The role of cell-free DNA measured by a fluorescent test in the management of isolated traumatic head injuries

BACKGROUND: Traumatic brain injury (TBI) is a major cause of death and disability. In this study a new method to measure cell free DNA (CFD) for the management of TBI is tested. Our hypothesis was that CFD concentrations correlate to the magnitude of brain damage, and may predict the outcome of injured patients. METHODS: Twenty eight patients with isolated head injury were enrolled. Their demographic and clinical data were recorded. CFD levels were determined in patients' sera samples by a direct fluorescence method developed in our laboratory. RESULTS: Mean admission CFD values were lower in patients with mild TBI compared to severe injury (760 ± 340 ng/ml vs. 1600 ± 2100 ng/ml, p = 0.03), and in patients with complete recovery upon discharge compared to patients with disabilities (680 ± 260 ng/ml vs. 2000 ± 2300 ng/ml, p = 0.003). Patients with high CFD values had a relative risk to require surgery of 1.5 (95% CI 0.83 to 2.9) a relative risk to have impaired outcome on discharge of 2.8 (95% CI 0.75 – 10), and a longer length of stay (12 ± 13 days vs. 3.4 ± 4.8 days, p = 0.02). CFD values did not correlate with CT scan based grading. CONCLUSIONS: CFD levels may be used as a marker to assess the severity of TBI and to predict the prognosis. Its use should be considered as an additional tool along with currently used methods or as a surrogate for them in limited resources environment

Visualization of both proximal M2-MCA segments in patients (the Tilted-V Sign) with acute M1-MCA occlusion stroke is associated with better procedural and prognostic outcomes

IntroductionWe aimed to assess the clinical significance of M1-MCA occlusion with visualization of both MCA-M2 segments [“Tilted-V sign” (TVS)] on initial CT angiography (CTA) in patients with acute ischemic stroke (AIS) undergoing endovascular thrombectomy (EVT).MethodsData for patients with consecutive AIS undergoing EVT for large vessel occlusion (LVO) in two academic centers are recorded in ongoing databases. Patients who underwent EVT for M1-MCA occlusions ≤ 6 h from symptom onset were included in this retrospective analysis.ResultsA total of 346 patients met the inclusion criteria; 189 (55%) had positive TVS. Patients with positive TVS were younger (68 ± 14 vs. 71 ± 14 years, P = 0.028), with similar rates of vascular risk factors and baseline modified Rankin scores (mRS) 0–2. The rates of achieving thrombolysis in cerebral ischemia (TICI) 2b-3 were similar to the two groups (79%), although successful first-pass recanalization was more common with TVS (64 vs. 36%, p = 0.01). On multivariate analysis, higher collateral score [odds ratio (OR) 1.38 per unit increase, p = 0.008] and lower age (OR 0.98 per year increase, p = 0.046) were significant predictors of TVS. Patients with positive TVS had higher post-procedural Alberta Stroke Program Early CT Score (ASPECTS; 6.9 ± 2.2 vs. 5.2 ± 2.3, p = 0.001), were discharged with lower National Institutes of Health Stroke Score (NIHSS; 6±6 vs. 9±7, p = 0.003) and higher rates of mRS 0–2 (29.5 vs. 12%, p = 0.001), and had lower rates of 90-day mortality (13.2 vs. 21.6%, p = 0.038). However, TVS was not an independent predictor of functional independence (OR 2.51; 95% CI 0.7–8.3).ConclusionTilted-V Sign, an easily identifiable radiological marker, is associated with fewer recanalization attempts, better functional outcomes, and reduced mortality

Implicit task switching in Parkinson's disease is preserved when on medication.

People with Parkinson's disease have been shown to have difficulty switching between movement plans. In the great majority of studies, the need to switch between tasks was made explicitly. Here, we tested whether people with Parkinson's disease, taking their normal medication, have difficulty switching between implicitly specified tasks. We further examined whether this switch is performed predictively or reactively. Twenty five people with Parkinson's disease continuously increased or decreased the frequency of their arm movements, inducing an abrupt-but unaware-switch between rhythmic movements (at high frequencies) and discrete movements (at low frequencies). We tested whether that precipitous change was performed reactively or predictively. We found that 56% of participants predictively switched between the two movement types. The ability of people with Parkinson's disease, taking their regular medication, to predictively control their movements on implicit tasks is thus preserved

The role of cell-free DNA measured by a fluorescent test in the management of isolated traumatic head injuries.

BackgroundTraumatic brain injury (TBI) is a major cause of death and disability. In this study a new method to measure cell free DNA (CFD) for the management of TBI is tested. Our hypothesis was that CFD concentrations correlate to the magnitude of brain damage, and may predict the outcome of injured patients.MethodsTwenty eight patients with isolated head injury were enrolled. Their demographic and clinical data were recorded. CFD levels were determined in patients' sera samples by a direct fluorescence method developed in our laboratory.ResultsMean admission CFD values were lower in patients with mild TBI compared to severe injury (760 ± 340 ng/ml vs. 1600 ± 2100 ng/ml, p = 0.03), and in patients with complete recovery upon discharge compared to patients with disabilities (680 ± 260 ng/ml vs. 2000 ± 2300 ng/ml, p = 0.003). Patients with high CFD values had a relative risk to require surgery of 1.5 (95% CI 0.83 to 2.9) a relative risk to have impaired outcome on discharge of 2.8 (95% CI 0.75 - 10), and a longer length of stay (12 ± 13 days vs. 3.4 ± 4.8 days, p = 0.02). CFD values did not correlate with CT scan based grading.ConclusionsCFD levels may be used as a marker to assess the severity of TBI and to predict the prognosis. Its use should be considered as an additional tool along with currently used methods or as a surrogate for them in limited resources environment

Disorders of the Oral Cavity in Parkinson’s Disease and Parkinsonian Syndromes

Awareness of nonmotor symptoms of Parkinson’s disease is growing during the last decade. Among these, oral cavity disorders are, although prevalent, often neglected by the patients, their caregivers, and physicians. Some of these disorders include increased prevalence of caries and periodontal disease, sialorrhea and drooling, xerostomia, orofacial pain, bruxism, and taste impairment. Though many of these disorders are not fully understood yet and relatively few controlled trials have been published regarding their treatment, physicians should be aware of the body of evidence that does exist on these topics. This paper reviews current knowledge regarding the epidemiology, pathophysiology, and treatment options of disorders of the oral cavity in Parkinson’s disease patients

Alcohol consumption and hangover patterns among migraine sufferers

Aims: Alcohol hangover is a poorly understood cluster of symptoms occurring following a heavy consumption of alcohol. The term “delayed alcohol-induced headache” is often used synonymously. Our objective was to compare alcohol hangover symptoms in migraine sufferers and nonsufferers. Materials and Methods: In this cross-sectional study, university students were asked to fill structured questionnaires assessing headache history, alcoholic consumption, and hangover symptoms (using the Hangover Symptom Scale (HSS)). Subjects were classified as suffering from migraine with or without aura and nonsufferers according the International Classification of Headache Disorders 2nd Edition (ICHD-II). The 13 hangover symptoms were divided by the researches into migraine-like and other nonmigraine-like symptoms. Results: Hangover symptoms among 95 migraine sufferers and 597 nonsufferers were compared. Migraine sufferers consumed less alcohol compared with the nonsufferers (mean drinks/week 2.34 ± 4.11 vs. 2.92 ± 3.58, P = 0.038) and suffered from higher tendency to migraine-like symptoms after drinking (mean 2.91 ± 3.43 vs. 1.85 ± 2.35, P = 0.002) but not to other hangover symptoms (mean 5.39 ± 6.31 vs. 4.34 ± 4.56, P = 0.1). Conclusions: Migraine sufferers consume less alcohol, especially beer and liquors, and are more vulnerable to migraine-like hangover symptoms than nonsufferers. The finding that the tendency to develop migraine attacks affects the hangover symptomatology may suggest a similarity in pathophysiology, and possibly in treatment options

Parkinson’s Disease Prevalence and Proximity to Agricultural Cultivated Fields

The risk for developing Parkinson’s disease (PD) is a combination of multiple environmental and genetic factors. The Negev (Southern Israel) contains approximately 252.5 km2 of agricultural cultivated fields (ACF). We aimed to estimate the prevalence and incidence of PD and to examine possible geographical clustering and associations with agricultural exposures. We screened all “Clalit” Health Services members in the Negev (70% of the population) between the years 2000 and 2012. Individual demographic, clinical, and medication prescription data were available. We used a refined medication tracer algorithm to identify PD patients. We used mixed Poisson models to calculate the smoothed standardized incidence rates (SIRs) for each locality. We identified ACF and calculate the size and distance of the fields from each locality. We identified 3,792 cases of PD. SIRs were higher than expected in Jewish rural localities (median SIR [95% CI]: 1.41 [1.28; 1.53] in 2001–2004, 1.62 [1.48; 1.76] in 2005–2008, and 1.57 [1.44; 1.80] in 2009–2012). Highest SIR was observed in localities located in proximity to large ACF (SIR 1.54, 95% CI 1.32; 1.79). In conclusion, in this population based study we found that PD SIRs were higher than expected in rural localities. Furthermore, it appears that proximity to ACF and the field size contribute to PD risk

Contribution of Solar Radiation and Pollution to Parkinson’s Disease

Background. Parkinson’s disease (PD) is believed to develop from epigenetic modulation of gene expression through environmental factors that accounts for up to 85% of all PD cases. The main objective of this study was to examine the association between PD onset and a cumulative exposure to potentially modifiable ambient exposures. Methods. The study population comprised 3343 incident PD cases and 31,324 non-PD controls in Southern Israel. The exposures were determined based on the monitoring stations and averaged per year. Their association with PD was modeled using a distributed lag non-linear model and presented as an effect of exposure to the 75th percentile as compared to the 50th percentile of each pollutant, accumulated over the span of 5 years prior to the PD. Results. We recorded an adverse effect of particulate matter of size ≤10 μm in diameter (PM10) and solar radiation (SR) with odds ratio (OR) = 1.06 (95%CI: 1.02; 1.10) and 1.23 (95%CI: 1.08; 1.39), respectively. Ozone (O3) was also adversely linked to PD, although with a borderline significance, OR: 1.12 (95%CI: 0.99; 1.25). Immigrants arriving in Israel after 1989 appeared to be more vulnerable to exposure to O3 and SR. The dose response effect of SR, non-existent for Israeli-born (OR = 0.67, 95%CI: 0.40; 1.13), moderate for immigrants before 1989 (OR = 1.17, 95%CI: 0.98; 1.40) and relatively high for new immigrants (OR = 1.25, 95%CI: 1.25; 2.38) indicates an adaptation ability to SR. Conclusions. Our findings supported previous reports on adverse association of PD with exposure to PM10 and O3. Additionally, we revealed a link of Parkinson’s Disease with SR that warrants an extensive analysis by research groups worldwide

ADHD and political participation: An observational study

Background and objective Over the past decade, researchers have been seeking to understand the consequences of adult attention-deficit/hyperactivity disorder (ADHD) for different types of everyday behaviors. In this study, we investigated the associations between ADHD and political participation and attitudes, as ADHD may impede their active participation in the polity. Methods This observational study used data from an online panel studying the adult Jewish population in Israel, collected prior the national elections of April 2019 (N = 1369). ADHD symptoms were assessed using the 6-item Adult ADHD Self-Report (ASRS-6). Political participation (traditional and digital), news consumption habits, and attitudinal measures were assessed using structured questionnaires. Multivariate linear regression analyses were conducted to analyze the association between ADHD symptoms (ASRS score Results 200 respondents (14.6%) screened positive for ADHD based on the ASRS-6. Our findings show that individuals with ADHD are more likely to participate in politics than individuals without ADHD symptoms (B = 0.303, SE = 0.10, p = .003). However, participants with ADHD are more likely to be passive consumers of news, waiting for current political news to reach them instead of actively searching for it (B = 0.172, SE = 0.60, p = .004). They are also more prone to support the idea of silencing other opinions (B = 0.226, SE = 0.10, p = .029). The findings hold when controlling for age, sex, level of education, income, political orientation, religiosity, and stimulant therapy for ADHD symptoms. Conclusions Overall, we find evidence that individuals with ADHD display a unique pattern of political activity, including greater participation and less tolerance of others’ views, but not necessarily showing greater active interest in politics. Our findings add to a growing body of literature that examines the impact of ADHD on different types of everyday behaviors