2,183 research outputs found
SFEMG: A piece in the diagnostic puzzle of myasthenia
No full textWe very much thank Haran (2014) for his comments on our paper. We completely agree that interpretation of the results coming from a diagnostic test must be done with great caution and that only a comprehensive evaluation of the clinical picture and instrumental results will lead to correct diagnosis and proper management of our patients. This is always true, especially in a treatable disease such as myasthenia.
Our view is clearly expressed in the very last sentence of the manuscript: “The results of SFEMG should not be interpreted in isolation from the clinical presentation and ancillary test results” (Padua et al., 2014); however, Haran’s reply gives us the opportunity to emphasize the concept even more, which is also the subject of a recent editorial (Caliandro et al., 2013). We know that myasthenia may be difficult to diagnose in individual cases and that we must use all available tools to reach the correct diagnosis (Caliandro et al., 2009), as Haran and coworkers did with their patient (Haran et al., 2013) who, although rare, is a paradigmatic myasthenic patient with antibodies to muscle-specific tyrosine kinase (MuSK-MG) (Evoli et al., 2003 and Evoli et al., 2012). In our work on the reliability of SFEMG in diagnosing myasthenia gravis, we concluded that patients with normal findings at SFEMG are unlikely to be affected by myasthenia gravis because the results from the sensitivity analysis underline that the positive likelihood ratio is always low in both evaluations and therefore, SFEMG has a small value as the confirmatory test for myasthenia gravis diagnosis. Meanwhile, the negative likelihood ratio, although with a wide range, has a low value in both analyses and, therefore, SFEMG has a moderate-to-large value as the test useful in identifying healthy subjects. All this means that normal findings at SFEMG are more meaningful than pathological findings, but of course, a normal SFEMG does not definitively exclude the diagnosis of myasthenia gravis
Defining a functional network homeostasis after stroke: EEG-based approach is complementary to functional MRI
No full textWe have read with great interest the article by Adhikari
et al
. entitled ‘Decreased integration and information capacity
in stroke measured by whole brain models of resting state
activity’ recently published in
Brain
(Adhikari
et al.
, 2017).
The authors of this excellent article found that the brain
network functional connectivity, evaluated by functional
MRI, is impaired among subjects with subacute stroke,
being the graph theoretical measures of integration and
segregation decreased. This kind of network reorganization
occurs both in the whole cerebral network and in the seven
resting state subnetworks [dorsal attention network (DAN),
ventral attention network (VAN), motor network, visual
network, frontal parietal network (FPN), language network
(LAN) and default mode network (DMN)]. In particular,
the integration is decreased among all resting state net-
works, while the segregation, intended as mean information
capacity, is decreased globally and among DAN and FPN
resting state networks.
In this frame, we would like to convey an analogous and
complementary EEG-based approach that could add more
‘dynamic’ information about functional cortical connectivity,
being EEG signals directly related to the cyclic firing of the
neuronal assemblies, reaching thus a temporal discrimin-
ation—particularly when fast EEG rhythms are con-
sidered—of few tens of milliseconds. Requiring a balance
in the brain activity between local specialization and
global integration (Tononi
et al
., 1994), properly quantified
by a small-world network model (Watts and Strogatz,
1998), characterized by high clustering coefficient (index of
functional segregation) and short path length coefficient
(index of functional integration) (Bassett and Bullmore,
2006; Stam and Reijneveld, 2007), we evaluated via EEG
the small-world characteristics (small-worldness) of resting
state cortical networks in 30 consecutive patients with
acute ischaemic stroke (Caliandro
et al.
, 2017). In fact,
using the eLORETA software (Pascual-Marqui, 2002), it is
possible to reconstruct 42 regions of interest, corresponding
to 42 Brodmann areas, for each hemisphere, and to calculate
the current density time series of the regions of interest
(lagged linear coherence) (Pascual-Marqui, 2007; Pascual-
Marqui
et al
., 2011) between all possible pairs of the regions
of interest for each of the seven independent EEG frequency
bands of delta (2–4Hz), theta (4–8Hz), alpha 1 (8–10.5Hz),
alpha 2 (10.5–13Hz), beta 1 (13–20Hz), beta 2 (20–30Hz),
and gamma (30–45Hz) rhythms for each subject. Given
this, an EEG-derived cortical network in which the nodes
are represented by the Brodmann areas and the edges
are weighted by lagged linear connectivity values can be
reconstructed (Pascual-Marqui, 2007). The aforementioned
EEG- and graph theory-based approach allowed us to find
network rearrangement in a frequency-dependent modality
doi:10.1093/brain/awx271
BRAIN 2017: 140; 1–2
|
e71
Advance Access publication November 3, 2017
ß
The Author (2017). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved.
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on 20 February 2018
(Caliandro
et al.
, 2017). In particular, in the delta band
we found a decreased small-worldness (similar to the
rearrangement in delta band, we found a bilateral theta
band small-worldness reduction only in patients with left
hemispheric stroke). On the hand, we found an increased
small-worldness in alpha 2 band. It is noteworthy that the
abovementioned network changes were found in the hemi-
sphere ipsilateral to the ischaemic lesion, in the contralateral
hemisphere and in the whole brain.
Compared with the Adhakiri
et al
. study, our data show
a greater complexity of cortical resting state remodelling
after acute stroke, probably because EEG signals reflect
the intricacy of neuronal spontaneous time-varying oscilla-
tions. It is noteworthy that segregation and integration are
simultaneously increased and reduced when compared to
healthy subjects according to the analysed EEG frequency.
Indeed, segregation is increased in low frequencies
(delta and theta) and reduced in alpha 2 frequency. A
specular behaviour is observed when evaluating integration,
where a reduction in delta and theta and an increase in
alpha 2 are observed. In other words, we facilitate a multi-
modal dynamic change, which could be interpreted as an
attempt to reach a balance between the damage caused
by the lesion and the brain compensatory reaction.
We can hypothesize that this fascinating connectivity
‘homeostasis’ has a double effect: on one hand, it confines
the functional coupling among Brodmann areas ‘patho-
logically’ clustered in low frequency network by reducing
their global integration; and on the other, it counterbal-
ances the impairment of ‘healthy’ alpha 2 clusters by
strengthening the physiological alpha 2 global integration
Perioperative evaluation of myastenia gravis
No full textA. Cardone, E. Congedo, P, Aceto, R. Sicuranza, E. Chinè, F. Caliandro, G. De Cosmo
Ann.Ital.Chir 2007; Vol. 78 / 5 – pag. 359-366
Myasthenia gravis (MG) is the prototype of antibody mediated autoimmune disease and results from the production of autoantibodies against the acetylcholine receptor (AChR) of the neuromuscular synapse. Adequate preoperative evaluation of the myasthenic patient must be carried out carefully. Age, sex, onset and duration of the disease as well as the presence of thymoma may determine the response to thymectomy. Specific attention should be paid to voluntary and respiratory muscle strength. The preoperative preparation of MG patients is essential for the success of surgery. It depends on the severity of clinical status and changes if myasthenic patients receive anticholinesterase therapy. Myasthenic patients may have little respiratory reserve, and hence depressant drugs for preoperative premedication should be used with caution and avoided in patients with bulbar symptoms. The anaesthetic management of myasthenic patient must be individualized in according to the severity of the disease and the type of surgery required. The use of regional or local anaesthesia seems warranted whenever possible. General anaesthesia can be performed safely when patient is optimally prepared and neuromuscular transmission is adequately monitored during and after surgery. Adequate postoperative pain control, pulmonary toilet, and avoidance of drugs that interfere with neuromuscular transmission will facilitate tracheal extubation. Myasthenia gravis is a disease with many implications for the safe administration of anaesthesia. The potential for respiratory compromise in these patients requires the anaesthesiologist to be familiar with the underlying disease state, as well as the interaction of anaesthetic and non-anaesthetic drugs with MG
"The love that made hell, paradise." Ouida re-writing the Paolo and Francesca theme in Held in Bondage
No full textThe bestselling Victorian author Ouida reveals in her novels, and, in particular, Held in Bondage, an extraordinary knowledge od Dante, by using characters and themes from the Commedia. The Paolo and Francesca theme actually constitutes part of the plot of the novel and is to be found in many of her other works, short stories and non-fiction writing
Reliability of SFEMG in diagnosing myasthenia gravis: Sensitivity and specificity calculated on 100 prospective cases.
No full textObjective
The study aimed to determine the utility of single-fibre electromyography (SFEMG) in the diagnosis of myasthenia gravis (MG) in subjects with a clinical suspicion of the disease.
Methods
We performed a prospective, single-blinded study on 100 consecutive patients. SFEMG was not considered a criterion in making the MG diagnosis. For all cases, a different physician than the one performing SFEMG made the diagnosis of MG. All subjects underwent standard SFEMG of a single muscle, the orbicularis oculi.
Results
SFEMG was abnormal in 67 of 100 patients. A final diagnosis of definite MG was made in 54 patients (30 men/24 women). SFEMG was positive in 53 of 54 patients diagnosed with MG. The sensitivity of SFEMG in diagnosing MG was 98% (95% CI: 0.94–1.02), while the specificity was 70% (95% CI: 0.54–0.86), with a positive predictive value of 79% (95% CI: 0.74–0.79) and a negative predictive value of 97% (95% CI: 0.94–0.99).
Conclusions
In this cohort of patients, normal SFEMG findings were unlikely to occur in patients with MG
HERStory Makers 2023: Francesca Fotheringham
No full textFrancesca Fotheringham is a postdoctoral research associate at the University of Edinburgh studying educational psychology with a focus on neurodiversity. She took part in HERStory Makers 2023.What is HERStory Makers?HERStory Makers is a social media competition for female-identifying early career researchers to share their research, their career journeys, and to inspire the next generation. Winners are selected by public vote. HERStory Makers is also part of EXPLORATHON, Scotland's contribution to European Researchers' Night.In 2022-23, EXPLORATHON Francescasupported by the Engineering & Physical Sciences Research Council [grant number EP/X020762/1].Author contributions to contentFrancesca conceived, planned, and recorded the video content. Kirsty Ross edited the video content to insert HERStory Maker credits, added subtitles, and reduce video length to below Twitter/X limit of 2 mins and 20 secs.</p
Medicina illuminata. La Biblioteca Lancisiana di Roma
No full textL'articolo presenta i codici miniati della Biblioteca Lancisiana di Roma. La prima parte, del coautore, è dedicata alla Biblioteca. La seconda parte, di F. Manzari, tratta dei manoscritti miniati, costituiti da due codici con le opere di Avicenna e dal Liber fraternitatis della Confraternita dell'Ospedale di Santo Spirito in Sassia a Roma.The article introduces the illuminated manuscripts of the Biblioteca Lancisiana in Rome. The first part of the article, by the co-author, is dedicated to the Library. The second part, by Francesca Manzari, illustrates the manuscipts; these are two manuscripts with the works of Avicenna and the Liber fraternitatis of the Confraternity of the Hospital of Santo Spirito in Sassia in Rome
Why protein ingestion enhances postprandial anabolism during short- term bed rest in young men
No full textDifferential involvement of A-delta and A-beta fibres in neuropathic pain related to carpal tunnel syndrome.
No full textCarpal tunnel syndrome (CTS), a common entrapment neuropathy involving the median nerve at the wrist, frequently manifests with neuropathic pain. We sought information on pain mechanisms in CTS. We studied 70 patients with a diagnosis of CTS (117 CTS hands). We used the DN4 questionnaire to select patients with neuropathic pain, and the Neuropathic Pain Symptom Inventory (NPSI) to assess the intensity of the various qualities of neuropathic pain. All patients underwent a standard nerve conduction study (NCS) to assess the function of non-nociceptive A?-fibres, and the cutaneous silent period (CSP) after stimulation of the IIIrd and Vth digits, to assess the function of nociceptive A?-fibres. In 40 patients (75 CTS hands) we also recorded laser-evoked potentials (LEPs) in response to stimuli delivered to the median nerve territory and mediated by nociceptive A?-fibres. We sought possible correlations between neurophysiological data and the various qualities of neuropathic pain as assessed by the NPSI. We found that the median nerve sensory conduction velocity correlated with paroxysmal pain and abnormal sensations, whereas LEP amplitude correlated with spontaneous constant pain. Our findings suggest that whereas paroxysmal pain and abnormal sensations reflect demyelination of non-nociceptive A?-fibres, spontaneous constant pain arises from damage to nociceptive A?-fibres
A DH-Leavened Musicological Toolbox
No full textGraduate-level training in music research methodologies tends to ignore digital humanities work and overlook the use of digital tools created in support of new forms of reading. Training instead focuses on source material in the student’s area of interest. This material includes secondary and primary (archival) resources, as well as information resources, such as: monuments of music and critical editions; indexes; bibliographies and thematic catalogs; dictionaries and encyclopedias; digital libraries of scores or editions; and databases of period-specific newspapers or journals. Graduate students taking research methods courses already have a toolbox built from their experiences as musicians and students of music, including the ability to read and interpret music notation, to understand theoretical and analytical concepts in music, as well as a command of music history, including the canon of musical works.
Digital humanities has become a major area of academic endeavor at the “interface of technological development, epistemological change and methodological concerns." An important characteristic of digital humanities research has been its interdisciplinarity. We argue that graduate training in musicology needs to include coverage of methodologies applied by digital humanists in support of new forms of reading, not only to broaden the canon of research topics in musicology, but also to build common ground with researchers of other disciplines. We propose that librarians are well positioned to provide this expertise and training
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