Self-Awareness After Brain Injury:Relation with Emotion Recognition and Effects of Treatment

Item does not contain fulltextSelf-awareness is often impaired after acquired brain injury (ABI) and this hampers rehabilitation, in general: unrealistic reports by patients about their functioning and poor motivation and compliance with treatment. We evaluated a self-awareness treatment that was part of a treatment protocol on executive dysfunction (Spikman, Boelen, Lamberts, Brouwer, & Fasotti, 2010). A total of 63 patients were included, aged 17-70, suffering non-progressive ABI, and minimum time post-onset of 3 months. Self-awareness was measured by comparing the patient's Dysexecutive Questionnaire (Wilson, Alderman, Burgess, Emslie, & Evans, 1996) score with that of an independent other. As emotion recognition is associated with self-awareness and influences the effect of rehabilitation treatment, we assessed this function using the Facial Expressions of Emotion-Stimuli and Tests (Young, Perrett, Calder, Sprengelmeyer, & Ekman, 2002). Results showed that patients in the experimental treatment group (n = 29) had better self-awareness after training than control patients (n = 34). Moreover, our results confirmed that the level of self-awareness before treatment was related to emotion recognition. Hence, self-awareness can improve after neuropsychological treatment fostering self-monitoring. Since neuropsychological treatment involves social learning, impairments in social cognition should be taken into account before starting and during treatment.8 p

Return to the workforce following first hospitalization for heart failure: a Danish nationwide cohort study

Background: Return to work is important financially, as a marker of functional status and for self-esteem in patients developing chronic illness. We examined return to work after first heart failure (HF) hospitalization. Methods: By individual-level linkage of nationwide Danish registries, we identified 21455 patients of working age (18-60 years) with a first HF hospitalization in the period of 1997-2012. Of these 11880 (55%) were in the workforce prior to HF hospitalization and comprised the study population. We applied logistic regression to estimate odds ratios (OR) for associations between age, sex, length of hospital stay, level of education, income, comorbidity and return to work. Results: One year after first HF hospitalization, 8040 (67.7%) returned to the workforce, 2981 (25.1%) did not, 805 (6.7%) died and 54 (0.5%) emigrated. Predictors of return to work included younger age (18-30 vs. 51-60 years, OR 3.12; 95% CI 2.42-4.03), male sex (OR 1.22 [1.18-1.34]) and level of education (long-higher vs. basic school OR 2.06 [1.63-2.60]). Conversely, hospital stay >7 days (OR 0.56 [0.51-0.62]) and comorbidity including history of stroke (OR 0.55 [0.45-0.69]), chronic kidney disease (OR 0.46 [0.36-0.59]), chronic obstructive pulmonary disease (OR 0.62 [0.52-0.75]), diabetes (OR 0.76 [0.68-0.85]) and cancer (OR 0.49 [0.40-0.61]) were all significantly associated with lower chance of return to work. Conclusions: Patients in the workforce prior to HF hospitalization had low mortality but high risk of detachment from the workforce one year later. Young age, male sex, and higher level of education were predictors of return to work

BAREFOOT RUNNING TRAINING: IMPLlCATtONS FOR JOINT STIFFNESS AND MUSCULAR CO-ACTWAlION

To determine the influence of barefoot training on neuromuscular w-activation of lower limb muscles on variables associated with injury risk during running. Trained shod runners (n=23) participated in a barefoot running program. Joint stiffness, agonist: antagonist co-activation and the co-activation index were calculated. A progressive barefoot training program induces longer co-activation of the shank complex and lower ankle stiffness in the barefoot condition. Footwear is implicated in changing injury risk factors whether soft tissue or bony related injuries. This paper suggests barefoot training as an avenue for rehabilitating ankle injuries as it promotes an even distribution of joint stillness and lower ankle stiffness when compared to shod running

Great Balls of FIRE III: Modeling Black Hole Mergers from Massive Star Clusters in Simulations of Galaxies

After the nearly hundred gravitational-wave detections reported by the LIGO-Virgo-KAGRA Collaboration, the question of the cosmological origin of merging binary black holes (BBHs) remains open. The two main formation channels generally considered are from isolated field binaries or via dynamical assembly in dense star clusters. Here, we focus on understanding the dynamical formation of merging BBHs within massive clusters in galaxies of different masses. To this end, we apply a new framework to consistently model the formation and evolution of massive star clusters in zoom-in cosmological simulations of galaxies. Each simulation, taken from the FIRE project, provides a realistic star formation environment with a unique star formation history and hosts realistic giant molecular clouds that constitute the birthplace of star clusters. Combined with the code for star cluster evolution CMC, we are able to produce populations of dynamically formed merging BBHs across cosmic time in different environments. As the most massive star clusters preferentially form in dense massive clouds of gas, we find that, despite their low metallicities favourable to the creation of black holes, low-mass galaxies contain few massive clusters and therefore have a limited contribution to the global production of dynamically formed merging BBHs. Furthermore, we find that massive clusters can host hierarchical BBH mergers with clear identifiable physical properties. Looking at the evolution of the BBH merger rate in different galaxies, we find strong correlations between BBH mergers and the most extreme episodes of star formation. Finally, we discuss the implications for future LIGO-Virgo-KAGRA gravitational wave observations.Comment: 14 pages, 9 figures, 3 table

Massive Star Cluster Formation and Destruction in Luminous Infrared Galaxies in GOALS

We present the results of a {\it Hubble Space Telescope} ACS/HRC FUV, ACS/WFC optical study into the cluster populations of a sample of 22 Luminous Infrared Galaxies in the Great Observatories All-Sky LIRG Survey. Through integrated broadband photometry we have derived ages and masses for a total of 484 star clusters contained within these systems. This allows us to examine the properties of star clusters found in the extreme environments of LIRGs relative to lower luminosity star-forming galaxies in the local Universe. We find that by adopting a Bruzual \& Charlot simple stellar population (SSP) model and Salpeter initial mass function, the age distribution of clusters declines as $dN/d\tau = \tau^{-0.9 +/- 0.3}$, consistent with the age distribution derived for the Antennae Galaxies, and interpreted as evidence for rapid cluster disruption occuring in the strong tidal fields of merging galaxies. The large number of $10^{6} M_{\odot}$ young clusters identified in the sample also suggests that LIRGs are capable of producing more high-mass clusters than what is observed to date in any lower luminosity star-forming galaxy in the local Universe. The observed cluster mass distribution of $dN/dM = M^{-1.95 +/- 0.11}$ is consistent with the canonical -2 power law used to describe the underlying initial cluster mass function (ICMF) for a wide range of galactic environments. We interpret this as evidence against mass-dependent cluster disruption, which would flatten the observed CMF relative to the underlying ICMF distribution.Comment: 63 pages, 58 Figures, 56 Tables, Accepted for publication in Ap

Complex SCN8A DNA-abnormalities in an individual with therapy resistant absence epilepsy

Background De novo SCN8A missense mutations have been identified as a rare dominant cause of epileptic encephalopathy. We described a person with epileptic encephalopathy associated with a mosaic deletion of the SCN8A gene. Methods Array comparative genome hybridization was used to identify chromosomal abnormalities. Next Generation Sequencing was used to screen for variants in known and candidate epilepsy genes. A single nucleotide polymorphism array was used to test whether the SCN8A variants were in cis or in trans. Results We identified a de novo mosaic deletion of exons 2–14 of SCN8A, and a rare maternally inherited missense variant on the other allele in a woman presenting with absence seizures, challenging behavior, intellectual disability and QRS-fragmentation on the ECG. We also found a variant in SCN5A. Conclusions The combination of a rare missense variant with a de novo mosaic deletion of a large part of the SCN8A gene suggests that other possible mechanisms for SCN8A mutations may cause epilepsy; loss of function, genetic modifiers and cellular interference may play a role. This case expands the phenotype associated with SCN8A mutations, with absence epilepsy and regression in language and memory skills

A case of antibody formation against octreotide visualized with ¹¹¹In-octreotide scintigraphy

A case of antibody formation in a patient with carcinoid syndrome is described. The patient was treated with octreotide in dosages up to 1.5 mg/day. Serum samples were analysed for the presence of octreotide antibodies before and after 20 months of octreotide treatment. In-vivo 111In-octreotide scintigraphy was performed before and during therapy, and after antibodies had developed. Before treatment, no serum antibodies against octreotide were detected. After 20 months of treatment, they were detectable up to a 1:115 serum dilution. The serum binding of 125I-Tyr3-octreotide was blocked by adding excess unlabelled Tyr3-octreotide, indicating the presence of specific octreotide antibodies. Before treatment, a normal distribution of radioactivity in the spleen and kidneys, irregular uptake in the liver due to metastases, and a hot spot in the lower abdomen were found during 111In-octreotide scintigraphy. After antibodies had developed, increased radioactivity over the heart and high background radioactivity in the abdomen with only faint visualization of the spleen, liver, and kidneys were found, indicating a prolonged presence of 111In-octreotide in the blood resulting from its being bound to antibodies. Increased radioactivity was also seen at the injection sites of the drug in the upper legs. In-vitro incubation of biopsy tissue from this site with 125I-Tyr3-octreotide revealed diffuse guanosine triphosphate (GTP) independent specific binding non-G-protein linked binding of labelled octreotide. This report describes the characteristic abnormalities during in-vivo 111In-octreotide scintigraphy in a patient with octreotide antibodies. These consisted of high background radioactivity due to prolonged circulation of antibody coupled 111In-octreotide together with visualization of the injection sites, which most probably results from local accumulation of antibodies.</p

Impact of proton pump inhibitor treatment on gastrointestinal bleeding associated with non-steroidal anti-inflammatory drug use among post-myocardial infarction patients taking antithrombotics: nationwide study

Study question What is the effect of proton pump inhibitors (PPIs) on the risk of gastrointestinal bleeding in post-myocardial infarction patients taking antithrombotics and treated with non-steroidal anti-inflammatory drugs (NSAIDs)? Methods This was a nationwide cohort study based on linked administrative registry data from all hospitals in Denmark between 1997 and 2011. The study included patients aged 30 years and over admitted with a first myocardial infarction who survived at least 30 days after discharge. The association between PPIs and risk of gastrointestinal bleeding according to NSAID plus antithrombotic therapy was estimated using adjusted time dependent Cox regression models. Study answer and limitations The use of PPIs was independently associated with decreased risk of gastrointestinal bleeding in post-myocardial infarction patients taking antithrombotics and treated with NSAIDs. Of 82 955 post-myocardial infarction patients (mean age 67.4 years, 64% (n=53 070) men), all of whom were taking single or dual antithrombotic therapy, 42.5% (n=35 233) filled at least one prescription for NSAIDs and 45.5% (n=37 771) received PPIs. Over a mean follow-up of 5.1 years, 3229 gastrointestinal bleeds occurred. The crude incidence rates of bleeding (events/100 person years) on NSAID plus antithrombotic therapy were 1.8 for patients taking PPIs and 2.1 for those not taking PPIs. The adjusted risk of bleeding was lower with PPI use (hazard ratio 0.72, 95% confidence interval 0.54 to 0.95) regardless of antithrombotic treatment regimen, type of NSAID, and type of PPI used. The main limitation of the study is its observational non-randomised design. The results suggest that PPI treatment probably has a beneficial effect regardless of underlying gastrointestinal risk and that when NSAIDs cannot be avoided in post-myocardial infarction patients, physicians might prescribe a PPI as well. The study does not clarify whether PPIs might be safely omitted in specific subgroups of patients with a low risk of gastrointestinal bleeding. What this study adds In post-myocardial infarction patients, bleeding complications have been associated with both antithrombotic and NSAID treatment. Concurrent use of PPIs was independently associated with a decreased risk of gastrointestinal bleeding in post-myocardial infarction patients taking antithrombotics and NSAID, regardless of antithrombotic treatment regimen, type of NSAID, and type of PPI used. Funding, competing interests, data sharing AMSO has received a grant from the Danish Council of Independent Research (grant 12-132760). GHG is supported by an unrestricted research scholarship from the Novo Nordisk Foundation