A Study on the Correlation of Various Factors in Patients With Severe Traumatic Brain Injuries.

INTRODUCTION: Traumatic brain injury (TBI), ranging from minor impacts to severe cases, affects temporal and frontal brain areas, contributing to mortality and disability worldwide. The Glasgow Coma Scale (GCS) evaluates consciousness levels, aiding in prioritizing emergency care, while the Disability Rating Score (DRS) assesses overall function, particularly in severe cases, with greater sensitivity than GCS for clinical changes in TBI patients. OBJECTIVES: To correlate various factors with each other in patients presented with severe TBIs. MATERIALS AND METHODS: The retrospective study analyzed data from patients with severe TBIs admitted to the hospital from February 2023 to April 2024. Patients' demographic and clinical data, including GCS and DRS scores, were collected. Statistical analysis, including logistic regression, assessed mortality predictors. RESULTS: The study revealed significant correlations (p<0.05) between age and marital status (p=0.002) and surgery (p=0.003). Surgery also correlated significantly with the mechanism of injury (p<0.001). Furthermore, a negative correlation was found between GCS after 24 hours and change in GCS (p<0.001), while a positive correlation existed between DRS after 24 hours and DRS on the 14th day (p<0.001). These findings highlight the complex interplay between demographic factors, medical interventions, and clinical outcomes in TBI patients. CONCLUSION: The study found that older individuals, particularly those involved in road traffic accidents, had poorer recovery outcomes and higher rates of surgery, with a strong correlation between changes in GCS and DRS scores.

Touching the unconscious in the unconscious - hypnotic communication with unconscious patients.

If hypnosis means contact to the unconscious to modulate psychological and physiological functions by means of suggestions, and if this is facilitated by attenuation of the critical mind, then the question arises as to whether suggestions also have an effect when waking consciousness is otherwise eliminated, namely by coma or anesthesia. A prerequisite would be perception, which actually is evidenced by reports of patients after traumatic brain injury, artificial coma, resuscitation or general anesthesia. Moreover, posttraumatic stress disorder (PTSD) frequently observed after these medical situations is hardly explainable without some sort of awareness under such conditions. Even advanced neurophysiological diagnostic cannot yet rule out consciousness or sensory processing. Especially reference to perception during unconsciousness is given by the results of a recent multicenter study on the effects of hypnotic communication with patients under controlled adequate deep general anesthesia. The observed reductions in incidence and severity of postoperative pain, opioid use, nausea and vomiting cannot be explained by the reaction of a few but only by a considerable proportion of patients. This leads to a strong plea for a more careful treatment of unconscious patients in the emergency room, operating theater or intensive care unit, for the abandonment of the restriction of therapeutic communication to awake patients, and for new aspects of communication and hypnosis research. Obviously, loss of consciousness does not protect against psychological injury, and continuation of communication is needed. But how and what to talk to unconscious patients? Generally addressing the unconscious mind with suggestions that generally exert their effects unconsciously, hypnotic communication appears to be the adequate language. Especially addressing meaningful topics, as derived from the basic psychological needs and known stressors, appears essential. With respect to negative effects by negative or missing communication or to the proposed protective and supporting effects of therapeutic communication with patients clinically rated as unconscious, the role of consciousness is secondary. For the effects of perceived signals and suggestions it does not matter whether consciousness is absent, or partial, or unrecognized present.

Dissociation and the insanity defense: A review of U.S. Federal appellate case law.

Pathological dissociation is relatively common in the United States and may be associated with violent or criminal behavior. Dissociative Disorders, especially Dissociative Identity Disorder, are considered controversial diagnoses by some in the psychiatric and legal professions. Individuals who offend during dissociative states may not be criminally responsible if they meet the legal standard for insanity, however, insanity pleas based on dissociative symptoms are rare. This review examined Federal appellate case law for potential legal barriers to the insanity defense for dissociative conditions and any restrictions imposed on related expert evidence. Few rulings directly addressed these questions but there do not appear to be any unique barriers for dissociation-related insanity pleas. Some cases provided valuable insights regarding the admission of expert evidence, effective expert testimony, and the role of defense counsel.

Unconsciously triggered cognitive conflict influences perceptual choice in active and sedentary individuals.

Introduction: People who regularly exercise and receive training perform better when actioning unconscious cognitive tasks. The information flow triggered by a single unconscious visual stimulus has been extensively investigated, but it remains unclear whether multiple unconscious visual stimuli interact. This study aimed to explore the relationship between three simultaneous subliminal arrow stimuli (pointing in same or different directions), focusing on how they interact with each other and the subsequent priming effect on the target arrow in active and sedentary groups. Methods: We used a priming paradigm combining flanker task to test the hypothesis. A total of 42 participants were recruited. Of these, 22 constituted the active group and 20 constituted the sedentary group. Results: Behavioral data results revealed that the main effects of group and prime-target compatibility were significant. In the neurophysiological data, prime-target compatibility significantly influenced the latency of PP1. The amplitude of TP1 and TN2 mainly influenced the prime-flanker congruency. The prime-flanker congruency and groups interacted when the prime-target showed sufficient compatibility. The prime-flanker congruency, and the prime-target compatibility considerably influenced the TP3 amplitude in the anterior central frontal region (CZ electrode point). Conclusion: Event-related potentials revealed the interactions between conscious processing and subliminal conflict in the early stages of perceptual and attention processing (target-related P1 potential component). These results suggest that exercise is helpful for coping with unconscious cognitive conflict.

[Neuromodulatory pharmacotherapy individualization in prolonged and chronic consciousness disorders after severe traumatic brain injury]. / K probleme individualizatsii neiromodulyatornoi farmakoterapii pri prolongirovannykh i khronicheskikh narusheniyakh soznaniya vsledstvie tyazheloi cherepno-mozgovoi travmy.

One of the most probable causes of effective therapy for post-comatose disorders of consciousness is the lack of individualization of drug prescriptions. In this observational study, we analyzed 48 courses of neuromodulatory therapy in 28 patients with prolonged and chronic disorders of consciousness following severe traumatic brain injury. Comparison of 24 effective and 24 ineffective courses demonstrated higher effectiveness of pharmacotherapy through its individualization, i.e. the choice of a drug whose neuromodulatory spectrum would correspond to neurological syndromes of neurotransmitter dysfunction. In this approach, 74% of therapy courses were effective while opposite management resulted only 34% of effective courses.

Movements after Captive Bolt Stunning in Cattle and Possible Animal- and Process-Related Impact Factors-A Field Study.

Movements in cattle after captive bolt stunning cause problems in the slaughter process and lead to uncertainties in assessing stunning effectiveness. The objective of this study was to categorize and quantify these movements and determine animal- and process-related impact factors, as well as connections to stunning effectiveness and shooting position. In total 2911 cows, heifers, and bulls (dairy, beef, and crossbreeds) were examined (mean age 3.02 years). Movements from landing until at least four minutes after sticking were recorded by action cams (Apeman® A100). Nine movement categories were defined ("kicking hind limb", "twitching", "bending and stretching hind limb", "lifting and bending forelimb", "body arching laterally", "body arching ventrally", and "arching backwards"). According to the movement severity, a score was assigned to each category. The scores were summed, either for certain process intervals, e.g., LANDING (ejection from the stunning box), HOISTING, or STICKING, or for the total time between LANDING and end of the FOURTH MINUTE OF BLEEDING (sum score). Statistical analysis (ANOVA) was performed on the scores. Only 6.6% of cattle showed no movement. Most movements occurred during STICKING and FIRST MINUTE OF BLEEDING, occurring rarely up to 8 min after sticking. While cows moved most at LANDING, bulls and heifers moved more if all process intervals were considered. The sum score was highest in German Angus, Charolais, and Limousin and lowest in Brown Swiss and Simmental. The score at LANDING was highest in German Angus and Black Holstein. The use of pneumatic stunners and an increase in bolt-exit length significantly reduced movements. No impact of stunning effectiveness on movements was found, but only 19 cattle showed reduced effectiveness.

Alternatives to Carbon Dioxide in Two Phases for the Improvement of Broiler Chickens' Welfare during Stunning.

This study evaluated the exposure to gas mixtures of carbon dioxide (CO2) associated with nitrogen (N2) as alternatives to CO2 in two phases to improve the welfare of broiler chickens at slaughter. Broilers were exposed to one of three treatments: 40C90C (1st phase: <40% CO2 for 2 min; 2nd phase: >90% CO2 and <2% O2 for 2 min, n = 92), 40C60N (40% CO2, 60% N2, and <2% O2 for 4 min, n = 79), or 20C80N (20% CO2, 80% N2, and <2% O2 for 4 min, n = 72). Brain activity (EEG) was assessed to determine the onset of loss of consciousness (LOC) and death. Behavioural assessment allowed for characterisation of an aversive response to the treatments and confirmed loss of posture (LOP) and motionlessness as behavioural proxies of LOC and brain death in 40C60N and 20N80C. However, the lack of quality of the EEG traces obtained in 40C90C did not allow us to determine the onset of LOC and brain death for this treatment. The onset of LOC in 40C60N was found at 19 s [14-30 s] and in 20C80N at 21 s [16-37 s], whereas a LOP was seen at 53 s [26-156 s] in 40C90C. Birds showed brain death in 40C60N at 64 s [43-108 s] and in 20C80N at 70 s [45-88 s]), while they became motionless in 40C90C at 177 s [89-212 s]. The 40C90C birds not only experienced more events of aversive behaviours related to mucosal irritation, dyspnoea, and breathlessness during induction to unconsciousness but were at risk of remaining conscious when the CO2 concentration was increased in the 2nd phase (known to cause severe pain). From an animal welfare point of view, 40C60N proved to be the least aversive of the three treatments tested, followed by 20C80N and 40C90C.

Towards an electroencephalographic measure of awareness based on the reactivity of oscillatory macrostates to hearing a subject's own name.

We proposed that the brain's electrical activity is composed of a sequence of alternating states with repeating topographic spectral distributions on scalp electroencephalogram (EEG), referred to as oscillatory macrostates. The macrostate showing the largest decrease in the probability of occurrence, measured as a percentage (reactivity), during sensory stimulation was labelled as the default EEG macrostate (DEM). This study aimed to assess the influence of awareness on DEM reactivity (DER). We included 11 middle cerebral artery ischaemic stroke patients with impaired awareness having a median Glasgow Coma Scale (GCS) of 6/15 and a group of 11 matched healthy controls. EEG recordings were carried out during auditory 1 min stimulation epochs repeating either the subject's own name (SON) or the SON in reverse (rSON). The DEM was identified across three SON epochs alternating with three rSON epochs. Compared with the patients, the DEM of controls contained more posterior theta activity reflecting source dipoles that could be mapped in the posterior cingulate cortex. The DER was measured from the 1 min quiet baseline preceding each stimulation epoch. The difference in mean DER between the SON and rSON epochs was measured by the salient EEG reactivity (SER) theoretically ranging from -100% to 100%. The SER was 12.4 ± 2.7% (Mean ± standard error of the mean) in controls and only 1.3 ± 1.9% in the patient group (P < 0.01). The patient SER decreased with the Glasgow Coma Scale. Our data suggest that awareness increases DER to SON as measured by SER.

One node among many: sevoflurane-induced hypnosis and the challenge of an integrative network-level view of anaesthetic action.

Building on their known ability to influence sleep and arousal, Li and colleagues show that modulating the activity of glutamatergic pedunculopontine tegmental neurones also alters sevoflurane-induced hypnosis. This finding adds support for the shared sleep-anaesthesia circuit hypothesis. However, the expanding recognition of many neuronal clusters capable of modulating anaesthetic hypnosis raises the question of how disparate and anatomically distant sites ultimately interact to coordinate global changes in the state of the brain. Understanding how these individual sites work in concert to disrupt cognition and behaviour is the next challenge for anaesthetic mechanisms research.

Hypoxic loss of consciousness in air diving: two cases of mixtures made hypoxic by oxidation of the scuba diving cylinder.

Without an adequate supply of oxygen from the scuba apparatus, humans would not be able to dive. The air normally contained in a scuba tank is dry and free of toxic gases. The presence of liquid in the tank can cause corrosion and change the composition of the gas mixture. Various chemical reactions consume oxygen, making the mixture hypoxic. We report two cases of internal corrosion of a scuba cylinder rendering the respired gas profoundly hypoxic and causing immediate hypoxic loss of consciousness in divers.

Acute Fatty Liver of Pregnancy Complicated With Mild Encephalitis/Encephalopathy With a Reversible Splenial Lesion: A Case Report.

Acute fatty liver of pregnancy (AFLP) is a rare complication of pregnancy that may result in fulminant hepatic failure. A 28-year-old woman, at 36 weeks of gestation, presented to a maternal-fetal outpatient clinic with fever and headache. She was prescribed analgesics and was planned for follow-up. Two days later, she was taken back for evaluation by her husband to the previous physician again because of the subacute onset of impaired consciousness. Blood tests showed a marked elevation of liver enzymes and C-reactive protein (CRP), and the patient was transported to a tertiary hospital. A clinical diagnosis of AFLP or hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome was made, and an emergency cesarean section was performed. Unconsciousness was prolonged due to mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) for three days. A liver biopsy was performed on postoperative day 11. Liver biopsy results showed large and small droplet fatty deposits, and the diagnosis of AFLP was confirmed. Thereafter, the elevated liver enzymes resolved spontaneously solely by supportive care. The patient presented with symptoms of impaired consciousness due to mild encephalitis/encephalopathy with a reversible splenial lesion (MERS), which led to a visit to a tertiary hospital and early intervention for AFLP. This case suggested that there may be similarities between the two pathologies of AFLP and MERS.

Farmed fish welfare during slaughter in Italy: survey on stunning and killing methods and indicators of unconsciousness.

Information on slaughter procedures for farmed fish in aquaculture is limited, both in Europe and in Italy, due to a general lack of field data. The aim of this study was to gather information on the procedures used to slaughter fish in Italy and to discuss them considering the WOAH and EFSA recommendations on fish welfare. Using a questionnaire survey, data were collected by official veterinarians in 64 slaughtering facilities where 20 different species of fish were slaughtered. The main species slaughtered were rainbow trout (Oncorhynchus mykiss; 29/64), followed by European sea bass (Dicentrarchus labrax; 21/64), sea bream (Sparus aurata; 21/64), Arctic char (Salvelinus alpinus; 14/64), European eel (Anguilla anguilla; 11/64), sturgeon (Acipenser spp; 11/64), common carp (Cyprinus carpio; 6/64), and brown trout (Salmo trutta fario L.; 5/64). The most applied stunning/killing methods were "asphyxia in ice/thermal shock" and "electric in water bath," followed by "percussion," "asphyxia in air," and "electric dry system." After the application of the method, the assessment of the fish level of unconsciousness was practiced in 72% of the facilities using more than one indicator, with "breathing" and "coordinated movements" the most practiced. The collected data showed a discrepancy between the available recommendations about the welfare of fish at slaughter and what is practiced in many production sites, but for many species precise recommendations are still not available.

Stunning Compliance in Halal Slaughter: A Review of Current Scientific Knowledge.

Muslim scholars are not unanimous on the issue of the application of stunning in the halal slaughtering of animals. Appropriate stunning makes animals unconscious instantaneously, thus avoiding unnecessary pain and stress during the slaughtering of animals. The present review comprehensively summarizes the available scientific literature on stunning methods in view of their halal compliance during the slaughter of animals. The issue of maximum blood loss, reversibility of consciousness, and animals remaining alive during the halal cut are the key determinants of approval of stunning in the halal slaughter. Further, missed stuns due to poor maintenance of equipment, improper applications, and poor restraining necessitates additional stunning attempts, which further aggravates pain and stress in animals. Scientific findings suggest that halal-compliant stunning technologies are reversible, do not kill animals prior to the halal cut, and do not obstruct blood loss. There is a need to carry out further research on the refinement of available stunning technologies and their application, proper restraints, proper identification of the death status of animals, and assurance of animal welfare in commercial halal meat production.

Loss of free will in the Iranian criminal justice system: Interdisciplinary analysis of law and neuroscience.

Today, with the development of neuroscience and the discovery of new secrets of the brain, the social sciences, including law, have made significant progress with the help of new findings in this science. One of the significant applications of neuroscience in modern criminal law is the explanation of the neurological dimensions of human free will, which in addition to creating a profound and scientific approach to the definition of this important element of criminal responsibility, can help ascertain the loss of free will causes. To this end, the present study is an attempt to answer this question in the context of the Iranian criminal justice system: What are the core causes of the loss of free will from the perspective of neurolaw? The paper strives to take an appropriate step toward the development of criminal justice. In this study, we found that mental disorders, coercion, drunkenness, somnambulism, and error are the core causes that can be assessed in particular ways using EEG and fMRI techniques, however, each with limitations.

A framework to simplify paediatric syncope diagnosis.

This paper aims to improve the diagnosis of syncope and transient loss of consciousness (TLOC) in children. Diagnostic problems stem, first, from some causes spanning various disciplines, e.g. cardiology, neurology and psychiatry, while the most common cause, vasovagal syncope, is not embraced by any specialty. Second, clinical variability is huge with overlapping signs and symptoms. Third, the approach to TLOC/syncope of the European Society of Cardiology (ESC) is underused in childcare. We explain the ESC guidelines using an additional paediatric literature review. Classification of TLOC and syncope is hierarchic and based on history taking. Loss of consciousness (LOC) is defined using three features: abnormal motor control including falling, reduced responsiveness and amnesia. Adding a < 5 min duration and spontaneous recovery defines TLOC. TLOC simplifies diagnosis by excluding long LOC (e.g. some trauma, intoxications and hypoglycaemia) and focussing on syncope, tonic-clonic seizures and functional TLOC. Syncope, i.e. TLOC due to cerebral hypoperfusion, is divided into reflex syncope (mostly vasovagal), orthostatic hypotension (mostly initial orthostatic hypotension in adolescents) and cardiac syncope (arrhythmias and structural cardiac disorders). The initial investigation comprises history taking, physical examination and ECG; the value of orthostatic blood pressure measurement is unproven in children but probably low. When this fails to yield a diagnosis, cardiac risk factors are assessed; important clues are supine syncope, syncope during exercise, early death in relatives and ECG abnormalities.  Conclusions: In adults, the application of the ESC guidelines reduced the number of absent diagnoses and costs; we hope this also holds for children. What is Known: • Syncope and its mimics are very common in childhood, as they are at other ages. • Syncope and its mimics provide considerable diagnostic challenges. What is New: • Application of the hierarchic framework of transient loss of consciousness (TLOC) simplifies diagnosis. • The framework stresses history-taking to diagnose common conditions while keeping an eye on cardiac danger signs.

Slow-wave modulation analysis during states of unconsciousness using the novel tau-modulation method.

Objective. Slow-wave modulation occurs during states of unconsciousness and is a large-scale indicator of underlying brain states. Conventional methods typically characterize these large-scale dynamics by assuming that slow-wave activity is sinusoidal with a stationary frequency. However, slow-wave activity typically has an irregular waveform shape with a non-stationary frequency, causing these methods to be highly unpredictable and inaccurate. To address these limitations, we developed a novel method using tau-modulation, which is more robust than conventional methods in estimating the modulation of slow-wave activity and does not require assumptions on the shape or stationarity of the underlying waveform.Approach. We propose a novel method to estimate modulatory effects on slow-wave activity. Tau-modulation curves are constructed from cross-correlation between slow-wave and high-frequency activity. The resultant curves capture several aspects of modulation, including attenuation or enhancement of slow-wave activity, the temporal synchrony between slow-wave and high-frequency activity, and the rate at which the overall brain activity oscillates between states.Main results. The method's performance was tested on an open electrocorticographic dataset from two monkeys that were recorded during propofol-induced anesthesia, with electrodes implanted over the left hemispheres. We found a robust propagation of slow-wave modulation along the anterior-posterior axis of the lateral aspect of the cortex. This propagation preferentially originated from the anterior superior temporal cortex and anterior cingulate gyrus. We also found the modulation frequency and polarity to track the stages of anesthesia. The algorithm performed well, even with non-sinusoidal activity and in the presence of real-world noise.Significance. The novel method provides new insight into several aspects of slow-wave modulation that have been previously difficult to evaluate across several brain states. This ability to better characterize slow-wave modulation, without spurious correlations induced by non-sinusoidal signals, may lead to robust and physiologically-plausible diagnostic tools for monitoring brain functions during states of unconsciousness.

Delays in the diagnosis of ischaemic stroke presenting with persistent reduced level of consciousness: A systematic review.

INTRODUCTION: Stroke presenting with a reduced level of consciousness (RLOC) may result in diagnostic error and/or delay. Missed or delayed diagnosis of acute ischaemic stroke may preclude otherwise applicable hyperacute stroke interventions. The frequency, reasons for, and consequences of diagnostic error and delay due to RLOC are uncertain. METHOD: The databases PubMed, EMBASE, and Cochrane library were searched in adherence with the PRISMA guidelines. The systematic review was prospectively registered on PROSPERO. RESULTS: Initial searches returned 1162 results, of which 6 fulfilled inclusion criteria. The majority of identified studies show that ischaemic stroke presenting with RLOC is at increased risk of missed or delayed diagnosis. Hyperacute stroke interventions may also be delayed. There is limited evidence regarding the reason for these delays; however, the delays may result from neuroimaging delay associated with diagnostic uncertainty. There is also limited evidence regarding the outcomes of patients with stroke and RLOC who experience diagnostic delay; however, the available literature suggests that outcomes may be poor, including motor and cognitive impairment, as well as long-term impaired consciousness. The included studies did not evaluate, but have suggested urgent MRI access, educational interventions, and protocolisation of the evaluation of RLOC as means to reduce poor outcomes. CONCLUSIONS: Ischaemic stroke patients with RLOC are at risk of diagnostic delay and error. These patients may have poor outcomes. Additional research is required to identify the contributing factors more clearly and to provide amelioration strategies.

Pre-Slaughter Stunning of Farmed Atlantic Halibut in CO2-Saturated Seawater: Assessment of Unconsciousness by Electroencephalography (EEG).

As fish welfare becomes a growing concern, it is important to ensure humane treatment during slaughter. This study aimed to assess the onset of unconsciousness in Atlantic halibut immersed in CO2-saturated seawater through electroencephalography (EEG). Of the 29 fish studied, 10 exhibited escape attempts, indicating aversion to CO2-saturated water despite its oxygenation. EEG signals showed four distinct phases: transitional, excitation (high amplitude-high frequency), suppressed, and iso-electric phases. The onset of the suppressed phase, indicative of unconsciousness, occurred on average 258.8 ± 46.2 s after immersion. The spectral analysis of the EEG signals showed a progressive decrease in median frequency, spectral edge frequency, and high frequency contribution, which corresponded to the gradual loss of consciousness. The study concludes that CO2-saturated water is not recommended for pre-slaughter handling of halibut due to the extended time required for the onset of unconsciousness and the observed aversive behaviour. Ensuring humane treatment during slaughter is important for addressing public concern and safeguarding fish welfare in all stages of production.