We report a case of bifacial weakness with paresthesia, a recognized Guillain-Barré syndrome subtype characterized by rapidly progressive facial weakness and paresthesia without ataxia or other ...cranial neuropathies, which was temporally associated with antecedent coronavirus 2019 (COVID-19). This case highlights a potentially novel but critically important neurologic association of the COVID-19 disease process. Herein, we detail the clinicoradiologic work-up and diagnosis, clinical course, and multidisciplinary medical management of this patient with COVID-19. This case is illustrative of the increasingly recognized but potentially underreported neurologic manifestations of COVID-19, which must be considered and further investigated in this pandemic disease.
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is the most common cause of postoperative infections in orthopaedic shoulder surgery and is hard to eradicate with current measures. Newer strategies focus on reducing bacterial load on the skin ...before surgery. Several previous studies have used a large number of both described and undescribed sampling techniques. The purpose of this study was to compare three previously described swab techniques to obtain bacterial cultures: Levine's (L) technique, the Z technique and the pencil eraser swab (PES) technique.
: Three consecutive skin swabs were collected from the right shoulder, on 15 healthy male volunteers, using Levine's technique, Z technique and PES technique from each participant. To determine the number of living bacteria, serial dilutions were made, and after culturing for 5 d, viable count (VC) was expressed as CFU/mL (with CFU representing colony-forming unit).
: The PES technique yielded significantly higher VC than the two others. PES: median 3700 CFU/mL, L: 200 CFU/mL and Z: 220 CFU/mL (
). There was no significant difference between the methods regarding the number of positive cultures. PES: 14/15, L: 11/15 and Z: 12/15.
: There is a need to harmonise sampling techniques of
in order to compare the efficacy of different measures to reduce the bacterial load on the skin before and during surgery. Of the three tested methods, the PES technique is simple and produces the highest bacterial counts.
Non-invasive EEG detection of very high frequency somatosensory evoked potentials featuring frequencies up to and above 1 kHz has been recently reported. Here, we establish the detectability of such ...components by combined low-noise EEG/MEG. We recorded SEP/SEF simultaneously using median nerve stimulation in five healthy human subjects inside an electromagnetically shielded room, combining a low-noise EEG custom-made amplifier (4.7 nV/√Hz) and a custom-made single-channel low-noise MEG (0.5 fT/√Hz @ 1 kHz). Both, low-noise EEG and MEG revealed three spectrally distinct and temporally overlapping evoked components: N20 (<100 Hz), sigma-burst (450-750 Hz), and kappa-burst (850-1200 Hz). The two recording modalities showed similar relative scaling of signal amplitude in all three frequencies domains (EEG 10 nV ≅ MEG 1 fT). Pronounced waveform (peak-by-peak) overlap of EEG and MEG signals is observed in the sigma band, whereas in the kappa band overlap was only partial. A decreasing signal-to-noise ratio (SNR; calculated for n = 12.000 averages) from sigma to kappa components characterizes both, electric and magnetic field recordings: Sigma-band SNR was 12.9 ± 5.5/19.8 ± 12.6 for EEG/MEG, and kappa-band SNR at 3.77 ± 0.8/4.5 ± 2.9. High-frequency performance of a tailor-made MEG matches closely with simultaneously recorded low-noise EEG for the non-invasive detection of somatosensory evoked activity at and above 1 kHz. Thus, future multi-channel dual-mode low-noise technology could offer complementary views for source reconstruction of the neural generators underlying such high-frequency responses, and render neural high-frequency processes related to multi-unit spike discharges accessible in non-invasive recordings.
► Non-invasive detection of 1kHz SEP components. ► Low-noise amplifier custom-made for high-frequency recordings. ► Time–frequency analysis and spatial characterization of somatosensory evoked ...high-frequency components.
Scalp-derived human somatosensory evoked potentials (SEPs) contain high-frequency oscillations (600Hz; ‘sigma-burst’) reflecting concomitant bursts of spike responses in primary somatosensory cortex that repeat regularly at 600Hz. Notably, recent human intracranial SEP have revealed also 1kHz responses (‘kappa-burst’), possibly reflecting non-rhythmic spiking summed over multiple cells (MUA: multi-unit activity). However, the non-invasive detection of EEG signals at 1kHz typical for spikes has always been limited by noise contributions from both, amplifier and body/electrode interface. Accordingly, we developed a low-noise recording set-up optimised to map non-invasively 1kHz SEP components.
SEP were recorded upon 4Hz left median nerve stimulation in 6 healthy human subjects. Scalp potentials were acquired inside an electrically and magnetically shielded room using low-noise custom-made amplifiers. Furthermore, in order to reduce thermal Johnson noise contributions from the sensor/skin interface, electrode impedances were adjusted to ⩽1kΩ. Responses averaged after repeated presentation of the stimulus (n=4000 trials) were evaluated by spatio-temporal pattern analyses in complementary spectral bands.
Three distinct spectral components were identified: N20 (<100Hz), sigma-burst (450–750Hz), and kappa-burst (850–1200Hz). The two high-frequency bursts (sigma, kappa) exhibited distinct and partially independent spatiotemporal evolutions, indicating subcortical as well as several cortical generators.
Using a dedicated low-noise set-up, human SEP ‘kappa-bursts’ at 1kHz can be non-invasively detected and their scalp distribution be mapped. Their topographies indicate a set of subcortical/cortical generators, at least partially distinct from the topography of the 600Hz sigma-bursts described previously.
The non-invasive detection and surface mapping of 1kHz EEG signals presented here provides an essential step towards non-invasive monitoring of multi-unit spike activity.
Motor activity in healthy young humans displays intrinsic fluctuations that are scale-invariant over a wide range of time scales (from minutes to hours). Human postmortem and animal lesion studies ...showed that the intact function of the suprachiasmatic nucleus (SCN) is required to maintain such scale-invariant patterns. We therefore hypothesized that scale invariance is degraded in patients treated for suprasellar tumors that compress the SCN. To test the hypothesis, we investigated 68 patients with nonfunctioning pituitary macroadenoma and 22 patients with craniopharyngioma, as well as 72 age-matched healthy controls (age range 21.0-70.6 years). Spontaneous wrist locomotor activity was measured for 7 days with actigraphy, and detrended fluctuation analysis was applied to assess correlations over a range of time scales from minutes to 24 h. For all the subjects, complex scale-invariant correlations were only present for time scales smaller than 1.5 h, and became more random at time scales 1.5-10 h. Patients with suprasellar tumors showed a larger decrease in correlations at 1.5-10 h as compared to healthy controls. Within healthy subject, gender and age >33 year were associated with attenuated scale invariance. Conversely, activity patterns at time scales between 10 and 24 h were significantly more regular than all other time scales, and this was mostly associated with age. In conclusion, scale invariance is degraded in healthy subjects at the ages of >33 year as characterized by attenuation of correlations at time scales 1.5-10 h. In addition, scale invariance was more degraded in patients with suprasellar tumors as compared to healthy subjects.
Myeloid leukemia in Down syndrome (ML-DS) clonally evolves from transient abnormal myelopoiesis (TAM), a preleukemic condition in DS newborns. To define mechanisms of leukemic transformation, we ...combined exome and targeted resequencing of 111 TAM and 141 ML-DS samples with functional analyses. TAM requires trisomy 21 and truncating mutations in GATA1; additional TAM variants are usually not pathogenic. By contrast, in ML-DS, clonal and subclonal variants are functionally required. We identified a recurrent and oncogenic hotspot gain-of-function mutation in myeloid cytokine receptor CSF2RB. By a multiplex CRISPR/Cas9 screen in an in vivo murine TAM model, we tested loss-of-function of 22 recurrently mutated ML-DS genes. Loss of 18 different genes produced leukemias that phenotypically, genetically, and transcriptionally mirrored ML-DS.
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•Genetic and functional analyses of myeloid preleukemia and leukemia in Down syndrome•Non-GATA1 preleukemic mutations are often not required for preleukemia•Previously undescribed transforming hotspot mutation in CSF2RB identified•Loss of function of 18 genes validated in transformation of preleukemia to leukemia
Myeloid leukemia in Down syndrome (ML-DS) evolves from transient abnormal myelopoiesis (TAM). Labuhn et al. show that trisomy 21 and GATA1 mutations are sufficient for the development of TAM. They further identify and functionally validate additional variants that drive TAM to ML-DS transformation.
Injury to the triangular fibrocartilage complex associated with distal radius fracture may cause symptoms of ulnar instability. Assessed by a radioulnar stress test, increased laxity of the distal ...radioulnar joint has in two previous studies been depicted to be associated with poorer outcome. This prospective study of 40 adults investigates the correlation of this test with functional outcome as measured by DASH. No clinically significant difference was found in relation to this test at two and five years after injury. Therefore using this test alone to decide whether or not to perform an acute repair of the TFCC cannot be recommended.
The thermal decompositions of furfural and benzaldehyde have been studied in a heated microtubular flow reactor. The pyrolysis experiments were carried out by passing a dilute mixture of the aromatic ...aldehydes (roughly 0.1%-1%) entrained in a stream of buffer gas (either He or Ar) through a pulsed, heated SiC reactor that is 2-3 cm long and 1 mm in diameter. Typical pressures in the reactor are 75-150 Torr with the SiC tube wall temperature in the range of 1200-1800 K. Characteristic residence times in the reactor are 100-200 μsec after which the gas mixture emerges as a skimmed molecular beam at a pressure of approximately 10 μTorr. Products were detected using matrix infrared absorption spectroscopy, 118.2 nm (10.487 eV) photoionization mass spectroscopy and resonance enhanced multiphoton ionization. The initial steps in the thermal decomposition of furfural and benzaldehyde have been identified. Furfural undergoes unimolecular decomposition to furan + CO: C4H3O-CHO (+ M) → CO + C4H4O. Sequential decomposition of furan leads to the production of HC≡CH, CH2CO, CH3C≡CH, CO, HCCCH2, and H atoms. In contrast, benzaldehyde resists decomposition until higher temperatures when it fragments to phenyl radical plus H atoms and CO: C6H5CHO (+ M) → C6H5CO + H → C6H5 + CO + H. The H atoms trigger a chain reaction by attacking C6H5CHO: H + C6H5CHO → C6H6CHO* → C6H6 + CO + H. The net result is the decomposition of benzaldehyde to produce benzene and CO.
Ultrafast electroencephalographic signals, having frequencies above 500 Hz, can be observed in somatosensory evoked potential measurements. Usually, these recordings have a poor signal-to-noise ratio ...(SNR) because weak signals are overlaid by intrinsic noise of much higher amplitude like that generated by biological sources and the amplifier. As an example, recordings at the scalp taken during electrical stimulation of the median nerve show a 600 Hz burst with submicro-volt amplitudes which can be extracted from noise by the use of massive averaging and digital signal processing only. We have investigated this signal by means of a very low noise amplifier made in-house (minimal voltage noise 2.7 nV Hz(-1/2), FET inputs). We examined how the SNR of the data is altered by the bandwidth and the use of amplifiers with different intrinsic amplifier noise levels of 12 and 4.8 nV Hz(-1/2), respectively. By analyzing different frequency contributions of the signal, we found an extremely weak 1 kHz component superimposed onto the well-known 600 Hz burst. Previously such high-frequency electroencephalogram responses around 1 kHz have only been observed by deep brain electrodes implanted for tremor therapy of Parkinson patients. For the non-invasive measurement of such signals, we recommend that amplifier noise should not exceed 4 nV Hz(-1/2).
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