Nonarteritic Anterior Ischemic Optic Neuropathy and Double Thrombophilic Defect: A New Observation

We report the first case of nonarteritic anterior ischemic neuropathy (NAION) associated with double thrombophilia: protein S deficiency and prothrombin G20210A mutation. A 58-year-old man is presented including the clinical and laboratory findings, cardiovascular profile and thrombophilia screening. The patient presented with 3/10 vision and an inferior altitudinal defect in the right eye. Funduscopic examination of the right eye revealed a hyperemic optic disk with blurred superior optic disk border and sectoral nerve fiber layer edema. Complete blood count, erythrocyte sedimentation rate and C-reactive protein were normal, suggesting a NAION. A workup of cardiovascular risk factors revealed hyperlipidemia, arterial hypertension and high-risk asymptomatic coronary artery disease. Due to the family history of deep vein thrombosis in the patient's daughter, a thrombophilia screening was additionally performed. The results revealed a double thrombophilic defect, namely congenital protein S deficiency and heterozygosity for prothrombin G20210A mutation, which were also identified in the patient's daughter. Anticoagulant warfarin therapy was initiated and the patient underwent a triple bypass surgery. At three-month follow-up, the right optic disk edema had resolved, leaving a pale superior optic nerve head. Visual acuity in the right eye had slightly improved to 4/10; however, the dense inferior altitudinal field defect had remained unchanged. The patient is currently treated with warfarin, atorvastatin, irbesartan and metoprolol. This case suggests that the first line of investigation in all patients with NAION involves assessment of cardiovascular risk factors. However, careful history taking will identify NAION patients who are eligible for additional thrombophilia screening: young patients without vasculopathic risk factors, bilateral or recurrent NAION, idiopathic or recurrent venous thromboembolism (VTE), positive family history of VTE, and VTE in young age or in unusual sites (e.g. cerebral, hepatic, mesenteric, or renal vein)

Μπορούν οι GLP-1 αγωνιστές να χρησιμοποιηθούν ως χημειοθεραπευτικά στη θεραπεία του ηπατοκυτταρικού καρκίνου;

ΕΙΣΑΓΩΓΗ-ΣΚΟΠΟΣ: Ο ηπατοκυτταρικός καρκίνος (ΗΚΚ) είναι ο πέμπτος πιο συχνός καρκίνος και η τέταρτη αιτία θανάτου από καρκίνο παγκοσμίως. Η ευρεία χρήση των GLP-1 αγωνιστών, στη θεραπεία του σακχαρώδη διαβήτη τύπου 2 (ΣΔ2) της στεατοηπατίτιδας (NASH) και της παχυσαρκίας που αποτελούν αναδυόμενους παράγοντες κινδύνου ΗΚΚ, οδήγησε στη συλλογή ενδείξεων περί πιθανής χημειοθεραπευτικής τους δράσης τον ΗΚΚ. Σκοπός της παρούσας συστηματικής βιβλιογραφικής ανασκόπησης είναι να διερευνήσει την ύπαρξη πιθανής αντικαρκινικής επίδρασης των GLP-1 αγωνιστών στην εξέλιξη και τη μεταστατική συμπεριφορά του ΗΚΚ. ΥΛΙΚΟ-ΜΕΘΟΔΟΣ: Διενεργήθηκε αναζήτηση σε διεθνείς βάσεις δεδομένων για την ανεύρεση άρθρων που εξέτασαν την επίδραση των GLP-1 αγωνιστών στο ΗΚΚ, σύμφωνα με τις κατευθυντήριες οδηγίες PRISMA statement (Moher 2010). Βάσει κριτηρίων ένταξης και αποκλεισμού, συγκρεντρώθηκαν 5 εργασίες προς ανασκόπηση, περιλαμβάνουσες in vitro πειράματα σε κύτταρα ηπατώματος και in vivo σε ποντίκια. ΑΠΟΤΕΛΕΣΜΑΤΑ: Οι αγωνιστές GLP-1 ασκούν στατιστικά σημαντική αναστολή του πολλαπλασιασμού των κυττάρων ηπατώματος μέσω των μηχανισμών αυτοφαγίας , γήρανσης και ανοσολογικής νέκρωσης. Ακόμα, αναστέλλουν τη μετανάστευσή τους. Αμφιλεγόμενη είναι η δράση τους στην απόπτωση. Δρουν μέσω αναστολής και ενεργοποίησης σημαντικών μονοπατιών σηματοδότησης που συνδέονται με την ηπατοκαρκινογένεση, με σημαντικότερα αυτά των mTOR,TGF-β και JNK. ΣΥΜΠΕΡΑΣΜΑΤΑ : Από την παρούσα ανασκόπηση φαίνεται οι GLP-1 αγωνιστές ασκούν χημειοθεραπευτική δράση στα κύτταρα ηπατώματος ανθρώπων ή ποντικών, όταν αυτά επωάζονται σε κυτταροκαλλιέργειες, αναστέλλοντας τον πολλαπλασιασμό και τη μετανάστευσή τους. Για τη διευκρίνιση αυτών των ενδείξεων και άρα για την πιθανή τους χρήση σα χημειοθεραπευτικά στο ΗΚΚ, απαιτούνται καλά σχεδιασμένες μελέτες σε ανθρώπους.BACKGROUND-PURPOSE: Ηepatocellular carcinoma (HCC) ranks fifth as cause of cancer and fourth of cancer related death worldwide. Widespread use of GLP-1 agonists, for the treatment of diabetes mellitus type 2 (SD2),steatohepatitis and obesity which are emerging risk factors of HCC, has risen evidence for their potential beneficial use in treating HCC. The purpose of this systematic review is to investigate whether GLP-1 agonists show anticancer effect on development and metastatic attitude of HCC. MATERIAL-METHOD: Search was performed in global data bases for finding papers concerning the effect of GLP-1 agonists in treating HCC, according to the guide lines of PRISMA statement (Moher 2010). Based on inclusion and exclusion criteria, 5 papers were collected for systematic review, including in vitro experiments in hepatocellular carcinoma cell lines and in vivo ones in mice, No studies in patients with HCC were found. RESULTS : GLP-1 agonists show a statistically significant effect on inhibiting the proliferation of hepatocellular carcinoma cell lines, through the mechanisms of autophagy, senescence and immune necrosis. Moreover, they suppress cell migration. The role of apoptosis is controversial. Their action is mediated via activation and inhibition of important signaling pathways, involved in hepatocarcinogenesis, including mTOR, TGF-β and JNK. CONCLUSIONS: This review indicates that GLP-1 agonists exhibit antitumor effect on hepatocellular carcinoma cell lines, when they grow in cultures, suppressing their proliferation and migration. Well-designed studies in human with HCC are required to further clarify the results of this review

Quantum-based Decision Making Under Uncertainty in the Presence of Entanglement for the Development of Optimal Strategies in Engineering Design

The work presented concerns the development of a quantum-based decision making model utilised in the identification of optimal strategies in engineering design under uncertainty in a quantum-like entangled decision making, assessing intention interference. Several experiments and decision making paradoxes have manifested the deficiency of rationality assumption employed by classical decision making theory, with humans often violating the hypotheses of the expected utility theory and Game Theory by making irrational choices. Quantum Decision Theory (QDT) is the basis of the proposed decision making model, since only this theory can be employed to develop an operational tool in any social interplay, given the preferences of the individuals/players, to assess the quantum probabilities of their strategies. The decision makers’ brain is assumed of a dual nature, with brain processes divided to conscious and subconscious constituent parts and the computed quantum strategic probabilities consisted of two parts, the first one being rationality related and the other one capturing biases, emotions and feelings. Hence, given a priori the preferences of the decision makers, this model can be utilised as an operational tool for decision making under uncertainty in the presence of entanglement assessing the quantum probabilities of the players’ strategies in any engineering design. This quantum-based decision making model, identifying the optimal strategic choices of the stakeholders involved, is employed in the presented conceptual design of an Unmanned Air System (UAS), based on both the stakeholders’ rationality, personal intuitive feelings and behavioural biases

Parathyroid apoplexy, the explanation of spontaneous remission of primary hyperparathyroidism: a case report

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Behavioral and brain pattern differences between acting and observing in an auditory task

<p>Abstract</p> <p>Background</p> <p>Recent research has shown that errors seem to influence the patterns of brain activity. Additionally current notions support the idea that similar brain mechanisms are activated during acting and observing. The aim of the present study was to examine the patterns of brain activity of actors and observers elicited upon receiving feedback information of the actor's response.</p> <p>Methods</p> <p>The task used in the present research was an auditory identification task that included both acting and observing settings, ensuring concurrent ERP measurements of both participants. The performance of the participants was investigated in conditions of varying complexity. ERP data were analyzed with regards to the conditions of acting and observing in conjunction to correct and erroneous responses.</p> <p>Results</p> <p>The obtained results showed that the complexity induced by cue dissimilarity between trials was a demodulating factor leading to poorer performance. The electrophysiological results suggest that feedback information results in different intensities of the ERP patterns of observers and actors depending on whether the actor had made an error or not. The LORETA source localization method yielded significantly larger electrical activity in the supplementary motor area (Brodmann area 6), the posterior cingulate gyrus (Brodmann area 31/23) and the parietal lobe (Precuneus/Brodmann area 7/5).</p> <p>Conclusion</p> <p>These findings suggest that feedback information has a different effect on the intensities of the ERP patterns of actors and observers depending on whether the actor committed an error. Certain neural systems, including medial frontal area, posterior cingulate gyrus and precuneus may mediate these modulating effects. Further research is needed to elucidate in more detail the neuroanatomical and neuropsychological substrates of these systems.</p

Collision avoidance in persons with homonymous visual field defects under virtual reality conditions

AbstractThe aim of the present study was to examine the effect of homonymous visual field defects (HVFDs) on collision avoidance of dynamic obstacles at an intersection under virtual reality (VR) conditions. Overall performance was quantitatively assessed as the number of collisions at a virtual intersection at two difficulty levels. HVFDs were assessed by binocular semi-automated kinetic perimetry within the 90° visual field, stimulus III4e and the area of sparing within the affected hemifield (A-SPAR in deg2) was calculated. The effect of A-SPAR, age, gender, side of brain lesion, time since brain lesion and presence of macular sparing on the number of collisions, as well as performance over time were investigated. Thirty patients (10 female, 20 male, age range: 19–71years) with HVFDs due to unilateral vascular brain lesions and 30 group-age-matched subjects with normal visual fields were examined. The mean number of collisions was higher for patients and in the more difficult level they experienced more collisions with vehicles approaching from the blind side than the seeing side. Lower A-SPAR and increasing age were associated with decreasing performance. However, in agreement with previous studies, wide variability in performance among patients with identical visual field defects was observed and performance of some patients was similar to that of normal subjects. Both patients and healthy subjects displayed equal improvement of performance over time in the more difficult level. In conclusion, our results suggest that visual-field related parameters per se are inadequate in predicting successful collision avoidance. Individualized approaches which also consider compensatory strategies by means of eye and head movements should be introduced

Mismatch task conditions and error related ERPs

<p>Abstract</p> <p>Background</p> <p>The N200 component of event related potentials (ERPs) is considered an index of monitoring error related responses. The aim of the present work was to study the effect of mismatch conditions on the subjects' responses in an auditory identification task and their relation to the N200 of stimulus-locked ERPs.</p> <p>Methods</p> <p>An auditory identification task required to correctly map a horizontal slider onto an active frequency range by selecting a slider position that matched the stimulus tone in each trial. Fourteen healthy volunteers participated in the study and ERPs were recorded by 32 leads.</p> <p>Results</p> <p>Results showed that the subjects' erroneous responses were equally distributed within trials, but were dependent on mismatch conditions, generated by large differences between the frequencies of the tones of consecutive trials. Erroneous trials showed a significantly greater negativity within the time window of 164-191 ms after stimulus, located mainly at the Cz and Fz electrodes. The LORETA solution showed that maximum activations, as well as maximum differences, were localized mainly at the frontal lobe.</p> <p>Conclusions</p> <p>These findings suggest that the fronto-central N200 component, conceived an index of "reorientation of attention", represents a correlate of an error signal, being produced when representation of the actual response and the required response are compared. Furthermore the magnitude of the amplitude of the N200 rests on the relation between the present and the previous stimulus.</p