Sexual Abuse Exposure Alters Early Processing of Emotional Words: Evidence from Event-Related Potentials.

This study aimed to compare the time course of emotional information processing between trauma-exposed and control participants, using electrophysiological measures. We conceived an emotional Stroop task with two types of words: trauma-related emotional words and neutral words. We assessed the evoked cerebral responses of sexual abuse victims without post-traumatic stress disorder (PTSD) and no abuse participants. We focused particularly on an early wave (C1/P1), the N2pc, and the P3b. Our main result indicated an early effect (55-165 ms) of emotionality, which varied between non-exposed participants and sexual abuse victims. This suggests that potentially traumatic experiences modulate early processing of emotional information. Our findings showing neurobiological alterations in sexual abuse victims (without PTSD) suggest that exposure to highly emotional events has an important impact on neurocognitive function even in the absence of psychopathology.

A comparative study of 3 portable oxygen concentrators during a 6-minute walk test in patients with chronic lung disease.

BACKGROUND: The purpose of this study was to compare the ability of 3 portable oxygen concentrators (POCs) to maintain S(pO2) ≥ 90% during exercise in patients with chronic lung disease. METHODS: Twenty-one subjects with chronic lung disease (18 with COPD, 3 with pulmonary fibrosis) and documented room air exertional S(pO2) ≤ 85% performed four 6-min walk tests: a control walk using the subject's current oxygen system and prescribed exertional flow rate, and 1 walk with each of the 3 POCs (Eclipse 3, EverGo, and iGo) at their maximum pulse-dose setting. RESULTS: S(pO2) was significantly higher pre-walk and post-walk with the Eclipse 3, compared to the other POCs (all P < .01). The subjects also walked farther and maintained a mean S(pO2) ≥ 90% with the Eclipse 3 (both P < .01), which delivers the largest oxygen bolus. The subjects indicated that they preferred the EverGo's physical characteristics, but that the Eclipse 3 responded best to their breathing. The iGo was rated less favorably than Eclipse 3 or EverGo. CONCLUSIONS: The Eclipse 3 was best at meeting the subjects' clinical needs. POC users should be appropriately tested during all activities of daily living, to ensure adequate oxygenation. The healthcare provider should provide information and help to direct the subject toward the most clinically appropriate oxygen system, while being mindful of the patient's preferences and lifestyle. (Clinicaltrials.gov NCT01653730).

Twenty-four hour noninvasive ventilation in Duchenne muscular dystrophy: a safe alternative to tracheostomy.

BACKGROUND: Almost all patients with Duchenne muscular dystrophy (DMD) eventually develop respiratory failure. Once 24 h ventilation is required, either due to incomplete effectiveness of nocturnal noninvasive ventilation (NIV) or bulbar weakness, it is common practice to recommend invasive tracheostomy ventilation; however, noninvasive daytime mouthpiece ventilation (MPV) as an addition to nocturnal mask ventilation is also an alternative. METHODS: The authors' experience with 12 DMD patients who used 24 h NIV with mask NIV at night and MPV during daytime hours is reported. RESULTS: The mean (± SD) age and vital capacity (VC) at initiation of nocturnal (only) NIV subjects were 17.8±3.5 years and 0.90±0.40 L (21% predicted), respectively; and, at the time of MPV, 19.8±3.4 years and 0.57 L (13.2% predicted), respectively. In clinical practice, carbon dioxide (CO2) levels were measured using different methods: arterial blood gas analysis, transcutaneous partial pressure of CO2 and, predominantly, by end-tidal CO2. While the results suggested improved CO2 levels, these were not frequently confirmed by arterial blood gas measurement. The mean survival on 24 h NIV has been 5.7 years (range 0.17 to 12 years). Of the 12 patients, two deaths occurred after 3.75 and four years, respectively, on MPV; the remaining patients continue on 24 h NIV (range two months to 12 years; mean 5.3 years; median 3.5 years). CONCLUSIONS: Twenty-four hour NIV should be considered a safe alternative for patients with DMD because its use may obviate the need for tracheostomy in patients with chronic respiratory failure requiring more than nocturnal ventilation alone.

Lung volume recruitment in multiple sclerosis.

INTRODUCTION: Pulmonary function abnormalities have been described in multiple sclerosis including reductions in forced vital capacity (FVC) and cough but the time course of this impairment is unknown. Peak cough flow (PCF) is an important parameter for patients with respiratory muscle weakness and a reduced PCF has a direct impact on airway clearance and may therefore increase the risk of respiratory tract infections. Lung volume recruitment is a technique that improves PCF by inflating the lungs to their maximal insufflation capacity. OBJECTIVES: Our goals were to describe the rate of decline of pulmonary function and PCF in patients with multiple sclerosis and describe the use of lung volume recruitment in this population. METHODS: We reviewed all patients with multiple sclerosis referred to a respiratory neuromuscular rehabilitation clinic from February 1999 until December 2010. Lung volume recruitment was attempted in patients with FVC <80% predicted. Regular twice daily lung volume recruitment was prescribed if it resulted in a significant improvement in the laboratory. RESULTS: There were 79 patients included, 35 of whom were seen more than once. A baseline FVC <80% predicted was present in 82% of patients and 80% of patients had a PCF insufficient for airway clearance. There was a significant decline in FVC (122.6 mL/y, 95% CI 54.9-190.3) and PCF (192 mL/s/y, 95% 72-311) over a median follow-up time of 13.4 months. Lung volume recruitment was associated with a slower decline in FVC (p<0.0001) and PCF (p = 0.042). CONCLUSION: Pulmonary function and cough decline significantly over time in selected patients with multiple sclerosis and lung volume recruitment is associated with a slower rate of decline in lung function and peak cough flow. Given design limitations, additional studies are needed to assess the role of lung volume recruitment in patients with multiple sclerosis.

Tracheostomy decannulation and cough peak flows in patients with neuromuscular weakness.

OBJECTIVE: The aim of this study was to examine the relationship between cough peak flows (CPFs) before and after tracheostomy tube removal (decannulation) in patients with neuromuscular respiratory muscle weakness. DESIGN: For 26 patients with occluded tracheostomies (capped or Passy-Muir valve), spontaneous CPF (CPF(sp)), CPF after lung volume recruitment (CPF(LVR)), and CPF after lung volume recruitment and a manually assisted cough (CPF(LVR) + MAC) were measured before and after decannulation. RESULTS: Decannulation resulted in a significant increase (P < 0.001) in CPF of 35.6, 34.5, and 42.6 l/min for CPF(sp), CPF(LVR), and CPF(LVR) + MAC, respectively. In addition, CPF(LVR) or CPF(LVR) + MAC with a capped tracheostomy in place were greater than spontaneous CPF with the tracheostomy tube removed. CONCLUSIONS: Our study suggests that assisted coughing with a capped tracheostomy tube in place can result in higher flows than removing the tube and relying on spontaneous cough alone. Postdecannulation CPF measured at the mouth can be predicted to be at least 34.5 l/min greater than predecannulation values, which may thereby lower the threshold of the CPF indicated for safe decannulation.

Lung volume recruitment slows pulmonary function decline in Duchenne muscular dystrophy.

OBJECTIVE: To evaluate the long-term effect on measures of forced vital capacity (FVC) before and after the introduction of regular lung volume recruitment (LVR) maneuvers (breath-stacking) in individuals with Duchenne muscular dystrophy (DMD). DESIGN: Retrospective cohort study of pulmonary function data, including FVC, cough peak flow (CPF), maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP). Data were collected for 33 months prior to and 45 months after LVR introduction. SETTING: Ambulatory care in a tertiary level regional rehabilitation center in Canada. PARTICIPANTS: All individuals (N=22) with DMD (mean age ± SD, 19.6±2.4y), who were prescribed LVR and reported adherence with therapy. INTERVENTIONS: Introduction of regular LVR (breath-stacking); 3 to 5 maximal lung inflations (maximum insufflation capacity [MIC]) using a hand-held resuscitation bag and mouthpiece, twice daily. MAIN OUTCOME MEASURES: Measures included the rate of decline of FVC in percent-predicted, before and after the introduction of regular LVR. Changes in maximum pressures (MIP, MEP), MIC, and cough peak flows were also measured. RESULTS: At LVR initiation, FVC was 21.8±16.9 percent-predicted, and cough peak flows were <270L/min (144.8±106.9L/min). Annual decline of FVC was 4.7 percent-predicted a year before LVR and 0.5 percent-predicted a year after LVR initiation. The difference, 4.2 percent-predicted a year (95% confidence interval, 3.5-4.9; P<.000), represents an 89% improvement in the annual rate of FVC decline. CONCLUSIONS: The rate of FVC decline in DMD patients improves dramatically with initiation of regular LVR.

Formal ventilation patient education for ALS predicts real-life choices.

Our objective was to evaluate a single-session, hands-on education programme on mechanical ventilation for ALS patients and caregivers in terms of knowledge, change in affect and to determine whether ventilator decisions made after the education sessions predict those made later in life. Questionnaires were administered to 26 patients and 26 caregivers on four separate occasions. The questionnaires assessed knowledge of ventilatory support, feedback on the nature of the education programme, as well as self-reported emotional well-being. All patients were followed until their death or until initiation of invasive ventilation. Both groups demonstrated significant improvements in knowledge as a result of the education session which was retained after one month. There was no change in patient or caregiver reports' self-reported emotional well-being. The choices of ventilatory support expressed at one month (T4) accurately predicted the real-life clinical choices made by 76% of patients. Any difference resulted from choosing palliative care. Hands-on patient and caregiver education results in improved knowledge, assists in decision-making with respect to ventilatory support, and is not associated with a worsening of affect. It also provides for an accurate prediction of real-life choices and avoids undesired life support interventions and critical care admissions.