Non-Pharmacological Management of Neurocardiogenic Syncope

AbstractNeurocardiogenic syncope is a common disorder. It is diagnosed by obtaining a detailed history and performing a head-up tilt test, with or without drug provocation. Several studies have been performed pertaining to its management. However, no treatment, whether pharmacological or non-pharmacological, except for counterpressure maneuvers and daily orthostatic tilt training, has been proven effective. Randomized studies of therapies for neurocardiogenic syncope are needed

Novel Treatment Criteria for Persistent Ductus Arteriosus in Neonates

BackgroundThe indications for ductus arteriosus ligation in very-low-birth-weight infants (VLBWIs) with persistent ductus arteriosus (PDA) are unclear. Increased left ventricular end-diastolic dimension (LVDd) is commonly found in patients with PDA. Here, the enlargement of LVDd in term and preterm neonates without congenital heart disease was estimated by two-dimensional echocardiography.MethodsThe value of the measured LVDd was divided by the normal LVDd as an index (LVDd ratio) to compare 30 patients who underwent PDA ligation with 30 patients treated with indomethacin and 30 patients who did not undergo radical therapy.ResultsAn LVDd ratio between 122% and 197% (mean, 142%) was considered to be an indication for the ligation procedure. The proportion of patients exceeding 130% in the LVDd ratio was 87% (26/30) in those patients who underwent ligation. Catecholamines and/or vasodilators were required in 83% patients for the treatment of low ejection fraction or hypertension after operations, suggesting that patients had been in preload and/or afterload remodeling failure during the operation. The percentage of patients with less than 115% in the LVDd ratio was 90% in the non-radical-therapy patients. The LVDd ratios of 130% and 115% were regarded as cut-off values for surgical ligation and indomethacin treatment.ConclusionThe LVDd ratio is a useful measure to determine the treatment of VLBWIs with PDA

Diaper-zero program in nursing home

With an aging population, the number of older adults admitted to nursing homes has increased. Diapers are often used to manage nursing home resident urinary incontinence, yet only one-third of these required assistance from caregivers to urinate. Unnecessary diaper use was reported in 23.9% of people, mostly for precautionary purposes. In this study, the Diaper-zero program caregivers asked residents regularly (every 2-3 h) whether they required voiding and prompted them to void. Over 11 months, the effects on 38 nursing home residents’ diaper use, nursing care level, physical activity, daily energy, and water intake were measured. A higher rate of diaper wearing was initially observed with lower daily energy and water intakes at the beginning of the Diaper-zero program, but this association was not observed after 11 months of the program. The diaper usage rate decreased significantly from 71.1% to 47.4% after 11 months. During this period, for all subjects, nursing care level, physical activity, and total daily intakes of energy and water were unchanged. In conclusion, this program enhances the desire to void, minimizing diaper usage, thus protecting the human dignity of nursing home residents

Effects of annealing of poly(3-hexylthiophene) film on the performance of double-layered EL devices of ITO/polymer/Alq3/Mg-Ag

Double layer devices with a structure of ITO/pHT/Alq3/Mg-Ag (ITO = indium tin oxide, pHT = regio-regular or random poly(3-hexylthiophene), Alq3 = tris(8-hydroxyquinoline)aluminium) were fabricated. The device with a random pHT film emitted a green-yellow light in all voltage region, while that having a regio-regular pHT film exhibited a color change from green to red by applying the bias voltage higher than 15 V. Annealing the pHT films prepared on ITO at 200 °C for 1 h in nitrogen, prior to vapor-deposition of the Alq3 layer, improved the device performance with lowering the onset bias voltage by 2-3 V. The EL colors and spectra were also affected by annealing. X-ray reflectivity measurements before and after annealing the pHT film on ITO indicated increased density of the pHT layer and structural changes in the pHT/ITO interface by annealing, which seems to be responsible for the improved EL device performanc

Influence of Visual Stimulation-Induced Passive Reproduction of Motor Images in the Brain on Motor Paralysis After Stroke

Finger flexor spasticity, which is commonly observed among patients with stroke, disrupts finger extension movement, consequently influencing not only upper limb function in daily life but also the outcomes of upper limb therapeutic exercise. Kinesthetic illusion induced by visual stimulation (KINVIS) has been proposed as a potential treatment for spasticity in patients with stroke. However, it remains unclear whether KINVIS intervention alone could improve finger flexor spasticity and finger extension movements without other intervention modalities. Therefore, the current study investigated the effects of a single KINVIS session on finger flexor spasticity, including its underlying neurophysiological mechanisms, and finger extension movements. To this end, 14 patients who experienced their first episode of stroke participated in this study. A computer screen placed over the patient’s forearm displayed a pre-recorded mirror image video of the patient’s non-paretic hand performing flexion–extension movements during KINVIS. The position and size of the artificial hand were adjusted appropriately to create a perception that the artificial hand was the patient’s own. Before and after the 20-min intervention, Modified Ashworth Scale (MAS) scores and active range of finger extension movements of the paretic hand were determined. Accordingly, MAS scores and active metacarpophalangeal joint extension range of motion improved significantly after the intervention. Moreover, additional experimentation was performed using F-waves on eight patients whose spasticity was reduced by KINVIS to determine whether the same intervention also decreased spinal excitability. Our results showed no change in F-wave amplitude and persistence after the intervention. These results demonstrate the potential clinical significance of KINVIS as a novel intervention for improving finger flexor spasticity and extension movements, one of the most significant impairments among patients with stroke. The decrease in finger flexor spasticity following KINVIS may be attributed to neurophysiological changes not detectable by the F-wave, such as changes in presynaptic inhibition of Ia afferents. Further studies are certainly needed to determine the long-term effects of KINVIS on finger spasticity, as well as the neurophysiological mechanisms explaining the reduction in spasticity

Paramyxovirus Sendai virus-like particle formation by expression of multiple viral proteins and acceleration of its release by C protein

AbstractEnvelope viruses maturate by macromolecule assembly and budding. To investigate these steps, we generated virus-like particles (VLPs) by co-expression of structural proteins of Sendai virus (SeV), a prototype of the family Paramyxoviridae. Simultaneous expression of matrix (M), nucleo- (N), fusion (F), and hemagglutinin-neuraminidase (HN) proteins resulted in the generation of VLPs that had morphology and density similar to those of authentic virus particles, although the efficiency of release from cells was significantly lower than that of the virus. By using this VLP formation as a model of virus budding, roles of individual proteins in budding were investigated. The M protein was a driving force of budding, and the F protein facilitated and the HN protein suppressed VLP release. Either of the glycoproteins, F or HN, as well as the N protein, significantly shifted density of VLPs to that of virus particles, suggesting that viral proteins bring about integrity of VLPs by protein–protein interactions. We further found that co-expression of a nonstructural protein, C, but not V, enhanced VLP release to a level comparable to that of virus particles, demonstrating that the C protein plays a role in virus budding

Cellular Immunity of Patients with Lung Cancer and Other Lung Diseases II. Analysis of interleukin-2 production

Interleukin-2 (IL-2) production by stimulated peripheral blood lymphocytes (PBL) from patients with lung cancer and noncancerous respiratory diseases was determined. The results are as follows: 1) Neither sex nor age difference was observed for IL-2 production among healthy people. 2) IL-2 production showed a positive correlation with the Leu-3a/Leu-2a ratio and a negative correlation with the percentage of HLA-DR+ cells. 3) IL-2 production of patients with lung cancer and noncancerous respiratory diseases did not differ from that of healthy persons. 4) No difference in IL-2 production was found in relation to the clinical stage of lung cancer, but subjects with low IL-2 production were mostly observed in the advanced stage group (Stage IV)

Supermassive black hole feeding and feedback observed on sub-parsec scales

Active galaxies contain a supermassive black hole at their center, which grows by accreting matter from the surrounding galaxy. The accretion process in the central ~10 parsecs has not been directly resolved in previous observations, due to the small apparent angular sizes involved. We observed the active nucleus of the Circinus Galaxy using sub-millimeter interferometry. A dense inflow of molecular gas is evident on sub-parsec scales. We calculate that less than 3% of this inflow is accreted by the black hole, with the rest being ejected by multiphase outflows, providing feedback to the host galaxy. The observations also reveal a dense gas disk surrounding the inflow; the disk is gravitationally unstable which drives the accretion into the central ~1 parsec.Comment: First release on Nov 3, 2023 in Science. 32 pages in one column = Main (13 pages, 4 figures) + Supplement (19 pages, 9 figures + 2 tables). This is the accepted version after peer revie