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While online grocery shopping has been rapidly expanding over the last several years, online sales of fresh produce have lagged far behind. One of the most significant contributing factors for this lag is the consumer’s inability to assess the quality of produce online. We hypothesized that this could be alleviated by machine vision technology. This study examines perceived sensory attributes derived from digital images of fresh fruits and compares them with sensory attributes obtained from the actual fruit. Digital images of fresh strawberries, cherry tomatoes, grapes, and blueberries were acquired using a high-resolution digital camera. Consumer panelists evaluated the appearance, texture, flavor, overall eating quality, and also determined purchase decision. Panel sizes ranging from 32 to 40 members (a total of 147) also conducted in situ evaluations of the different fruits. The paired t-test indicated that the mean results between pairs of image scores and in situ evaluation scores were statistically insignificant. The scores obtained for texture and overall eating quality showed some variability, but the scores for quality appearance were remarkably consistent revealing no difference across the evaluations of the various commodities. The results demonstrated that digital images can be utilized to effectively relay the appearance attributes of fresh produce. This finding is relevant for the industry, as the appropriate construction of real time images can help to build consumers’ trust in the quality of e-deliveries, nudge consumers to purchase fruits and vegetables, and increase the overall e-commerce acceptance for fresh produce. A discussion of the limitations and opportunities for improving the effectiveness of digital sensory analysis of fresh produce is provided.

Turkmenistan has experienced increasing educational migration, and many of these students hope to return home after graduating. The ability of returned migrants to succeed in Turkmenistan’s labor m...

Background: Human Immunodeficiency Virus (HIV) infection remains a serious immunological disease with new infections in the U.S. disproportionately reported in minority populations, with the District of Columbia (DC) still having the highest HIV infection rate in the nation. Drug abuse and addiction is also prevalent in DC and has traditionally been linked to HIV/AIDS because of the likelihood for opportunistic infections. Despite this data, the relationship between HIV status, drugs of abuse, and the incidence of neurological disorders are scarcely reported for minority populations. Method: We carried out a retrospective study on the prevalence of substance abuse in HIV and their association with neuropsychiatric comorbidities in an African American subpopulation in Washington DC, USA. Findings: Our data suggests an 86 percent prevalence of drug use in the HIV patients with neuropsychiatric comorbidities, with cocaine use being significantly higher in patients with Major Depressive Disorder (MDD) and bipolar disorder (BD), and PCP use associated with patients with schizophrenia. The mean CD4 count was elevated in the patients with neuropsychiatric disease, and specifically in the MDD patient group, whereas CD8 counts were not influenced by a specific neuropsychiatric disease diagnosis, although elevated as expected for HIV status. A majority (2/3) of patients were on HAART therapy, however the records did not account for adherence. Conclusion: These data suggest that neuropsychiatric comorbidities in HIV, is independent of HIV disease progression, but certain illicit drugs are correlated with the incidence of neuropsychiatric disease.

Previous research suggests Hispanic vaccination rates for H1N1 were similar to non-Hispanic whites. These previous estimates do not take into account nativity status. Using the 2010 National Health Interview Survey, we estimate adult H1N1 vaccination rates for non-Hispanic whites (n = 8780), U.S.-born Hispanics (n = 1142), and foreign-born Hispanics (n = 1912). To test Fundamental Cause Theory, we estimate odds of H1N1 vaccination while controlling for flexible resources (e.g., educational and economic capital), ethnicity, and nativity status. Foreign-born Hispanics experienced the lowest rates of H1N1 vaccination (15%), followed by U.S.-born Hispanics (18%) and non-Hispanic whites (21%). Regression models show odds of H1N1 vaccination did not differ among these three groups after controlling for sociodemographic characteristics. Insufficient access to flexible resources and healthcare coverage among foreign-born Hispanics was responsible for relatively low rates of H1N1 vaccination. Addressing resource disparities among Hispanics could increase vaccination uptake in the future, reducing inequities in disease burden.

Background The goal of the present study was to determine the prevalence of left ventricular systolic dysfunction (LVSD) and associated clinical correlates in African Americans (AA) diagnosed with ischemic stroke (IS). Methods Retrospective chart analysis was done on all diagnosed AA IS patients between January 2010 and March 2012. Patients with atrial fibrillation were excluded. A total of 147 patients were included in the study. Transthoracic 2-dimensional echocardiography was used to assess left ventricular systolic function, and study groups were categorized as normal, mild, moderate, and severely abnormal, based on the ejection fraction (EF). Available imaging studies were analyzed for data collection. Logistic regression and Pearson chi-square tests were performed. Results Normal EF was present in 114 of 147 patients (78%). Mild abnormality was present in 9 of 147 (6%), moderate in 8 of 147 (5%), and severe in 16 of 147 (11%) patients. In patients with mildly reduced EF, smoking was the most common (RF). In patients with moderately and severely reduced EFs, hypertension was the most common RF. History of smoking was commonly found in systolic dysfunction group compared with normal group ( P = .001). Logistic regression analysis revealed that smoking and advanced age were the significant predictors for LVSD. Large-vessel IS were more common in systolic dysfunction group than normal EF group ( P = .017). Conclusions Prevalence of LVSD in AA with IS was 22% in our study. Smoking was a significant modifiable RF associated with systolic dysfunction. A history of smoking and higher age could predict the occurrence of LVSD. There were more large-vessel IS in patients with LVSD.

Akinetic mutism is described in various clinical presentations but typically is defined as a state wherein the patient appears awake but does not move or speak. It can be divided into two different subtypes; the most common subtypes depend on the lesion location, mesencephalic-diencephalic region, also called apathetic akinetic mutism (somnolent mutism), and those involving the anterior cingulate gyrus and adjacent frontal lobes called hyperpathic akinetic mutism. The pathway of akinetic mutism is believed to originate from circuits that link the frontal and subcortical structures. This case reports a 48-year-old African American female with bilateral anterior cerebral artery stroke and akinetic mutism with coexisting thyroid storm. This patient with bilateral anterior cerebral artery infarcts presented with characteristics that are typical for akinetic mutism such as having intact eye movements but an inability to respond to auditory or visual commands. With the incidence of bilateral anterior cerebral artery (ACA) ischemic stroke being rare and the incidence of akinetic mutism secondary to ischemic stroke even rarer, we suspect that this patient potentially had a unilateral occlusion of anomalous anterior cerebral vasculature.

Hypercoagulability occurs in 15% of patients with malignancy and represents a clinical spectrum ranging from abnormal coagulation tests but no clinically evident thromboembolic disease, to arterial and venous thrombosis, migratory thrombophlebitis, nonbacterial thrombotic endocarditis (NBTE) and disseminated intravascular coagulation. The combination of increased procoagulant activity and decreased fibrinolytic activity accelerates the prothrombotic potential of endothelial cells in malignancy. NBTE is a rare manifestation of cancer-induced hypercoagulability and is commonly seen with mucin-producing adenocarcinomas, but rarely seen with ovarian clear cell carcinoma (OCCC). Cerebrovascular embolization ranges from 14–91% in NBTE. We report a rare case of a 62-year-old female presenting with occipital stroke as a consequence of NBTE in OCCC. Association of NBTE in OCCC has only been reported in 2 cases so far, but presentation with stroke has never been reported in the literature.

A rare case of subependymoma in a young patient presenting with sensory dysesthesia is reported. Computed tomography scan and magnetic resonance imaging revealed a posterior fossa mass occluding the fourth ventricle with infiltration to the right side immediately behind the pontine tegmentum and impinging on the right spinothalamic tract. Postoperative tumor histopathology revealed the classical appearance of subependymoma. Subependymoma is a rare, asymptomatic, slow-growing, low-grade glioma of the central nervous system. If symptomatic, the clinical features are commonly secondary to hydrocephalus, but subependymoma presenting with sensory dysesthesia has never been reported in the literature.

Rationale PROTECT DC examines whether stroke navigators can improve cardiovascular risk factors in urban underserved individuals newly hospitalized for stroke or ischemic attack. Within one-year of hospital discharge, up to one-third of patients no longer adhere to secondary prevention behaviors. Adherence rates are lower in minority-underserved groups, contributing to health disparities. In-hospital programs increase use of stroke prevention therapies but may not be as successful in underserved individuals. In these groups, low literacy, limited healthcare access, and sparse community resources may reduce adherence. Lay community health workers (navigators) improve adherence in other illnesses through education and assisting in overcoming barriers to achieving desired health behaviors and obtaining needed healthcare services. Aims and design PROTECT DC is a Phase II, single-blind, randomized, controlled trial comparing in-hospital education plus stroke navigators to usual care. Atherogenic ischemic stroke and transient ischemic attack survivors are recruited from Washington, DC hospitals. Navigators meet with participants during the index hospitalization, perform home visits, and meet by phone. They focus on stroke education, medication compliance, and overcoming practical barriers to adherence. The interventions are driven by the theories of reasoned action and planned behavior. Study outcomes The primary dependent measure is a summary score of four objective measures of stroke risk factor control: systolic blood pressure, low-density lipoprotein, hemoglobin Hb A1C, and antiplatelet agent pill counts. Secondary outcomes include stroke knowledge, exercise, dietary modification, and smoking cessation. Conclusion PROTECT DC will determine whether a Phase III trial of stroke navigation for urban underserved individuals to improve adherence to secondary stroke prevention behaviors is warranted.

The Korsakoff syndrome is defined as “an abnormal mental state in which memory and learning are affected out of all proportion to other cognitive functions in an otherwise alert and responsive patient.” Confabulation refers to false or erroneous memories arising, not deliberately, in the context of a neurological amnesia and is often thought of as pathognomonic of the Korsakoff syndrome. Although the exact pathophysiology is unknown, various studies have identified brain lesions in the thalami, mammillary bodies, and frontal cortex. We report a case of a 68-year-old male presenting with acute altered mental status on July 16, 2015. The neuropsychological dysfunctions included prominent Korsakoff’s syndrome, which became apparent when the altered mental status resolved. Amnesia was accompanied by prominent confabulation, disorientation, and lack of insight into his own disability. Neuroradiological data indicated that the intralaminar and dorsomedial nuclei in bilateral thalami were infarcted by occlusion of the artery of Percheron. We believe that ours is one of few reported cases of Korsakoff syndrome in a patient with infarction involving the territory of the artery of Percheron. We conclude that bilateral thalamic lesions could cause Korsakoff’s syndrome and the intralaminar and dorsomedial nuclei might be important structures in the pathogenesis of confabulation.

Background We sought to investigate the frequency of microbleed development following intracerebral hemorrhage in a predominantly African-American population and to identify predictors of new microbleed formation. Aims and/or hypothesis To investigate the frequency and predictors of new microbleeds following intracerebral hemorrhage. Methods The DECIPHER study was a prospective, longitudinal, magnetic resonance-based cohort study designed to evaluate racial/ethnic differences in risk factors for microbleeds and to evaluate the prognostic impact of microbleeds in this intracerebral hemorrhage population. We evaluated new microbleed formation in two time periods: from baseline to 30 days and from 30 days to year 1. Results Of 200 subjects enrolled in DECIPHER, 84 had magnetic resonance imaging at all required time points to meet criteria for this analysis. In the baseline to day 30 analysis, 11 (13·1%) had new microbleeds, compared with 25 (29·8%) in the day 30 to year 1 analysis. Logistic regression analysis demonstrated that baseline number of microbleeds [odds ratio 1·05 (95% confidence interval 1·01, 1·08), P = 0·01] was associated with new microbleed formation at 30 days. A logistic regression model predicting new microbleed at one-year included baseline number of microbleeds [odds ratio 1·05 (1·00, 1·11), P = 0·046], baseline age [odds ratio 1·05 (1·00, 1·10), P = 0·04], and white matter disease score [odds ratio 1·18 (0·96, 1·45). P = 0·115]. Overall, 28 of 84 (33·3%) intracerebral hemorrhage subjects formed new microbleeds at some point in the first year post-intracerebral hemorrhage. Conclusions We found that one-third of intracerebral hemorrhage subjects in this cohort surviving one-year developed new microbleeds, which suggests a dynamic and rapidly progressive vasculopathy. Future studies are needed to examine the impact of new microbleed formation on patient outcomes.

Importance The applicability of β-amyloid peptide (Aβ) positron emission tomography (PET) as a biomarker in clinical settings to aid in selection of individuals at preclinical and prodromal Alzheimer disease (AD) will depend on the practicality of PET image analysis. In this context, visual-based Aβ PET assessment seems to be the most feasible approach. Objectives To determine the agreement between visual and quantitative Aβ PET analysis and to assess the ability of both techniques to predict conversion from mild cognitive impairment (MCI) to AD. Design, Setting, and Participants A longitudinal study was conducted among the Alzheimer’s Disease Neuroimaging Initiative (ADNI) sites in the United States and Canada during a 1.6-year mean follow-up period. The study was performed from September 21, 2010, to August 11, 2014; data analysis was conducted from September 21, 2014, to May 26, 2015. Participants included 401 individuals with MCI receiving care at a specialty clinic (219 [54.6%] men; mean [SD] age, 71.6 [7.5] years; 16.2 [2.7] years of education). All participants were studied with florbetapir F 18 [ 18 F] PET. The standardized uptake value ratio (SUVR) positivity threshold was 1.11, and one reader rated all images, with a subset of 125 scans rated by a second reader. Main Outcomes and Measures Sensitivity and specificity of positive and negative [ 18 F] florbetapir PET categorization, which was estimated with cerebrospinal fluid Aβ1-42 as the reference standard. Risk for conversion to AD was assessed using Cox proportional hazards regression models. Results The frequency of Aβ positivity was 48.9% (196 patients; visual analysis), 55.1% (221 patients; SUVR), and 64.8% (166 patients; cerebrospinal fluid), yielding substantial agreement between visual and SUVR data (κ = 0.74) and between all methods (Fleiss κ = 0.71). For approximately 10% of the 401 participants in whom visual and SUVR data disagreed, interrater reliability was moderate (κ = 0.44), but it was very high if visual and quantitative results agreed (κ = 0.92). Visual analysis had a lower sensitivity (79% vs 85%) but higher specificity (96% vs 90%), respectively, compared with SUVR. The conversion rate was 15.2% within a mean of 1.6 years, and a positive [ 18 F] florbetapir baseline scan was associated with a 6.91-fold (SUVR) or 11.38-fold (visual) greater hazard for AD conversion, which changed only modestly after covariate adjustment for apolipoprotein e4, concurrent fludeoxyglucose F 18 PET scan, and baseline cognitive status. Conclusions and Relevance Visual and SUVR Aβ PET analysis may be equivalently used to determine Aβ status for individuals with MCI participating in clinical trials, and both approaches add significant value for clinical course prognostication.

Acute disseminated encephalomyelitis is a demyelinating disease, typically occurring in children following a febrile infection or a vaccination. Primary and secondary immune responses contribute to inflammation and subsequent demyelination, but the exact pathogenesis is still unknown. Diagnosis of acute disseminated encephalomyelitis is strongly suggested by temporal relationship between an infection or an immunization and the onset of neurological symptoms. Biopsy is definitive. In general, the disease is self-limiting and the prognostic outcome is favorable with anti-inflammatory and immunosuppressive agents. Locked-in syndrome describes patients who are awake and conscious but have no means of producing limb, speech, or facial movements. Locked-in syndrome is a rare complication of acute disseminated encephalomyelitis. We present a case of incomplete locked-in syndrome occurring in a 34-year-old male secondary to acute disseminated encephalomyelitis. Our case is unique, as acute disseminated encephalomyelitis occurred in a 34-year-old which was poorly responsive to immunosuppression resulting in severe disability.

We have used a model to investigate the damage mechanism in the retinas of monkeys and rabbits due to bubble formation induced by lasers at 0.514 μm, 0.633 μm, 0.694 μm and 1.06 μm with pulse duration in the sub-micro-second regime. In this model, the main absorbers are the melanosomes in the retinal pigment epithelium (RPE) which are surrounded by a non-absorbing cellular medium with thermal characteristics of water. The growth of the bubble was calculated from the experimentally derived values reported in the literature for the absorption coefficient of melanosomes using the ideal gas law under adiabatic conditions. Our calculated ED50 values are 2.235 J cm−2 (0.514 μm), 4.484 J cm−2 (0.633 μm), 7.420 J cm−2 (0.694 μm), 32.870 J cm−2 (1.060 μm) for monkey; 3.550 J cm−2 (0.514 μm), 6.770 J cm−2 (0.633 μm), 10.510 J cm−2 (0.694 μm) and 45.710 J cm−2 (1.06 μm) for rabbit considering that the shape of the RPE cell is hexagonal. The ED50 values reported in the present work are 18.2% and 74.9%, higher than th...

Immune reconstitution inflammatory syndrome (IRIS) development in HIV with preexistent progressive multifocal leukoencephalopathy (PML) has been extensively studied. PML-IRIS typically manifests clinically as new or worsening neurologic symptoms in conjunction with enlarging CNS lesions and occurs in approximately 10–20 percent of HIV-infected patients with PML who begin HAART. Likewise, Multicentric Castleman’s Disease (MCD), a rare malignant lymphoproliferative disorder, has a strong and well-known association with HIV. Our case provides a rare instance of PML-IRIS in combination with MCD in an HIV-positive individual. The combination of all three diseases has never been reported in the literature. Both MCD and PML were present during initial determination of HIV infection in our patient and their disease courses were altered during the subsequent development of IRIS.

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome in which patients present with an acute or subacute clinical presentation of seizures, visual disturbances, headache, and altered mental status. The pathophysiology of PRES may be explained by endothelial dysfunction that leads to transudation of fluids and protein, resulting in vasogenic cerebral edema. PRES is typically associated with many conditions such as hypertension, uremia, immunosuppressive drugs, and sepsis. This is a case report of a 39-year-old woman with untreated HIV infection and end-stage renal disease (ESRD) who developed PRES with a normal blood pressure and no other known causes of PRES. Untreated HIV is associated with known endothelial dysfunction and we believe that this, in combination with her untreated end-stage renal disease, contributed to her unique presentation of PRES. Although uncommon in HIV-infected patients and challenging to diagnose, prompt recognition of PRES is critical to provide appropriate care and ensure reversibility of the vasogenic edema seen in PRES.

Background and Purpose— Hypertension is the most important risk factor associated with intracerebral hemorrhage. We explored racial differences in blood pressure (BP) control after intracerebral hemorrhage and assessed predictors of BP control at presentation, 30 days, and 1 year in a prospective cohort study. Methods— Subjects with spontaneous intracerebral hemorrhage were identified from the DiffErenCes in the Imaging of Primary Hemorrhage based on Ethnicity or Race (DECIPHER) Project. BP was compared by race at each time point. Multivariable linear regression was used to determine predictors of presenting mean arterial pressure, and longitudinal linear regression was used to assess predictors of mean arterial pressure at follow-up. Results— A total of 162 patients were included (mean age, 59 years; 53% male; 77% black). Mean arterial pressure at presentation was 9.6 mm Hg higher in blacks than whites despite adjustment for confounders ( P =0.065). Fewer than 20% of patients had normal BP (P =0.331), blacks were more likely than whites to have Stage I/II hypertension at 1 year ( P =0.036). Factors associated with lower mean arterial pressure at follow-up in multivariable analysis were being married at baseline ( P =0.032) and living in a facility (versus personal residence) at the time of BP measurement ( P =0.023). Conclusions— Long-term BP control is inadequate in patients after intracerebral hemorrhage, particularly in blacks. Further studies are needed to understand the role of social support and barriers to control to identify optimal approaches to improve BP in this high-risk population.

Objective: Hypertension is the most important risk factor for both primary and secondary prevention of intracerebral hemorrhage (ICH). We sought to determine the frequency of blood pressure control after ICH and explored predictors of higher blood pressure (BP) at presentation, 30 days, and 1 year in a prospective cohort study. Methods: Individuals with spontaneous non-traumatic ICH were prospectively enrolled in the DiffErenCes in the Imaging of Primary Hemorrhage based on Ethnicity or Race (DECIPHER) Project. BP was measured at 30 days and 1 year during in-person visits, and BP at presentation was abstracted from the medical record. Linear regression was used to determine factors associated with mean arterial pressure (MAP) at presentation, and longitudinal linear regression was used to determine baseline predictors of MAP at 30 days at 1 year. Results: A total of 143 patients had blood pressure data available at either 30 days (125 patients) or 1 year (85 patients). Mean age was 59, 57% were men, and 80% were African American (AA) and the rest were White (other race/ethnic groups excluded due to low numbers). AAs were younger (57 vs. 65, p=0.002), less likely to be married (37% vs. 61%, p=0.02), more likely to have a history of hypertension (90% vs. 71%, p=0.03), and more likely to be smokers (30% vs. 11%, p=0.03) than Whites. Average BP at presentation was 178±35/99±24mmHg. Multivariable linear regression revealed that AAs had a presenting MAP that was on average 14mmHg higher than Whites despite adjustment for age, gender, socioeconomic status, body mass index, private health insurance, marital status, smoking, cocaine, and ICH volume. Blood pressure control at follow-up was poor, with fewer than 20% of patients having a normal blood pressure ( Conclusions: AAs had a higher MAP than Whites at the time of presentation with ICH. Optimal blood pressure control at 1 year occurred in less than 20% of the cohort. The only factor predictive of lower MAP at follow up was being married at baseline. Additional efforts are urgently needed to improve blood pressure control in both AA and White ICH survivors.

Acquired myasthenia gravis is a relatively uncommon disorder, with prevalence rates that have increased to about 20 per 100,000 in the US population. This autoimmune disease is characterized by muscle weakness that fluctuates, worsening with exertion, and improving with rest. In about two-thirds of the patients, the involvement of extrinsic ocular muscle presents as the initial symptom, usually progressing to involve other bulbar muscles and limb musculature, resulting in generalized myasthenia gravis. Although the cause of the disorder is unknown, the role of circulating antibodies directed against the nicotinic acetylcholine receptor in its pathogenesis is well established. As this disorder is highly treatable, prompt recognition is crucial. During the past decade, significant progress has been made in our understanding of the disease, leading to new treatment modalities and a significant reduction in morbidity and mortality.

A rare case of acute ischemic stroke in a young patient with iron deficiency anemia (IDA) is reported. IDA has been suggested to have an association with stroke, but few cases have proven it thus far. Three physiological mechanisms explaining IDA to ischemic stroke include a hypercoagulable state secondary to IDA, thrombocytosis secondary to IDA, and anemic hypoxia induced by IDA. Our paper shows an example of a hypoxia-induced stroke secondary to IDA in a young woman with menorrhagia. Thrombus formation was ruled out as the Magnetic Resonance Angiogram (MRA) showed no evidence. As all other known causes for stroke were ruled out, the patient's IDA is a reasonable cause for her stroke. Iron deficiency decreases the amount of hemoglobin, which consequently decreases the amount of oxygen in the blood resulting in low-oxygen delivery to the brain. This causes hypoxic conditions in the brain, leading to death of brain tissue. Thus, we suggest a possible relationship between IDA and ischemic stroke in young adults. Considering IDA as one of the risk factors for ischemic stroke and treating with timely transfusions would be an important step one can take to prevent stroke.

The current study was undertaken to evaluate the effects of cholinomimetic drugs on cocaine-induced central cardiorespiratory depression. Cats anesthetized by urethane (2.0 g/kg) were subjected to topical application at the caudal ventrolateral medullary surface (cVMS) of cocaine and two cholinomimetic pretreatment drugs. The following drug regimens were tested: 37 mM cocaine 1) given alone; 2) given 5 min after 2.7 mM carbachol pretreatment; and 3) given 5 min after 3.6 mM physostigmine pretreatment. In 7 of 11 cats, pretreatment with physostigmine decreased the incidence of cocaine-induced apneusis and hypoventilation significantly (p < 0.05); these animals showed no significant change in the mean arterial blood pressure during the 5-min pretreatment before administration of cocaine. In 4 of 11 cats, the physostigmine pretreatment produced a significant decrease in mean arterial blood pressure followed by lethal cardiorespiratory arrest when cocaine was administered. Pretreatment with carbachol resulted in cardiorespiratory responses which were not significantly different from those produced by cocaine alone. In anesthetized cats not exhibiting hypotensive responses to physostigmine, pretreatment may ameliorate cocaine-induced respiratory failure by ventral brainstem control mechanisms.

This book chapter is to further improve our understanding of the underlying mechanism of local injury that occurs after manual acupuncture needle manipulation that initiates muscle degeneration/regeneration process, which is essential for muscle maintenance and adaptation. Muscle injury triggers a sequence of events that begins with the host inflammation, secretion of myogenic transcription factor and various growth factors that are important for the activation and proliferation of muscle satellite (stem) cells. Skeletal muscle is maintained by resident stem cells call muscle satellite cells because of their location on the periphery of the myofiber under the surrounding basal lamina (Mauro, 1961). Satellite cells are quiescent mononuclear cells that are present in different types of skeletal muscle and are associated with all muscle fiber types, although the distribution might be unequal. For instance the percentage of satellite cell in adult tibialis anterior muscle is larger than other muscles (Pavlath et al., 1998). Satellite cells are responsible for post natal growth, hypertrophy and repair of skeletal muscle (Grounds, 1999). In normal undisturbed muscle, these cells remain in a quiescent stage (Schultz et al., 1985). After muscle injury, satellite cells become mitotically active, proliferate, differentiate and eventually fuse together to regenerate new muscle fiber, which is well-innervated, fully vascularized, through a process that resembles in some aspects embryonic (Seale et al., 2001). During muscle differentiation, satellite cells exhibit increased expression of the myogenic transcription factor MyoD (Cooper et al., 1999). Analysis of muscle regeneration has previously been studied using experimental models that induce muscle injury by various protocol such as eccentric contraction (Rathbone et al., 2003) or treadmill exercise (Smith et al., 2001). Although exercise induces injury-related satellite cell activation (Smith et al. 2001), its use is limited in patients with restricted exercise capacity during long periods of bed rest. Instead, such injury can be induced during acupuncture needle manipulation, which has been shown to induce muscle injury on acupuncture point (ST-36) in the tibialis anterior (TA) muscle (see Figure 1) and produce muscle regeneration via up-regulation of MyoD (see Figure 2 and Figure 3).

Background and Purpose— Some prior studies have shown that racial disparities exist in intravenous tissue plasminogen activator (tPA) use for acute ischemic stroke. We sought to determine whether race was associated with tPA treatment for stroke in a predominantly black urban population. Methods— Systematic chart abstraction was performed on consecutive hospitalized patients with ischemic stroke from all 7 acute care hospitals in the District of Columbia from February 1, 2008, to January 31, 2009. Results— Of 1044 patients with ischemic stroke, 74% were black, 19% non-Hispanic white, and 5% received intravenous tPA. Blacks were one third less likely than whites to receive intravenous tPA (3% versus 10%, P P =0.004) and also less likely to be tPA-eligible (5% versus 13%, P P =0.023). The treatment rate for tPA-eligible patients was similar for blacks and whites (70% versus 76%, P =0.62). Conclusions— In this predominantly black urban population hospitalized for acute ischemic stroke, blacks were significantly less likely to be treated with intravenous tPA due to contraindications to treatment, delayed presentation, and stroke severity. Effective interventions designed to increase treatment in this population need to focus on culturally relevant education programs designed to address barriers specific to this population.

The protective effect of physical activity (PA) on risk of stroke remains controversial as a result of lack of insight into the sources of heterogeneity between studies. We performed a comprehensive meta-analysis of studies to (1) quantify the association between PA level and risk of stroke outcomes and (2) test the hypothesis that the association of PA level with stroke outcomes will be similar between men and women. The outcome measures are stroke incidence, stroke mortality, or both.Cohort studies were identified by searching MEDLINE and EMBASE (from 1986 to 2005) and meta-analysis conducted according to meta-analysis of Observational Studies in Epidemiology (MOOSE) group recommendations. Data were reported as pooled relative risk (RR) and 95% confidence intervals (CI) using random-effects models to assess the association of stroke outcomes with PA level. Heterogeneity was investigated, and sensitivity analysis was performed. Stratified analysis by gender was performed.Of 992 articles, 13 satisfied all eligibility criteria and were studied. Compared with low PA, moderate PA caused an 11% reduction in risk of stroke outcome (RR = 0.89, 95% CI 0.86-0.93, p0.01) and high PA a 19% reduction (RR = 0.81, CI 0.77-0.84, p0.01). Among the men, results showed a 12% reduction in risk associated with moderate PA (RR = 0.88, CI 0.82-0.94, p0.01) and 19% reduction for high PA (RR = 0.81, CI 0.75-0.87, p0.01). Among the women, results showed a 24% reduction in risk for high PA (RR = 0.76, CI 0.64-.89, p0.01). There was, however, no significant risk reduction associated with a moderate PA level in women.Increased PA level appears beneficial in reduction of risk of stroke and related outcomes. However, higher levels of PA may be required in women to achieve as significant a risk reduction as in men. An exercise regimen tailored to women to improve related physiological mechanisms will likely be beneficial.

Vascular occlusive diseases affect brain blood flow, brain metabolism and are associated with arterial ischemic stroke. This study was designed to measure the brain blood flow velocity, brain oxygenation, hemoglobin concentrations, hematocrit, and cell free hemoglobin at pre- and post-exchange red cell transfusion in an 18 year old male patient with sickle cell disease and moyamoya syndrome (MMS). Exchange transfusion increased cerebral oxygen saturation 12%, total hemoglobin concentration 2%, hemoglobin AA 80%, and reduced sickle (SS) hemoglobin 12%, arterializations 33%, and cell free hemoglobin 33%. Brain blood flow velocity values were unaffected by transfusion. These observations suggest that exchange transfusion increases the hemoglobin carrying capacity and reduces sickle hemoglobin and shunting of blood, which may improve the peripheral and cerebral oxygenation. Transfusion did not affect the brain blood flow in this patient. Therefore the risk of transient ischemic attack and arterial ischemic stroke from mms still exist.

We have previously reported that the anticholinergic properties of cocaine may be important in cocaine induced apneusis. We have studied the effects of the cholinergic muscarinic antagonist atropine (ATR) on cocaine induced apneusis at the caudal chemosensitive areas of the ventrolateral medulla oblongata (CVLM). Experiments were performed in urethane anesthetized and tracheotomized cats with the CVLM surgically exposed. Topical application of ATR (44 mM ) to the CVLM produced significant decrements in minute ventilation (V(E)) and mean arterial blood pressure (MABP) (P

Objective: To study the prevalence and neurological manifestations associated with human immunodeficiency virus infection in African Americans in the District of Columbia (DC) metropolitan area. Background Approximately two-thirds of patients with HIV infection will develop CNS involvement during the course of their disease. Three percent of the DC population has HIV infection, which is the highest in the nation. Currently, no literature is available regarding the demographics and neurological manifestations in the African American population with HIV infection. Design/Methods: Medical records of 282 consecutive HIV-positive African American patients with concurrent neurological diagnosis admitted in 2010 to Howard University Hospital, Washington, DC were retrospectively reviewed for demographic variables, neurological manifestations and in relation to CD4 counts. Results: Of the 282 hospitalized patients, 152 were males and 130 were females, with a median age of 47. There were 121 patients CD4 counts > 200, and the most common concurrent neurological diagnosis was neuropsychiatric in nature, which was seen in all patients. These manifestations included depression, bipolar disorder, schizophrenia and psychosis. The other non neuropsychiatric manifestations included epilepsy in 23 patients, ischemic stroke in 19 patients, peripheral neuropathy in 14 patients and opportunistic infections in 4 patients. Eighty-nine patients were presented with CD4 counts Conclusions: The study concluded that neuropsychiatric disease is the most common neurologic manifestation among the African American population with HIV infection, with a relatively higher number among those with CD4 >200. There is a paradigm shift of neurological diseases from opportunistic infections to neuropsychiatric manifestations, which may be related to longer survival secondary advent of effective antiretroviral treatment. Disclosure: Dr. Chapman has nothing to disclose. Dr. Pessu has nothing to disclose. Dr. Chimah has nothing to disclose. Dr. Khan has nothing to disclose. Dr. Kurukumbi has nothing to disclose. Dr. Jayam-Trouth has nothing to disclose.

Cocaine hydrochloride was applied topically to the ventrolateral medullary surface (VMS) where chemosensitive respiratory and vasomotor control sites are colocalized. Cats (n = 16) were anesthetized with urethane (2.0 g/kg, 80 percent of dose titrated over 60 min). The trachea of each animal was cannulated and the VMS was surgically exposed. Tidal volume (VT), frequency of breathing (f), systolic and diastolic blood pressure (SBP and DBP, respectively), and heart rate (HR) were measured. Cocaine (62.5 micrograms per site) administered at the VMS control sites decreased f, SBP, and DBP significantly (p0.05), without changing HR or VT values. This cocaine-induced hypoventilation was associated with brief intervals of inspiratory cramp (apneusis). Central cocaine neurotoxicity may result from interaction of cocaine with VMS sites, producing increased inspiratory drive and decreased vasomotor tone.

Electroretinograms (ERG) were recorded from dark- and chromatic-adapted compound eyes in the dusk-active firefly,Photinus pyralis ♂, at different wavelengths ranging from 320 to 700 run and over 4.5 log units change in stimulus intensity. ERG waveforms differed in the short (near-UV and violet) and long (yellow) wavelengths (Fig. 1). Waveform differences were quantitated by analysis of rise and fall times as a function of the amplitude of the response. Rise times were found to be relatively constant for all stimulus wavelengths. However, variations in the fall times were detected and followed characteristically different functions for short and long wavelengths (Fig. 2).

The waveform of the electroretinograms (ERGs) recorded from the compound eyes in the dark-active fireflyPhoturis lucicrescens was different in the short (near-UV and violet) and long (green-yellow) wavelengths (Fig. 1). The spectral sensitivity curves in the dark and chromatic adaptation conditions suggested the presence of receptor types in the short (near-UV, Fig. 4, and violet, Fig. 5) and long wavelength (green; λmax 550 nm, Figs. 3–5) regions of the spectrum. The green peak is in correspondence with the species' bioluminescence emission peak at 554 nm (Fig. 3c).

We studied anesthetized dogs subjected to graded increases in intracranial pressure (ICP) to assess the role of the systemic vasopressor (Cushing) response in the arterial hypoxemia associated with increased ICP. The arterial PO2 decrement was significantly greater with rapidly increased ICP compared to slowly increased ICP (P less than 0.01). Systemic vasopressor responses generated in cats by direct electrical stimulation of the vasomotor center resulted in arterial hypoxemia during controlled ventilation. Therefore, arterial hypoxemia was coincident with increased systemic blood pressure produced by either elevation of ICP or electrical stimulation of the vasomotor center.

Brain injury has been commonly associated with respiratory failure and uncontrolled skeletal muscle activity. In the present study, neuromuscular (NM) blockade induced by injection of succinylcholine hydrochloride was used to block uncontrolled muscle contractions in dogs with brain injury caused by rapid elevation of intracranial pressure (ICP). Decerebrate posturing, a decrease in value (mean +/- SEM) of arterial oxygen tension (Pa02) of 26 +/- 1 torr, and an increase in arterial carbon dioxide tension (PaCO2) of 11 +/- 1 torr occurred in the dogs, which were supported by mechanical ventilation. The arterial hypoxemia developed independently of the decerebration; however, dogs that demonstrated decerebrate posturing exhibited significantly larger decreases in Pa02 than dogs that did not (P less than 0.01). NM blockade ameliorated the effects of elevated ICP on the arterial blood gases; i.e., the amount of hypoxemia in decerebrate dogs was significantly less in dogs subjected to NM blockade than in dogs not subjected to NM blockade. It is concluded that uncontrolled skeletal muscle activity that exacerbates arterial hypoxemia associated with brain injury is ameliorated by use of NM blockade as a therapeutic adjunct to mechanical ventilation.

In the field cricket Gryllus firmus, the electroretinographic visual spectral sensitivity functions [S(λ)] of the median and lateral ocelli show the presence of a single receptor system sensitive to the green region with a maximum at 520 nm. The S(λ) functions match the nomogram for a P520 visual pigment. The waveforms of the electroretinogram elicited by light stimuli across the spectrum are similar. The slopes of the Vlog I curves are also similar at different stimulus wavelengths across the spectrum. The ocelli are capable of responding over 3–5 log units of change in the stimulus intensity.

In humans, dyspneic ventilatory failure has been associated with mountain sickness (Anholm et al. 1979) by the mechanism of hypoxia (Sutton et al. 1976). Hypoxia elevates pulmonary arterial pressure (Reeves 1973), enlarging the volume of extravascular lung fluid, and in some cases progressing to acute pulmonary edema (Gray et al. 1975). Similar responses also occur following severe head injury (Schumacker et al. 1979; Huang et al. 1963; Froman 1968; Simmons et al. 1969).

The mechanism or mechanisms responsible for the arterial hypoxemia demonstrated in experimental animals (1,5,4) as well as in patients (2,3,6,7) with increased intracranial pressure (ICP) remains somewhat obscure. Intracranial pathological disorders producing chronic elevation of ICP are rarely associated with arterial hypoxemia; whereas those disorders which produce acute elevations of ICP are quite commonly associated with arterial hypoxemia. Additionally, it has been observed that those patients with increased ICP exhibiting decerebrate rigidity appeared to demonstrate this response more consistently and profoundly. This variable correlation between elevated ICP and arterial hypoxemia suggests that the observed arterial hypoxemia may not occur as a direct response or result of the elevated ICP, but is more likely a result of non-specific cardiopulmonary responses associated with ICP elevations. Thus, these investigations were designed to assess the correlation of the development of arterial hypoxemia with the rate of development of increased ICP and the severity of the associated vasopressor responses.

Introduction Lemierre's syndrome is an extremely rare and almost universally fatal disease characterized as thrombophlebitis of the internal jugular venous system with subsequent metastatic infection. Fusobacterium necrophorum is the most common organism implicated in causation of Lemierre's syndrome. Group A Streptococcus has mainly been observed as a polymicrobial organism in the syndrome. We report a rare finding of a rare disease where Group A Streptococcus was the sole organism triggering Lemierre's syndrome. To our knowledge, this is only the third recorded patient with such an occurrence. Case presentation We describe a 9-year-old African American boy, who presented with otitis media and mastoiditis that culminated in Lemierre's syndrome. Isolates bore only Group A Streptococcus. The patient was appropriately treated and responded with full recovery from the syndrome. Conclusion Since Lemierre's syndrome is classically detected by clinical diagnosis, these findings should prompt clinicians to consider Group A Streptococcus as an alternative catalyst. It should be pondered that patients who present with typical Group A streptococcal infections have the possibility for developing Lemierre's syndrome. Though this complication appears to be rare, early diagnosis and prompt intervention have proven critical in survival outcome. Indeed, what would seem to be a routine case of strep throat or otitis media easily treated with antibiotics could end up being an unalterable progression to death unless Lemierre's syndrome is immediately diagnosed and treated.

• Brachial plexus neuropathy is an acute neurologic disorder characterized by pain, weakness, and atrophy of the muscle groups affected. Although well documented in the adult literature, relatively few cases have been reported in children. Despite the lack of knowledge concerning its etiology, and lack of an effective therapy, the long-term prognosis is excellent. It is perhaps for these reasons that spinal fluid analysis is not routinely performed during the acute phase of this illness. An evaluation of the clinical course of three children, together with epidemiologic data, suggests that early lumbar punctures and an extensive search for an infecting viral agent, notably coxsackievirus B, are warranted. (Am J Dis Child134:299-300, 1980)