Rapid and Reversible Recruitment of Early Visual Cortex for Touch

The loss of vision has been associated with enhanced performance in non-visual tasks such as tactile discrimination and sound localization. Current evidence suggests that these functional gains are linked to the recruitment of the occipital visual cortex for non-visual processing, but the neurophysiological mechanisms underlying these crossmodal changes remain uncertain. One possible explanation is that visual deprivation is associated with an unmasking of non-visual input into visual cortex.We investigated the effect of sudden, complete and prolonged visual deprivation (five days) in normally sighted adult individuals while they were immersed in an intensive tactile training program. Following the five-day period, blindfolded subjects performed better on a Braille character discrimination task. In the blindfold group, serial fMRI scans revealed an increase in BOLD signal within the occipital cortex in response to tactile stimulation after five days of complete visual deprivation. This increase in signal was no longer present 24 hours after blindfold removal. Finally, reversible disruption of occipital cortex function on the fifth day (by repetitive transcranial magnetic stimulation; rTMS) impaired Braille character recognition ability in the blindfold group but not in non-blindfolded controls. This disruptive effect was no longer evident once the blindfold had been removed for 24 hours.Overall, our findings suggest that sudden and complete visual deprivation in normally sighted individuals can lead to profound, but rapidly reversible, neuroplastic changes by which the occipital cortex becomes engaged in processing of non-visual information. The speed and dynamic nature of the observed changes suggests that normally inhibited or masked functions in the sighted are revealed by visual loss. The unmasking of pre-existing connections and shifts in connectivity represent rapid, early plastic changes, which presumably can lead, if sustained and reinforced, to slower developing, but more permanent structural changes, such as the establishment of new neural connections in the blind

ENSAT registry-based randomized clinical trials for adrenocortical carcinoma

Adrenocortical carcinoma (ACC) is an orphan disease lacking effective systemic treatment options. The low incidence of the disease and high cost of clinical trials are major obstacles in the search for improved treatment strategies. As a novel approach, registry-based clinical trials have been introduced in clinical research, so allowing for significant cost reduction, but without compromising scientific benefit. Herein, we describe how the European Network for the Study of Adrenal Tumours (ENSAT) could transform its current registry into one fit for a clinical trial infrastructure. The rationale to perform randomized registry-based trials in ACC is outlined including an analysis of relevant limitations and challenges. We summarize a survey on this concept among ENSAT members who expressed a strong interest in the concept and rated its scientific potential as high. Legal aspects, including ethical approval of registry-based randomization were identified as potential obstacles. Finally, we describe three potential randomized registry-based clinical trials in an adjuvant setting and for advanced disease with a high potential to be executed within the framework of an advanced ENSAT registry. Thus we, therefore, provide the basis for future registry-based trials for ACC patients. This could ultimately provide proof-of-principle of how to perform more effective randomized trials for an orphan disease

Extreme physical phenomena during the Trojan war

The Homeric Epic, Iliad, describes the Trojan War’s events during a period of only seven days around Patroclus’ death. These events are initiated after Athena’s appearance as a shooting star. During this period, the poet describes in detail various physical phenomena, which attributed to the gods. Zeus’ thunderbolts in a clear sky, ‘divine’ screams, a fallen thunder stone inducing odor of sulphur, sporadic yellow, red and dark clouds appearing out of nowhere, red droplets are falling from the sky, river Xanthus is flooding and turns into red, Hephaestus’ ‘flames’ ignite fires, whereas seismic activity and raising of the sea level are recorded. The above phenomena can be explained as a consequence of the local weather’s circumstances and landscape peculiarities, as well as due to the partial solar eclipse’s manifestation, which occurred during the same period. We analysed all these descriptions in detail and we concluded that an intense astronomical phenomenon like a meteor shower including some fireball’s explosions is indicated by the poet, in parallel with the Trojan War’s combats. This is in accordance with the mythological account of a comet’s appearance during Troy’s fall, because meteor showers produced by the remnants of the comets, when they approach to the Sun. © 2016 MAA Open Access. Printed in Greece. All rights reserved

Scar perceptions after thyroid and parathyroid surgery: Comparison of minimal and conventional approaches

Background. An incision less than 3 cm in length in the neck is the main feature that discriminates the minimally invasive thyroidectomy and parathyroidectomy from traditional procedures. Smaller neck scars are assumed to yield better patient satisfaction, although no established data support this. In this analysis, we evaluated the satisfaction of patients who had undergone both procedures, while examining the effects of sociodemographic and surgical characteristics. Methods. We analyzed data from 691 patients who underwent a thyroidectomy or parathyroidectomy between January 2000 and March 2010. We assessed the satisfaction of patients who underwent conventional compared to minimally invasive procedures, using the validated Patient Scar Assessment Questionnaire (PSAQ). We included both the appearance and the consciousness subscales. Results. Overall, patients were satisfied with their neck scars, as indicated by the low scores in appearance (13.3; range, 9 to 31) and consciousness (8.5; range, 6 to 24) subscales. The degree of satisfaction, improved with increased time since surgery (P<.001). Patient satisfaction was similar regardless of the procedure used, implying that smaller scars do not provide better patient satisfaction. Most patients (81.2%) reported that they would not have preferred a transaxillary procedure over the procedure they received. Conclusion. A smaller incision in the neck was not associated with better patient satisfaction. New surgical approaches aimed at maximizing cosmesis while minimizing scar size should be evaluated for cost-effectiveness and clinical outcomes, as well as patient-satisfaction, before becoming the standard of care. (Surgery 2013;153:400-7.

Clinical use of smartphones among medical and nursing staff in Greece: A survey

The aim of this study was to investigate the clinical use of smartphones among medical and nursing staff in Greece. This study used a 17-item questionnaire that was administered to the participants by the authors. The sample consists of 974 participants of 1200 who were asked to participate (ie, a response rate of 81.3%). The survey was open to all categories of medical and nursing staff (junior doctors, specialized doctors, assistant nurses, and RNs). In total, 167 participants (18.5%) were nurse assistants; 385 participants (42.6%), nurses; 154 participants (17%), specialized doctors; and 198 participants (21.9%), junior doctors. The data analysis was performed using SPSS Statistics (version 21), and the significance level was set to .05. Medical doctors own smartphones on a higher percentage in comparison with nurses. Among smartphone owners, medical doctors use their devices for clinical issues more frequently compared with nurses. Although medical doctors believe that smartphones can be a great tool for their work, they state that they do not use it for clinical reasons. Nurses state that they do not use their smartphones for clinical reasons because they are not aware of the existence of applications that can be used to assist them in their daily clinical tasks

Retroperitoneal perforation of a duodenal diverticulum with colonic necrosis - Report of a case

Primary duodenal diverticula are usually asymptomatic. About 115 perforations have been reported, but none with right colon necrosis. We report a 45-year-old woman, with a five days history of high fever along with epigastric and periumbilical pain. Physical examination revealed right upper and lower quadrant tenderness with peritoneal signs. White blood cell count was 11 500/mm(3) while biochemical and hepatic biology tests were normal. Abdominal radiographs showed no pathologic findings. Ultrasound disclosed fluid in the lower pelvis. Computerized tomography revealed fluid collection in the right hepatorenal space. Intraoperative findings included purulent fluid in the lower pelvis, segmental necrotic changes of the right colon, and a perforated diverticulum on the antimesenteric border of the third part of the duodenum. Surgery consisted of right hemicolectomy and ileo-transverse anastomosis, diverticulectomy, and decompressive lateral duodenostomy at the second duodenal portion. The patient had an uneventful postoperative course. A contrast study from the duodenostomy tube on the 6(th) postoperative day showed no leakage or obstruction. Duodenostomy tube was removed on the 14(th) postoperative day. Histology confirmed the diagnosis of a primary duodenal diverticulum

What will the future hold for artificial organs in the service of assisted reproduction: prospects and considerations

Assisted reproduction provides a wide spectrum of treatments and strategies addressing infertility. However, distinct groups of infertile patients with unexplained infertility, congenital disorders, and other complex cases pose a challenge in in vitro fertilization (IVF) practices. This special cohort of patients is associated with futile attempts, IVF overuse, and dead ends in management. Cutting edge research on animal models introduced this concept, along with the development of artificial organs with the aim to mimic the respective physiological functions in reproduction. Extrapolation on clinical application leads to the future use of infertility management in humans. To date, the successful clinical application of artificial reproductive organs in humans is not feasible because further animal model studies are required prior to clinical trials. The application of these artificial organs could provide a solution to infertility cases with no other options. This manuscript presents an overview on the current status, future prospects, and considerations on the potential clinical application of artificial ovary, uterus, and gametes in humans. This paper presents how the IVF practice landscape may be shaped and challenged in the future, along with the subsequent concerns in assisted reproductive treatments. © 2019, Higher Education Press and Springer-Verlag GmbH Germany, part of Springer Nature

Bile duct injuries associated with laparoscopic and open cholecystectomy: An 11-year experience in one institute

Purpose. Bile duct injury (BDI) represents the most serious complication of laparoscopic cholecystectomy (LC). The aim of this retrospective single-institution study was to evaluate the real incidence of BDI during laparoscopic and open cholecystectomy (OC) in a tertiary academic center in Athens, Greece. Methods. Between January 1991 and December 2001, 3637 patients underwent cholecystectomy in our department; as LC in 2079 patients (LC group) and as OC in 1558 patients (OC group). All the LCs were performed or supervised by five staff surgeons and all the OCs were performed or supervised by another five staff surgeons. Results. There were 13 BDIs associated with LC (0.62%) and 6 associated with OC (0.38%) (P = 0.317). There was one death associated with BDI after LC. Only two (15.4%) of the BDIs associated with LC occurred within the proposed learning curve limit of 50 LCs per individual surgeon. Conclusion. Laparoscopic cholecystectomy is safe and is not associated with a higher incidence of BDI than OC. Moreover, we did not find that the learning curve for LC affected BDI occurrence