Prevention of secondary damage is an important goal in the treatment of severe neurological conditions, such as major head trauma or stroke. However, there is currently a lack of non-invasive methods ...for monitoring cerebral physiology. Diffuse optical methods have been proposed as an inexpensive, non-invasive bedside monitor capable of providing neurophysiology information in neurocritical patients. However, the reliability of the technique to provide accurate longitudinal measurement during the clinical evolution of a patient remains largely unaddressed. Here, we report on the translation of a hybrid diffuse optical system combining frequency domain diffuse optical spectroscopy (FD-DOS) and diffuse correlation spectroscopy (DCS) for real-time monitoring of cerebral physiology in a neuro intensive care unit (neuro-ICU). More specifically, we present a case study of a patient admitted with a high-grade aneurysmal subarachnoid hemorrhage, who was monitored throughout hospitalization. We show that the neurophysiological parameters measured by diffuse optics at the bedside are consistent with the clinical evolution of the patient at all the different stages following its brain lesion. These data provide support for clinical translation of DOS/DCS as a useful biomarker of neurophysiology in the neuro-ICU, particularly in locations where other clinical resources are limited.
The hypothalamic-pituitary-adrenal and sympathetic-adrenomedullary axes are the main systems activated in response to stress. Alterations in salivary components and flow rate have been associated ...with oral health problems and psychological stress.
The aim of the present study was to investigate the influence of psychological stress on salivary flow, total protein concentration and IgG, IgM and IgA concentrations.
Thirty-eight medical students, average age of 21.4 +/- 2.1 years and enrolled in the 2nd to 5th years of their course, took part voluntarily in the study which involved two different periods: the first after vacations and the second during the final exams (a gap of 4 months). An Oral Health Questionnaire and the Lipp Inventory of Stress Symptoms for Adults (ISSL) were applied during both these periods. The flow rate, total protein concentration and immunoglobulin titers of saliva samples, collected after stimulation and stored in a container with protease inhibitor, were measured.
Analysis of the ISSL showed that 42.1% (n = 16) of the students had stress during the post-vacation period, and 44.7% (n = 17) during the final exams. The students' salivary flow rate was significantly lower during the latter period than during the post-vacation period (p < 0.0001), regardless of the presence or absence of psychological stress as measured by the ISSL. There was a reduction in salivary flow rate and a consequent reduction in total protein concentration during the exam period (p = 0.0058). However, during both periods of the study there was no significant difference in total salivary protein concentration between the groups of students with or without psychological stress according to the ISSL (p > 0.05). IgG predominated over IgA and IgM (p < 0.001) during both study periods, regardless of the presence or absence of psychological stress. The study period and the presence of stress influenced the secretion of salivary immunoglobulins. IgM titers during the post-vacation period (p = 0.0044), and IgA (p = 0.028), IgG (p = 0.022) and IgM (p = 0.0075) titers during the final exams were higher in students with symptoms of psychological stress.
Although the immunoglobulin titers were high, there was a reduction in the students' salivary flow rates and a consequent reduction in total protein concentrations.
Few resting-state functional magnetic resonance imaging (RS-fMRI) studies evaluated the impact of acute ischemic changes on cerebral functional connectivity (FC) and its relationship with functional ...outcomes after acute ischemic stroke (AIS), considering the side of lesions. To characterize alterations of FC of patients with AIS by analyzing 12 large-scale brain networks (NWs) with RS-fMRI. Additionally, we evaluated the impact of the side (right (RH) or left (LH) hemisphere) of insult on the disruption of brain NWs. 38 patients diagnosed with AIS (17 RH and 21 LH) who performed 3T MRI scans up to 72 h after stroke were compared to 44 healthy controls. Images were processed and analyzed with the software toolbox UF
C with SPM12. For the first level, we generated individual matrices based on the time series extraction from 70 regions of interest (ROIs) from 12 functional NWs, constructing Pearson's cross-correlation; the second-level analysis included an analysis of covariance (ANCOVA) to investigate differences between groups. The statistical significance was determined with p < 0.05, after correction for multiple comparisons with false discovery rate (FDR) correction. Overall, individuals with LH insults developed poorer clinical outcomes after six months. A widespread pattern of lower FC was observed in the presence of LH insults, while a contralateral pattern of increased FC was identified in the group with RH insults. Our findings suggest that LH stroke causes a severe and widespread pattern of reduction of brain networks' FC, presumably related to the impairment in their long-term recovery.
Objective: To construct a theoretical model intended for evaluative researches on the worker’s health into the Family Health Strategy, supported by Christophe Dejours’s theory. Methods: The ...theoretical model was built between September and December 2010, through the integration of Dejours’s theory and the facts, the current situation of health workers, represented by official documents, which allowed the instrumentalization of thought, making affordable the features related to worker’s health. Results: Dejourian theory was adopted as the basic element in the construction of this model, due to its approach to the dynamics of the mental processes involved in the confrontation between the subject and his reality in work, focusing the interest in the worker’s subjective experiences (main source of pleasure and suffering in work). Given the influence played by the work organization on the worker’s health, it becomes essential to perform the analysis of the variables that influence pleasure-suffering process among these actors of such an importance for the health practices that reorganize the primary care. Conclusion: Christophe Dejours’s theory reveals its great potential for the analysis of the psychological processes involved in the confrontation between the worker in primary care and his reality, since it is vital to understand how the issues related to work in health area are disclosed, and the way the worker shall react to difficult work situations.
Construir um modelo teórico destinado às pesquisas avaliativas da saúde do
trabalhador na Estratégia Saúde da Família, suportado pela teoria de Christophe Dejours.
Métodos: O modelo teórico foi ...construído entre o período de setembro a dezembro de 2010,
através da integração da teoria de Dejours com os fatos, a situação atual do trabalhador
da saúde, representada pelos documentos oficiais, o que permitiu a instrumentalização
do pensamento, tornando abordáveis as propriedades relativas à saúde do trabalhador.
Resultados: A teoria Dejouriana, por abordar a dinâmica dos processos psíquicos envolvidos
na confrontação do sujeito com a realidade do trabalho, voltando para o interesse das vivências
subjetivas dos sujeitos (principal fonte de prazer e sofrimento no trabalho), foi tomada
como base na construção deste modelo. Diante da influência da organização do trabalho
na saúde do trabalhador torna-se indispensável a análise das variáveis que influenciam o
processo prazer-sofrimento destes atores importantes nas práticas de saúde reorganizadoras
da atenção primária. Conclusão: Revela-se grande potencial na teoria de Christophe Dejours
para a análise dos processos psíquicos envolvidos na confrontação do trabalhador da atenção
primária com sua realidade, visto que é fundamental o entendimento de como se manifestam
as questões referentes ao trabalho em saúde e a forma com que este reagirá às dificuldades
das situações de trabalho.
OBJECTIVETo examine cerebral cortex thickness in asymptomatic first-degree relatives of patients with mesial temporal lobe epilepsy (MTLE).
METHODSWe investigated 127 asymptomatic first-degree ...relatives of patients with MTLE due to hippocampal sclerosis (HS) (mean age ± SD = 39.4 ± 13 years) and 203 healthy control individuals (mean age ± SD = 36.0 ± 11 years). Participants underwent a comprehensive clinical evaluation and structural brain MRI at 3 study sites. Images were processed simultaneously at each site using a surface-based morphometry method to quantify global brain measures, hippocampal volumes, and cerebral cortical thickness. Differences in brain measures between relatives of patients and controls were examined using generalized models, while controlling for relevant covariates, including age and sex.
RESULTSNone of the asymptomatic first-degree relatives of MTLE + HS patients showed evidence of HS on qualitative image assessments. Compared to the healthy controls, the asymptomatic relatives of patients displayed no significant differences in intracranial volume, average hemispheric surface area, or hippocampal volume. Similarly, no significant cerebral cortical thinning was identified in the relatives of patients. This was consistent across the 3 cohorts.
CONCLUSIONLack of cortical thickness changes in the asymptomatic relatives of patients indicates that the previously characterized MTLE + HS-related cortical thinning is not heritable, and is likely driven by disease-related factors. This finding therefore argues for early and aggressive intervention in patients with medically intractable epilepsy.
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