Accuracy of clinical, laboratory, and computed tomography findings for identifying hollow viscus injury in blunt trauma patients with unexplained intraperitoneal free fluid without solid organ injury.

BACKGROUND: We sought to define the accuracy of findings for detecting hollow viscus injury (HVI) in patients with blunt abdominal trauma (BAT) and unexplained intra-peritoneal free fluid without solid organ injury (UIPFFWSOI). METHODS: We screened all consecutive hemodynamically stable patients presenting to a quaternary-care trauma-centre who had an abdominal computed tomography (CT) scan for BAT and UIPFFWSOI (January 2007-December 2014). RESULTS: Of 3796 patients identified during the study period, 39 presented with UIPFFWSOI. Fifteen underwent therapeutic laparotomy. Seatbelt sign (+LR approaches infinity), diffuse peritonitis (+LR approaches infinity), number of CT cuts with fluid (c-statistic = 0.65), and a lower arterial pH at presentation (c-statistic = 0.62) were most predictive of HVI. Patients operated on within 24 h had shorter stays than those operated on later (median 9 vs. 14 days, p = 0.03). CONCLUSIONS: Our findings suggest that clinical examination and measurements of intraperitoneal fluid volume may help identify HVIs in BAT patients.

Processing of emotional distraction is both automatic and modulated by attention: evidence from an event-related fMRI investigation.

Traditionally, emotional stimuli have been thought to be automatically processed via a bottom-up automatic "capture of attention" mechanism. Recently, this view has been challenged by evidence that emotion processing depends on the availability of attentional resources. Although these two views are not mutually exclusive, direct evidence reconciling them is lacking. One limitation of previous investigations supporting the traditional or competing views is that they have not systematically investigated the impact of emotional charge of task-irrelevant distraction in conjunction with manipulations of attentional demands. Using event-related fMRI, we investigated the nature of emotion-cognition interactions in a perceptual discrimination task with emotional distraction by manipulating both the emotional charge of the distracting information and the demands of the main task. Our findings show that emotion processing is both automatic and modulated by attention, but emotion and attention were only found to interact when finer assessments of emotional charge (comparison of most vs. least emotional conditions) were considered along with an effective manipulation of processing load (high vs. low). The study also identified brain regions reflecting the detrimental impact of emotional distraction on performance as well as regions involved in coping with such distraction. Activity in the dorsomedial pFC and ventrolateral pFC was linked to a detrimental impact of emotional distraction, whereas the dorsal ACC and lateral occipital cortex were involved in helping with emotional distraction. These findings demonstrate that task-irrelevant emotion processing is subjective to both the emotional content of distraction and the level of attentional demand.

High risk of sleep disordered breathing in the enuresis population.

PURPOSE: Enuresis is 1 of the most common complaints facing pediatric urologists and it has significant implications with respect to quality of life. Although the pathophysiology is incompletely understood, there is growing evidence that sleep disordered breathing in children, including obstructive sleep apnea, has a fundamental role. There are also potentially fundamental differences between monosymptomatic enuresis, which may be a sleep disorder, and nonmonosymptomatic enuresis, which may relate to a primary bladder storage problem. We prospectively evaluated the incidence of obstructive sleep apnea in patients with enuresis and analyzed differences between patients with monosymptomatic and nonmonosymptomatic enuresis. MATERIALS AND METHODS: A total of 69 children with enuresis were given 3 validated questionnaires to complete, including the Dysfunctional Voiding and Incontinence Symptom Score, the Obstructive Sleep Apnea Quality of Life survey and the Modified Pediatric Sleep Questionnaire. The Dysfunctional Voiding and Incontinence Symptom Score quantifies patient dysfunctional voiding habits. The Obstructive Sleep Apnea Quality of Life survey evaluates patient quality of life in regard to obstructive sleep apnea and its effects. Modified Pediatric Sleep Questionnaire results describe the severity of patient sleep disturbances. RESULTS: The mean Obstructive Sleep Apnea Quality of Life Survey score was 43 and 54% of patients had positive Modified Pediatric Sleep Questionnaire results, indicating that obstructive sleep apnea was prevalent in our population. Those with enuresis and daytime incontinence were significantly more likely to have sleep disordered breathing than those with monosymptomatic enuresis (p <0.05). CONCLUSIONS: Our study confirms the link between sleep disordered breathing and enuresis. All pediatric health care providers should be aware of this risk. The risk may be magnified in patients with concomitant daytime incontinence.

A combined SPM-ICA approach to fMRI.

Independent component analysis (ICA) and statistical parametric mapping (SPM) are two commonly used methods of analyzing fMRI measurements. Typically, these methods are applied separately to the measurements to produce brain maps indicating active brain regions in response to a stimulus or a performed task. However, ICA can also be used to develop a hemodynamic response model that can be used as a regressor in SPM of fMRI measurements. This may lead to a more accurate method of localizing brain activity that corresponds to performing a task or to various pathologies. In this study, BOLD fMRI data were acquired from a subject performing a finger flexion task in a block design paradigm. Both spatial and temporal ICA was performed on the subject's BOLD fMRI measurements. Two hemodynamic response model signals were generated from ICA results to use as regressors in SPM of the subject data. IC maps and SPM-generated brain maps of the subject data using the canonical hemodynamic response model and the ICA-derived models were compared. In all cases, there was significant overlap in voxel activations.