[Validation of the flexion-relaxation test to define a lumbar deficit with tetrapolar electrodes]

INTRODUCTION AND OBJECTIVE

To obtain a new cut-off point (CP) for a lumbar flexion-relaxation (RF) test established with tetrapolar (e.) electrodes, from values already defined with bipolar devices.

MATERIALS AND METHODS

The study sample consists of 47 patients in a situation of temporary disability due to low back pain (DL). They were evaluated by means of an isometric dynamometry test, a kinematic test and an assessment of the FR phenomenon. Two experiments with ROC curves are proposed. The first, with 47 patients who consecutively performed the RF test with both types of electrodes, using the cut-off point (CP) known for the e. bipolar (2.49μV). In the second, with the EMG data recorded with e. tetrapolar in 17 patients, a DeLong test was performed that compares the 2 ROC curves that were constructed on the one hand, by classifying the sample from dynamometry and kinematic tests, and on the other, by classifying them with the bipolar EMG values.

RESULTS

A total of 34 patients adequately completed the evaluations of the first experiment and 17 patients the second. The first study shows a cut-off point of 1.2μV, with an AUC of 87.7%; Sensitivity 84.2% and Specificity 80%. The second shows a PC for e. bipolars of 1.21μV (AUC 87.5%) and for e. tetrapolar values of 1.43 (AUC 82.5%) with a DeLong test without significant differences between both curves (p>0.4065).

CONCLUSIONS

The validation methodology with ROC curves has made it possible to obtain a new PC for the RF test in a practical way, simply by simultaneously performing both tests on the same group of patients until a significant sample is obtained.

Evaluation of whether there is residual polyp tissue after hysteroscopic morcellation at Cam and Sakura City Hospital: a retrospective cohort study

BACKGROUND

In polypectomy with mechanical hysteroscopic morcellators, the tissue removal procedure continues until no polyp tissue remains. The decision that the polypoid tissues were removed completely is made based on visual evaluation. In a situation where the polyp tissue was visually completely removed and no doubt that the polyp has been completely removed, short spindle-like tissue fragments on the polyp floor continue in most patients. There are no studies in the literature on whether visual evaluation provides adequate information at the cellular level in many patients in whom polypoid tissues have been determined to be completely removed. The aim of the present study was to analyze the pathological results of the curettage procedure, which was applied following the completion of polyp removal with operative hysteroscopy, and to evaluate whether there was residual polyp tissue in the short spindle-like tissue fragments that the mechanical hysteroscopic morcellator could not remove. The secondary aims of this study were to compare conventional loop resection hysteroscopy with hysteroscopic morcellation for the removal of endometrial polyps in terms of hemoglobin/hematocrit changes, polypectomy time and the amount of medium deficit.

METHODS

A total of 70 patients with a single pedunculate polypoid image of 1.5-2 cm, which was primarily visualized by office hysteroscopy, were included in the study. Patients who had undergone hysteroscopic polypectomy were divided into two groups according to the surgical device used: the morcellator group (n = 35, Group M) and the resectoscope group (n = 35, Group R). The histopathological results of hysteroscopic specimens and curettage materials of patients who had undergone curettage at the end of operative hysteroscopy were evaluated. In addition, the postoperative 24th hour Hb/HCT decrease amounts in percentage, the polypectomy time which was measured from the start of morcellation, and deficit differences were compared between groups.

RESULTS

In total, 7 patients in the morcellator group had residual polyp tissue detected in the full curettage material. The blood loss was lower in the morcellator group than in the resectoscope group (M, R; (-0.07 ± 0.08), (-0,11 ± 0.06), (p < 0.05), respectively). The deficit value of the morcellator group were higher (M, R; (500 ml), (300 ml), (p < 0.05), respectively). The polypectomy time was shorter in the morcellator group (M, R; mean (2.30 min), (4.6 min), (p < 0.05)).

CONCLUSIONS

Even if the lesion is completely visibly removed during hysteroscopic morcellation, extra caution should be taken regarding the possibility of residual tissue. There is a need for new studies investigating the presence of residual polyp tissue.

Comparison of unilateral and bilateral strength ratio, strength and knee proprioception in older adult fallers and non-fallers

BACKGROUND

Asymmetry of lower limb muscle strength and knee proprioception have been linked with risk of falling among elderly with and without history of falling.

OBJECTIVE

This study aimed to determine the comparison of hamstrings to quadriceps strength ratio (CSR) and bilateral knee strength ratio, hamstrings and quadriceps muscles' strength and knee proprioception in elderly male fallers and non-fallers.

METHODS

Sixty older adults, 65 years and older were recruited into faller (fell twice in the last six months) and non-faller groups. Then, the knee extension and flexion strength and proprioception at 45° knee flexion for the dominant leg (DL) and non-dominant legs (NDL) were measured with a Biodex Isokinetic Dynamometer.

RESULTS

The strength of quadriceps and hamstring muscles showed significantly higher values in DL by 5.4 %, 9.2 % and NDL by 11.7 %, 15.5 % in the non-faller compared to the faller (p < 0.05). Significantly greater bilateral asymmetry (>10 % difference) was observed with the quadriceps (p = 0.014, -7.9 %, ES = 0.76) and hamstrings (p < 0.001, -18.4 %, ES = 1.5) as well as reduced CSR (<72 %) by 7.6 % in DL (ES = 0.64) and 11.3 % in NDL (ES = 0.81) with fallers versus non-fallers. Significantly less knee proprioception was found with the DL by -1.5 % (ES = 1.15) and NDL (ES = 1.50) by -2.1 % (p < 0.001) in non-faller compared to faller.

CONCLUSION

It concluded that non-fallers have better strength symmetry, bilateral and unilateral knee strength ratios as well as more sensitive knee proprioception than fallers. It is suggestive that older adult fallers may need to improve bilateral knee strength symmetry and proprioception to prevent the risk of falling.

Determinants of local government deficit: evidence from Spanish municipalities

Understanding the determinants of fiscal deficits is justified by the fact that persistent deficits rapidly lead to the accumulation of public debt. Therefore, the aim of this paper is to analyze the factors that explained the fiscal deficits of Spanish municipalities in the period 2011-2020. The deficit at the municipal level for Spain is explained by considering several determinants covering socioeconomic and political dimensions, such as GDP per capita, unemployment rate, population, political participation, political sign of the ruling party or political force, among others. The method of moments quantile regression (MMQ) and mean group (MG) estimator are applied for the overall sample and for each group of municipalities. In addition, the causality between the deficit and the explanatory variables is analyzed using the Juodis et al. (2021) test. It is found that economic growth only has a long-term beneficial effect on the deficit as it reduces the deficit at all quantile levels except at the 10% quantile. Unemployment increases the deficit in both the short and long run. Political participation and right-wing political parties contribute to the growth of the deficit in the higher quantiles. To reduce the budget deficit, the analysis shows that unemployment should be reduced and economic growth should be boosted. The results are robust to those based on mean group estimators. With this paper, we contribute to the scarce literature on deficit determinants by analyzing the determinants for Spanish municipalities. Furthermore, our findings have important implications for politicians, citizens and stakeholders.

Fiscal adjustment in a panel of countries 1870-2016

The financial crisis from 2007 and, even more so, the Covid-19 pandemic caused large increases in public sector deficits and debts in many countries and prompted concern about fiscal adjustment. This paper examines fiscal adjustment to debt and deficits for a panel of 17 countries over 1870-2016 using the Jordà-Schularick-Taylor Macrohistory Database. This long span panel is informative since it contains many examples of large fiscal shocks similar to those recently experienced. The results from reduced-form models suggest that large deficits or surpluses tend to prompt stabilising feedbacks, mainly through changes in revenue, and there is greater pressure to adjust on countries running a deficit versus those running a surplus. However, the debt-GDP ratio prompts much less stabilising feedback by expenditure or revenue.

Somatropin therapy in italian adults with growth hormone deficiency

BACKGROUND

In adult population, Growth Hormone Deficiency (GHD) is a complex clinical condition with heterogeneity of causes and duration. Growth Hormone (GH) replacement therapy has beneficial effects entailing a chronic and expensive use. Therefore, entity, appropriateness and standardization of GHD treatment need to be accurately analysed. In Italy, the epidemiological surveillance on somatropin therapy is entrusted to the National Register of Growth Hormone Therapy (Registro Nazionale degli Assuntori dell'Ormone della Crescita-RNAOC) by the Italian Regulation, in accordance of which the RNAOC-database is collecting the notifications of somatropin prescriptions.

METHODS

Aim of this study is to analyse data on somatropin-treated adult population communicated to the RNAOC by the specialist centres of 15 Italian regions and 2 autonomous provinces.

RESULTS

From 2011 to 2019, the somatropin-treated adults were 970 with 4061 examinations (1.21 ± 0.33 visits/year). The diagnoses were: hypopituitarism (n = 579); hypophysectomy (n = 383); and congenital GHD (n = 3). Five subjects were addressed with diagnoses not included in the regulation. The starting posology of somatropin was 0.320 (± 0.212) mg/day, 0.292 (± 0.167) mg/day in male and 0.360 (± 0.258) in female patients, with 7 administrations/week in 70.31% of the prescriptions. The differences in posology by gender persisted at 10th year of the follow-up. Starting dosage was higher in patients diagnosed with adult GHD before the age of 30 (0.420 ± 0.225 mg/day), with a progressive decrease of the dosage during the follow-up.

CONCLUSIONS

This is the first report on adult GH treatment, describing numbers, diagnoses, and pharmaceutical prescriptions associated to somatropin therapy in a large cohort of Italian GHD-adults.

Preclinical Evaluation of Attention and Impulsivity Relevant to Determining ADHD Mechanisms and Treatments

People with Attention-Deficit Hyperactivity Disorder (ADHD) exhibit inattention, hyperactivity, and/or impulsivity. Symptoms of ADHD emerge in childhood and can continue throughout adulthood. Clinical assessments to diagnose ADHD can include administration of continuous performance tests (CPTs). CPTs provide an objective measure of inattention, requiring individuals to respond to targets (attention), and inhibit response to non-targets (impulsivity). When investigating the mechanisms of, and novel treatments for, ADHD it is important to measure such behavioral domains (attention and impulsivity). Some well-established preclinical tasks purport to assess attention in rodents but, unlike CPTs, do not require non-target inhibition, limiting their ADHD-relevance.Recently developed tasks recreate CPTs for rodents. The 5-Choice CPT (5C-CPT) contains non-target stimuli, enabling use of signal detection theory to evaluate performance, consistent with CPTs. The 5C-CPT has been adapted for use in humans, enabling direct cross-species comparisons of performance. A newer task, the rodent CPT (rCPT), is a touchscreen-based analog of CPTs, utilizing symbols instead of a simple stimulus array. Currently, the rCPT may be more akin to a go/no-go task, equally presenting targets/non-targets, although numerous variants exist - a strength. The 5C-CPT and rCPT emulate human CPTs and provide the most up-to-date information on ADHD-relevant studies for understanding attention/impulsivity.

Identifying the spatial disparities and determinants of ecosystem service balance and their implications on land use optimization

Ecosystem services (ESs) are increasingly affected by human interventions, and the ES balance between supply and demand plays a vital role in guaranteeing the expected efficacy of ecosystem restoration projects. However, the spatial disparities of ES balance, along with its determinants and spillover effects, remain unclear, constraining effective ES management and landscape planning. The aim of this study was to fill these gaps by quantifying the ES balance in the restoring Loess Plateau using an expert-based ES matrix approach and by examining the spatial associations between ES balance and driving factors via an integrated regression approach. The results showed that the county-scale ES balance was closely related to the land-use composition and population density. Geographic locations of counties with ES surplus were mainly concentrated in mountainous areas with high proportions of woodland and grassland, while urbanized land and a high population density resulted in an ES deficit. Forest and grass regeneration, due to revegetation practices, alleviated ES deficits, while rapid urbanization and population growth aggravated ES imbalance. The integrated regression approach demonstrated that the ES balance and its dependencies (i.e., landscape metrics and population density) had remarkable spatial heterogeneity and spillover effects, which should be practically considered in localized ES management and landscape optimization. Excessive agricultural reclamation and urban expansion improved grain productivity and economic profits but deteriorated landscape fragmentation, further aggravating the ES deficit. In contrast, excessive revegetation practices promoted ecosystem restoration and improved ES surplus but threatened food security. Therefore, an appropriate balanced state should be maintained for sustainable ecosystem restoration through timely and efficient policy interventions and landscape optimization.

Does Dysbiosis Increase the Risk of Developing Schizophrenia? - A Comprehensive Narrative Review

BACKGROUND

There is increasing evidence regarding the influence of the intestinal microbiota on the disease processes of various organs and systems. Dysbiosis, that is, alteration of the composition and function of the microbiota may constitute an important risk factor for the development of mental disorders, namely, schizophrenia.

OBJECTIVE

This works aims to review current evidence regarding the pathological mechanisms leading from dysbiosis to schizophrenia and in particular the deficit syndrome in schizophrenia.

METHODS

Scientific articles from PubMed, SCOPUS, EMBASE, and Web of Science Core Collection published between September 2017 and December 2020 were included in this review.

RESULTS

The commensal intestinal flora plays an important role in neurodevelopment. In the presence of dysbiosis, this maturation gets disturbed, resulting in the modification of brain structures and inflammatory responses at the intestinal, systemic, and Central Nervous System (CNS) levels. These disturbances may be linked to the development of symptoms of the disease. The microbiota exerts its influence on the CNS through several pathways, however, in this paper we focused on the membrane hypothesis and the inflammatory hypothesis. We explored the evidence concerning the use of probiotics, prebiotics, and fecal transplants.

CONCLUSION

Although there is no consensus regarding the alterations that could constitute a risk factor for schizophrenia, some of the species appear to be more frequently altered, and their relationship with the host is dysregulated in patients at risk and with established schizophrenia, particularly in deficit schizophrenia.

Power calculations in single-case neuropsychology: A practical primer

Researchers and clinicians in neuropsychology often compare individual patients against healthy control samples, to quantify evidence for cognitive-behavioural deficits and dissociations. Statistical methods for these comparisons have been developed that control Type I (false positive) errors effectively. However, remarkably little attention has been given to the power of these tests. In this practical primer, we describe, in minimally technical terms, the origins and limits of power for case-control comparisons. We argue that power calculations can play useful roles in single-case study design and interpretation, and we make suggestions for optimising power in practice. As well as providing figures, tables and tools for estimating the power of case-control comparisons, we hope to assist researchers in setting realistic expectations for what such tests can achieve in general.

COVID-19 Pandemic Recession and Recovery

This review draws pragmatic lessons for developing countries to address COVID-19-induced recessions and to sustain a developmental recovery. These recessions are unique, caused initially by supply disruptions, largely due to government-imposed ‘stay-in-shelter lockdowns’. These have interacted with falling incomes and demand, declining exports (and imports), collapsing commodity prices, shrinking travel and tourism, decreasing remittances and foreign exchange shortages. Highlighting implications for employment, wellbeing and development, it argues that governments need to design comprehensive relief measures and recovery policies to address short-term problems. These should prevent cash-flow predicaments from becoming full-blown solvency crises. Instead of returning to the status quo ante, developing countries’ capacities and capabilities need to be enhanced to address long-term sustainable development challenges. Multilateral financial institutions should intermediate with financial sources at low cost to supplement the International Monetary Fund’s Special Drawing Rights to lower borrowing costs for relief and recovery.

The Caudate Nucleus: Its Connections, Surgical Implications, and Related Complications

BACKGROUND

The caudate nucleus is a C-shaped structure that is located in the center of the brain and is divided into 3 parts: the head, body, and tail.

METHODS

We detail the anatomic connections, relationships with other basal ganglia structures, and clinical implications of injury to the caudate nucleus.

RESULTS

Anatomically, the most inferior transcapsular gray matter is the lentiform peduncle, which is the connection between the lentiform nucleus and caudate nucleus as well as the amygdala. The border between the tail and body of the caudate nucleus is the posterior insular point. The tail of the caudate nucleus is extraependymal in some parts and intraependymal in some parts of the roof of the temporal horn of the lateral ventricle. The tail of the caudate nucleus crosses the inferior limiting sulcus (temporal stem), and section of the tail during approaches to lesions involving the temporal stem may cause motor apraxia. The mean distance from the temporal limen point, which is the junction of the limen insula and inferior limiting sulcus, to the tail of the caudate nucleus in the temporal stem is 15.87 ± 3.10 mm.

CONCLUSIONS

Understanding of the functional anatomy and connections of the distinct parts of the caudate nucleus is essential for deciding the extent of resection of lesions involving the caudate nucleus and the types of deficits that may be found postoperatively.

Outcome after surgical treatment of complex elbow fractures: a single-center follow-up study

INTRODUCTION

Elbow injuries present particular challenges for the treating surgeons. The aim of the present study was to evaluate the postoperative outcome after surgical treatment of complex elbow fractures.

PATIENTS AND METHODS

Retrospective analysis with subsequent clinical follow-up examination of all patients with complex elbow fractures admitted to our level I trauma center over a 6-year period. The patients were stratified into three groups: single fractures of the proximal forearm (olecranon fractures type Mayo IIB, radial head fractures type Mason II-IV), distal humerus fractures (AO type C1-3), and combined injures. The clinical examination included the range of motion, grip strength measured with a Jamar dynamometer, DASH and MEP score.

RESULTS

Overall, 39 patients with complex elbow fractures were included in the study. Twelve patients presented with a distal, intra-articular humerus fracture, 16 patients had an isolated proximal forearm fracture and 11 patients suffered multiple fractures. The functional scores showed good overall results, with a median DASH score of 6.7 points and median MEP score of 85.0 points. The median extension deficit in the elbow joint was 15.0° (mean 16.2° ± 12.8°), the median flexion deficit was 5.0° (9.8° ± 12.3°) and the median pronation/supination (overall rotation) deficit was 5.0° (16.7° ± 23.6°). Patients with intra-articular distal humerus fractures showed a significantly increased extension and flexion deficit compared to the other groups.

CONCLUSION

The surgical treatment of complex elbow fractures was associated with good to excellent clinical results. However, distal intra-articular humerus fractures presented the most prominent loss of elbow motion in the follow-up examination.

The impact of sample size on the reproducibility of voxel-based lesion-deficit mappings

This study investigated how sample size affects the reproducibility of findings from univariate voxel-based lesion-deficit analyses (e.g., voxel-based lesion-symptom mapping and voxel-based morphometry). Our effect of interest was the strength of the mapping between brain damage and speech articulation difficulties, as measured in terms of the proportion of variance explained. First, we identified a region of interest by searching on a voxel-by-voxel basis for brain areas where greater lesion load was associated with poorer speech articulation using a large sample of 360 right-handed English-speaking stroke survivors. We then randomly drew thousands of bootstrap samples from this data set that included either 30, 60, 90, 120, 180, or 360 patients. For each resample, we recorded effect size estimates and p values after conducting exactly the same lesion-deficit analysis within the previously identified region of interest and holding all procedures constant. The results show (1) how often small effect sizes in a heterogeneous population fail to be detected; (2) how effect size and its statistical significance varies with sample size; (3) how low-powered studies (due to small sample sizes) can greatly over-estimate as well as under-estimate effect sizes; and (4) how large sample sizes (N ≥ 90) can yield highly significant p values even when effect sizes are so small that they become trivial in practical terms. The implications of these findings for interpreting the results from univariate voxel-based lesion-deficit analyses are discussed.

Glenohumeral and scapulothoracic strength impairments exists in patients with subacromial impingement, but these are not reflected in the shoulder pain and disability index

BACKGROUND

Pain and loss of function are cardinal symptoms associated with Subacromial impingement syndrome (SIS), while the presence and magnitude of deficits in strength and range of motion (ROM) are largely undescribed in non-athletic patients with SIS. Moreover, the relevance of impairments in strength and ROM to patient-reported shoulder function is not well described, even though testing of strength is recommended in clinical guidelines. The purpose of this study was, first, to investigate impairments in glenohumeral and scapulothoracic strength and in abduction and internal rotation ROM in patients with SIS. Secondly, to investigate the influence of these impairments on patient-reported shoulder function.

METHODS

Cross-sectional study based on a consecutive cohort of 157 patients referred to specialist examination and diagnosed with shoulder impingement (SIS) using predefined validated diagnostic criteria. Prior to specialist examination, questionnaires regarding shoulder function (Shoulder Pain And Disability Index, SPADI) demographics and kinesiophobia (TSK-11) were collected, and shoulder strength and ROM was measured by trained testers, with the patient reporting pain levels during testing and for the last week. Impairments in strength (abduction, external-rotation, (protraction and horizontal-extension) and ROM (abduction and internal rotation) were investigated in patients with unilateral shoulder pain, using one-sample t-tests. SPADI total score (SPADI) and SPADI function score (SPADI-F), were chosen as dependent variables in multiple regressions to investigate the influence of impairments on patient-reported shoulder function. Independent variables of interest were; strength in abduction and external rotation, abduction ROM, pain-during-tests, pain-last-week and kinesiophobia.

RESULTS

Significant impairments were found for all impairment tests, but most pronounced for glenohumeral strength and abduction ROM (29-33% deficits), and less for scapulothoracic strength and internal rotation ROM (8-18% deficits). Pain variables influenced SPADI and SPADI-F score to a high degree (R² = 23.4-31.6%, p < 0.001), while strength and ROM did not.

CONCLUSION

Substantial strength and ROM impairments were found in patients with SIS. Only pain significantly influenced patient-reported function, while impairments did not. As SPADI score does not reflect the substantial strength and ROM impairments in external rotation and abduction observed in patients with SIS, supplemental assessment of these impairments seems important.

Statistical learning and dyslexia: a systematic review

The existing literature on developmental dyslexia (hereafter: dyslexia) often focuses on isolating cognitive skills which differ across dyslexic and control participants. Among potential correlates, previous research has studied group differences between dyslexic and control participants in performance on statistical learning tasks. A statistical learning deficit has been proposed to be a potential cause and/or a marker effect for early detection of dyslexia. It is therefore of practical importance to evaluate the evidence for a group difference. From a theoretical perspective, such a group difference would provide information about the causal chain from statistical learning to reading acquisition. We provide a systematic review of the literature on such a group difference. We conclude that there is insufficient high-quality data to draw conclusions about the presence or absence of an effect.

Focal brachial enhancement deficit: a normal anatomic variant?

OBJECTIVE

To identify the incidence of brachialis enhancement deficits (BEDs) on contrast-enhanced elbow MRIs and determine if there is an association between the presence of BEDs and presenting symptoms, other imaging findings, or patient positioning.

MATERIALS AND METHODS

Elbow MRIs from 138 patients (64 males, mean age 45.3 years) were reviewed. The presence, size, and degree of enhancement of BEDs as well as degree of elbow flexion, relative degree of forearm rotation, and additional finding of pathology on the MRI were recorded.

RESULTS

BEDs were found in 54 % (75/138) of contrast-enhanced elbow MRIs. No statistically significant difference was seen between age, gender, presenting symptoms and the presence of BEDs. The BEDs varied considerably in size and degree of diminished enhancement compared to adjacent muscle. There was a very significant correlation between degree of elbow flexion and presence of BEDs (p < 0.0001) and a significant inverse correlation between cross-sectional size of BEDs and degree of flexion (p < 0.01). There was no significant correlation between BED enhancement difference and degree of flexion and no significant correlation between degree of forearm rotation and cross-sectional area or enhancement difference of the BEDs. No correlation was found between the presence of BEDs and other pathology present on the MRI.

CONCLUSION

BEDs are a common, likely asymptomatic phenomenon seen on post contrast elbow MRIs. The etiology of BEDs is uncertain, but they may represent a vascular phenomenon related to elbow flexion causing diminished enhancement related to brachialis compression.

Virtual water flows in the international trade of agricultural products of China

With the rapid development of the economy and population, water scarcity and poor water quality caused by water pollution have become increasingly severe in China. Virtual water trade is a useful tool to alleviate water shortage. This paper focuses on a comprehensive study of China's international virtual water flows from agricultural products trade and completes a diachronic analysis from 2001 to 2013. The results show that China was in trade surplus in relation to the virtual water trade of agricultural products. The exported virtual water amounted to 29.94billionm(3)/yr. while 155.55billionm(3)/yr. was embedded in imported products. The trend that China exported virtual water per year was on the decline while the imported was on a rising trend. Virtual water trade of China was highly concentrated. Not all of the exported products had comparative advantages in virtual water content. Imported products were excessively concentrated on water intensive agricultural products such as soya beans, cotton, and palm oil. The exported virtual water mainly flowed to the Republic of Korea, Hong Kong of China and Japan, while the imported mainly flowed from the United States of America, Brazil and Argentina. From the ethical point of view, the trade partners were classified into four types in terms of "net import" and "water abundance": mutual benefit countries, such as Australia and Canada; unilateral benefit countries, such as Mongolia and Norway; supported countries, such as Egypt and Singapore; and double pressure countries, such as India and Pakistan. Virtual water strategy refers to water resources, agricultural products and human beings. The findings are beneficial for innovating water resources management system, adjusting trade structure, ensuring food security in China, and promoting the construction of national ecological security system.

Cryptococcosis-the impact of delay to diagnosis

Cryptococcosis is a mycotic disease caused by the yeast Cryptococcus sp. It is associated with significant mortality and morbidity, including long-term neurological sequelae. It is not known whether the high morbidity observed is related to a delay in diagnosis. A retrospective chart review of all cryptococcal infections that had been diagnosed in the region between 1997 and 2015 was performed. Twenty-nine cases were identified. Overall mortality rate was 10.3%, with an attributable mortality rate of 6.9%. Forty-five per cent of patients with central nervous system involvement developed long-term neurological deficits. Significant associations were noted between those with and without long-term neurological deficits and in both time from onset of symptoms to diagnosis (median of 45.5 days versus 18.5 days, respectively) and time from presentation to diagnosis (median 14.5 days versus 7 days, respectively). In addition, raised intracranial pressure (p 0.03) and female gender (p 0.02) were significantly associated with poor neurological outcomes. This highlights the importance of early diagnosis and the need to limit raised intracranial pressure to minimize long-term neurological deficits.

Critical care: Meeting protein requirements without overfeeding energy

BACKGROUND AND AIMS

Relatively high protein input has been associated with improved clinical outcome in critical illness. However, until recently differences in clinical outcome have been examined in terms of the energy goal-versus under-feeding. Most studies failed to set the energy goal by an accurate measure or estimate of expenditure or independently set protein prescription. This leads to under-prescription of protein, possibly adversely affecting outcome. We determined whether an enteral nutrition prescription could meet local and international protein guidelines.

METHODS

Protein prescriptions of consecutive patients admitted to Southmead Hospital ICU and requiring full enteral nutrition were audited against local and international guidelines. Prescriptions were designed to not exceed energy expenditure based on a validated estimation equation, minus non-nutritional energy, and protein requirements were based on local or international guidelines of between 1.2 and 2.5 g protein/kg/d or 2-2.5/kg ideal body weight (Hamwi ideal body weight)/d.

RESULTS

From 15/1/15 to 12/4/15 139 ICU patients were prescribed full enteral nutrition. Protein prescriptions failed to meet local guidelines in 75% (p < 0.001) and international guidelines in 45-100%. Prescriptions meeting at least 90% of protein guidelines and 130 g of carbohydrate could be increased from between 0 and 55%, depending on the guideline, to between 53 and 94% using a protein supplement and 82 and 100% using a protein plus glucose supplement. Non-nutritional energy (NNE) proportionately reduces feed protein prescription and contributed 19% of energy expenditure in 10% of patients.

CONCLUSIONS

We need feeds with a lower non-protein energy: nitrogen (NPE:gN) ratio and/or protein supplementation if prescriptions are to meet protein guidelines for critical illness. NNE must be adjusted for in prescriptions to ensure protein needs are met.

Impaired facial emotion recognition in individuals at ultra-high risk for psychosis and with first-episode schizophrenia, and their associations with neurocognitive deficits and self-reported schizotypy

OBJECTIVE

This study aims to quantify facial emotion recognition abnormalities and their relation to neurocognitive dysfunction and schizotypy in individuals at ultra-high risk (UHR) for psychosis and patients with first-episode schizophrenia (FES).

METHODS

Forty individuals at UHR for psychosis, 24 patients with FES and 46 normal controls performed a facial emotion recognition task that presented facial photographs encompassing all basic emotions. The perceptual aberration scale and revised social anhedonia scale were employed for self-reported assessment of schizotypy. An intellectual functioning (IQ) test and a broad battery of neurocognitive tests were conducted. Emotional task performance indexed by accuracy rate of specific emotion was compared among three groups. The correlation of accuracy rate with neurocognitive tests and schizotypy scales were analyzed within each clinical group.

RESULTS

A recognition deficit of facial emotions was present in both clinical groups, even after adjusting for IQ and gender as covariates. This emotional deficit showed few significant relationships with broad range of individual neurocognitive measures. Meanwhile, this deficit demonstrated significant relationships with schizotypy, especially perceptual aberration in each clinical group.

CONCLUSIONS

Facial emotion recognition deficit may not only be present in FES patients, but may already have evolved prior to the onset of overt psychotic symptoms. This emotion recognition deficit may be linked to a perceptual aberration and largely independent of broad range of neurocognitive dysfunction.

Recovery of knee function in the isolated MCL and combined ACL-MCL deficient knee

BACKGROUND

The MCL is the prime medial stabiliser of the knee and is a commonly injured structure which leads to valgus instability of the knee.

OBJECTIVES

We aim to analyse differences in recovery of knee motion and muscle function over one year follow up in the isolated MCL and combined ACL-MCL injured knee. We hypothesized that combined ACL-MCL injuries lead to greater knee motion and muscle function deficits at 1 year.

METHODS

Isolated MCL (Group I) or combined ACL-MCL injuries (Group II) from 2006-2010 were included. Those with a previous MCL injury, injury to contralateral limb or presenting 2 weeks post-injury were excluded. At certain outpatient follow up intervals, we recorded pre-determined parameters of knee function. Follow-up was at weeks 2, 6, 12, 26, 52.

RESULTS

The cohort included 82 patients (54 males:28 females) with a mean age of 32 (range 16-56). Group II showed a deficit in Total Range of Movement (TROM) and flexion at 6 month follow up (p < 0.05). Group II showed an extension deficit at week 2 (p < 0.05). The Peak Torque Deficit (PTD) and Average Power Deficit (APD) improved for quadriceps and hamstrings across all follow up intervals (p > 0.05).

CONCLUSION

There is a TROM and flexion deficit at 6 months in group II, resolving by 1 year. There was no difference in PTD or APD in either group.

International observational study of nutritional support in mechanically ventilated patients following burn injury

INTRODUCTION

It has been proposed that nutritional therapy in critically ill patients after major burn reduces mortality. However, the actual practice of nutrient delivery, and the effect on outcome, has not been described.

STUDY OBJECTIVES

To evaluate international practices related to nutritional support and outcomes in mechanically ventilated patients with burn injury.

METHODS

Data from the International Nutrition Surveys (2007-2011) for patients with a primary diagnosis of burn were extracted and analysed.

RESULTS

Eighty-eight of 90 patients (aged 16-84 years) received enteral nutrition. The median time for initiation of enteral feeding was 17 h [range 0-65]. Fifty patients (57%) had interruptions to nutrient delivery, most often these interruptions were fasting for operative procedures. There were substantive energy and protein deficits [943 (654) kcal/day and 49 (41) g/day, respectively; mean (SD)]. Nineteen (21%) patients died within 60 days of admission, and the energy and protein deficits were greater in those that died compared with survivors [died vs. survived, energy: 1251 (742) vs. 861 (607) kcal/d; p=0.02; and protein 67(42) vs. 44(39) g/d; p=0.03]. Energy and protein deficits were associated with increased mortality with the greater the deficit, the stronger the association with death (odds ratio for death: energy deficit/100 kcal 1.10 (1.01, 1.19); p=0.028 and protein/10 g 1.16 (1.01, 1.33); p=0.037). Results were similar and remained significant after adjusting for severity of illness.

CONCLUSIONS

Mechanically ventilated patients following burn develop substantial energy and protein deficits, with lesser deficits observed in survivors.

Lumbar disc herniation associated with contralateral neurological deficit: can venous congestion be the cause?

Lumbar disc herniation (LDH) associated with a contralateral neurological deficit is sometimes encountered by surgeons. Compression against the opposite pedicle in case of a large discal herniation and prominent stenotic changes of contralateral side are held responsible for contralateral symptoms and findings. In this study, we report a case of LDH associated with a painless contralateral neurological deficit. Prominent venous engorgement and congestion at the contralateral side of discal herniation were detected during the operation. It's treatment with bipolar coagulation and significant improvement was seen after the operation.