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Background The impact of glioma location on quality of life (QOL) has not been conclusively studied, possibly due to the prohibitively high sample size that standard statistical analyses would require and the inherent heterogeneity of this disease. By using a novel algorithm, we investigated the impact of tumor location on QOL in a limited set of 53 consecutive patients. Methods The glial tumors of 53 consecutive patients were segmented and registered to a standardized atlas. The Euclidian distance between 90 brain regions and each tumor's margin was calculated and correlated to the patient's self-reported QOL as measured by the Sherbrooke Neuro-Oncology Assessment Scale questionnaire. Results QOL was not correlated to tumor volume, though a significant correlation was observed with its proximity to these areas: right supramarginal gyrus, right rolandic operculum, right superior temporal gyrus, right middle temporal gyrus, right angular gyrus, and right inferior parietal lobule. Interestingly, all identified areas are in the right hemisphere, and localized in the temporoparietal region. We postulate that the adverse relation between proximity to these areas and QOL results from disruption in visuospatial functioning. Conclusions Although the areas identified in this study are traditionally considered non-eloquent areas, tumor proximity to these regions showed more impact on QOL than any other brain regions. We postulate that this effect is mediated via an adverse impact on the visuospatial functioning.

Background Past studies have shown that pain memories are often inaccurate, a phenomenon known as mnemonic pain bias. Pain memories are thought to play an important role on how future pain is felt. Recent evidence from our laboratory suggests that individuals who exaggerate past pain display increased superior temporal gyrus (STG) and parahippocampal gyrus (PHG) activity during the encoding of experimental painful stimulations, suggesting that these brain structures play an important role in pain memories. Objective /hypothesis To determine whether a virtual lesion paradigm, targeting the STG during pain encoding, can affect long-lasting pain memories. We hypothesized that interfering with the activity of the STG (and possibly of the PHG via distant/ remote effects) would attenuate mnemonic bias. Methods Randomized double-blind study with two parallel groups. Participants received either sham (n = 21) or real (n = 21) transcranial magnetic stimulation (TMS - virtual lesion paradigm) over the STG during pain encoding (milliseconds after the administration of a painful stimuli). Pain intensity and unpleasantness were evaluated using a visual analog scale (VAS; 0 to 10) immediately after the painful event, and at recall, 2 months later. The mnemonic pain bias (calculated by subtracting the pain scores obtained at recall from the pain score obtained during encoding) was compared between the two groups for both pain intensity and unpleasantness. Results Participants in both groups did not differ in terms of age and gender (real TMS = 27 years ± 9, 43% female; sham TMS = 25 years ± 4, 49% female; p > 0.64). The mnemonic bias related to pain intensity was similar in both groups (p = 0.83). However, the mnemonic bias related to pain unpleasantness was lower in the real TMS group (p = 0.04). Conclusions Our results provide the first evidence that the STG and/or the PHG, and possibly the PHG, are causally involved in the formation of biased memories of pain unpleasantness.

Background and purpose Many psychological factors are known to influence pain perception. Among them, intolerance of uncertainty (IU) may play a key modulating role in situations where uncertainty prevails, especially uncertainty regarding the timing of painful events. The objective of this study was to explore the impact of individual differences in IUon pain perception during predictable and unpredictable stimulation timings. We hypothesized that people with high IU, as opposed to those with low IU, would perceive more pain when the timing of painful stimulations cannot be predicted, as compared to when they can. Methods Twenty (20) healthy adults, aged between 18 and 35 years old, were recruited. Painful sensations were provoked using transcutaneous electrical stimulations of the right sural nerve. By measuring IU (Intolerance of Uncertainty Scale) and subjective pain (verbal numerical rating scale), it was possible to test the relationship between IU and pain perception, by simulating predictable and unpredictable painful experiences. This was done through cued shock interval (CSI) blocks, with either variable timing or fixed timings (long or short time frame). Self-administered questionnaires were also used to measure pain hypervigilance, pain catastrophizing, state anxiety, and trait anxiety. Results Pearson correlations confirmed the presence of an association (r = 0.63) between IU and the change in pain intensity provoked by unpredictable stimulation timings. Importantly, this association was significant only for stimulations provided at long CSIs, indicating that higher IU scores predicted higher pain intensity scores when stimulation timings became unpredictable, and when the cued delay was long. No association was found between pain scores and other psychological variables. Conclusions Our results show that IU moderately correlates to the change in pain intensity provoked by unpredictable stimulation timings. High IU scores were associated with a worsening of the subjective pain experience, especially during long delays in an unpredictable situation. These observations suggest that IU could be considered as a psychological variable that is able to influence pain perception in certain situations. Implications Assessing and addressing IU could be an added value in pain-related therapy, especially in chronic pain.

Sex differences in pain perception are still poorly understood, but they may be related to the way the brains of men and women respond to the affective dimensions of pain. Using a matched pain intensity paradigm, where pain intensity was kept constant across participants but pain unpleasantness was left free to vary among participants, we studied the relationship between pain unpleasantness and pain-evoked brain activity in healthy men and women separately. Experimental pain was provoked using transcutaneous electrical stimulation of the sural nerve while pain-related brain activity was measured using somatosensory-evoked brain potentials with source localization. Cardiac responses to pain were also measured using electrocardiac recordings. Results revealed that subjective pain unpleasantness was strongly associated with increased perigenual anterior cingulate cortex activity in women, whereas it was strongly associated with decreased ventromedial prefrontal cortex activity in men. Only ventromedial prefrontal cortex deactivations in men were additionally associated with increased autonomic cardiac arousal. These results suggest that in order to deal with pain's objectionable properties, men preferentially deactivate prefrontal suppression regions, leading to the mobilization of threat-control circuits, whereas women recruit well-known emotion-processing areas of the brain. Perspective This article presents neuroimaging findings demonstrating that subjective pain unpleasantness ratings are associated with different pain-evoked brain responses in men and women, which has potentially important implications regarding sex differences in the risk of developing chronic pain.

summary Background & aims: Group B streptococci (GBS) are a major cause of neonatal infection. The existence of a link between levels of vitamin D and vaginal carriage of GBS was investigated. Methods: Vitamin D level, assayed from umbilical venous blood at birth, and the status of GBS vaginal carriage during the last term of pregnancy were available from 2246 motherechild couples. Results: Levels of vitamin D in cord blood at birth was deficient ( 30 ng/ml) in 32.1%, 53.0% and 14.9% of tested subjects, respectively. Levels differed significantly depending on the season of delivery, the duration of exposure to sunlight, the skin phototype, and on vitamin D supplementation. The percentage of GBS vaginal carriage was 15.4. A negative association was observed between GBS vaginal carriage and level of vitamin D (P < 0.01 by chi-square test). No relationship was established between GBS colonisation (27 cases identified) or infection (7 cases identified) and vitamin D status. Conclusions: A correct vitamin D level was associated with a lower rate of GBS vaginal carriage during pregnancy. This calls for the monitoring of vitamin D status in pregnant women, a screen which could greatly reduce the need for intrapartum antibiotic prophylaxis.

Although aggressive tumor resection favors survival in neuro-oncology, its effects on quality of life (QOL) are largely unspecified. The objective of the present study, therefore, was to study the relationship between tumor resection and QOL.We conducted a longitudinal study among 35 patients presenting with a suspected, and later confirmed, glioblastoma multiforme tumor. Following surgery, all patients received radiation therapy with concomitant temozolomide. Tumor volumes were segmented manually, and extent of resection was calculated by comparing pre- and post-operative volumes. QOL was obtained at intake and 3 months later, using the Sherbrooke Neuro-Oncology Assessment Scale. Change in QOL was determined by computing the difference between intake and follow-up data. Confounds were controlled for by detrending change in QOL scores from the effects of age, initial tumor volume, tumor location, and baseline QOL.Results showed that larger tumors at intake provoke increased pain (mostly headaches; r = 0.41, p = 0.015) and decreased social support/acceptance of disease (r = 0.43, p = 0.009). Results also showed that compared to biopsies, craniotomies were associated with preserved well-being across nearly all domains of QOL. When extent of resection was analyzed more specifically, results confirmed that larger resections prevented the decay in functional well-being (r = 0.616, p = 0.005) and neurocognitive function (r = 0.51, p = 0.026) typically observed as time progresses. Larger resections were also independently associated with prolonged survival.Although the data were obtained from a relatively small sample of patients, results indicate that aggressive resections avert decay in QOL, and thus prolong optimized survival.

Although humans differ widely in how sensitive they are to painful stimuli, the neural correlates underlying such variability remains poorly understood. A better understanding of this is important given that baseline pain sensitivity scores relate closely to the risk of developing refractory, chronic pain. To address this, we used a matched perception paradigm which allowed us to control for individual variations in subjective experience. By measuring subjective pain, nociceptive flexion reflexes, and, somatosensory evoked brain potentials (with source localization analysis), we were able to map the brain's sequential response to pain while also investigating its relationship to pain sensitivity (i.e. change in the stimulation strength necessary to experience pain) and spinal cord activity. We found that pain sensitivity in healthy adults was closely tied to pain-evoked responses in the contralateral precuneus. Importantly, the precuneus did not contribute to the actual representation of pain in the brain, suggesting that pain sensitivity and pain representation depend on separate neuronal sub-systems.

Objective Ever since the characterization of schizophrenia, clinicians have noted abnormal pain sensitivity in their patients. The published literature, however, is inconsistent concerning the nature of the change reported. The objective of this study was to characterize the pain response profile of schizophrenic patients by providing both acute and prolonged (i.e., rapidly repeating) painful stimuli to schizophrenic participants and control subjects. Participants Twelve schizophrenic subjects and eleven controls were included in the final analysis. Diagnosis was made according to Diagnostic and Statistical Manual of mental disorders-4th edition, text revision (DSM-IV-TR) criteria. Methods Intermittent, transcutaneous stimulations of the left sural nerve were administered to all participants. Painful sural nerve stimulations provoked a nociceptive flexion reflex response which was measured using an electromyographic recording of the bicep femoris muscle. Pain ratings were obtained using a 0–10 verbal numerical scale. Among schizophrenic participants, the relationship between subjective pain, reflex amplitude, and clinical features was investigated. The Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, and Subjective Scale to Investigate Cognition in Schizophrenia were used to evaluate clinical features. Results Compared with controls, schizophrenic subjects showed increased sensitivity to acute pain (i.e., lower pain thresholds; P = 0.019), but decreased subjective pain sensitization (P = 0.027). Group differences in subjective pain sensitization were not accompanied by group differences in nociceptive reflex activity (P = 0.260), suggesting supraspinal origins to the change in pain experienced by schizophrenic subjects. Moreover, positive symptoms correlated negatively with pain threshold values among schizophrenic participants (r = −0.696, P = 0.012), suggesting that distortions of thought and function relate to pain sensitivity in schizophrenic patients. Conclusion Results indicate that schizophrenic subjects present a specific experimental pain response profile, characterized by elevated sensitivity to acute pain but reduced sensitivity to prolonged pain.

Background:The impact of malignant glioma resection on survival is still a matter of controversy. The lack of well-designed prospective studies as well as control of all factors in retrospective studies plays an important role in this debate. Amongst some of these uncontrolled factors, are the inclusion of different histological grades, the lack of objective methods to estimate the extent of resection and unspecified delays in post-operative imaging.Methods:We retrospectively reviewed 126 consecutive patients with glioblastoma, operated on by the senior authors at the Centre Hospitalier Universitaire de Sherbrooke, who met the following criteria: >18 years of age, newly diagnosed glioblastoma, pre-operative magnetic resonance imaging (MRI) within 2 weeks prior to surgery, and a post-operative MRI within 72 hours after surgery. Extent of tumour resection was calculated using pre and post-operative tumour delimitation on gadolinium-enhanced T1 MRI in a volumetric analysis.Results:Applying stringent specific inclusion criteria, 126 patients were retained in the analysis. The median overall survival was 271 days and the median extent of resection was 65%. Patients with more than 90% of tumour resection had a significantly better outcome, improving median survival from 225 to 519 days (P=0.006). Other factors that significantly improved survival were the use of radiotherapy, the number of regimens and type of chemotherapy used.Conclusion:A more aggressive approach combining maximal safe resection and use of salvage chemotherapy seems to confer a survival advantage for glioblastoma patients.

On pathophysiologic grounds, fibromyalgia (FM) is characterized by a deficit in diffuse noxious inhibitory controls (DNIC), but the role of depressive symptoms on these mechanisms has not been investigated. We hypothesized that the deficit in pain inhibition would be more pronounced in FM patients with depressive symptoms (FM+D), relative to patients without such symptoms (FM-D).Fifty-two women diagnosed with FM (American College of Rheumatology criteria) and 10 healthy women participated in this study. Thermal stimuli were used to measure pain thresholds and DNIC efficacy (spatial summation paradigm). Clinical pain was measured using visual analog scales.We found that the amplitude of DNIC was smaller in FM+D patients, relative to the FM-D group; and that daily pain (unpleasantness) was higher in the FM+D group, relative to FM-D patients.We found that FM+D patients have a more pronounced deficit in pain inhibition as well increased clinical pain. As such, these results show the usefulness of combining psychologic factors and psychophysical measures to identify subgroups of FM patients. These results may have implications for future treatment of FM patients with and without comorbid depressive symptoms.

Objectives Previous studies have shown a reduction of diffuse noxious inhibitory controls (DNICs) in elderly adults compared with younger adults. Unfortunately, little is known regarding the developmental course of DNIC deficits and so it is still unclear whether middle-aged adults also show a DNIC deficit. The aims of the present study were to better characterize the developmental time course of the change in DNIC response by adding a middle-aged group. The role of expectations was also investigated. Methods The pain thresholds (PTs) of 20 young, 20 middle-aged, and 20 healthy elderly volunteers were assessed before and during a cold pressor task (water at 7 degrees C). Acute nociceptive stimuli were administered using a thermode and consisted of a range of painless and painful heat pulses. Results Analyses showed that thermal PTs increase by middle age but that the DNIC-induced increase in PT dampens progressively with advancing age. DNIC response was negatively correlated with advancing age, however, expectations regarding DNIC efficacy did not vary with age. This suggests that age-related changes in the size of the DNIC response are not best explained by an age-related change in expectation. Discussion The findings tell us that changes in pain perception and endogenous pain modulation arrive earlier than previously suggested. Studies on aging and pain should include a middle-aged group when comparing pain measures across the adult lifespan.

In order to understand how the brain prepares for and executes a switch in task demand, we measured reaction time (RT), accuracy, and event-related brain potentials associated with performance in single and mixed-task blocks using a cued design. Our results show that trials which repeat in a mixed-task block (repeat trials) were more demanding than trials which repeated in a single-task block, as reflected by the presence of a RT mixing cost and by the presence of a smaller target-locked positivity (P3b) on repeat trials. Within a mixed-task block, repeat and switch trials also differed, where repeat trials showed evidence of greater preparation (larger cue-locked negativity), more efficient target processing (larger target-locked P3b), and shorter RTs. In addition, the cue-locked negativity difference remained despite equating repeat and switch trials on RT, suggesting that this negativity difference is specific to the switching process. Our results are discussed in light of existing models of task switching.

A deficit of endogenous pain inhibitory systems has been suggested to contribute to some chronic pain conditions, one of them being fibromyalgia. The aim of the investigation was to test whether endogenous pain inhibitory systems were activated by a spatial summation procedure in 30 fibromyalgia, 30 chronic low back pain, and 30 healthy volunteers who participated in a cross-over trial (two sessions). Each session consisted of visual analog scale ratings of pain during the immersion of different surfaces of the arm in circulating noxious cold (12 degrees C) water. The arm was arbitrarily divided into eight segments from the fingertips to the shoulder. One session was ascending (from the fingertips to the shoulder) and the other was descending (from the shoulder to the fingertips); they included eight consecutive 2-min immersions separated by 5-min resting periods. For healthy and low back pain subjects, pain was perceived differently during the ascending and descending sessions (P=0.0001). The descending session resulted in lower pain intensity and unpleasantness. This lowering of the perception curve seems to be due to a full recruitment of inhibitory systems at the beginning of the descending session as opposed to a gradual recruitment during the ascending session. For fibromyalgia subjects, no significant differences were found between the increasing and decreasing sessions (P>0.05). These data support a deficit of endogenous pain inhibitory systems in fibromyalgia but not in chronic low back pain. The treatments proposed to fibromyalgia patients should aim at stimulating the activity of those endogenous systems.

Several studies have suggested that glucose hypometabolism may be present in specific brain regions in cognitively normal older adults and could contribute to the risk of subsequent cognitive decline. However, certain methodological shortcomings, including a lack of partial volume effect (PVE) correction or insufficient cognitive testing, confound the interpretation of most studies on this topic. We combined [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) and magnetic resonance (MR) imaging to quantify cerebral metabolic rate of glucose (CMRg) as well as cortical volume and thickness in 43 anatomically defined brain regions from a group of cognitively normal younger (25 ± 3 yr old; n = 25) and older adults (71 ± 9 yr old; n = 31). After correcting for PVE, we observed 11–17% lower CMRg in three specific brain regions of the older group: the superior frontal cortex, the caudal middle frontal cortex, and the caudate ( P ≤ 0.01 false discovery rate-corrected). In the older group, cortical volumes and cortical thickness were 13–33 and 7–18% lower, respectively, in multiple brain regions ( P ≤ 0.01 FDR correction). There were no differences in CMRg between individuals who were or were not prescribed antihypertensive medication. There were no significant correlations between CMRg and cognitive performance or metabolic parameters measured in fasting plasma. We conclude that highly localized glucose hypometabolism and widespread cortical thinning and atrophy can be present in older adults who are cognitively normal, as assessed using age-normed neuropsychological testing measures.

Chronic pain and the apparent insensitivity (or indifference) to acute pain constitute two very different, yet often observed clinical phenomena in psychiatry—depending of course on the type of pathology being considered. The presence of such dichotomous response profiles demand that we pay close attention to the processing of nociceptive signals and to the presence of a possible change in the expression of subjective pain ratings among psychiatric patients. A better understanding of how psychiatric patients actually process pain holds the promise of better understanding psychiatric problems in their own right, and, of better understanding the neurobiological roots of psychiatric ailments. The current chapter provides an overview of issues concerning pain perception and mental illness. It is divided as a function of the clinical disorders most frequently associated with a change in perceived pain. Our review is based on the careful consideration of the most recent, and sometimes older but seminal, peer-reviewed scientific literature. Our classification of mental disorders is based on the multiaxial taxonomy of the Diagnostic and Statistical Manual of Mental Disorders–4th edition, text revision (DSM IV-TR) [2]. We begin our overview of pain and mental health by focusing on severe, or principal, psychopathological conditions (i.e., clinical disorders: Axis I of the DSM IV-TR). In this manner, schizophrenia, autism, anxiety disorders, mood disorders, and somatoform disorders will all be discussed. Our chapter then proceeds to review the impact of personality on the development and/or maintenance of painful conditions. Here, the emphasis is placed on personality disorders (Axis II of the DSM IV-TR), but we will also consider the influence of personality or character traits (N.B., personality traits are not maladaptive, as is the case for personality disorders, but rather define enduring patterns of behavior and feelings that pervade most aspects of day to day life among healthy adults. Personality traits, taken together, define one’s personality). Finally, it is worth noting that this chapter provides a general appraisal of issues and findings that concern pain and mental illness. It offers an introduction to this rapidly evolving field and prepares the reader for the more detailed chapters that follow.

Background: Because glioblastoma is currently incurable, the goal of therapy is the optimization of the patient’s quality of life (QOL). Tumor location is critical in screening surgical candidates, yet the impact of tumor location on QOL has never been demonstrated. By using a novel computer-driven algorithm, we set out to investigate the impact of tumor location on QOL. Methods: The tumors of fourty consecutive glioblastoma patients were segmented and the Euclidian distance between 90 brain regions and each tumor’s margin was calculated and correlated to the patients’ self-reported QOL as measured by the SNAS questionnaire. Results: QOL was statistically associated with proximity to three areas: the right para-hypocampal gyrus, the right posterior cingulate cortex and the right postcentral gyrus. We postulate that the adverse relation between proximity to these areas and QOL results from disruption in large-scale networks involved in high-order functions such as visuospatial memory. While harder to detect with a bedside clinical examination, such deficits are likely more impactful on QOL than those related to the motor cortex or Broca’s area. Conclusions: Tumor proximity to right parietooccipital region are associated with decreased QOL. This should be considered in the management strategies of glioma patients.

Placebo effects are well-known phenomena in medicine and biology. In fact, placebos are used as control conditions in randomized cross-over clinical trials to validate new treatments. Only recently, however, has it become apparent that the conditioning and/or expectation effects provided by the experience of placebos can influence the results of clinical trials. It seems that combining shams and sequences has prejudiced the conclusions provided by cross-over designs. Frighteningly, this bias is always in the same direction, namely to increase the risk of rejecting potentially valid treatments. New models for clinical trials should be encouraged if we wish to market new and truly valid treatments.

INTRODUCTION: Glioblastoma is the most frequent primary brain tumor. Because it is currently incurable, the goal of therapy is the optimization of the patient's quality of life (QOL). While maximal surgical resection has been shown to improve survival and QOL, not all tumors can be safely resected. Tumor location is critical in screening surgical candidates, yet the impact of tumor location on QOL has never been convincingly demonstrated, possibly due to the prohibitively high sample size that standard statistical analyses would require. By using a novel computer-driven algorithm, we set out to investigate the impact of tumor location on QOL. METHODS: The tumors of fourty consecutive glioblastoma patients were segmented and registered to a Talairach-space standard brain image. The Euclidian distance between 90 brain regions and each tumor's margin was calculated and correlated to the patients' self-reported QOL as measured by the SNAS questionnaire. Multiple linear regression analyses were performed between QOL, tumor location and clinical parameters. RESULTS: QOL was statistically associated with proximity to three areas: the right para-hypocampal gyrus, the right posterior cingulate cortex and the right postcentral gyrus. We postulate that the adverse relation between proximity to these areas and QOL results from disruption in large-scale networks involved in high-order functions such as visuospatial memory. While harder to detect with a bedside clinical examination, such deficits are likely more impactful on QOL than those related to the motor cortex or Broca's area. CONCLUSION: Tumor proximity to the right para-hypocampal gyrus, the right posterior cingulate cortex and the right postcentral gyrus are associated with decreased QOL, probably via an impact in visuospatial functionning. While traditionally considered non-eloquent, these affected areas have more impact on QOL than any other brain region and this should be considered in the management strategies of glioma patients.

Although most people who suffer from headache do not present with an underlying mass lesion, a large number of patients with brain tumors do complain of headache (as many as 60% in our institution). The problem for clinicians is that the tumor-headache association is not universal, as evidenced by anecdotal reports of patients with large tumors, elevated intracranial pressure but a complete absence of headache. In this chapter, we examine over 80 years of research on brain tumor headaches, delineating the link between tumor location, laterality, growth-rate, and pain. Most importantly, we position our review within the context of current aetiological theories and propose new models involving the peripheral and central sensitization of nociresponsive neurons. A brief examination of headaches as a result of surgery and adjuvant chemo-radiation therapy is also provided.

Although most people who have headache pain do not present with an underlying mass lesion, a large number of patients with brain tumors do report headache (as many as 60% in our institution). The problem for clinicians is that the tumor-headache association is not universal, as evidenced by anecdotal reports of patients with large tumors and increased intracranial pressure, but a complete absence of headache pain. In this review, we examine more than 80 years of research on brain tumor headaches, delineating the link between tumor location, laterality, growth rate, and pain. Most importantly, we position our review within the context of current etiological theories and propose new models involving the peripheral and central sensitization of nociresponsive neurons. This review will help clinicians understand why debulking surgery sometimes fails to alleviate neoplastic headache pain in select patients. A brief examination of headaches as a result of surgery and adjuvant chemoradiation therapy is also provided. Headaches can be an early indicator of central nervous system tumors. However, headaches are present in a wide variety of other condition, and are sometimes (surprisingly) absent in patients with primary neoplasms or metastatic tumors. This observation complicates the possibility of linking headaches to brain tumors. Nevertheless, some generalizations concerning brain tumor headaches can be drawn. The following sections review these generalizations, presenting caveats where appropriate. Lingering questions in the field are also addressed and presented together with promising future research avenues.

Background Apparent life-threatening events (ALTE) and/or prolonged apnoea have been well-documented during respiratory syncytial virus (RSV) infection in infants less than 2 months of age but fundamental mechanisms remain unclear. The possibility of a central origin for the development of severe cardiac and respiratory events encouraged us, to explore the autonomic nervous system (ANS) profile of infected infants, since ANS activity may contribute to the constellation of symptoms observed during severe forms of RSV bronchiolitis. Methods Eight infants (2 preterm and 6 full-term) less than 2 months of age and presenting with severe and apnoeic forms of RSV infection were evaluated using non-invasive electrophysiological monitoring obtained simultaneously for approximately 2 consecutive hours, including a quiet sleep period. Eight control subjects, paired for gestational and postnatal age, were also evaluated. ANS status was monitored using electrocardiogram recordings and quantified through a frequency-domain analysis of heart rate variability (HRV). This included sympathetic (VLF and LF) and parasympathetic (HF) indices as well as a measure of baroreflex sensitivity (BRS) obtained using non-invasive continuous arterial pressure. Results Regardless of gestational and postnatal age, heart rate variability components (Ptot, VLF, LF, and HF) and baroreflex components (α LF, α HF and sBR) were found to be significantly lower in the RSV-infected group than in the control group ( p Conclusion RSV infection in neonates is associated with profound central autonomic dysfunction. The potentially fatal consequence stresses the importance of maintaining prolonged cardiopulmonary monitoring.

Background:The purpose of this study was to develop and validate a self-administered questionnaire to measure the health-related quality of life (QOL) of patients with brain cancer. We wanted to assess both core and disease-specific concerns in a single, easy-to-use instrument, thus promoting concision and clinical utility. The questionnaire departs from its predecessors in that it was designed for- and validated among French speaking Canadians.Methods:A focus group of health professionals was used to develop items for the questionnaire, which was later validated with 105 patients suffering from brain cancer. The underlying structure of the questionnaire was investigated using principal component analysis and confirmed using a principal factor analysis.Results:The final version of the questionnaire contains 30 items. Seven multi-item scales, tapping into distinct dimensions of QOL, were uncovered (i.e., functional well-being, symptom severity/fear of death, social support/acceptance of disease, autonomy in personal care, digestive symptomatology, neurocognitive function, and pain). Assessment of reliability revealed elevated internal consistency for each of the seven scales (Cronbach coefficient alpha ≥≥.65), whereas known-groups validity (anchor-based approach) revealed that the different dimensions uniquely discriminated between patients with different functional levels (Karnofsky Performance Scores) and clinical status (exposure to neurosurgery, radiotherapy, and use of chemotherapy and anticonvulsants).Conclusion:Our QOL questionnaire, the Sherbrooke Neuro-Oncology Assessment Scale, or SNAS, taps into both core and disease-specific issues relevant to neuro-oncology patients. It has good validity and reliability, and clearly reflects the multidimensional nature of QOL. Depending on the research focus, it may be used in clinical trials to track the impact of disease and/or treatment on satisfaction, functional status, and general well-being.

populations, and delivery volumes in Ohio. Local data abstractors in the initial 39 Week Project were replaced by birth certificate personnel at each site who were educated by Ohio Vital Statistics staff and supported by quality improvement experts. Ohio Birth Certificate data were collected and reported promptly. Rates of scheduled inductions of labor that lacked a documented medical indication were reported in monthly QI webinars. Local teams used IHI techniques to promote compliance with ACOG practice guidelines. RESULTS: Rates of scheduled inductions of labor 39 weeks without a medical indication in the 15 pilot sites decreased while the original OPQC project was ongoing, and declined further when Ohio began reporting hospital rates on a public website. Rates have continued to decline in pilot project sites since project inception (see graph), and accuracy of birth certificate information has improved. CONCLUSION: Collaboration by clinical, administrative, and Ohio Vital Statistics staff to improve the accuracy of birth certificate data has been accompanied by a decline in scheduled births 39 weeks gestation in medium sized maternity units.

We investigated age-related differences in task-switching performance by using behavioral measures and event-related brain potentials. We tested younger and older adults, and we separated older adults into groups with high and low working memory (WM); that is, we separated them into old-high-WM and old-low-WM groups. On average, all participants responded more slowly in mixed-task than in single-task blocks (i.e., reaction time or RT mixing cost). Younger adults and old-high-WM participants had equivalent RT mixing costs and showed larger posterior negative slow-wave activity when preparing for mixed trials than for single-task trials, suggesting that mixed-task trials required trial-to-trial preparation. Old-high-WM participants also showed frontally distributed activity on mixed-task trials, suggesting their use of executive control to offset age-related differences in mixed-task preparation. In contrast, old-low-WM participants had large RT mixing costs and large posterior event-related brain potential negativities during single-task trials, suggesting that they prepare during single- and mixed-task blocks. High WM, therefore, may help older adults offset the age-related difficulties often observed when they are task switching.

The interaction between pain and the motor system is well-known, with past studies showing that pain can alter corticomotor excitability and have deleterious effects on motor learning. The aim of this study was to better understand the cortical mechanisms underlying the interaction between pain and the motor system. Experimental pain was induced on 19 young and healthy participants using capsaicin cream, applied on the middle volar part of the left forearm. The effect of pain on brain activity and on the corticomotor system was assessed with electroencephalography (EEG) and transcranial magnetic stimulation (TMS), respectively. Compared to baseline, resting state brain activity significantly increased after capsaicin application in the central cuneus (theta frequency), left dorsolateral prefrontal cortex (alpha frequency), and left cuneus and right insula (beta frequency). A pain-evoked increase in the right primary motor cortex (M1) activity was also observed (beta frequency), but only among participants who showed a reduction in corticospinal output (as depicted by TMS recruitment curves). These participants further showed greater beta M1-cuneus connectivity than the other participants. These findings indicate that pain-evoked increases in M1 beta power are intimately tied to changes in the corticospinal system, and provide evidence that beta M1-cuneus connectivity is related to the corticomotor alterations induced by pain. The differential pattern of response observed in our participants suggest that the effect of pain on the motor system is variable from on individual to another; an observation that could have important clinical implications for rehabilitation professionals working with pain patients.