Post-operative nonketotic hyperglycemic induced focal motor status epilepticus related to treatment with corticosteroids following standard anterior temporal lobectomy

•Complications from standard ATL are uncommon and the use of post-operative corticosteroids may reduce complications.•Following standard ATL, FMSE was present after treatment with corticosteroids that resolved after blood sugar control.•After epilepsy surgery, corticosteroids should be used cautiously in people with comorbid diabetes mellitus

Trajectories of anxiety and health related quality of life during pregnancy

Published: July 24, 2017Anxiety and health related Quality of Life (HRQoL) have emerged as important mental health measures in obstetric care. Few studies have systematically examined the longitudinal trajectories of anxiety and HRQoL in pregnancy. Using a linear growth modeling strategy, we analyzed the course of State-Trait Anxiety Inventory (STAI)- and Short Form (36) Health Survey (SF-36) scores between the 12th and the 36th week of gestation, in a sample of 355 women. We additionally analyzed the impact of depressive symptoms and a chronic medical condition (asthma), on STAI and SF-36 trajectory curves. STAI scores remained stable throughout pregnancy. A previous history of anxiety increased the overall STAI scores. Asthma and depressive symptoms scores had no impact on the STAI trajectory. Physical SF-36 scores decreased over the course of pregnancy, whereas mental SF-36 trended towards improvement. Asthma reduced physical SF-36 overall. While high depressive symptoms decreased the overall mental SF-36, they were also significantly associated with mental SF-36 improvements over time. Anxiety symptoms are stable during pregnancy and are not modulated by depressive symptoms or asthma. Physical HRQoL declines in pregnancy. In contrast, mental HRQoL appears to improve, particularly in women with high initial levels of depressive symptoms.K. Oliver Schubert, Tracy Air, Scott R. Clark, Luke E. Grzeskowiak, Edward Miller, Gustaaf A. Dekker, Bernhard T. Baune, Vicki L. Clifto

Structural Material Property Tailoring Using Deep Neural Networks

Advances in robotics, artificial intelligence, and machine learning are ushering in a new age of automation, as machines match or outperform human performance. Machine intelligence can enable businesses to improve performance by reducing errors, improving sensitivity, quality and speed, and in some cases achieving outcomes that go beyond current resource capabilities. Relevant applications include new product architecture design, rapid material characterization, and life-cycle management tied with a digital strategy that will enable efficient development of products from cradle to grave. In addition, there are also challenges to overcome that must be addressed through a major, sustained research effort that is based solidly on both inferential and computational principles applied to design tailoring of functionally optimized structures. Current applications of structural materials in the aerospace industry demand the highest quality control of material microstructure, especially for advanced rotational turbomachinery in aircraft engines in order to have the best tailored material property. In this paper, deep convolutional neural networks were developed to accurately predict processing-structure-property relations from materials microstructures images, surpassing current best practices and modeling efforts. The models automatically learn critical features, without the need for manual specification and/or subjective and expensive image analysis. Further, in combination with generative deep learning models, a framework is proposed to enable rapid material design space exploration and property identification and optimization. The implementation must take account of real-time decision cycles and the trade-offs between speed and accuracy

Human mucocutaneous leishmaniasis in Três Braços, Bahia - Brazil : an area of Leishmania braziliensis braziliensis transmission. II. Cutaneous disease. Presentation and evolution

Foram analisados os dados clínicos de 182 pacientes com leishmaniose cutânea, provavelmente causada por Leishmania braziliensis braziliensis. Sessenta e oito por cento apresentavam uma única lesão, usualmente uma úlcera, na terça parte inferior anterior da tíbia. Todos os grupos etários estavam representados e muitos apresentaram histórico de um a dois meses. Treze por cento apresentavam lesões fechadas de natureza verrucosa ou em placa. Após tratamento, a evolução destas lesões foi relacionada à regularidade da terapia por antimônio. Embora a cura usualmente ocorresse em três meses, o tempo de cicatrização, após o início de tratamento, foi variável e relativo ao tamanho da lesão (p < 0.01). Em geral a lesão fechava quando era dado suficiente antimônio como tratamento. Sete entre dez pacientes que apresentavam teste cutâneo negativo para leishmania tomavam positivos após o tratamento. Observou-se por fluorescência indireta, um declínio significante nos títulos de anticorpos em pacientes acompanhados durante e após a terapia. _________________________________________________________________________________ ABSTRACTThe clinical records of 182 patients with cutaneous leishmaniasis probably due to Leishmania braziliensis braziliensis are analysed. 68% had a single lesion which was usually an ulceron the lower anterior tibial third. Many had short histories of one to two months and all age groups were represented 13% had closed lesions of a verrucose or plaque like nature. Evolution of these skin lesions after treatment was related to the regularity of antimony therapy. Although healing usually occurred in three months, the time to scarring after commencing treatment was variable and related to the size ofthe lesion (p < 0.01). Usually if sufficient antimony treatment was given the lesion closed. Seven of the ten patients with initially negative leishmanin skin tests converted to positive after treatment. A significant decline of indirect fluorescent antibody titres occurred in patients followed, during and after therapy

The prototype HIV-1 maturation inhibitor, bevirimat, binds to the CA-SP1 cleavage site in immature Gag particles

<p>Abstract</p> <p>Background</p> <p>Bevirimat, the prototype Human Immunodeficiency Virus type 1 (HIV-1) maturation inhibitor, is highly potent in cell culture and efficacious in HIV-1 infected patients. In contrast to inhibitors that target the active site of the viral protease, bevirimat specifically inhibits a single cleavage event, the final processing step for the Gag precursor where p25 (CA-SP1) is cleaved to p24 (CA) and SP1.</p> <p>Results</p> <p>In this study, photoaffinity analogs of bevirimat and mass spectrometry were employed to map the binding site of bevirimat to Gag within immature virus-like particles. Bevirimat analogs were found to crosslink to sequences overlapping, or proximal to, the CA-SP1 cleavage site, consistent with previous biochemical data on the effect of bevirimat on Gag processing and with genetic data from resistance mutations, in a region predicted by NMR and mutational studies to have α-helical character. Unexpectedly, a second region of interaction was found within the Major Homology Region (MHR). Extensive prior genetic evidence suggests that the MHR is critical for virus assembly.</p> <p>Conclusions</p> <p>This is the first demonstration of a direct interaction between the maturation inhibitor, bevirimat, and its target, Gag. Information gained from this study sheds light on the mechanisms by which the virus develops resistance to this class of drug and may aid in the design of next-generation maturation inhibitors.</p

Incidence of hyperoxia in trauma patients receiving pre-hospital emergency anaesthesia:results of a 5-year retrospective analysis

Abstract Background Previous studies have demonstrated an association between hyperoxia and increased mortality in various patient groups. Critically unwell and injured patients are routinely given high concentration oxygen in the pre-hospital phase of care. We aim to investigate the incidence of hyperoxia in major trauma patients receiving pre-hospital emergency anesthesia (PHEA) in the pre-hospital setting and determine factors that may help guide clinicians with pre-hospital oxygen administration in these patients. Methods A retrospective cohort study was performed of all patients who received PHEA by a single helicopter emergency medical service (HEMS) between 1 October 2014 and 1 May 2019 and who were subsequently transferred to one major trauma centre (MTC). Patient and treatment factors were collected from the electronic patient records of the HEMS service and the MTC. Hyperoxia was defined as a PaO2 > 16 kPA on the first arterial blood gas analysis upon arrival in the MTC. Results On arrival in the MTC, the majority of the patients (90/147, 61.2%) had severe hyperoxia, whereas 30 patients (20.4%) had mild hyperoxia and 26 patients (19.7%) had normoxia. Only 1 patient (0.7%) had hypoxia. The median PaO2 on the first arterial blood gas analysis (ABGA) after HEMS handover was 36.7 [IQR 18.5–52.2] kPa, with a range of 7.0–86.0 kPa. SpO2 pulse oximetry readings before handover were independently associated with the presence of hyperoxia. An SpO2 ≥ 97% was associated with a significantly increased odds of hyperoxia (OR 3.99 [1.58–10.08]), and had a sensitivity of 86.7% [79.1–92.4], a specificity of 37.9% [20.7–57.8], a positive predictive value of 84.5% [70.2–87.9] and a negative predictive value of 42.3% [27.4–58.7] for the presence of hyperoxemia. Conclusion Trauma patients who have undergone PHEA often have profound hyperoxemia upon arrival at hospital. In the pre-hospital setting, where arterial blood gas analysis is not readily available a titrated approach to oxygen therapy should be considered to reduce the incidence of potentially harmful tissue hyperoxia

Adjuvant medical therapy in cervical dystonia after deep brain stimulation: A retrospective analysis

Background: There is limited information on optimization of symptomatic management of cervical dystonia (CD) after implantation of pallidal deep brain stimulation (DBS). Objectives: To describe the long-term, real-world management of CD patients after DBS implantation and the role of reintroduction of pharmacologic and botulinum toxin (BoNT) therapy. Methods: A retrospective analysis of patients with focal cervical or segmental craniocervical dystonia implanted with DBS was conducted. Results: Nine patients were identified with a mean follow-up of 41.7 ± 15.7 months. All patients continued adjuvant oral medication(s) to optimize symptom control post-operatively. Three stopped BoNT and four reduced BoNT dose by an average of 22%. All patients remained on at least one medication used to treat dystonia post-operatively. Conclusion: Optimal symptom control was achieved with DBS combined with either BoNT and/or medication. We suggest utilization of adjuvant therapies such as BoNT and/or medications if DBS monotherapy does not achieve optimal symptom control

Nonstop Flying Is Safer Than Driving

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73935/1/j.1539-6924.1991.tb00584.x.pd