Changes in the superior longitudinal fasciculus and anterior thalamic radiation in the left brain are associated with developmental dyscalculia

Developmental dyscalculia is a neurodevelopmental disorder specific to arithmetic learning even with normal intelligence and age-appropriate education. Difficulties often persist from childhood through adulthood lowering the individual’s quality of life. However, the neural correlates of developmental dyscalculia are poorly understood. This study aimed to identify brain structural connectivity alterations in developmental dyscalculia. All participants were recruited from a large scale, non-referred population sample in a longitudinal design. We studied 10 children with developmental dyscalculia (11.3 ± 0.7 years) and 16 typically developing peers (11.2 ± 0.6 years) using diffusion-weighted magnetic resonance imaging. We assessed white matter microstructure with tract-based spatial statistics in regions-of-interest tracts that had previously been related to math ability in children. Then we used global probabilistic tractography for the first time to measure and compare tract length between developmental dyscalculia and typically developing groups. The high angular resolution diffusion-weighted magnetic resonance imaging and crossing-fiber probabilistic tractography allowed us to evaluate the length of the pathways compared to previous studies. The major findings of our study were reduced white matter coherence and shorter tract length of the left superior longitudinal/arcuate fasciculus and left anterior thalamic radiation in the developmental dyscalculia group. Furthermore, the lower white matter coherence and shorter pathways tended to be associated with the lower math performance. These results from the regional analyses indicate that learning, memory and language-related pathways in the left hemisphere might be related to developmental dyscalculia in children

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Automatic segmentation of human facial tissue by MRI-CT fusion: A feasibility study

The aim of this study was to develop automatic image segmentation methods to segment human facial tissue which contains very thin anatomic structures. The segmentation output can be used to construct a more realistic human face model for a variety of purposes like surgery planning, patient specific prosthesis design and facial expression simulation. Segmentation methods developed were based on Bayesian and Level Set frameworks, which were applied on three image types: magnetic resonance imaging (MRI), computerized tomography (CT) and fusion, in which case information from both modalities were utilized maximally for every tissue type. The results on human data indicated that fusion, thickness adaptive and postprocessing options provided the best muscle/fat segmentation scores in both Level Set and Bayesian methods. When the best Level Set and Bayesian methods were compared, scores of the latter were better. Number of algorithm parameters (to be trained) and computer run time measured were also in favour of the Bayesian method

Neural Mechanisms Underlying Time Perception and Reward Anticipation

Parmi les débats ayant marqué la scène politique israélienne au cours de l’année 2005, figure en bonne place la controverse qui a opposé le président de la Cour suprême, Aharon Barak, à la ministre de la Justice sur la nomination de trois juges à la Cour. Cette controverse s’est cristallisée autour de la candidature de la professeure de droit, Ruth Gavison, à laquelle s’est fermement opposé Aharon Barak du fait de sa critique virulente de l’orientation politique et de l’activisme judiciaire d..

Neural Mechanisms Underlying Time Perception and Reward Anticipation

Findings suggest that the physiological mechanisms involved in the reward anticipation and time perception partially overlap. But the systematic investigation of a potential interaction between time and reward systems using neuroimaging is lacking. Eighteen healthy volunteers (all right-handed) participated in an event-related functional magnetic resonance imaging (fMRI) experiment that employs a visual paradigm that consists monetary reward to assess whether the functional neural representations of time perception and reward prospection are shared or distinct. Subjects performed a time perception task in which observers had to extrapolate the velocity of an occluded moving object in “reward” vs. “no-reward” sessions during fMRI scanning. There were also “control condition” trials in which participants judged about the color tone change of the stimuli. Time perception showed a fronto-parietal (more extensive in the right) cingulate and peristriate cortical as well as cerebellar activity. On the other hand, reward anticipation activated anterior insular cortex, nucleus accumbens, caudate nucleus, thalamus, cerebellum, postcentral gyrus, and peristriate cortex. Interaction between the time perception and the reward prospect showed dorsolateral, orbitofrontal, medial prefrontal and caudate nucleus activity. Our findings suggest that a prefrontal-striatal circuit might integrate reward and timing systems of the brain