Brain oxygenation patterns during the execution of tool use demonstration, tool use pantomime, and body-part-as-object tool use

© 2015 Elsevier B.V. Divergent findings exist whether left and right hemispheric pre- and postcentral cortices contribute to the production of tool use related hand movements. In order to clarify the neural substrates of tool use demonstrations with tool in hand, tool use pantomimes without tool in hand, and body-part-as-object presentations of tool use (BPO) in a naturalistic mode of execution, we applied functional Near InfraRed Spectroscopy (fNIRS) in twenty-three right-handed participants. Functional NIRS techniques allow for the investigation of brain oxygenation during the execution of complex hand movements with an unlimited movement range. Brain oxygenation patterns were retrieved from 16 channels of measurement above pre- and postcentral cortices of each hemisphere. The results showed that tool use demonstration with tool in hand leads to increased oxygenation as compared to tool use pantomimes in the left hemispheric somatosensory gyrus. Left hand executions of the demonstration of tool use, pantomime of tool use, and BPO of tool use led to increased oxygenation in the premotor and somatosensory cortices of the left hemisphere as compared to right hand executions of either condition. The results indicate that the premotor and somatosensory cortices of the left hemisphere constitute relevant brain structures for tool related hand movement production when using the left hand, whereas the somatosensory cortex of the left hemisphere seems to provide specific mental representations when performing tool use demonstrations with the tool in hand

Long-Term Follow-Up of Survivors of Extracorporeal Life Support Therapy for Cardiogenic Shock: Are They Really Survivors?

Background and Objectives: Cardiogenic shock (CS) is a medical emergency associated with a high mortality rate. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has become an accepted therapy for CS. Despite widely available data for short-term survival rates, there are only limited data available regarding long-term outcomes following successful VA-ECMO therapy. Materials and Methods: We analyzed the demographics, past medical history, adverse events, and outcomes of survivors who received VA-ECMO support for CS at our center from January 2012 to December 2019. Post-cardiotomy cases were excluded. Results: A total of 578 VA-ECMO implantations on 564 consecutive patients due to CS were identified during the study period. Successful weaning was achieved in 207 (36.7%) patients. Among the survivors, 126 (63%) patients received VA-ECMO therapy without preceding cardiac surgery during their current admission. A follow-up exceeding 12 (mean: 36 ± 20.9) months was available in a total of 55 (43.7%) survivors. The mean VA-ECMO perfusion time was 10.9 (±7.7) days with a mean intensive care unit (ICU) stay of 38.2 (±29.9) days and a mean hospital stay of 49.9 (±30.5) days. A total of 3 deaths were recorded during long-term follow-up (mean survival of 26 ± 5.3 months). Conclusions: Despite the high mortality associated with VA-ECMO therapy, a long-term follow-up with an acceptably low rate of negative cardiac events can be achieved in many survivors. We observed an acceptable low rate of new cardiac events. Further evaluation, including a quality-of-life assessment and a close follow-up for rarer complications in these patients, is needed to elucidate the longer-term outcomes for survivors of invasive VA-ECMO therapy

Cardiac Myxoma and Cerebrovascular Events: A Retrospective Cohort Study

Background: Cardiac myxoma (CM) is the most frequent, cardiac benign tumor and is associated with enhanced risk for cerebrovascular events (CVE). Although surgical CM excision is the only curative treatment to prevent CVE recurrence, in recent reports conservative treatment with antiplatelet or anticoagulant agents in high-risk patients with CM-related CVE has been discussed.Methods: Case records at the University Hospital of Tübingen between 2005 and 2017 were screened to identify patients with CM-related CVE. Clinical features, brain and cardiac imaging findings, histological reports, applied treatments and long-term neurological outcomes were assessed.Results: 52 patients with CM were identified and among them, 13 patients with transient ischemic attack, ischemic stroke or retinal ischemia were included to the (to our knowledge) largest reported retrospective study of CM-related CVE. In all identified patients, CVE was the first manifestation of CM; 61% suffered ischemic stroke, 23% transient ischemic attack and 15% retinal ischemia. In 46% of the patients, CVE occurred under antiplatelet or anticoagulation treatment, while 23% of the patients developed recurrent CVE under bridging-antithrombotic-therapy prior to CM surgical excision. Prolonged time interval between CVE and CM-surgery was significantly associated with CVE recurrence (p = 0.021). One patient underwent i.v. thrombolysis, followed by thrombectomy, with good post-interventional outcome and no signs of hemorrhagic transformation.Discussion: Our results suggest that antiplatelet or anticoagulation treatment is no alternative to cardiac surgery in patients presenting with CM-related CVE. We found significantly prolonged time-intervals between CVE and CM surgery in patients with recurrent CVE. Therefore, we suggest that the waiting- or bridging-interval with antithrombotic therapy until curative CM excision should be kept as short as possible. Based on our data and review of the literature, we suggest that in patients with CM-related CVE, i.v. thrombolysis and/or endovascular interventions may present safe and efficacious acute treatments

What iconic gesture fragments reveal about gesture-speech integration: When synchrony is lost, memory can help

The present series of experiments explores several issues related to gesture-speech integration and synchrony during sentence processing. To be able to more precisely manipulate gesture-speech synchrony, we used gesture fragments instead of complete gestures, thereby avoiding the usual long temporal overlap of gestures with their coexpressive speech. In a pretest, the minimal duration of an iconic gesture fragment needed to disambiguate a homonym (i.e., disambiguation point) was therefore identified. In three subsequent ERP experiments, we then investigated whether the gesture information available at the disambiguation point has immediate as well as delayed consequences on the processing of a temporarily ambiguous spoken sentence, and whether these gesture-speech integration processes are susceptible to temporal synchrony. Experiment 1, which used asynchronous stimuli as well as an explicit task, showed clear N400 effects at the homonym as well as at the target word presented further downstream, suggesting that asynchrony does not prevent integration under explicit task conditions. No such effects were found when asynchronous stimuli were presented using a more shallow task (Experiment 2). Finally, when gesture fragment and homonym were synchronous, similar results as in Experiment 1 were found, even under shallow task conditions (Experiment 3). We conclude that when iconic gesture fragments and speech are in synchrony, their interaction is more or less automatic. When they are not, more controlled, active memory processes are necessary to be able to combine the gesture fragment and speech context in such a way that the homonym is disambiguated correctly

Progression of Fibrosis in Usual Interstitial Pneumonia: Serial Evaluation of the Native Lung after Single Lung Transplantation

Background: Idiopathic pulmonary fibrosis (IPF) is a progressive disease with a poor prognosis. Usual interstitial pneumonia (UIP) is the histopathological pattern identifying patients with the clinical entity of IPF. Despite aggressive immunosuppressive therapy the clinical course is usually dismal. For selected patients only lung transplantation improves prognosis and quality of life. After lung transplantation patients often receive a potent cyclosporine-based immunosuppressive therapy. Some reports suggest that cyclosporine has the potential to prevent progression of fibrosis. Objective: In patients with single lung transplantation (sLTx) for UIP we evaluated the effect of cyclosporine-based immunosuppressive therapy on progression of fibrosis using a high-resolution computed tomography (HRCT) scoring system. Methods: This retrospective observational study included 13 patients (24–64 years old) with histologically confirmed UIP who had HRCT scans preceding and following sLTx and who survived at least 6 months after sLTx. All pa- tients were initially treated with cyclosporin A, prednisone and azathioprine. Three radiologists analyzed HRCT scans by setting a score regarding fibrosis [fibrosis score (FS); range 0–5 for each lobe] and ground-glass opacity [ground-glass score (GGS); range 0–5 for each lobe]. A comparison of serial changes (interval: 12–96 months posttransplant, 2–4 HRCT examinations/patient) was performed with the sign test. Results: Mean pretransplant FS and GGS of the nontransplanted lung were 1.80 and 1.61, respectively. Comparing pre- and posttransplant HRCT scans, mean lung FS significantly increased (0.35 8 0.15/year; p = 0.00024), while GGS tended to decrease (0.06 8 0.26/year; p = 0.5). Conclusion: A cyclosporin A based triple immunosuppressive regimen following sLTx does not seem to prevent progression of the fibrotic changes of the native lung in patients with IPF