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Purpose: Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs) are often seen during continuous electroencephalographic (cEEG) monitoring in coma. Given their uncertain clinical significance, our prospective study evaluated incidence of SIRPIDs in comatose patients in the neuroscience intensive care unit (NSICU) who underwent a standard stimulation protocol and defined interreader reliability for cEEG., Methods: Of 146 patients prospectively screened who underwent cEEG during a 6-month period, 53 patients were included and 93 patients were excluded. Our protocol used a sequence of auditory, mild tactile, and painful stimuli tested in a quiet room. Continuous electroencephalogram were then reviewed offline by blinded experts, with interrater agreement assessed by kappa statistic. By Pearson χ and Wilcoxon rank-sum tests, we then compared binary and numerical clinical features between those with and without SIRPIDs., Results: Of 53 patients who underwent our protocol, one patient with a corrupt cEEG file was excluded. Traumatic brain injury was the most common diagnosis. Moderate interrater agreement was observed for 66 total stimulations: 20 patients (38.5%) had possible or definite SIRPIDs by minimum one reviewer. For 19 stimulations reviewed by a third reviewer, consensus was reached in 10 cases making the incidence of SIRPIDs 19.3% in our cohort. There was a moderate interrate agreement with kappa of 0.5 (95% confidence interval: 0.1, 0.7). Median intensive care unit stay was 15 days in patients with SIRPIDs versus 6.5 days in those without (P = 0.021)., Conclusions: Our prospective study of SIRPIDs in the neuroscience intensive care unit found a 19% incidence by cEEG using a standard stimulation protocol, most often rhythmic delta activity, and showed a moderate interrater agreement.

Purpose: To examine bone adaptation to the mechanical loading of baseball using quantitative computed tomography., Methods: Quantitative computed tomography was performed on both throwing and nonthrowing humeri of 8 male college baseball players. Quantitative computed tomography geometric variables and volumetric cortical density were measured at each of 5 sites, located at 15%, 25%, 35%, 50%, and 75% of humeral length from distal to proximal. Volumetric trabecular density was measured at the most distal site only., Results: Significant side-to-side differences in favor of the throwing arm were found at all sites for total cross-sectional bone area (8%-17%, P < 0.01), cortical bone area (17%-29%, P < 0.01), and cortical bone thickness (18%-31%, P < 0.05). There were no important differences seen for cortical density; in contrast, trabecular density was significantly different in favor of the throwing arm at the one site measured (38%, P < 0.05)., Conclusion: The dominant humerus of baseball players adapts via increases in cortical size and trabecular density.