The Hemostatic Efficacy of Hydrogen Peroxide Irrigation to Control Intraoperative Bleeding in Adenoidectomy

Objective:Although adenoidectomy is generally accepted as a safe procedure, intraoperative hemorrhage is still the most common and potentially life- threating complication, especially in pediatric patients. We evaluated the clinical effect of intraoperative hydrogen peroxide irrigation with respect to hemostasis and operation times in pediatric adenoidectomy.Methods:This was a prospective, randomized, double- blind study to investigate hydrogen peroxide solution in hemostasis in pediatric patients undergoing adenoidectomy. The patient, the surgeon, and the study nurse were blinded to the surgical technique used.Results:One hundred seventeen (56 males and 61 females) consecutive pediatric patients with a mean age of 5.46±1.19 years were included in the study. There were 58 patients in the hydrogen peroxide group (median age: 6 years, mean age: 5.62±1.28 years) and 59 patients in the control group (median age: 5 years, mean age: 5.31±1.07 years). No significant difference was observed between the two groups with respect to age (p=0.151), gender (p=0.646), or adenoid size (p=0.767). On the other hand, the difference between the groups with respect to operation and hemostasis times was found to be statistically significant (p<0.001 for both). The average operation times were 8.67±0.48 min in the hydrogen peroxide group and 12.30±0.69 min in the control group. The average hemostasis times were 3.67±0.27 min in the hydrogen peroxide group and 5.73±0.31 min in the control group.Conclusion:Hydrogen peroxide solution can be effectively used in adenoidectomy for reducing intraoperative blood loss and for economic benefits

Hemispheric asymmetries in resting-state EEG and fMRI are related to approach and avoidance behaviour, but not to eating behaviour or BMI

Much of our behaviour is driven by two motivational dimensions-approach and avoidance. These have been related to frontal hemispheric asymmetries in clinical and resting-state EEG studies: Approach was linked to higher activity of the left relative to the right hemisphere, while avoidance was related to the opposite pattern. Increased approach behaviour, specifically towards unhealthy foods, is also observed in obesity and has been linked to asymmetry in the framework of the right-brain hypothesis of obesity. Here, we aimed to replicate previous EEG findings of hemispheric asymmetries for self-reported approach/avoidance behaviour and to relate them to eating behaviour. Further, we assessed whether resting fMRI hemispheric asymmetries can be detected and whether they are related to approach/avoidance, eating behaviour and BMI. We analysed three samples: Sample 1 (n = 117) containing EEG and fMRI data from lean participants, and Samples 2 (n = 89) and 3 (n = 152) containing fMRI data from lean, overweight and obese participants. In Sample 1, approach behaviour in women was related to EEG, but not to fMRI hemispheric asymmetries. In Sample 2, approach/avoidance behaviours were related to fMRI hemispheric asymmetries. Finally, hemispheric asymmetries were not related to either BMI or eating behaviour in any of the samples. Our study partly replicates previous EEG findings regarding hemispheric asymmetries and indicates that this relationship could also be captured using fMRI. Our findings suggest that eating behaviour and obesity are likely to be mediated by mechanisms not directly relating to frontal asymmetries in neuronal activation quantified with EEG and fMRI.Peer reviewe

Cortical thickness and resting-state cardiac function across the lifespan: a cross-sectional pooled mega analysis

Understanding the association between autonomic nervous system [ANS] function and brain morphology across the lifespan provides important insights into neurovisceral mechanisms underlying health and disease. Resting state ANS activity, indexed by measures of heart rate [HR] and its variability [HRV] has been associated with brain morphology, particularly cortical thickness [CT]. While findings have been mixed regarding the anatomical distribution and direction of the associations, these inconsistencies may be due to sex and age differences in HR/HRV and CT. Previous studies have been limited by small sample sizes, which impede the assessment of sex differences and aging effects on the association between ANS function and CT. To overcome these limitations, 20 groups worldwide contributed data collected under similar protocols of CT assessment and HR/HRV recording to be pooled in a mega-analysis (N = 1,218 (50.5% female), mean age 36.7 years (range: 12-87)). Findings suggest a decline in HRV as well as CT with increasing age. CT, particularly in the orbitofrontal cortex, explained additional variance in HRV, beyond the effects of aging. This pattern of results may suggest that the decline in HRV with increasing age is related to a decline in orbitofrontal CT. These effects were independent of sex and specific to HRV; with no significant association between CT and HR. Greater CT across the adult lifespan may be vital for the maintenance of healthy cardiac regulation via the ANS – or greater cardiac vagal activity as indirectly reflected in HRV may slow brain atrophy. Findings reveal an important association between cortical thickness and cardiac parasympathetic activity with implications for healthy aging and longevity that should be studied further in longitudinal research

Variabilität der Herz- und Hirnaktivität über die Lebensspanne

The world population is rapidly aging. In Germany for example, the percentage of individuals 60 years and older is projected to be 38% in 2050. Longer lifetimes entail more progressive impairment of brain and body. It is therefore a crucial question how to assess and quantify these frequently occurring alterations associated with aging. In order to address this question, the overarching goal of this dissertation is to explore and characterize bodily and neural signals which reflect effects of aging across the adult lifespan. To this end, I performed two studies as lead investigator and contributed to three more large-scale collaborative studies. In Study 1 (Kumral et al., 2019), I investigated the relationship of heart rate variability (HRV) to brain structure (gray matter) and resting state (rs) brain activity (functional connectivity) in a well-characterized sample of healthy subjects across the adult lifespan (N=388). For Study 2 (Koenig et al., 2020), I contributed to a mega analysis testing the association between cortical thickness and heart-rate variability (HRV) at rest, also across the lifespan (N=1218). In Study 3 (Kumral et al., 2020), I examined whether different measures of brain signal variability – identified with hemodynamic (functional magnetic resonance imaging; fMRI) or electrophysiological (EEG) methods – reflect the same underlying physiology in healthy younger and older adults (N=189). Lastly, during my dissertation work, I was part of the Mind-Body-Emotion group in Leipzig, which established two publicly available – and now widely used – datasets (Datasets 1 and 2; Babayan et al., 2019, Mendes et al., 2019), which include structural and functional MRI, EEG data as well as a range of physiological and behavioral measures. In Study 1, I showed that age-related decreases in resting HRV are accompanied by age-dependent and age-invariant alterations in brain function, particularly located along cortical midline structures. In Study 2, we found that the age-related decrease of resting HRV was associated with cortical thinning in prefrontal brain structures. In Study 3, I demonstrated age differences in brain signal variability obtained with rs-fMRI and rs-EEG, respectively. Surprisingly, the two measures of neural variability showed no significant correlation, but rather seemed to provide complementary information on the state of the aging brain. The present dissertation provides evidence that measures of cardiovascular and neural signal variability may be useful biomarkers for neurocognitive health (and disease) in aging. With these measures, we can further specify the dynamic interplay of the human body and the brain in relation to individual health-related factors.Die Weltbevölkerung wird immer älter. In Deutschland wird der Anteil der Personen, die 60 Jahre und älter sind, bis zum Jahr 2050 voraussichtlich auf 38 Prozent ansteigen. Eine längere Lebensdauer bedeutet auch eine fortschreitende Beeinträchtigung des Gehirns und des Körpers. Es ist daher eine entscheidende Frage, wie diese häufigen alterungsbedingten Veränderungen festgestellt und quantifiziert werden können. Das Ziel dieser Dissertation bestand daher darin, Körper- und Gehirnsignale zu untersuchen und zu charakterisieren, welche die Auswirkungen des Alterns über die gesamte Lebensspanne widerspiegeln. Für dieses Ziel führte ich in meiner Dissertation zwei Studien als „lead investigator“ durch, darüber hinaus habe ich mich an drei weiteren Kooperations-Projekten beteiligt. In Studie 1 (Kumral et al., 2019) habe ich die Beziehung zwischen der Herzfrequenzvariabilität in Ruhe (HFV), dem Gehirnvolumen (graue Substanz) und der Gehirnaktivität (bzw. Konnektivität) im Ruhezustand anhand einer gut charakterisierten Stichprobe gesunder Probanden über die gesamte Lebensspanne (N=388) untersucht. Studie 2 (Koenig et al., 2020) ist eine Mega Analyse des Zusammenhangs zwischen der kortikalen Dichte und der HFV im Ruhezustand über die gesamte Lebensdauer (N=1218), zu der ich wesentlich beigetragen habe. Im Mittelpunkt von Studie 3 (Kumral et al., 2020) stand die Frage, ob verschiedene Messungen der Variabilität des Gehirnsignals – erhoben mit hämodynamischen (funktionelle Magnetresonanztomografie; fMRT) oder elektrophysiologischen (EEG) Methoden – die gleichen physiologischen Grundlagen bei gesunden jüngeren und älteren Menschen widerspiegeln (N=189). Als Teil der Mind-Body-Emotion-Gruppe in Leipzig war ich an der Erstellung von zwei großen – öffentlich zugänglichen und weltweit genutzten – Datensätzen aktiv beteiligt (Datensätze 1 und 2; Babayan et al., 2019, Mendes et al., 2019), die neben strukturellen und funktionellen MRT- sowie EEG-Daten auch physiologische und Verhaltensmaße umfassen. In Studie 1 fand ich, dass die altersbedingte Abnahme der Ruhe-HFV von altersabhängigen und altersinvarianten Veränderungen der Gehirnfunktion begleitet war, insbesondere entlang der kortikalen Mittellinie. In Studie 2 berichteten wir, dass die altersbedingte Abnahme der Ruhe-HFV mit einer kortikalen Verdünnung präfrontaler Hirnstrukturen verbunden war. In Studie 3 beobachtete ich Altersunterschiede in der Variabilität des Gehirnsignals, das mit Ruhe-fMRT und Ruhe-EEG gemessen wurde. Überraschenderweise zeigten die zwei Messmethoden der neuronalen Variabilität keine signifikante Korrelation, sondern lieferten ergänzende Informationen über den Zustand des alternden Gehirns. Die vorliegende Dissertation erbringt den Nachweis, dass die Messungen der kardiovaskulären und neuronalen Signalvariabilität nützliche Biomarker für die neurokognitive Gesundheit (und Krankheit) während des Alterns sein können. Mit diesen Markern können wir das dynamische Zusammenspiel des menschlichen Körpers und des Gehirns im Verhältnis zu individuellen, gesundheitsbezogenen Faktoren weiter spezifizieren

Diffuse Cerebral Toxoplasmosis In An Immunocompetent Patient

Background. Cerebral involvement of toxoplasmosis is an unusual presentation in nonimmunocompromised individuals, and the diagnosis may be challenging due to insignificant radiological findings. Result. We present a case of severe toxoplasma encephalitis in an immunocompetent individual mimicking clinical picture of vertebrobasilar ischemia at onset. Conclusion. The highest diagnostic yield was the detection of DNA by polymerase chain reaction (PCR) examination of the brain tissue which has been also diagnostic in our patien

Vascular risk factors, white matter microstructure, and depressive symptoms: A longitudinal analysis in the UK Biobank

Cumulative burden from vascular risk factors (VRFs) has been associated with an increased risk of depressive symptoms in mid- and later life, but the mechanisms underlying this link are still unclear. One hypothesis is that VRFs disconnect fronto-subcortical white matter tracts that underlie mood and emotion regulation, which in turn puts older adults at higher risk of developing depressive symptoms. However, evidence for the hypothesis that disconnection of white matter tracts underlies the association between VRF burden and depressive symptoms from longitudinal studies is scarce. This preregistered study analysed longitudinal data from 6,964 middle-aged and older adults from the UK Biobank who participated in consecutive assessments of VRFs, brain imaging, and depressive symptoms. Using mediation modelling, we directly tested to what extend white matter microstructure mediates the longitudinal association between VRF burden and depressive symptoms. Our results showed small associations between VRF burden and depressive symptoms at follow-up. However, there was no evidence that fractional anisotropy (FA) of white matter tracts mediated this association. Additional analyses also yielded no mediating effects using alternative operationalisations of VRF burden, mean diffusivity (MD) of single tracts, or overall average of tract-based white matter microstructure (global FA, global MD, white matter hyperintensity volume). Taken together, these results lend no support to the hypothesis that disconnection of white matter tracts underlies the association between VRF burden and depressive symptoms, while highlighting the relevance of using longitudinal data to directly test pathways linking vascular and mental health. Future studies should examine alternative mechanisms and potentially more fine-grained associations between VRFs and depressive symptoms using similar longitudinal study designs

Kumral et al., 2023

Dream EEG and Mentation (DREAM) dataset=======================================Dataset information-------------------- Common name: Kumral et al., 2023- Full name: N/A- Authors: Deniz Kumral, Jessica Palmieri, Steffen Gais, Monika Schönauer- Location: Albert-Ludwigs-Universität Freiburg, Eberhard Karls Universität Tübingen, Ludwig-Maximilians-Universität München- Year: 2013- Set ID: 19- Amendment: 0- Corresponding author ID: 19Previous publications:Kumral, D., Palmieri, J., Gais, S., & Schoenauer, M. (2023). Daytime experiences shape neural activity and dream content in the sleeping brain. bioRxiv, 2023-07.Correspondence:M. Schönauer, Institute of Psychology, Neuropsychology, University of Freiburg; Freiburg im Breisgau, Germany, phone: +49 761 203 2463, Engelbergerstraße 41, Freiburg im Breisgau, 79106, GermanyMetadata--------- Key ID: 21- Date entered: 2024-01-22T05:30:40+00:00- Number of samples: 66- Number of subjects: 19- Proportion REM: 0.136363636- Proportion N1: 0.090909091- Proportion N2: 0.636363636- Proportion W: 0- Proportion experience: 0.636363636- Proportion no-experience: 0.363636364- Proportion healthy: 1- Provoked awakening: Yes- Time of awakening: Mixed- Form of response: Free- Date approved: 2024-01-25T05:53:22+00:00How to decode data files------------------------* EEG files: All the EEG data are already transformed into ".edf" format from original Brainvision files. We extracted sleep data from the point after we stopped the audiobook (see: procedure) until the time right before awakening. Due to the resolution of sleep scoring for this dataset (30 secs), up to one minute of data before the actual point of waking up may thus have been cut from the files.* Dream Reports: Dream data is reported using Excel files in .csv (UTF-8) format.### Treatment group codes ###N/AExperimental description------------------------Participants20 participants (10 male) aged 20 – 30 years (25.5 ± 2.7) completed the study. They were healthy, nonsmokers, and did not ingest any alcohol, caffeine or medication other than oral contraceptives on the days of the experiment. The participants reported sleeping between 6 and 10 hours per night, had a regular circadian rhythm, and were neither extreme morning nor evening chronotypes, as measured by the Munich Chronotype Questionnaire. They had no shift work or long-distance flights during the six weeks preceding the experiment and did not have any sleep-related pathology. All participants were right-handed, confirmed by the Edinburgh Handedness Questionnaire. The experiment was approved by the local ethics committee (Department of Psychology, Ludwig-Maximilians-Universität München). Informed consent was obtained from all subjects. One participant had to be excluded because due to a technical problem with the audiobook.ProcedureAll participants visited the sleep laboratory twice, once for an adaptation night to become familiar with the experimental procedure and environment (i.e., wearing an EEG cap), and again for the night of the main experiment. On the experimental night, participants fell asleep while listening to one of four randomly assigned audiobooks. Participants had not read the book or listened to the audiobook prior to the experiment. Participants were instructed to remember the content of the audiobook. The audiobook was turned off once they reached consolidated stage 2 sleep. Participants were awoken multiple times during the night, approximately every 90 minutes, to answer questions regarding their cognitive experiences during sleep (i.e. dreaming) and about the content of the audiobook passage they had listened to. After these tests, they continued listening to the same audiobook while falling asleep again. After each 90-min sleep cycle, participants were awoken and reported their cognitive experience (i.e., dreaming) in a standardized dream recall procedure. They were asked up to three times what was going through their minds immediately before waking up. If the participants were able to remember any dream, we instructed them that they should proceed to give a detailed report on who participated in the dream, where the dream was set, and what happened in the dream. We recorded their full dream report, asking up to three times “Can you recall more?”### DREAM categorization procedure ###In this study, we define a “dream” as any mental experience recalled from sleep. We did not assess whether participants might have been dreaming, but failed to recall the dream. Therefore, the dream reports are coded as:* 0 = no experience* 2 = experienceTechnical details-----------------N/A### Data acquisition ###Sleep EEG was recorded using an active 128 channel Ag/AgCl-electrode system (BrainAmp MR with ActiCap, Brain Products, Gilching, Germany) with a 1 kHz sampling frequency and a high-pass filter of 0.1 Hz. Electrodes were positioned according to the extended international 10–20 electrode system.### Data preprocessing ###The EEG data is not preprocessed. As mentioned earlier, we extracted sleep data from the point after we stopped the audiobook (see: procedure) until the time right before awakening. Due to the resolution of sleep scoring for this dataset (30 secs), up to one minute of data before the actual point of waking up may thus have been cut from the files.</p