Faith Binckes, Kathryn Laing, Hannah Lynch (1859-1904): Irish Writer, Cosmopolitan, New Woman

She wrote with a passion for perfection. (p. 1) The recent decade in Irish literature has been marked by a boom in critical research that seeks to restore fairness to the canon’s gender inequality. Although there is always a risk of exclusion, in the case of Ireland, women writers have suffered from a serious degree of under-representation in Irish critical discourse. The change is detectable by a new wave of inspiring critics who challenge previous traditions, showing the cultural richness o..

Modulating Visuomotor Sequence Learning by Repetitive Transcranial Magnetic Stimulation: What Do We Know So Far?

Predictive processes and numerous cognitive, motor, and social skills depend heavily on sequence learning. The visuomotor Serial Reaction Time Task (SRTT) can measure this fundamental cognitive process. To comprehend the neural underpinnings of the SRTT, non-invasive brain stimulation stands out as one of the most effective methodologies. Nevertheless, a systematic list of considerations for the design of such interventional studies is currently lacking. To address this gap, this review aimed to investigate whether repetitive transcranial magnetic stimulation (rTMS) is a viable method of modulating visuomotor sequence learning and to identify the factors that mediate its efficacy. We systematically analyzed the eligible records (n = 17) that attempted to modulate the performance of the SRTT with rTMS. The purpose of the analysis was to determine how the following factors affected SRTT performance: (1) stimulated brain regions, (2) rTMS protocols, (3) stimulated hemisphere, (4) timing of the stimulation, (5) SRTT sequence properties, and (6) other methodological features. The primary motor cortex (M1) and the dorsolateral prefrontal cortex (DLPFC) were found to be the most promising stimulation targets. Low-frequency protocols over M1 usually weaken performance, but the results are less consistent for the DLPFC. This review provides a comprehensive discussion about the behavioral effects of six factors that are crucial in designing future studies to modulate sequence learning with rTMS. Future studies may preferentially and synergistically combine functional neuroimaging with rTMS to adequately link the rTMS-induced network effects with behavioral findings, which are crucial to develop a unified cognitive model of visuomotor sequence learning

Outcome in patients perceived as receiving excessive care across different ethical climates: a prospective study in 68 intensive care units in Europe and the USA

Purpose: Whether the quality of the ethical climate in the intensive care unit (ICU) improves the identification of patients receiving excessive care and affects patient outcomes is unknown. Methods: In this prospective observational study, perceptions of excessive care (PECs) by clinicians working in 68 ICUs in Europe and the USA were collected daily during a 28-day period. The quality of the ethical climate in the ICUs was assessed via a validated questionnaire. We compared the combined endpoint (death, not at home or poor quality of life at 1 year) of patients with PECs and the time from PECs until written treatment-limitation decisions (TLDs) and death across the four climates defined via cluster analysis. Results: Of the 4747 eligible clinicians, 2992 (63%) evaluated the ethical climate in their ICU. Of the 321 and 623 patients not admitted for monitoring only in ICUs with a good (n = 12, 18%) and poor (n = 24, 35%) climate, 36 (11%) and 74 (12%), respectively were identified with PECs by at least two clinicians. Of the 35 and 71 identified patients with an available combined endpoint, 100% (95% CI 90.0–1.00) and 85.9% (75.4–92.0) (P = 0.02) attained that endpoint. The risk of death (HR 1.88, 95% CI 1.20–2.92) or receiving a written TLD (HR 2.32, CI 1.11–4.85) in patients with PECs by at least two clinicians was higher in ICUs with a good climate than in those with a poor one. The differences between ICUs with an average climate, with (n = 12, 18%) or without (n = 20, 29%) nursing involvement at the end of life, and ICUs with a poor climate were less obvious but still in favour of the former. Conclusion: Enhancing the quality of the ethical climate in the ICU may improve both the identification of patients receiving excessive care and the decision-making process at the end of life

Veseérintettséggel járó ANCA-pozitív vasculitisek gyermekkorban

A vasculitis elnevezés egy rendkívül heterogén betegségcsoportot magában foglaló gyűjtőnév, mely csoportba különböző kóreredetű és prognózisú, változatos klinikai tünetekkel jellemzett kórképeket értünk, melyek közös tulajdonsága, hogy az érfalak gyulladását okozzák. Az ANCA-asszociált vasculitisek (AAV) közé tartozó kórképek a mikroszkópos polyangiitis, a granulomatosis polyangiitissel és az eosinophil granulomatosis polyangiitissel. A betegség korai felismerése és a megfelelő terápia elindítása kiemelkedően fontos az irreverzibilis szervkárosodások, sőt, egyes esetekben az életet veszélyeztető súlyos állapot megelőzése érdekében. A diagnózis azonban gyakran nehézségekbe ütközik a változatos klinikai tünetek jelenléte miatt. Az AAV prognózisa kezelés nélkül rendkívül rossz, azonban az 1970-es években bevezetett, jelenleg is standard indukciós terápiának tekinthető cyclophosphamid és nagy dózisú corticosteroid jelentősen megváltoztatta a mortalitási mutatót. A pathogenezis egyre mélyrehatóbb megismerésével újabb és újabb terápiás lehetőségek látnak napvilágot mind a remisszió indukcióban, mind a fenntartó kezelésben, aminek köszönhetően olyan betegek gyógyítására is van remény, akik a standard kezelésekre kevésbé reagálnak, vagy akár kontraindikált a hagyományos szerek alkalmazása. A súlyos szervi károsodások veszélye miatt szintén erőteljes kutatások folynak a terápia sikerét mutató, és a relapsusok előrejelzését minél korábban, megfelelő specificitással és szenzitivitással előrejelző biomarkerek felfedezésére. A DEKK Gyermekgyógyászati Intézetében az elmúlt 6 évben 3 gyermeket kezeltek veseérintettséggel járó AAV miatt. Eseteik áttekintésével láthatjuk azt, hogy milyen diszkrepancia lehetséges a klinikai tünetek súlyossága és az autoantitest-titerek között. Az általános állapot, a fennálló tünetek súlyossága, az ANCA-titer, a biopsziás minták és a kiegészítő diagnosztikai eljárások együttes értékelése szükséges a megfelelő terápia kiválasztásához.egységes, osztatlanáltalános orvosmagyarnappaliP.J.SZ

A novel percutaneous transhepatic treatment of a benign bile duct stricture – a pilot study

Aim To assess the effectiveness and outcome of repeated percutaneous transhepatic balloon dilatation combined with targeted intramucosal corticosteroid injection in patients with benign biliary stricture. Methods This single-center pilot study, conducted between February 2014 and June 2016, involved five patients with benign biliary stricture (4 men and 1 woman, mean age 58.2 years). The study included only patients in whom previous surgical or/and non-surgical treatments failed or could not be performed due to patients’ medical history and local status.Results We successfully developed an alternative treatment for patients with benign biliary stricture and performed it without side effects. There were no major complications, and the only one minor complication was cholangitis. In the median follow-up period of 30.24 months (range 14.5 to 44.6 months), no re-occlusion was detected. The disease-free survival, calculated after excluding the first patient (who died of heart attack), was 34.175 months. Conclusion Percutaneous transhepatic corticosteroid injection combined with balloon dilatation could provide an alternative method for the treatment of benign biliary strictures that is effective in the long term and results in positive outcomes

Expressed monophasic action potential alternans before the onset of ventricular arrhythmias induced by intracoronary bolus administration of endothelin-1 in dogs.

We showed previously a direct arrhythmogenic effect of the intracoronary infusion of endothelin-1 (ET-1). We aimed to examine the electrophysiological effects of intracoronary bolus administration of ET-1 using monophasic action potential (MAP) recordings. Eight mongrel dogs received boli of ET-1 (1 and 2 nmol) into the left anterior descending coronary artery. These intracoronary ET-1 boli rapidly caused a marked decrease in coronary blood flow (1 nmol, 78+/-7%; 2 nmol, 89+/-7%). Ischaemic changes of MAP morphology, a decrease in upstroke velocity (baseline, 1.78+/-0.2 V/s; 1 nmol, 0.95+/-0.18 V/s; 2 nmol, 0.45+/-0.21 V/s; P<0.01) and a decrease in MAP duration at 90% repolarization (MAPD(90)) [1 nmol, from 191+/-3 to 176+/-5 ms (P<0.05); 2 nmol, from 212+/-4 to 180+/-8 ms (P<0.05)] occurred after ET-1 bolus administration. However, at 7-10 min after the 1 nmol bolus, a significant increase in MAPD(90) was observed (10 min, in the left ventricular anterior epicardial region: from 191+/-3 to 206+/-6 ms; P<0.05). The incidence of ventricular arrhythmias was as follows: after the 1 nmol ET-1 bolus: ventricular tachycardia, 3/8 animals; ventricular fibrillation, 1/8; after the 2 nmol ET-1 bolus: ventricular tachycardia, 5/7; ventricular fibrillation, 5/7. MAP alternans was present in each animal (1 nmol, 18.2+/-5.8%; 2 nmol, 10.8+/-2.5%). Thus electrophysiological and coronary blood flow changes indicate the predominance of an ischaemic arrhythmogenic effect of the bolus administration of ET-1 (shortening of action potential duration; appearance of MAP alternans), whereas the observed delayed prolongation of MAPD(90) suggests a direct arrhythmogenic effect of ET-1. The expressed MAP alternans could have a pathogenic role in the onset of ventricular arrhythmias induced by an intracoronary bolus of ET-1