Citations

AbstractThe antithrombotic surface of endothelium is regulated in a coordinated manner. Tissue factor pathway inhibitor (TFPI) localized at the endothelial cell surface regulates the production of FXa by inhibiting the TF/VIIa complex. Systemic homozygotic deletion of the first Kunitz (K1) domain of TFPI results in intrauterine lethality in mice. Here we define the cellular sources of TFPI and their role in development, hemostasis, and thrombosis using TFPI conditional knockout mice. We used a Cre-lox strategy and generated mice with a floxed exon 4 (TFPIFlox) which encodes for the TFPI-K1 domain. Mice bred into Tie2-Cre and LysM-Cre lines to delete TFPI-K1 in endothelial (TFPITie2) and myelomonocytic (TFPILysM) cells resulted in viable and fertile offspring. Plasma TFPI activity was reduced in the TFPITie2 (71% ± 0.9%, P < .001) and TFPILysM (19% ± 0.6%, P < .001) compared with TFPIFlox littermate controls. Tail and cuticle bleeding were unaffected. However, TFPITie2 mice but not TFPILysM mice had increased ferric chloride–induced arterial thrombosis. Taken together, the data reveal distinct roles for endothelial- and myelomonocytic-derived TFPI.

Abstract Purpose: Deep brain stimulation (DBS) is a surgical option which has been demonstrated to be effective for treatment of many symptoms in several movement disorders. The purpose of this paper is to describe this surgical option and to discuss its effects on motor speech. Method: The literature is reviewed to provide a summary of the information available to describe DBS surgery and its effects on motor speech in neurological disorders. Primary focus is placed on DBS as a treatment for Parkinson's disease (PD) and Essential Tremor (ET). Results and Conclusions: DBS surgery is a relatively low-risk, common, and reversible surgery used to treat the motor symptoms in many movement disorders, especially PD and ET. It is not currently used as a treatment for any motor speech disorder. Dysarthria is a commonly reported side-effect of bilateral more than unilateral DBS surgery. The reported frequency of motor speech difficulties varies, and few studies have specifically examined motor speech with reliable and objective measures. However, though frequently present, negative effects of DBS on motor speech appear to be mild in severity.

Abstract Purpose: Amyotrophic lateral sclerosis (ALS) is a progressive neurologic disease that frequently affects speech and swallowing. The purpose of this article is to emphasize the role of the speech-language pathologist (SLP) in management of the progressive speech and swallowing symptoms. Methods: A review of the neurologic degeneration and resulting symptoms of ALS are presented, including the cognitive, sensory and speech-language changes that accompany the progressive motor impairment. The important role of the SLP on a multidisciplinary team is described. Approaches to management of both swallowing and speech are discussed. Results and Conclusions: ALS is a progressive, degenerative neurologic disease. SLPs play a vital role in helping patients maintain effective communication and manage dysphagia symptoms.

Background. There are a variety of techniques for targeting placement of an infraclavicular blockade; these include eliciting paresthesias, nerve stimulation, and 2-dimensional (2D) ultrasound (US) guidance. Current 2D US allows direct visualization of a “flat” image of the advancing needle and neurovascular structures but without the ability to extensively analyze multidimensional data and allow for real-time manipulation. Three-dimensional (3D) ultrasonography has gained popularity and usefulness in many clinical specialties such as obstetrics and cardiology. We describe some of the potential clinical applications of 3D US in regional anesthesia.Methods. This case represents an infraclavicular catheter placement facilitated by 3D US, which demonstrates 360-degree spatial relationships of the entire anatomic region.Results. The block needle, peripheral nerve catheter, and local anesthetic diffusion were observed in multiple planes of view without manipulation of the US probe.Conclusion. Advantages of 3D US may include the ability to confirm correct needle and catheter placement prior to the injection of local anesthetic. The spread of local anesthetic along the length of the nerve can be easily observed while manipulating the 3D images in real-time by simply rotating the trackball on the US machine to provide additional information that cannot be identified with 2D US alone.

Seligman’s theory of causal attribution predicts that patients with a pessimistic explanatory style will have less favourable health outcomes. We identified 702 patients who had undergone 894 primary total knee replacements between 1993 and 2005, who responded to follow-up surveys at two (n = 783 knee replacements) and/or five years (n = 443 knee replacements) and had also completed the Minnesota Multiphasic Personality Inventory long before the joint replacement (median = 16.6 and 14.5 years for two- and five-year cohorts, respectively). Scores from the Minnesota Multiphasic Personality Inventory Optimism-Pessimism scale were used to categorise patients as pessimistic (t-score > 60) or non-pessimistic (t-score ≤ 60). Multivariate logistic regression models assessing the effect of pessimistic explanatory style on pain or improvement in knee function were adjusted for gender, age, distance from the place of treatment and depression score. Pessimists reported (a) significantly more moderate or severe pain at two years with odds ratio 2.21 (95% confidence interval (CI) 1.12 to 4.35; p = 0.02), but not at five years when the odds ratio was 1.21 (95% CI 0.51 to 2.83; p = 0.67); and (b) less improvement in knee function at two years when the odds ratio was 0.53 (95% CI 0.30 to 0.96; p = 0.04), but not at five years when the odds ratio was 1.26 (95% CI 0.57 to 2.77; p = 0.57). No significant associations with moderate or severe limitation of activity were seen at two or five years. We conclude that a pessimistic explanatory style is associated with worse pain and functional outcomes two years after total knee replacement.