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https://www.readbyqxmd.com/read/28937345/practical-implications-of-the-minimally-conscious-state-diagnosis-in-adults
#1
Karola V Kreitmair, Katherine E Kruse
This article addresses questions surrounding the minimally conscious state (MCS) from the perspective of adult clinical ethics. It describes the background of the MCS diagnosis, analyzes phenomenological ambiguities inherent in the nature of MCS, and raises epistemological concerns surrounding its diagnosis. It argues that in many cases, the burdens of prolonging treatment for people who have sustained certain severe brain injuries (SBI) outweigh the benefits, even if they are in or have the prospect of entering into MCS...
October 2017: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
https://www.readbyqxmd.com/read/28936641/empathy-and-the-aesthetic-why-does-art-still-move-us
#2
Despina Stamatopoulou
In this article I will argue for the affective-motivation (background affective attitude or orientation) hypothesis that incubates the aesthetic experience and sets the deep frame of our engagement with art. For this, I look at these microgenetic-early passages of (a) affective perception as mapped into the early emergence of tertiary qualities that underlie a sensorimotor synchronization-a coupling of action, emotion and perception via mirroring that result in dynamic embodied anticipatory control and a feeling of proximity/connectedness and (b) developmental passages that are characterized by spatiotemporal coordination and proximity of the self-other/interactive object and thus structure intentionality, shape experience, in an engaging world of action potentialities forming a background affective attitude...
September 21, 2017: Cognitive Processing
https://www.readbyqxmd.com/read/28934895/high-early-fluid-input-after-aneurysmal-subarachnoid-hemorrhage-combined-report-of-association-with-delayed-cerebral-ischemia-and-feasibility-of-cardiac-output-guided-fluid-restriction
#3
Leonie J M Vergouw, Mohamud Egal, Bas Bergmans, Diederik W J Dippel, Hester F Lingsma, Mervyn D I Vergouwen, Peter W A Willems, Annemarie W Oldenbeuving, Jan Bakker, Mathieu van der Jagt
BACKGROUND: Guidelines on the management of aneurysmal subarachnoid hemorrhage (aSAH) recommend euvolemia, whereas hypervolemia may cause harm. We investigated whether high early fluid input is associated with delayed cerebral ischemia (DCI), and if fluid input can be safely decreased using transpulmonary thermodilution (TPT). METHODS: We retrospectively included aSAH patients treated at an academic intensive care unit (2007-2011; cohort 1) or managed with TPT (2011-2013; cohort 2)...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28918680/transcranial-direct-current-stimulation-in-disorders-of-consciousness-a-review
#4
Ye Zhang, Weiqun Song
It is a challenge to evaluate and treat the patients with disorders of consciousness (DOC) in the clinic. Due to the huge costs of prolonged intensive care, the management of these patients raises great financial strain on families and important ethical questions. To date, several studies have attempted to specifically detect pharmacologic or non-pharmacologic effectiveness, until now there were no evidence-based guidelines about the treatment of patients with DOC. Recently, because of ethical and procedural limitations on the use of invasive stimulation techniques, non-invasive brain stimulation, such as the transcranial direct current stimulation (tDCS), has been investigated for improving the level of consciousness in patients with DOC...
September 18, 2017: International Journal of Neuroscience
https://www.readbyqxmd.com/read/28902713/long-lasting-repetitive-transcranial-magnetic-stimulation-modulates-electroencephalography-oscillation-in-patients-with-disorders-of-consciousness
#5
Xiaoyu Xia, Yang Liu, Yang Bai, Ziyuan Liu, Yi Yang, Yongkun Guo, Ruxiang Xu, Xiaorong Gao, Xiaoli Li, Jianghong He
Repetitive transcranial magnetic stimulation (rTMS) has been applied for the treatment of patients with disorders of consciousness (DOC). Timely and accurate assessments of its modulation effects are very useful. This study evaluated rTMS modulation effects on electroencephalography (EEG) oscillation in patients with chronic DOC. Eighteen patients with a diagnosis of DOC lasting more than 3 months were recruited. All patients received one session of 10-Hz rTMS at the left dorsolateral prefrontal cortex and then 12 of them received consecutive rTMS treatment everyday for 20 consecutive days...
September 11, 2017: Neuroreport
https://www.readbyqxmd.com/read/28901969/disorders-of-consciousness-after-severe-brain-injury-therapeutic-options
#6
Caroline Schnakers, Martin M Monti
PURPOSE OF REVIEW: Very few options exist for patients who survive severe traumatic brain injury but fail to fully recover and develop a disorder of consciousness (e.g. vegetative state, minimally conscious state). RECENT FINDINGS: Among pharmacological approaches, Amantadine has shown the ability to accelerate functional recovery. Although with very low frequency, Zolpidem has shown the ability to improve the level of consciousness transiently and, possibly, also in a sustained fashion...
September 9, 2017: Current Opinion in Neurology
https://www.readbyqxmd.com/read/28898867/cerebral-fat-embolism-clinical-presentation-diagnostic-steps-and-long-term-follow-up
#7
Juliane Dunkel, Christian Roth, Frank Erbguth, Wenke Dietrich, Monika Hügens-Penzel, Andreas Ferbert
OBJECTIVE: Symptomatic cerebral fat embolism (CFE) is a rare complication that occurs after a traumatic injury or orthopaedic surgery and is diagnostically challenging. No data is currently available concerning long-term follow-up. METHODS: We identified from medical records 9 patients with CFE and revised the clinical signs and the diagnostic process. We then analysed long-term follow-up data, targeting clinical course after discharge, neurological impairment, and current quality of life, using the Barthel index and the modified Rankin Scale...
2017: European Neurology
https://www.readbyqxmd.com/read/28892566/brain-heart-interactions-reveal-consciousness-in-non-communicating-patients
#8
Federico Raimondo, Benjamin Rohaut, Athena Demertzi, Melanie Valente, Denis Engemann, Moti Salti, Diego Fernandez Slezak, Lionel Naccache, Jacobo D Sitt
Objective We here aimed at characterizing heart-brain interactions in patients with disorders of consciousness. We tested how this information impacts data-driven classification between unresponsive and minimally conscious patients. Methods A cohort of 127 patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS, n=70) and minimally conscious state (MCS, n=57) were presented with the 'Local-Global' auditory oddball paradigm, which distinguishes two levels of processing: short-term deviation of local auditory regularities and global long-term rule violations...
September 11, 2017: Annals of Neurology
https://www.readbyqxmd.com/read/28872596/survey-of-veterinarians-using-a-novel-physical-compression-squeeze-procedure-in-the-management-of-neonatal-maladjustment-syndrome-in-foals
#9
Monica Aleman, Kalie M Weich, John E Madigan
Horses are a precocious species that must accomplish several milestones that are critical to survival in the immediate post-birth period for their survival. One essential milestone is the successful transition from the intrauterine unconsciousness to an extrauterine state of consciousness or awareness. This transition involves a complex withdrawal of consciousness inhibitors and an increase in neuroactivating factors that support awareness. This process involves neuroactive hormones as well as inputs related to factors such as cold, visual, olfactory, and auditory stimuli...
September 5, 2017: Animals: An Open Access Journal From MDPI
https://www.readbyqxmd.com/read/28870587/the-value-of-midbrain-morphology-in-predicting-prognosis-in-chronic-disorders-of-consciousness-a-preliminary-ultrasound-study
#10
Antonino Chillura, Antonino Naro, Katia Micchia, Alessia Bramanti, Placido Bramanti, Rocco Salvatore Calabrò
Transcranial sonography (TCS) of the brainstem is currently used to support the clinical diagnosis of movement disorders. The aim of the study was to assess the usefulness of midbrain TCS in assessing outcome in patients with Chronic Disorders of Consciousness (DOC). Eleven patients with Minimally Conscious State (MCS) and Unresponsive Wakefulness Syndrome (UWS) were included in the study. We measured the area and echogenicity of the midbrain by encoding and digitally analyzing the corresponding images from the orbitomeatal plane, the morphology of brain parenchyma from the thalamic and cella media plane, and the intracranial circulation...
September 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28852014/anesthetic-alterations-of-collective-terahertz-oscillations-in-tubulin-correlate-with-clinical-potency-implications-for-anesthetic-action-and-post-operative-cognitive-dysfunction
#11
Travis J A Craddock, Philip Kurian, Jordane Preto, Kamlesh Sahu, Stuart R Hameroff, Mariusz Klobukowski, Jack A Tuszynski
Anesthesia blocks consciousness and memory while sparing non-conscious brain activities. While the exact mechanisms of anesthetic action are unknown, the Meyer-Overton correlation provides a link between anesthetic potency and solubility in a lipid-like, non-polar medium. Anesthetic action is also related to an anesthetic's hydrophobicity, permanent dipole, and polarizability, and is accepted to occur in lipid-like, non-polar regions within brain proteins. Generally the protein target for anesthetics is assumed to be neuronal membrane receptors and ion channels, however new evidence points to critical effects on intra-neuronal microtubules, a target of interest due to their potential role in post-operative cognitive dysfunction (POCD)...
August 29, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28831314/surgery-averted-using-a-novel-minimally-invasive-approach-to-treat-very-severe-radial-artery-spasm
#12
Anthony A Cochet, Daniel A Bellin
A 42-year-old male admitted with a non-ST elevation myocardial infarction was referred for invasive angiographic assessment. Based on preprocedural assessment, the right radial artery approach was selected. Despite possessing none of the consensus risk factors for radial artery spasm, in addition to receiving standard arterial spasm prophylaxis and conscious sedation, the patient suffered very severe radial artery spasm with initial catheter placement, resulting in entrapment of a 5 Fr pigtail catheter within the left ventricle...
2017: Case Reports in Cardiology
https://www.readbyqxmd.com/read/28828002/corrigendum-frontal-connectivity-in-eeg-gamma-30-45-hz-respond-to-spinal-cord-stimulation-in-minimally-conscious-state-patients
#13
Yang Bai, Xiaoyu Xia, Zhenhu Liang, Yong Wang, Yi Yang, Jianghong He, Xiaoli Li
[This corrects the article on p. 177 in vol. 11, PMID: 28701924.].
2017: Frontiers in Cellular Neuroscience
https://www.readbyqxmd.com/read/28826983/impact-of-a-stay-in-the-intensive-care-unit-on-the-preparation-of-advance-directives-descriptive-exploratory-qualitative-study
#14
Pascal Andreu, Auguste Dargent, Audrey Large, Nicolas Meunier-Beillard, Sandrine Vinault, Uriel Leiva Rojas, Fiona Ecarnot, Sébastien Prin, Pierre-Emmanuel Charles, Isabelle Fournel, Jean-Philippe Rigaud, Jean-Pierre Quenot
BACKGROUND: Our objective was to assess, through a qualitative, exploratory study, the thought processes of patients regarding the formulation of Advance Directives (AD) after a stay in the ICU. METHODS: Study performed from May to July 2016 using telephone interviews performed by four senior ICU physicians. Inclusion criteria were: patients discharged from ICU to home >3 months previously. Semi-directive interviews with patients focused on 5 main points surrounding AD...
August 4, 2017: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/28826583/successful-resection-of-a-growing-distal-medial-lenticulostriate-artery-pseudoaneurysm-presenting-with-isolated-intraventricular-hemorrhage
#15
Yosuke Sato, Kazuhiro Ando, Makoto Kawaguchi, Kenichi Kakinuma
INTRODUCTION: Distal medial lenticulostriate artery (LSA) aneurysms associated with isolated intraventricular hemorrhage (IVH) are extremely rare. We report a very rare case of the isolated IVH due to the rupture of the distal medial LSA pseudoaneurysm that was not visible at the initial angiography but later emerged and grew. CASE REPORT: A 61-year-old woman with a history of hypertension had sudden onset of severe headache and mild consciousness disturbance. The computed tomography scan revealed the IVH, but the initial angiographies showed no evidence of aneurysm...
August 17, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28819796/simultaneous-eeg-pet-fmri-measurements-in-disorders-of-consciousness-an-exploratory-study-on-diagnosis-and-prognosis
#16
Daniel Golkowski, Katharina Merz, Caroline Mlynarcik, Tobias Kiel, Barbara Schorr, Alex Lopez-Rolon, Mathias Lukas, Denis Jordan, Andreas Bender, Rüdiger Ilg
Previous studies could demonstrate that functional magnetic resonance imaging (fMRI), fludeoxyglucose positron emission tomography (FDG-PET), and electroencephalography (EEG) measures contain information about patients suffering from disorders of consciousness (DOC) and thus improve the clinical diagnosis. Additionally, the technical modalities were able to predict the outcome of patients. However, most studies lack proven reproducibility in a clinical setting. We here applied a standardized combined EEG/fMRI/FDG-PET measurement to a cohort of 20 patients suffering from DOC and focused on parameters that have been demonstrated to contain information about diagnosis and prognosis of these patients...
August 17, 2017: Journal of Neurology
https://www.readbyqxmd.com/read/28814181/full-mouth-intraoral-radiographic-survey-in-rabbits
#17
Adriana Regalado, Loïc Legendre
Dental pathologies are highly prevalent in pet rabbit populations, making oral radiography an essential tool in the evaluation of lagomorph dentitions. The unique anatomy of the rabbit's mouth limits the examination of the conscious animal to the rostral portion of it's mouth. In addition, the oral examination of an aradicular hypsodont tooth is restricted to the short coronal fraction of its crown. Erstwhile images obtained by the extraoral technique were once considered the most practical and informative tool in rabbit dentistry; however, limited visualization of the key structures of individual teeth became the major drawback of this technique...
September 2017: Journal of Veterinary Dentistry
https://www.readbyqxmd.com/read/28800340/reducing-the-rate-of-misdiagnosis-in%C3%A2-patients-with-chronic-disorders-of%C3%A2-consciousness-is-there-a-place-for-audiovisual-stimulation
#18
Antonino Naro, Antonino Leo, Rocco Bruno, Antonino Cannavò, Antonio Buda, Alfredo Manuli, Alessia Bramanti, Placido Bramanti, Rocco Salvatore Calabrò
BACKGROUND: The patients with chronic Disorders of Consciousness (DoC) mostly present with extremely challenging differential diagnosis. The advanced analysis of electroencephalographic (EEG) signals induced by brain stimulation paradigms may provide an appropriate approach to differentiate patients with DoC, besides the clinical assessment. OBJECTIVE: This study was performed with an objective of identifying residual brain network perturbations following an innovative, non-invasive audiovisual stimulation protocol, which could be related to behavioral responsiveness in patients with DoC...
August 11, 2017: Restorative Neurology and Neuroscience
https://www.readbyqxmd.com/read/28777724/active-inference-curiosity-and-insight
#19
Karl J Friston, Marco Lin, Christopher D Frith, Giovanni Pezzulo, J Allan Hobson, Sasha Ondobaka
This article offers a formal account of curiosity and insight in terms of active (Bayesian) inference. It deals with the dual problem of inferring states of the world and learning its statistical structure. In contrast to current trends in machine learning (e.g., deep learning), we focus on how people attain insight and understanding using just a handful of observations, which are solicited through curious behavior. We use simulations of abstract rule learning and approximate Bayesian inference to show that minimizing (expected) variational free energy leads to active sampling of novel contingencies...
October 2017: Neural Computation
https://www.readbyqxmd.com/read/28728060/clinical-neurophysiology-of-prolonged-disorders-of-consciousness-from-diagnostic-stimulation-to-therapeutic-neuromodulation
#20
REVIEW
Aldo Ragazzoni, Massimo Cincotta, Fabio Giovannelli, Damian Cruse, G Bryan Young, Carlo Miniussi, Simone Rossi
The identification of signs of awareness in patients with prolonged disorders of consciousness (DoC) after severe brain injury is a challenging task for clinicians. Differentiating on behavioural examination the vegetative state (VS) from the minimally conscious state (MCS) can lead to a high misdiagnosis rate. Advanced neuroimaging and neurophysiological techniques can supplement clinical evaluation by providing physiological evidence of brain activity. However, an open issue remains whether these empirical results are directly or indirectly associated with covert consciousness and limitations emerge for their diagnostic application at the single-patient level...
September 2017: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
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