Utility of a multimodal neurophysiologic assessment tool in distinguishing between individuals with and without a history of mild traumatic brain injury.

This was a preliminary validation study of a multimodal concussion assessment battery incorporating eye-tracking, balance, and neurocognitive tests on a new hardware platform, the Computerized Brain Injury Assessment System. Using receiver-operating characteristics analyses, (1) we identified a subset of the most discriminating neurophysiological assessment tests involving smooth pursuit eye movement tracking errors, corrective saccade counts, a balance score ratio sensitive to vestibular balance performance, and two neurocognitive tests of response speed and memory/incidental learning; (2) we demonstrated the enhancement in discriminatory capability of detecting concussion-related deficits through the combination of the identified subset of assessments; and (3) we demonstrated the effectiveness of a robust and readily implemented global scoring approach was demonstrated for both eye track and balance assessment tests. These results are significant in introducing a comprehensive solution for concussion assessment that incorporates an economical, compact, and mobile hardware system and an assessment battery that is multimodal and time efficient and whose efficacy has been demonstrated on a preliminary basis.

Should a radiological diagnosis of hepatocellular carcinoma be routinely confirmed by a biopsy? No.

Modern multiphase diagnostic imaging allows diagnosis of hepatocellular carcinoma with high specificity in a large proportion of cases. Additional aspects of tumor biology also can be evaluated noninvasively through observation of tumor behavior (growth rate, satellites, vascular invasion) and other indicators of tumor biology (avid uptake of fluorodeoxyglucose, high circulating levels of tumor markers such as alphafetoprotein). Routinely requiring biopsy confirmation for diagnosis of HCC exposes many patients to unnecessary risk, may delay diagnosis, and in some cases leads to withholding of potentially beneficial treatment.

Ventricular reflex interactions during transmural myocardial ischemia.

The role of left ventricular receptors with sympathetic afferent fibers in the reflex response to myocardial ischemia is controversial, particularly in the canine model. Previous experiments have shown that reflex excitatory responses mediated by left ventricular sympathetic afferents can be detected in sinoaortic denervated and vagotomized dogs during transmural myocardial ischemia. The purpose of these experiments was to determine if reflex excitatory responses occur in dogs with intact left ventricular vagal afferents.

Cardiac nociceptive reflexes after transmyocardial laser revascularization: implications for the neural hypothesis of angina relief.

Objective: The mechanism by which transmyocardial laser revascularization relieves angina is not understood. One theory is that laser-induced thermal damage to cardiac nerves results in cardiac denervation. This study examined the acute effects of transmyocardial laser revascularization on reflex responses mediated by cardiac nociceptors, the left ventricular receptors with sympathetic afferent fibers that are thought to mediate anginal chest pain.

Vagal cardiopulmonary reflexes after total cardiac deafferentation.

Background: There are conflicting data regarding whether the primary source of afferent input for the vagal cardiopulmonary reflex emanates from receptors located in the ventricles, atria, and/or lungs. This study evaluated the effects of total cardiac deafferentation on the reflex control of efferent renal sympathetic nerve activity (RSNA) in response to a stimulus that affected all vagal receptors in the cardiopulmonary region.

Methods And Results: Experiments were performed in 14 chloralose-anesthetized dogs with sinoaortic denervation.

Vagal and sympathetic mechanisms in patients with orthostatic vasovagal syncope.

Background: Autonomic and particularly sympathetic mechanisms play a central role in the pathophysiology of vasovagal syncope. We report direct measurements of muscle sympathetic nerve activity in patients with orthostatic vasovagal syncope.

Methods And Results: We studied 53 otherwise healthy patients with orthostatic syncope.