Tics are caused by alterations in prefrontal areas, thalamus and putamen, while changes in the cingulate gyrus reflect secondary compensatory mechanisms

BACKGROUND: Despite strong evidence that the pathophysiology of Tourette syndrome (TS) involves structural and functional disturbances of the basal ganglia and cortical frontal areas, findings from in vivo imaging studies have provided conflicting results. In this study we used whole brain diffusion tensor imaging (DTI) to investigate the microstructural integrity of white matter pathways and brain tissue in 19 unmedicated, adult, male patients with TS “only” (without comorbid psychiatric disorders) and 20 age- and sex-matched control subjects. RESULTS: Compared to normal controls, TS patients showed a decrease in the fractional anisotropy index (FA) bilaterally in the medial frontal gyrus, the pars opercularis of the left inferior frontal gyrus, the middle occipital gyrus, the right cingulate gyrus, and the medial premotor cortex. Increased apparent diffusion coefficient (ADC) maps were detected in the left cingulate gyrus, prefrontal areas, left precentral gyrus, and left putamen. There was a negative correlation between tic severity and FA values in the left superior frontal gyrus, medial frontal gyrus bilaterally, cingulate gyrus bilaterally, and ventral posterior lateral nucleus of the right thalamus, and a positive correlation in the body of the corpus callosum, left thalamus, right superior temporal gyrus, and left parahippocampal gyrus. There was also a positive correlation between regional ADC values and tic severity in the left cingulate gyrus, putamen bilaterally, medial frontal gyrus bilaterally, left precentral gyrus, and ventral anterior nucleus of the left thalamus. CONCLUSIONS: Our results confirm prior studies suggesting that tics are caused by alterations in prefrontal areas, thalamus and putamen, while changes in the cingulate gyrus seem to reflect secondary compensatory mechanisms. Due to the study design, influences from comorbidities, gender, medication and age can be excluded

The Phenomenon of Exquisite Motor Control in Tic Disorders and its Pathophysiological Implications

The unifying characteristic of movement disorders is the phenotypic presentation of abnormal motor outputs, either as isolated phenomena or in association with further clinical, often neuropsychiatric, features. However, the possibility of a movement disorder also characterized by supranormal or enhanced volitional motor control has not received attention. Based on clinical observations and cases collected over a number of years, we here describe the intriguing clinical phenomenon that people with tic disorders are often able to control specific muscle contractions as part of their tic behaviors to a degree that most humans typically cannot. Examples are given in accompanying video documentation. We explore medical literature on this topic and draw analogies with early research of fine motor control physiology in healthy humans. By systematically analyzing the probable sources of this unusual capacity, and focusing on neuroscientific accounts of voluntary motor control, sensory feedback, and the role of motor learning in tic disorders, we provide a novel pathophysiological account explaining both the presence of exquisite control over motor output and that of overall tic behaviors. We finally comment on key questions for future research on the topic and provide concluding remarks on the complex movement disorder of tic behaviors

Anomalous Origin and Retropulmonary Course of an Atherosclerotic Stenosed Left Circumflex Coronary Artery

We here present the case of a rarely seen anomalous origin and retropulmonary course of the left circumflex artery from the proximal right coronary artery. The patient suffered from coronary ischemia due to stenotic lesions both in the aberrant circumflex coronary artery and in the first and second diagonal branches. Coronary bypass operation was performed

Effects of yeast combined with chromium propionate on growth performance and carcass quality of finishing steers

Citation: Vanbibber-Krueger, C. L., Axman, J. E., Gonzalez, J. M., Vahl, C. I., & Drouillard, J. S. (2016). Effects of yeast combined with chromium propionate on growth performance and carcass quality of finishing steers. Journal of Animal Science, 94(7), 3003-3011. doi:10.2527/jas2016-0454A combination of yeast and chromium propionate (Y+Cr) was added to the diets of crossbred finishing steers (n = 504; 402 kg ± 5.76 initial BW) to evaluate impact on feedlot performance and carcass traits. We hypothesized supplementation of Y+Cr would increase growth of feedlot steers. Steers with initial plasma glucose concentrations ?6.0 mM were stratified by initial BW and randomly allocated, within strata, to receive 0 (control) or 3.3 g/d Y+Cr. Steers were further divided into heavy and light weight blocks with 6 pens/diet within each weight block. Cattle were housed in dirt-surfaced pens with 21 steers/pen and had ad libitum access to feed. Body weights were measured at 21-d intervals. Blood samples were collected on d 49 and 94 from a subset of steers (5/pen) for analyses of plasma glucose and lactate concentrations. At the end of the finishing phase, animals were weighed and transported 450 km to an abattoir in Holcomb, KS. Severity of liver abscesses and HCW were collected the day of harvest, and after 36 h of refrigeration, USDA yield and quality grades, LM area, and 12th rib subcutaneous fat thickness were determined. There were no treatment × time × weight block interactions (P > 0.05) and no treatment × block interaction for ADG, DMI, or final BW (P ? 0.06), but a treatment × block interaction (P = 0.03) was observed for G:F, in which control, light cattle had poorer efficiency compared with other groups. Treatment × weight group interactions were observed for overall yield grade and carcasses that graded yield grade 1 (P ? 0.04). Light steers supplemented with Y+Cr had decreased overall yield grade and increased percentage of carcasses grading yield grade 1 compared with their control counterparts, with no differences observed for heavy steers. Regardless of weight group, a greater percentage of carcasses from steers supplemented with Y+Cr graded yield grade 2 (P = 0.03) and fewer carcasses from steers supplemented Y+Cr graded yield grade 3 (P 0.10). Overall, yeast in combination with chromium propionate may improve feed efficiency and decrease yield grade of light cattle but had no effect on remaining carcass traits and blood constituents. © 2016 American Society of Animal Science. All rights reserved

Toward Optimizing Risk Adjustment in the Dutch Surgical Aneurysm Audit

Background: To compare hospital outcomes of aortic aneurysm surgery, casemix correction for preoperative variables is essential. Most of these variables can be deduced from mortality risk prediction models. Our aim was to identify the optimal set of preoperative variables associated with mortality to establish a relevant and efficient casemix model.Methods: All patients prospectively registered between 2013 and 2016 in the Dutch Surgical Aneurysm Audit (DSAA) were included for the analysis. After multiple imputation for missing variables, predictors for mortality following univariable logistic regression were analyzed in a manual backward multivariable logistic regression model and compared with three standard mortality risk prediction models: Glasgow Aneurysm Score (GAS, mainly clinical parameters), Vascular Biochemical and Haematological Outcome Model (VBHOM, mainly laboratory parameters), and Dutch Aneurysm Score (DAS, both clinical and laboratory parameters). Discrimination and calibration were tested and considered good with a C-statistic &gt; 0.8 and Hosmer-Lemeshow (H-L) P &gt; 0.05. Results: There were 12,401 patients: 9,537 (76.9%) elective patients (EAAA), 913 (7.4%) acute symptomatic patients (SAAA), and 1,951 (15.7%) patients with acute rupture (RAAA). Overall postoperative mortality was 6.5%; 1.8% after EAAA surgery, 6.6% after SAAA, and 29.6% after RAAA surgery. The optimal set of independent variables associated with mortality was a mix of clinical and laboratory parameters: gender, age, pulmonary comorbidity, operative setting, creatinine, aneurysm size, hemoglobin, Glasgow coma scale, electrocardiography, and systolic blood pressure (C-statistic 0.871). External validation overall of VBHOM, DAS, and GAS revealed C-statistics of 0.836, 0.782, and 0.761, with an H-L of 0.028, 0.00, and 0.128, respectively.Conclusions: The optimal set of variables for casemix correction in the DSAA comprises both clinical and laboratory parameters, which can be collected easily from electronic patient files and will lead to an efficient casemix model.</p

Evaluation of Calcium Hydroxide-Treated Stover (Second Crop) in Receiving and Growing Diets and Effects on Cattle Performance

Production of ethanol from corn as an alternative fuel source has significantly affected the pricing landscape for corn as an energy source for livestock. As ethanol usage has become more prevalent, corn prices have become more volatile, especially in critical corn-growing areas that have been affected by drought. Consequently, many beef cattle feeders have become interested in alternative energy sources in an effort to control cost of gain. Second Crop (ADM Corp., Decatur, IL) is a process in which calcium hydroxide is added to fibrous crop residues, such as wheat straw and corn stover. When applied to low-quality roughages, calcium hydroxide disrupts the chemical bonds between lignin and hemicellulose, thus improving digestibility of the fiber by ruminal microbes. Treatment of low-quality forage with the Second Crop process could improve the energy value of forages, effectively decreasing reliance on cereal grains as sources of supplemental energy

Flake Density, Roll Diameter, and Flake Moisture All Influence Starch Availability of Steam-Flaked Corn

Steam-flaked corn is commonly fed in feedlot finishing diets because steam-flaking improves starch availability and nutrient utilization, thus improving the overall feeding value of corn. In most operations which utilize steam-flaked corn, grain is processed to a pre-determined flake density by setting the rolls to a specific separation distance and using tension to hold rolls together. Flaked grain is most often produced to a bulk density between 24 and 32 lb/bu, with a common recommendation of 27 lb/bu for corn; however, flake density among steam-flakers within a single mill and among feedlots can vary greatly. Flaking to a similar density using 2 flakers does not ensure similar starch availability. The degree of starch gelatinization or starch availability of steam-flaked corn can be estimated using analytical procedures such as enzymatic hydrolysis, gas production, and steam-flaked corn gelatinization methods. Routinely evaluating starch availability is used as a quality control method to standardize the steam-flaking process to ensure within-day and day-to-day manufacturing consistency. The concentration of readily available starch in steam-flaked corn is indicative of the rate of starch fermentation in the rumen. When starch is too readily available and is fermented at an excessively rapid rate, acid can accumulate in the rumen, reducing ruminal pH, and ultimately resulting in increased prevalence of digestive disturbances. Factors that contribute to variation between feedlot operations with respect to steamflaked corn quality include type and dimensions of flaking equipment, grain type, grain variety and moisture content, roll wear, and steam-flaking procedures. Sampling and handling procedures contribute to precision of results; therefore, sampling procedures need special attention, and consistency must be evaluated when attempting to determine starch availability of steam-flaked corn. The objective of this study was to evaluate starch availability of steam-flaked corn comparing roll dimensions and steam-flaked corn flake densities among flaking systems and feedyards and to provide information on the equipment utilized, steam-flaked corn flaking procedures, and to define current manufacturing practices of steam-flaking in commercial feedlot operations

Relationship Between Trauma Sustained at Unloading and Carcass Bruise Prevalence in Finished Cattle at Commercial Slaughter Facilities

Bruising in cattle can be an indicator of poor animal welfare, as well as a significant cause of economic loss due to decreased carcass value. Previous literature suggests sources of trauma causing bruising in beef carcasses include horn prevalence, rough transport conditions, cattle handling techniques, cattle temperament, and vehicle design; however, evidence of correlations between such trauma and actual carcass bruising is limited. The objective of this study was to evaluate the relationship between trauma sustained at unloading and carcass bruise prevalence in finished cattle at commercial slaughter facilities

European clinical guidelines for Tourette syndrome and other tic disorders:summary statement

In 2011 a working group of the European Society for the Study of Tourette syndrome (ESSTS) developed the first European Guidelines for Tourette syndrome (TS) published in the ECAP journal. After a decade ESSTS now presents updated guidelines, divided into four sections: Part I: assessment, Part II: psychological interventions, Part III: pharmacological treatment and Part IV: deep brain stimulation (DBS). In this paper, we summarise new developments described in the guidelines with respect to assessment and treatment of tics. Further, summary findings from a recent survey conducted amongst TS experts on these same topics are presented, as well as the first European patient representative statement on research. Finally, an updated decision tree is introduced providing a practical algorithm for the treatment of patients with TS. Interestingly, in the last decade there has been a significant shift in assessment and treatment of tics, with more emphasis on non-pharmacological treatments