Ventricular tachycardia in a Brugada syndrome patient caused by a novel deletion in SCN5A

The aim of the present study was to identify the molecular mechanism behind ventricular tachycardia in a patient with Brugada syndrome. Arrhythmias in patients with Brugada syndrome often occur during sleep. However, a 28-year-old man with no previously documented arrhythmia or syncope who experienced shortness of breath and chest pain during agitation is described. An electrocardiogram revealed monomorphic ventricular tachycardia; after he was converted to nodal rhythm, he spontaneously went into sinus rhythm, and showed classic Brugada changes with coved ST elevation in leads V(1) to V(2). Mutation analysis of SCN5A revealed a novel mutation, 3480 deletion T frame shift mutation, resulting in premature truncation of the protein. Heterologous expression of this truncated protein in human embryonic kidney 293 cells showed a markedly reduced protein expression level. By performing whole-cell patch clamp experiments using human embryonic kidney 293 cells transfected with the mutated SCN5A, no current could be recorded. Hence, the results suggest that the patient suffered from haploinsufficiency of Na(v)1.5, and that this mutation was the cause of his Brugada syndrome.

Auditory event-related potentials, bispectral index, and entropy for the discrimination of different levels of sedation in intensive care unit patients

BACKGROUND: Sedation protocols, including the use of sedation scales and regular sedation stops, help to reduce the length of mechanical ventilation and intensive care unit stay. Because clinical assessment of depth of sedation is labor-intensive, performed only intermittently, and interferes with sedation and sleep, processed electrophysiological signals from the brain have gained interest as surrogates. We hypothesized that auditory event-related potentials (ERPs), Bispectral Index (BIS), and Entropy can discriminate among clinically relevant sedation levels. METHODS: We studied 10 patients after elective thoracic or abdominal surgery with general anesthesia. Electroencephalogram, BIS, state entropy (SE), response entropy (RE), and ERPs were recorded immediately after surgery in the intensive care unit at Richmond Agitation-Sedation Scale (RASS) scores of -5 (very deep sedation), -4 (deep sedation), -3 to -1 (moderate sedation), and 0 (awake) during decreasing target-controlled sedation with propofol and remifentanil. Reference measurements for baseline levels were performed before or several days after the operation. RESULTS: At baseline, RASS -5, RASS -4, RASS -3 to -1, and RASS 0, BIS was 94 [4] (median, IQR), 47 [15], 68 [9], 75 [10], and 88 [6]; SE was 87 [3], 46 [10], 60 [22], 74 [21], and 87 [5]; and RE was 97 [4], 48 [9], 71 [25], 81 [18], and 96 [3], respectively (all P < 0.05, Friedman Test). Both BIS and Entropy had high variabilities. When ERP N100 amplitudes were considered alone, ERPs did not differ significantly among sedation levels. Nevertheless, discriminant ERP analysis including two parameters of principal component analysis revealed a prediction probability PK value of 0.89 for differentiating deep sedation, moderate sedation, and awake state. The corresponding PK for RE, SE, and BIS was 0.88, 0.89, and 0.85, respectively. CONCLUSIONS: Neither ERPs nor BIS or Entropy can replace clinical sedation assessment with standard scoring systems. Discrimination among very deep, deep to moderate, and no sedation after general anesthesia can be provided by ERPs and processed electroencephalograms, with similar P(K)s. The high inter- and intraindividual variability of Entropy and BIS precludes defining a target range of values to predict the sedation level in critically ill patients using these parameters. The variability of ERPs is unknown.

Rapid tranquilization of severely agitated patients with schizophrenia spectrum disorders: a naturalistic, rater-blinded, randomized, controlled study with oral haloperidol, risperidone, and olanzapine

INTRODUCTION Agitation is a major problem in acute schizophrenia. Only a few studies have tested antipsychotic agents in severely agitated patients, mainly because of legal issues. Furthermore, most studies were limited to the first 24 hours. We aimed to investigate the efficacy of oral haloperidol, risperidone, and olanzapine in reducing psychotic agitation in severely agitated patients with schizophrenia or schizophreniform or schizoaffective disorder over 96 hours using a prospective, randomized, rater-blinded, controlled design within a naturalistic treatment regimen. METHODS In total, 43 severely agitated patients at acute care psychiatric units were enrolled. Participants were randomly assigned to receive either daily haloperidol 15 mg, olanzapine 20 mg, or risperidone 2 to 6 mg over 5 days. Positive and Negative Syndrome Scale psychotic agitation subscale score was the primary outcome variable. A mixed-model analysis was applied. RESULTS All drugs were effective for rapid tranquilization within 2 hours. Over 5 days, the course differed between agents (P < 0.001), but none was superior. Dropouts occurred only in the risperidone and olanzapine groups. Men responded better to treatment than did women during the initial 2 hours (P = 0.046) as well as over the 5-day course (P < 0.001). No difference between drug groups was observed regarding diazepam or biperiden use. CONCLUSIONS Oral haloperidol, risperidone, and olanzapine seem to be suitable for treating acute severe psychotic agitation in schizophrenia spectrum disorders. Response to oral antipsychotics demonstrated a gender effect with poorer outcome in women throughout the study.

Sustained attention in children with two etiologies of early hydrocephalus.

Several studies have shown that children with spina bifida meningomyelocele (SBM) and hydrocephalus have attention problems on parent ratings and difficulties in stimulus orienting associated with a posterior brain attention system. Less is known about response control and inhibition associated with an anterior brain attention system. Using the Gordon Vigilance Task (Gordon, 1983), we studied error rate, reaction time, and performance over time for sustained attention, a key anterior attention function, in 101 children with SBM, 17 with aqueductal stenosis (AS; another condition involving congenital hydrocephalus), and 40 typically developing controls (NC). In SBM, we investigated the relation between cognitive attention and parent ratings of inattention and hyperactivity and explored the impact of medical variables. Children with SBM did not differ from AS or NC groups on measures of sustained attention, but they committed more errors and responded more slowly. Approximately one-third of the SBM group had attention symptoms, although parent attention ratings were not associated with task performance. Hydrocephalus does not account for the attention profile of children with SBM, which also reflects the distinctive brain dysmorphologies associated with this condition.

Rapid tranquilization of severely agitated patients with schizophrenia spectrum disorders: a naturalistic, rater-blinded, randomized controlled study with oral haloperidol, risperidone, and olanzapine

Agitation is a major problem in acute schizophrenia. Still, only limited evidence exists on antipsychotic efficacy in severely agitated patients after the first 24 hours. We aimed to investigate the efficacy of oral haloperidol, risperidone, and olanzapine in reducing psychotic agitation in severely agitated patients with schizophrenia or schizophreniform or schizoaffective disorder over 96 hours using a prospective, randomized, rater-blinded, controlled design within a naturalistic treatment regimen. We enrolled 43 severely agitated patients at acute care psychiatric units. Participants were randomly assigned to receive either daily haloperidol 15 mg, olanzapine 20 mg, or risperidone 2 – 6 mg over 5 days. Positive and Negative Syndrome Scale psychotic agitation (PANSS-PAS) subscore was the primary outcome variable. A mixed model analyses was applied. All drugs were effective for rapid tranquillization within 2 hours. Over 5 days, the course differed between agents (p < 0.001) but none was superior. Dropouts occurred only in the risperidone and olanzapine groups. Men responded better to treatment than women during the initial 2 hours (p = 0.046) as well as over the 5 day course (p < 0.001). No difference between drug groups was observed regarding diazepam or biperiden use. Oral haloperidol, risperidone, and olanzapine seem to be suitable for treating acute severe psychotic agitation in schizophrenia spectrum disorders. We observed a gender effect with poorer outcome in women.

Effect of sedation level on the prevalence of delirium when assessed with CAM-ICU and ICDSC

Purpose We hypothesized that reduced arousability (Richmond Agitation Sedation Scale, RASS, scores −2 to −3) for any reason during delirium assessment increases the apparent prevalence of delirium in intensive care patients. To test this hypothesis, we assessed delirium using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Intensive Care Delirium Screening Checklist (ICDSC) in intensive care patients during sedation stops, and related the findings to the level of sedation, as assessed with RASS score. Methods We assessed delirium in 80 patients with ICU stay longer than 48 h using CAM-ICU and ICDSC during daily sedation stops. Sedation was assessed using RASS. The effect of including patients with a RASS of −2 and −3 during sedation stop (“light to moderate sedation”, eye contact less than 10 s or not at all, respectively) on prevalence of delirium was analyzed. Results A total of 467 patient days were assessed. The proportion of CAM-ICU-positive evaluations decreased from 53 to 31 % (p < 0.001) if assessments from patients at RASS −2/−3 (22 % of all assessments) were excluded. Similarly, the number of positive ICDSC results decreased from 51 to 29 % (p < 0.001). Conclusions Sedation per se can result in positive items of both CAM-ICU and ICDSC, and therefore in a diagnosis of delirium. Consequently, apparent prevalence of delirium is dependent on how a depressed level of consciousness after sedation stop is interpreted (delirium vs persisting sedation). We suggest that any reports on delirium using these assessment tools should be stratified for a sedation score during the assessment.

Aufruf an das deutsche Gesammt-Vaterland

Boberach: Die Unruhe in dem seit der Ersten Polnischen Teilung preußischen Netzedistrikt ist nur eine Folge der Agitation des polnischen Adels. Weil der Bodenpreis in der Provinz Posen niedrig ist, sollen sich Binnendeutsche dort ansiedeln

Zwei Gespräche mit Seiner Majestät dem Könige Friedrich Wilhelm dem Vierten (am 23sten November 1847, und am 19ten März 1848) : in geschichtlichen Rahmen gefaßt

Boberach: Auf einer Eisenbahnreise äußerte sich der König 1847 nur über Mendelssohn und andere Komponisten. Das Gespräch am 19. März 1848 im Berliner Schloß hatte Rellstab erbeten, um den König zu bewegen, die Truppen zurückzuziehen; dieser habe jedoch noch geglaubt, die Volksbewegung, die er auf Agitation von Fremden zurückführte, unterdrücken zu können; Bodelschwingh und ein General seien derselben Meinung gewesen

Frankreich's dritte Revolution : eine übersichtliche Darstellung der Februar-Ereignisse in Frankreich nebst einer geschichtlichen Einleitung

Boberach: Die Februarrevolution wird im Zusammenhang der Revolutionen 1830 und 1789 betrachtet, wobei das Schwergewicht auf der Agitation um die Wahlrechtsreform liegt

Woher und Wohin? : eine populaire Schrift zur Aufklärung über die social-politische Bewegung der Neuzeit

Boberach: Der von französischen Stubengelehrten erfundene Sozialismus und Kommunismus wird verurteilt. Nationalwerkstätten von Arbeiterassoziationen können nur die Konkurrenz vernichten. Die Forderungen der Ultraliberalen sind nur ein Umweg zur Republik, aber ihre Propaganda ist leider wirkungsvoll. - Wentzke: Gegen die Verwendung kommunistischer Ideen zu politischer Agitation durch die deutschen Demagogen. Für die konstitutionelle Monarchie

Analyses of the Erosive Effect of Dietary Substances and Medications on Deciduous Teeth.

This study aimed at analysing the erosive potential of 30 substances (drinks, candies, and medicaments) on deciduous enamel, and analyse the associated chemical factors with enamel dissolution. We analysed the initial pH, titratable acidity (TA) to pH 5.5, calcium (Ca), inorganic phosphate (Pi), and fluoride (F) concentration, and degree of saturation ((pK -pI)HAP, (pK -pI)FAP, and (pK-pI)CaF2) of all substances. Then, we randomly distributed 300 specimens of human deciduous enamel into 30 groups (n = 10 for each of the substances tested. We also prepared 20 specimens of permanent enamel for the sake of comparison between the two types of teeth, and we tested them in mineral water and Coca-Cola®. In all specimens, we measured surface hardness (VHN: Vickers hardness numbers) and surface reflection intensity (SRI) at baseline (SHbaseline and SRIbaseline), after a total of 2 min (SH2min) and after 4 min (SH4min and SRI4min) erosive challenges (60 ml of substance for 6 enamel samples; 30°C, under constant agitation at 95 rpm). There was no significant difference in SHbaseline between deciduous and permanent enamel. Comparing both teeth, we observed that after the first erosive challenge with Coca-Cola®, a significantly greater hardness loss was seen in deciduous (-90.2±11.3 VHN) than in permanent enamel (-44.3±12.2 VHN; p = 0.007), but no differences between the two types of teeth were observed after two challenges (SH4min). After both erosive challenges, all substances except for mineral water caused a significant loss in relative surface reflectivity intensity, and most substances caused a significant loss in surface hardness. Multiple regression analyses showed that pH, TA and Ca concentration play a significant role in initial erosion of deciduous enamel. We conclude that drinks, foodstuffs and medications commonly consumed by children can cause erosion of deciduous teeth and erosion is mainly associated with pH, titratable acidity and calcium concentration in the solution.

Juli: Unter den Tuchlauben: Der Schwarzgelbe: Wir verlangen endliche Befestigung derjenigen Behörden ...

Welsch (Projektbearbeiter): Karikaturen auf die Furcht des jüdischen Bevölkerungsteils vor der antisemitischen Agitation des Journalisten Johann Quirin Endlich sowie auf die bisweilen übertriebene Pflichtauffassung der Nationalgarde die Aufrechterhaltung von 'Ruhe und Ordnung' betreffend

Extractos de residuos de la vitivinicultura : concentración de polifenoles

El objetivo del trabajo fue determinar la concentración de polifenoles en extractos de hojas de verano y otoño y de escobajo de variedades tintas de vitis vinifera, obtenidos por distintos métodos.Se trabajó con hojas de verano y de otoño de variedad Syrah y con hojas de otoño variedad Malbec, dividiéndolas por su color en rojas y amarillas, y con escobajo de variedad Malbec. Los extractos se obtuvieron por maceración en agua y baño María hirviente durante tres horas (BM), maceración en agua y agitación, a temperatura ambiente, durante 48 horas (AG). Se utilizó como referencia oleorresina de romero. El orden decreciente respecto de la cantidad de polifenoles expresados en g de quercitina / g de extracto seco fue el siguiente: oleorresina de romero: 56,3 ± 0,3 extracto de: hojas de otoño Syrah por maceración y agitación en agua a temperatura ambiente durante 48 horas: 7,5 ± 0,3; escobajo Malbec por maceración y agitación en agua a temperatura ambiente durante 48 horas: 24 ± 0,3; hojas de otoño rojas Malbec por maceración y agitación en agua a temperatura ambiente durante 48 horas: 22 ± 0,3; escobajo de Malbec: a baño María 21,4 ± 0,3; hojas de otoño Syrah 3 horas a baño María: 21,1 ±0,3; hojas de otoño amarillas Malbec por maceración y agitación en agua a temperatura ambiente durante 48 horas: 17 ± 0,3; hojas de verano Syrah 3 horas a baño María: 16,5 ± 0,3; hojas de otoño rojas Malbec 3 horas a baño María: 13,8 ± 0,3; hojas de otoño amarillas Malbec 3 horas a baño María: 12,4 ± 0,3; hojas de verano Syrah por maceración y agitación en agua a temperatura ambiente durante 48 horas: 12,2 ± 0,3. Se concluyó que las hojas de otoño contienen mayor cantidad de polifenoles que las de verano; la variedad Syrah posee más polifenoles en hojas que la variedad Malbec; el escobajo de Malbec contiene más olifenoles que las hojas de la misma variedad; y el mejor método de extracción para obtener estos compuestos activos fue por maceración en agua y agitación a temperatura ambiente durante 48 horas.

Las huelgas de los estibadores portuarios en el sur santafesino en 1928

El 2 de mayo de 1928 se inicia una huelga de estibadores portuarios en Rosario después de años de tibia actividad sindical. Días más tarde, varios hechos de sangre provocaron la solidaridad obrera con dos paros generales que conmovieron a la ciudad por su agitación y violencia. Los portuarios villenses también se solidarizaron y, un mes más tarde, encabezaron un violento reclamo laboral. El motivo inicial de las huelgas fue el salarial, pero la cuestión de fondo que hilvana a ambas experiencias es la puja social por el deterioro de las condiciones laborales y las imposiciones empresarias en el control y selección de la fuerza de trabajo.En principio la espontaneidad de la protesta tomó por sorpresa a las organizaciones sindicales de izquierda que durante la década del 20 habían mostraban varias fracturas, no obstante será la oportunidad que explica la reorganización y difusión del movimiento obrero con posterioridad. En otro sentido, los conflictos en Rosario y Villa Constitución reflejan la compleja trama de la política santafesina y su conexión con el ámbito laboral. Asimismo, creemos que los sucesos de 1928 tienen una repercusión mayor que la estrictamente local engarzándose en un ciclo de conflictividad que involucra a buena parte de la economía agroexportadora

Las huelgas de los estibadores portuarios en el sur santafesino en 1928

El 2 de mayo de 1928 se inicia una huelga de estibadores portuarios en Rosario después de años de tibia actividad sindical. Días más tarde, varios hechos de sangre provocaron la solidaridad obrera con dos paros generales que conmovieron a la ciudad por su agitación y violencia. Los portuarios villenses también se solidarizaron y, un mes más tarde, encabezaron un violento reclamo laboral. El motivo inicial de las huelgas fue el salarial, pero la cuestión de fondo que hilvana a ambas experiencias es la puja social por el deterioro de las condiciones laborales y las imposiciones empresarias en el control y selección de la fuerza de trabajo.En principio la espontaneidad de la protesta tomó por sorpresa a las organizaciones sindicales de izquierda que durante la década del 20 habían mostraban varias fracturas, no obstante será la oportunidad que explica la reorganización y difusión del movimiento obrero con posterioridad. En otro sentido, los conflictos en Rosario y Villa Constitución reflejan la compleja trama de la política santafesina y su conexión con el ámbito laboral. Asimismo, creemos que los sucesos de 1928 tienen una repercusión mayor que la estrictamente local engarzándose en un ciclo de conflictividad que involucra a buena parte de la economía agroexportadora