Treatment outcomes in the inpatient management of severe functional neurological disorder: a retrospective cohort study.

Functional neurological disorder (FND) is a heterogeneous condition; severe forms can be disabling. Multidisciplinary treatment and rehabilitation are recommended for severe FND, but there remains a lack of evidence for its efficacy and lack of understanding of the predictors and components of recovery. We report clinical outcome data for an inpatient cohort with severe FND. Clinical Global Impression Improvement with treatment is the primary outcome measure. Admission and discharge measures (Euroqol quality of life measures, Beck Depression Inventory, Spielberger Trait Anxiety Inventory, Cambridge Depersonalisation Scale, Illness Perception Questionnaire (Revised) and Functional Mobility Scale) are reported as secondary outcomes. We describe an FND cohort (n=52) with chronic illness (mean symptom duration 9.7 years). At admission, there were clinically relevant levels of depression, anxiety and depersonalisation derealisation. At the time of discharge, most (43/52) patients' global condition had improved. Measures of mobility, depression and quality of life also significantly improved while at discharge, symptoms were experienced as more understandable and less distressing than at admission. An admission measure of patient confidence in treatment was predictive of eventual clinical outcome. The most frequent outcome of inpatient rehabilitation is global improvement, even when symptoms are chronic and severe, reflected in measurable changes in both physical and psychological functioning. Significant levels of depersonalisation derealisation seen in this patient group suggest that routine enquiry into such experiences could help personalise FND treatment approaches. Patient confidence in treatment is key in determining clinical outcomes. [Abstract copyright: © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Monolithes de silice et de carbone à porosité hiérarchisée obtenus par frittage SPS

La silice SBA-15 et le carbone CMK-3 possèdent une grande surface spécifique et un volume important de mésopores ordonnés dans une symétrie hexagonale (groupe d’espace p6 mm). Il est nécessaire de préserver leurs caractéristiques lors de la mise en forme de ces matériaux, pour un grand nombre d’applications. Le frittage SPS (Spark Plasma Sintering) des poudres a été effectué sans charge ou avec une charge uniaxiale de 25 MPa et à des températures de 600 à 800 ◦C pour la silice et 1100 à 1300 ◦C pour le carbone, pendant 5 minutes. Les isothermes d’adsorption/désorption d’azote montrent que les monolithes obtenus conservent une surface spécifique élevée (300 à 500 m2/g) et un volume mésoporeux de l’ordre de 0,7 cm3/g. La coexistence de la mésoporosité et d’une macroporosité interconnectée de volume voisin est observée par MEB (Microscopie Électronique à Balayage) et MET (Microscopie Électronique en Transmission). En outre, l’organisation de la mésoporosité est partiellement maintenue comme le mettent en évidence la DRX (Diffraction des Rayons X) et la MET

Avaliação do impacto dos cruzamentos Bos taurus x Bos indicus e tecnologias post mortem na qualidade gustativa de lombos de novilhos terminados a pasto

This experiment aimed to evaluate the effects of Brahman crossbreeding and postmortem technologies (electrical stimulation and vacuum aging) on eating quality of loins from pasture-finished bulls. Fifty yearling bulls representing five Brahman-influenced types (n = 10 each): Brahman (BRAH), F1-Angus (F1ANG), F1-Chianina (F1CHI), F1-Romosinuano (F1ROM), and F1-Simmental (F1SIM) were supplemented on pasture until reaching a desirable conformation at a suitable live weight of ca. 480 kg. All carcasses were classified as “Bullocks” according to U.S. standards. Carcass’s right sides were subjected to high-voltage electrical stimulation (ES) while the left sides were not stimulated (NOES). Longissimus lumborum (LL) steaks from ES and NOES carcasses were allotted either to the vacuum aging control treatment for 2 d (NOAGING) or 10 d (AGING).  LL steaks were evaluated for Warner-Bratzler shear force (WBSF) and sensory traits by trained panelists. No differences in WBSF, juiciness, or flavor ratings were detected among breed types (P > 0.05). Sensory ratings for tenderness-related traits varied little with breed type (P < 0.05). Steaks from F1ANG received higher ratings for muscle fiber tenderness, overall tenderness, and amount of connective tissue, and differed (P < 0.05) from those of F1ROM and F1SIM which received the lowest ratings. Bullock loins were more responsive to ES+AGING in WBSF reduction and desirable tenderness ratings than other postmortem treatments (P < 0.05) by reaching a greater proportion (72%) of “tender” (WBSF < 40.1 N) steaks than AGING (48%), ES (36%), and NOES-NOAGING (24%) samples (P < 0.01). Tenderness of bullock loin steaks is marginally improved by crossbreeding; therefore, the application of ES+AGING is necessary to ensure a higher proportion of tenderloin steaks.Se evaluaron los efectos de cruzamientos interraciales y tecnologías postmortem sobre la calidad gustativa de lomos de toros terminados a pasto.  Cincuenta toros añosos representando cinco tipos raciales (n = 10 cada uno): Brahman puro (BRAH), F1-Angus (F1ANG), F1-Chianina (F1CHI), F1-Romosinuano (F1ROM) y F1-Simmental (F1SIM) se suplementaron a pastoreo hasta alcanzar una conformación satisfactoria a un peso vivo de ca. 480 kg. Todas las canales clasificaron como “Bullocks” (Toretes) por la norma estadounidense. Los lados derechos de cada canal se sometieron a estimulación eléctrica de alto voltaje (ES) mientras que los lados izquierdos no fueron estimulados (NOES).  Bistés de longissimus lumborum ES y NOES se asignaron a tratamientos de maduración al vacío por 2 d (NOMADURADOS) ó 10 d (MADURADOS). Los bistés se evaluaron para fuerza de corte Warner-Bratzler (FCWB) y rasgos sensoriales calificados por panelistas capacitados. No se detectaron diferencias en valores FCWB, o calificaciones para jugosidad o intensidad de sabor entre tipos raciales (P > 0.05).  Los rasgos relacionados con terneza variaron poco con el tipo racial (P < 0.05). Los bistecs de F1ANG recibieron calificaciones más altas para terneza de fibra muscular, terneza general y cantidad de tejido conectivo, y difirieron (P < 0.05) de los F1ROM y F1SIM, que recibieron las calificaciones más bajas. Los bistés ES+MADURADOS tuvieron menor FCWB y mayores calificaciones para rasgos asociados con la terneza que los ES ó los MADURADOS (P < 0.05) alcanzando una mayor proporción (72%) de "bistés tiernos" (FCWB < 40.1 N) que la de MADURADOS (48%), ES (36%) y NOES-NOMADURADOS (24%) (P < 0.01). La mejora en terneza de lomos de toretes Brahman mediante cruzamiento con razas taurinas es marginal; por lo tanto, se requiere aplicar el tratamiento combinado de ES y maduración al vacío para asegurar una proporción mayor de bistés tiernos.Foram avaliados os efeitos de cruzamentos interraciais e tecnologias postmortem na qualidade do sabor de lombos de touros terminados a pasto. Cinquenta touros envelhecidos representando cinco tipos de raça (n = 10 cada): Brahman puro (BRAH), F1-Angus (F1ANG), F1-Chianina (F1CHI), F1-Romosinuano (F1ROM) e F1-Simmental (F1SIM) foram suplementados. pastado com uma conformação satisfatória com um peso vivo de ca. 480kg Toda as carcaças classificadas como “Boi” (Toretes) pela norma americana. Os lados direitos de cada canal foram submetidos à estimulação elétrica de alta voltagem (ES), enquanto os lados esquerdos não foram estimulados (NOES). Bifes ES e NOES longissimus lumborum foram submetidos a tratamentos de maturação a vácuo por 2 d (NOMATURED) ou 10 d (MATURED). Os bifes foram avaliados quanto à resistência ao cisalhamento Warner-Bratzler (FCWB) e características sensoriais avaliadas por provadores treinados. Não foram detectadas diferenças nos valores de FCWB, ou classificações de suculência ou intensidade de sabor entre os tipos de raça (P > 0,05). As características relacionadas à ternura variaram pouco com o tipo de raça (P < 0,05). Os bifes F1ANG receberam pontuações mais altas para maciez da fibra muscular, maciez geral e quantidade de tecido conjuntivo, e diferiram (P <0,05) do F1ROM e F1SIM, que receberam as pontuações mais baixas. Os bifes ES + MADUROS apresentaram menor FCWB e maiores classificações para características associadas à maciez do que os bifes ES ou MATURADOS (P < 0,05), atingindo uma proporção maior (72%) de "bifes macios" (FCWB < 40,1 N) do que os bifes MATURADOS (48 %), ES (36%) e NOES-NOMATURADO (24%) (P < 0,01). A melhora na maciez dos lombos de touros Brahman pelo cruzamento com raças tauromáquicas é marginal; portanto, o tratamento combinado de ES e envelhecimento a vácuo é necessário para garantir uma maior proporção de bifes macios

Acetylcholine induces fibrogenic effects via M2/M3 ACh receptors in NASH and in primary human hepatic stellate cells

BACKGROUND: The parasympathetic nervous system (PNS), via neurotransmitter Acetylcholine (ACh), modulates fibrogenesis in animal models. However, the role of ACh in human hepatic fibrogenesis is unclear. AIMS: We aimed to determine the fibrogenic responses of human hepatic stellate cells (hHSC) to ACh and the relevance of the PNS in hepatic fibrosis in patients with non-alcoholic steatohepatitis (NASH). METHODS: Primary hHSC were analysed for synthesis of endogenous ACh and acetylcholinesterase (AChE), and gene expression of choline acetyltransferase (ChAT) and muscarinic acetylcholine receptors (mAChR). Cell proliferation and fibrogenic markers were analysed in hHSC exposed to ACh, Atropine (Atrop), Mecamylamine (Mec), methoctramine and 4-Diphenylacetoxy-N-methylpiperidine methiodide (4-DAMP). MAChR expression was analysed in human NASH scored for fibrosis. RESULTS: We observed that hHSC synthesise ACh and AChE, and express ChAT and M1-M5 mAChR. We also show that M2 was increased during NASH progression, while both M2 and M3 were found upregulated in activated hHSC. Furthermore, endogenous ACh is required for hHSC basal growth. Exogenous ACh resulted in hHSC hyperproliferation via mAChR and PI-3 K and MEK signalling pathways, as well as increased fibrogenic markers. CONCLUSION: We show that ACh regulates hHSC activation via M2 and M3 mAChR involving the PI-3 K and MEK pathways in vitro. Finally, we provide evidence that the PNS may be involved in human NASH fibrosis

Preliminary observations on carcass traits and meat yield of five types of Brahman-influenced grass-fed bulls

Benefiting from interventions of the savanna ecosystem, breeders in Los Llanos of Apure State (Venezuela) are exploring the opportunity to improve cattle genetics by implementing crossbreeding programs.  Fifty yearling bulls of five types of Brahman influence [ST-Brahman (n = 10), F1 Angus x Brahman (F1-Angus; n = 10), F1 Chianina x Brahman (F1-Chianina; n = 10), F1 Romosinuano x Brahman (F1-Romosinuano; n = 10), and F1 Simmental x Brahman (F1-Simmental; n = 10)] were selected to be compared in carcass performance (linear measurements, quality and quantity indicators, Venezuelan and U.S. grades, and cutability) at a desirable conformation endpoint with a suitable market weight of 480 kg.  Shorter ST-Brahman carcasses exhibited the most abundant finish, significantly different from the longer F1-Simmental and F1-Romosinuano counterparts.  All carcasses fell into the A youngest maturity and were eligible for the USDA "Bullock “class designation; 62% reached the top Venezuelan quality grade, 96% graded US Standard and 64% reached the US yield grade 1, indicating superior cutability. Significant differences in yield of individual cuts (ribeye + strip loin, and cuts from the round) were detected between F1-Romosinuano and St-Brahman, F1-Angus and F1-Chianina counterparts.  F1-Chianina bulls had slight but significant advantages in yield of high-valued boneless cuts as compared to those of F1-Romosinuano and F1-Simmental counterparts. Conversely, F1-Romosinuano outperformed F1-Chianina in 1.73 percentage points of medium-valued boneless cuts (P < 0.05).  Under the sample selection criteria and harvest endpoint, slight changes in carcass performance can be expected from crossbreeding.Con intervenciones del ecosistema sabana y aplicando un manejo adecuado de los pastos, ganaderos de Los Llanos del Estado Apure (Venezuela) estan explorando mejorar la genética del ganado con programas de cruzamiento.  Cincuenta machos enteros añosos de cinco tipos raciales con influencia Brahman [Brahman puro (n = 10), F1 Angus x Brahman (F1-Angus; n = 10), F1 Chianina x Brahman (F1-Chianina; n = 10), F1 Romosinuano x Brahman (F1-Romosinuano; n = 10) y F1 Simmental x Brahman (F1-Simmental; n = 10)] se compararon en desempeño de la canal (mediciones lineales, indicadores de calidad y cantidad, categorías de clasificación y rendimiento carnicero) a un punto final de conformación deseable con un peso corporal aproximado de 480 kg.  Canales más cortas de Brahman puros exhibieron acabado más abundante, diferente (P<0.05) de las contrapartes más largas F1-Simmental y F1-Romosinuano.  Todas las canales cayeron en la madurez más joven (A) y fueron elegibles para la designación de clase "Bullock" del USDA; el 62% alcanzó el grado de calidad superior venezolano (categoría A), el 96% calificó en el grado de calidad Standard y el 64% alcanzó el grado máximo de rendimiento carnicero (grado 1 USDA).  Los toretes F1-Chianina tuvieron ventajas leves pero significativas en rendimiento en cortes deshuesados de alto valor, en comparación con los de F1-Romosinuano y F1-Simmental.  Por el contrario, F1-Romosinuano superó a F1-Chianina en 1,73 puntos porcentuales de cortes deshuesados de valor medio (P <0.05).  Bajo los criterios de selección de la muestra y el punto final de la cosecha, no se pueden esperar grandes cambios en el rendimiento carnicero a partir del cruzamiento.Com o uso de tecnologias em um ecossistema de savana e aplicando um manejo adequado das pastagens, os criadores de Los Llanos do Estado de Apure (Venezuela) estão tentando melhorar a genética do gado através da utilização de programas de cruzamento.  Cinquenta bovinos machos não castrados, com peso de abate de ~480 kg, de cinco cruzamentos com Brahman [Brahman puro (n = 10), F1 Angus x Brahman (F1-Angus; n = 10), F1 Chianina x Brahman (F1-Chianina; n = 10), F1 Romosinuano x Brahman (F1-Romosinuano; n = 10) e F1 Simental x Brahman (F1-Simental; n = 10)], foram comparados quanto às características (medidas lineares, indicadores de qualidade e quantidade e rendimento de desossa) y tipificacao de carcaça.    Carcaças de Brahman puros apresentaram maior cobertura de gordura do que carcaças de animais F1-Simmental e F1-Romosinuano (P<0.05).  Todas as carcaças foram com maturidade “A” (jovem / Bullock), sendo que 96% se qualificaram no grau de qualidade USDA “Standard” e 64% alcançaram o grau máximo de rendimento de desossa (grau 1).  Pelo padrão venezuelano, 62% das carcaças alcançaram o grau de qualidade superior (categoria A).  Diferenças significativas foram detectadas no rendimento de cortes individuais (filé de costela e contrafilé e cortes do coxão) entre carcaças de F1-Romosinuano e F1-Simental e F1-Angus e F1-Chianina. Carcaças de F1-Chianina apresentaram maiores rendimentos em cortes desossados de alto valor em comparação com F1-Romosinuano e F1-Simmental.  Carcaças de F1-Romosinuano tiveram 1,73 pontos percentuais a mais de rendimento em cortes desossados de valor intermediário, que carcaças de F1-Chianina (P <0,05). Segundo os critérios de seleção da amostra e o ponto final de abate, não se podem esperar grandes mudanças na qualidade e rendimento das carcaças de diferentes cruzamentos. &nbsp