Visuaalisen neglectin tunnistamisen haasteet kognitiivisessa ajokykyarviossa: tapaustutkimus

Tämän tutkimuksen tarkoituksena oli selvittää, kuinka luotettavasti visuaalista vasemman puolen neglectiä ja ajokykyä pystytään arvioimaan kognitiivisilla kynä-paperitehtävillä kliinisessä yksilöarvioinnissa. Suoriutumista kynä-paperitehtävissä (Rey, Reyn välitön tahaton mieleenpalautus, BIT perinteiset osatehtävät, Vilkin viivat) verrattiin suoriutumiseen simulaattoriajossa. Lisäksi tarkasteltiin visuaalista havainnointia simulaattoriajon aikana silmänliikkeitä mittaamalla. Tutkimukseen osallistui kolme neglect-potilasta ja 17 tervettä verrokkia. Lopulliseen aineistoanalyysiin otettiin kymmenen verrokkia, koska seitsemän joutui keskeyttämään simulaattoripahoinvoinnin takia. Vasemman puolen havainnointi oli oikeaa puolta heikompaa ja ajaminen erittäin virhealtista siitä huolimatta, että kognitiivinen testisuoriutuminen ei antanut kahdella kolmesta neglect-potilaasta viitteitä neglect-oireista ja siten antanut aihetta epäillä heidän ajokykyään. Lisäksi neglect-potilaiden oiretiedostus näyttäytyi huomattavan heikkona. Tämä tutkimus antaa viitteitä siitä, että perinteiset kynä-paperitehtävät eivät ole riittävän herkkiä tunnistamaan visuaalista vasemman puolen neglectiä kliinisessä yksilöarvioinnissa 6–7,5 kuukautta aivoverenvuodon jälkeen eivätkä pysty luotettavasti ennustamaan potilaiden ajokykyisyyttä. Abstract The aim of this study was to clarify how reliably neglect symptoms and driving ability can be evaluated by cognitive paper and pencil tests in clinical assessment. Paper and pencil test performance (Rey, Rey immediate recall, BIT traditional subtests, Vilkki visual search for parallel lines) was compared to the driving simulator performance. Additionally, the visual search was recorded by eye-tracking device during simulator drive. Three neglect patients and 17 healthy controls participated in this study. Ten healthy controls were included in the final analyses. Seven healthy controls quit the study due to simulator sickness and their data was excluded from final analyses. Despite the fact that neglect was not revealed in the cognitive tests and thus there was no reason to doubt the driving ability of two out of three patients, neglect patients’ simulator drive was full of driving errors and perception of the left side was weaker than of the right side. Additionally, all the patients had clear anosognosia. This study suggests that traditional paper and pencil tests are not sensitive enough to recognize left visual neglect in clinical assessment 6–7.5 months after hemorrhage and cannot reliably predict the ability to drive. Keywords: neglect, hemi-inattention, driving, simulator, assessmen

The biological activity of serum bacterial lipopolysaccharides associates with disease activity and likelihood of achieving remission in patients with rheumatoid arthritis

Peer reviewe

The biological activity of serum bacterial lipopolysaccharides associates with disease activity and likelihood of achieving remission in patients with rheumatoid arthritis

Peer reviewe

Truncating <em>NFKB1 </em>variants cause combined NLRP3 inflammasome activation and type I interferon signaling and predispose to necrotizing fasciitis

\ua9 2024 The AuthorsIn monogenic autoinflammatory diseases, mutations in genes regulating innate immune responses often lead to uncontrolled activation of inflammasome pathways or the type I interferon (IFN-I) response. We describe a mechanism of autoinflammation potentially predisposing patients to life-threatening necrotizing soft tissue inflammation. Six unrelated families are identified in which affected members present with necrotizing fasciitis or severe soft tissue inflammations. Exome sequencing reveals truncating monoallelic loss-of-function variants of nuclear factor κ light-chain enhancer of activated B cells (NFKB1) in affected patients. In patients’ macrophages and in NFKB1-variant-bearing THP-1 cells, activation increases both interleukin (IL)-1β secretion and IFN-I signaling. Truncation of NF-κB1 impairs autophagy, accompanied by the accumulation of reactive oxygen species and reduced degradation of inflammasome receptor nucleotide-binding oligomerization domain, leucine-rich repeat-containing protein 3 (NLRP3), and Toll/IL-1 receptor domain-containing adaptor protein inducing IFN-β (TRIF), thus leading to combined excessive inflammasome and IFN-I activity. Many of the patients respond to anti-inflammatory treatment, and targeting IL-1β and/or IFN-I signaling could represent a therapeutic approach for these patients

Rizatriptan versus rizatriptan plus rofecoxib versus rizatriptan plus tolfenamic acid in the acute treatment of migraine

BACKGROUND: Rizatriptan is an effective and fast acting drug for the acute treatment of migraine. Some nonsteroidal anti-inflammatory drugs (NSAID) have also demonstrated efficacy in treating migraine attacks. There is evidence that the combination of a triptan and a NSAID decreases migraine recurrence in clinical practice. The primary aim of this randomized open label study was to assess the recurrence rates in migraine sufferers acutely treated with rizatriptan (RI) alone vs. rizatriptan plus a COX-2 enzyme inhibitor (rofecoxib, RO) vs. rizatriptan plus a traditional NSAID (tolfenamic acid, TO). We were also interested in comparing the efficacy rates within these three groups. METHODS: We assessed 45 patients from a headache clinic in Rio de Janeiro (35 women and 10 men, ages 18 to 65 years, mean 37 years). Patients with IHS migraine were randomized to one out of 3 groups, where they had to treat 6 consecutive moderate or severe attacks in counterbalanced order. In group 1, patients treated the first two attacks with 10 mg RI, the third and fourth attacks with RI + 50 mg RO and the last attacks with RI + 200 mg of TA. In group 2, we began with RI + TA, followed by RI, and RI + RO. Group 3 treated in the following order: RI + RO, RI + TA, RI alone. The presence of headache, nausea and photophobia at 1, 2 and 4 hours, as well as recurrence and side effects were compared. RESULTS: A total of 33 patients finished the study, treating 184 attacks. The pain-free rates at 1 hour were: RI: 15.5%; RI + RO: 22.6%; RI + TA: 20.3%(NS). Pain-free rates at 2 h were: RI: 37.9%; RI + RO: 62.9%, and RI + TA: 40.6% (p = 0.008 for RI vs. RI + RO; p = 0.007 for RI + RO vs. RI + TA, NS for RI vs RI + TA). At 4 h, pain-free rates were: RI: 69%; RI + RO: 82.3%; RI + TA: 78.1% (NS for all comparisons). The combination of RI + RO was superior to RI and to RI + TA in regard of the absense of nausea and photophobia at 4 hours. Recurrence (after being pain-free at 2 h) was observed in 50% of patients treated with RI, in 15,4% of those treated with RI + RO, and in 7,7% of those treated with RI + TA. CONCLUSIONS: Despite the methodological limitations of this study, the combination of RI and RO revealed a higher response rate at 2 hours. Recurrence was also clearly decreased with both combinations in relation to the use of RI alone. Controlled studies are necessary to provide additional evidence

Substantial variation in the timing of pollen production reduces reproductive synchrony between distant populations of Pinus sylvestris L. in Scotland

The ability of a population to genetically adapt to a changing environment is contingent not only on the level of existing genetic variation within that population, but also on the gene flow received from differently adapted populations. Effective pollen-mediated gene flow among plant populations requires synchrony of flowering. Therefore differences in timing of flowering among genetically divergent populations may reduce their ability to adapt to environmental change. To determine whether gene flow among differently adapted populations of native Scots pine (Pinus sylvestris) in Scotland was restricted by differences in their flowering phenology, we measured timing of pollen release among populations spanning a steep environmental gradient over three consecutive seasons (2014–2016). Results showed that, over a distance of 137 km, there were as many as 15.8 days’ difference among populations for the predicted timing of peak pollen shedding, with the earliest development in the warmer west of the country. There was much variation between years, with the earliest development and least synchrony in the warmest year (2014) and latest development and greatest synchrony in the coolest year (2015). Timing was negatively correlated with results from a common-garden experiment, indicative of a pattern of countergradient variation. We conclude that the observed differences in reproductive synchrony were sufficient to limit gene flow via pollen between populations of P. sylvestris at opposite ends of the environmental gradient across Scotland. We also hypothesize that continually warming, or asymmetrically warming spring temperatures will decrease reproductive synchrony among pine populations

Työmaa-aikainen sähköverkko rakennustyömailla

Tässä opinnäytetyössä esitellään työmaa-aikaista sähköverkkoa sekä esitellä ratkaisuja kestävään sähköverkkoon. Kestävällä tarkoitetaan sitä, että ylikuormaa ei tule eikä sähkönsyöttö katkea. Opinnäytetyössä tuodaan esille myös työmaa-aikaisen sähköverkon tuomia ongelmia rakennustyömailla Suurimpia ongelmia työmaa-aikaisessa sähköverkossa on sääolosuhteet, ylikuorma, rikkinäiset laitteet tai muut ulkoiset tekijät. Kuormituksen laskeminen on tärkeä osa kestävän sähköverkon rakentamisen kannalta. Muita keskeisiä asioita kestävän sähköverkon rakentamisen kannalta ovat oikeanlainen kalusto ja sen huolto. Oikeanlaisen kaluston valinta on erittäin tärkeää ja sitä tuodaan myös esille tässä opinnäytetyössä. Myös kaluston huolto on tärkeää ja sitä tuodaan myös esille. Tämän opinnäytetyön ratkaisuja voidaan hyödyntää lähes jokaisella työmaalla. Työ-maa voi olla niin uudisrakennuskohde kuin saneerauskohdekin.The purpose of this work is to introduce how to build functional temporary electrical grid at the worksite. Functional electrical grid means that there aren’t overloads and the electrical grid won’t shut down. Biggest problems of temporary electrical grid are that weather changes, overloads and broken machines. It’s very important to calculate the loads of electrical grid. It’s also very important to choose the right machines and equipment. Also it’s neces-sary to maintain equipment so it won’t cause any problems. The results of this thesis could be used in every worksite