carmen C Solórzano
In recent years, the use of robotic-assisted adrenalectomy (RA) has increased; however, many surgeons question its reported higher cost. In this study, we review our experience and strategies to reduce the cost of RA comparing it to Laparoscopic adrenalectomy (LA). Since May of 2010, 122 consecutive patients underwent minimally invasive adrenalectomy (58 RAs and 64 LA) by a high-volume adrenal surgeon at our institution. A cost analysis was performed for RA versus LA. Cost calculations included anesthesia professional fee, procedure time and consumables fees...
January 31, 2018: Journal of Robotic Surgery
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