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Disorders of consciousness are neurological conditions characterized by impaired arousal and awareness of self and environment. Behavioural responses are absent or are present but fluctuate. Disorders of consciousness are commonly encountered as a consequence of both acute and chronic brain injuries, yet reliable epidemiological estimates would require inclusive, operational definitions of the concept, as well as wider knowledge dissemination among involved professionals. Whereas several manifestations have been described, including coma, vegetative state/unresponsive wakefulness syndrome and minimally conscious state, a comprehensive neurobiological definition for disorders of consciousness is still lacking. The scientific literature is primarily observational, and studies-specific aetiologies lead to disorders of consciousness. Despite advances in these disease-related forms, there remains uncertainty about whether disorders of consciousness are a disease-agnostic unitary entity with a common mechanism, prognosis or treatment response paradigm. Our knowledge of disorders of consciousness has also been hampered by heterogeneity of study designs, variables, and outcomes, leading to results that are not comparable for evidence synthesis. The different backgrounds of professionals caring for patients with disorders of consciousness and the different goals at different stages of care could partly explain this variability. The Prospective Studies working group of the Neurocritical Care Society Curing Coma Campaign was established to create a platform for observational studies and future clinical trials on disorders of consciousness and coma across the continuum of care. In this narrative review, the author panel presents limitations of prior observational clinical research and outlines practical considerations for future investigations. A narrative review format was selected to ensure that the full breadth of study design considerations could be addressed and to facilit

We report the rare case of a 81-year old lady presenting with a prolactin-secreting pituitary carcinoma after a long history of a prolactinoma diagnosed at the age of 59, first responsive to medical treatment with bromocriptine then becoming completely resistant to maximal doses of bromocriptine and cabergoline. Three asymptomatic intracranial metastases were diagnosed at MRI in 2010. Six months later, the patient became symptomatic, suffering from left perineal and right hemifacial nevralgia. Cerebro-spinal imaging showed at that time two new metastases, located respectively close to the right trigeminal nerve and in the lumbar spine. The diagnosis of prolactin-secreting pituitary carcinoma is based here on the clinical history with acquired resistance to dopamine agonists, very high prolactin concentrations in the cerebro-spinal fluid, and the correlation observed between radiological findings and clinical and biological evolution of the patient. A treatment with temozolomide has been initiated, allowing after 3 months a PRL decrease of 50% and a 20%-reduction in size of most metastases.

Autogenous marrow-cancellous bone chips were transplanted into 20 canine frontal sinus cavities and the anterior wall surgical defect covered with a nylon-backed cellulose acetate filter. The autoclaved cellulose acetate was found to easily crack and flake from the nylon backing after even minimal manipulation. This technique did not given a normal frontal contour unless the frontal sinus was completely filled with the autogeneous graft at the time of transplant surgery. (Author)

The purpose of these studies was to establish whether acute exertional rhabdomyolysis could be produced in potassium- or magnesium-deficient dogs. In addition, attempts were made to induce exertional rhabdomyolysis in control dogs by repetitive exhaustive exercise of gracilis muscles. Exertional rhabdomyolysis was induced in the exercised gracilis muscle of one potassium deficient animal. No evidence of rhabdomyolysis was observed in any of the other six potassium deficient animals nor in the magnesium deficient dogs. No evidence of rhabdomyolysis was observed in the gracilis muscles of control dogs whose muscles were exhaustively exercised, allowed to rest for various time intervals, and then re-exercised. In vitro metabolic studies of potassium- and magnesium-deficient muscles revealed that optimal glycogenolysis and glycolysis occurred at concentrations of these ions far below that seen in the muscle cell water of such muscles. We concluded that a functional impairment of glycogenolysis and glycolysis is not the mechanism by which potassium and magnesium deficiencies lead to rhabdomyolysis. (Author)

A new insect repellent jacket constructed of polyester and cotton netting has been developed. The Naval Medical Field Research Laboratory began studying the possibility of using cool, wide-mesh netting treated with space repellents in 1965. Insect repellent jackets were developed as a result of the initial research. The current jacket is lightweight and cool. It is designed as a waist-length overjacket with extra length sleeves and a hood with an open face. The production model has front closure snaps in addition to a drawstring on the hood. Good consumer acceptance has been received from test users. The jacket to date has proven effective against mosquitoes, Leptoconops, Culicoides, black flies, and deer flies.

Thirty-two subjects were given training on the Hecht-Shlaer Adaptometer for one week and, on the basis of average threshold, divided into three groups. For the next three weeks, all subjects were tested each morning and then transported to Onslow Beach. During this period, one group had maximum protection from the sun by wearing dark-adaptor goggles; another group was issued sunglasses, N-1; the third group had no protection for their eyes. Average thresholds for each group were computed and compared. No significant differences were found between any of the groups. Possible reasons for the apparent discrepancy between these results and those of other investigators are outlined. (Author)

Ninety-six pairs of sunglasses were issued to enlisted Marine Corps personnel for general field use at Camp Lejeune, N.C. The men were instructed to wear the glasses as much as possible while they carried on their regular training activities in bivouac areas. The glasses were examined every week. The scratches on the plastic filters were rated, breaks and fractures noted, and the comments of the subjects recorded. After seven weeks of use 48 percent of the glasses issued were rejected for further use because of the extensive damage. Rejection was determined by a double criterion: (1) unwillingness of the subject to wear them longer, and (2) rejection rating by the experimenters. No pair of glasses was rejected unless it met both of these criteria. Twenty-three percent of the glasses were still in use, although 91 percent of these were severely scratched. Twenty-one percent had been lost, and eight percent were on hand.

Eighteen Staff Non-Commissioned Officer Academy students were studied before and after a six-week training program. Various biochemical aspects (serum pyruvate, serum enzymes, red blood cell count, 2,3 diphosphoglycerate), physiologic parameters (systolic intervals, maximal oxygen uptake, heart rates), and the U. S. Marine Corps Physical Fitness Test (USMC PFT) were assessed on all men on several occasions. The USMC PFT was found to correlate well with some sophisticated tests of physical fitness, such as maximal oxygen uptake. Improvement of physical fitness and endurance capacity was documented by increase in maximal oxygen uptake, PFT scores, decrease in heart rate, time for three-mile run, and systolic time intervals. Biochemical parameters in this study did not serve as a good predictor of physical fitness. (Author)

Specimens of blood from 330 Marine recruits at the Marine Corps Recruit Depot, Parris Island, South Carolina, were obtained daily during the first week of their recruit training. Each sample was analyzed for serum myoglobin, CPK, GOT and LDH. It was found that 7.9% of those recruits tested had myoglobin and enzyme levels compatible with the diagnosis of subclinical exertional rhabdomyolysis. One recruit had levels as high as those individuals who had been hospitalized with the diagnosis of acute exertional rhabdomyolysis. Ambient noon temperatures during the study were not high nor was salt intake excessive. (Author)

The maximal oxygen intake of Marine Corps enlisted men was assessed by means of a treadmill test and predicted by means of a step test and a bicycle ergometer ride. The subjects then ran 1000 meters, 1.5 miles, and 3 miles. Correlations between the assessed maximal oxygen intakes and the predicted intakes were made. (Author)

The object was: (1) To devise a technique which will allow high-power radio telemetering of heart rate as detected by means of electrocardiogram skin electrodes, without being restricted by simultaneous electrocardiogram amplifier overload or saturation; (2) To design an electronic circuit which, when attached to an electrocardiogram amplifier, will allow the taking of an ECG without requiring readjustment for each body type. (Author), See also Report no. 3, AD-726 406.

The results on the feasibility of utilizing hypoidous acid (HOI) tablets as an agent for microbial decontamination of water is presented. Characteristics which were evaluated were disinfectant capabilities, solubility, and the influence of storage on these parameters. HOI tablets were stored for one year at 4C, ambient conditions, and 29C with a relative humidity of approximately 85%. Storage conditions did adversely influence the iodine content, coloration, and solubility of the HOI tablets. Fresh tablets or those stored at 4C maintained high bactercidal and amoebicidal potency. (Author), See also Report on Phase 1, AD-723 561.

Students at the USMC Physical Fitness Academy were tested to determine whether times in the 1000-yard run and the three-mile run successfully predicted times in the 20-mile forced march. The r between the 1000-yard run and the criterion was 0.56; that between the three-mile run and the criterion was 0.77. These correlations are not high enough to provide satisfactory predictions. (Author), See also Part 1, AD-733 675. Prepared in cooperation with the Marine Corps Physical Fitness Academy, Quantico, Va., Rept. no PFA-72-1.

The physical fitness test developed by the International Committee on the Standardization of Physical Fitness Tests (ICSPFT) was proposed for Marine Corps use. Evaluation of the test led to the recommendation that it not be adopted for Marine Corps use. (Author)

During the years 1965-1970 Navy entomologists provided technical assistance to allied forces in the five northern provinces of South Vietnam. During these years, over 500,000 mosquito specimens were collected and identified. This report is a summary of those records. One hundred seven species and 14 genera are reported as being present in the northern provinces. Where possible, the bionomics and vector potential are listed. (Author)

Investigations were made to determine the feasibility of utilizing hypoiodous acid tablets (HOI) as an agent for microbial decontamination of water. The paper presents results of studies of the palatability, disinfectant capability and iodine content of the HOI tablets stored at 4C, ambient conditions, and 29C with a relative humidity of approximately 85%. Tablets stored at 29C with a relative humidity of approximately 85% turned yellowish-green, and the time required for a tablet to dissolve was increased. Storage conditions influenced the iodine content, coloration and solubility of the HOI tablets. (Author)

A light trap survey was conducted in Da Nang, Vietnam for 42 weeks beginning 1 June 1969. Over 150,000 specimens were sorted and identified. The most numerous mosquitoes collected were Culex tritaeniorhynchus, Anopheles sinensis, and Anopheles vagus. C. tritaeniorhynchus was the most prevalent mosquito throughout the study. A. sinensis reached peaks during September, October and November. A. vagus exhibited the most seasonal distribution of the three species. (Author)

The program involves efforts to convert the Naval Medical Field Research Laboratory's prototype telemetry equipment to a low-duty cycle tone burst system. A proprietary modulated by a series of 700 Hz tone bursts originating from especially designed equipment provided the best telemetered data yet recorded in this series of studies. It is recommended that further studies be conducted using monolithic and hybrid fabricated electronic circuits., See also Report no. 2, AD-628 690.

Serum uric acid levels were measured in successful Marine Corps Officer Candidate School students before and after the 12 weeks' intensive physical training. There was a significant fall in the serum uric acid level of 52 subjects from 6.01 mg percent to 5.15 mg percent. The association of falling uric acid levels and physical conditioning could not, however, be separated from the effects of dietary changes, sleeping habits, or psychological factors. (Author)

Studies were conducted to determine whether pulsed tone burst (A2 emission) would provide acceptable data during the telemetering of body core temperatures under actual field conditions. It was determined that it provided usable temperature data at ranges up to 1,000 yards in hilly terrain and up to 600 yards in dense scrub. (Author)

The U.S. Marine Corps Physical Fitness Test includes a two-minute bent knee sit-up. The purpose of the study was to investigate the validity of this item. It was concluded that this test does not measure the strength of the abdominal muscles and the hip flexors to a significant degree. Apparently it is primarily a measure of trunk flexion speed and secondarily a measure of the endurance of the abdominal muscles and hip flexors. (Author)

One platoon at an officer candidate school was trained by use of interval running techniques, while a control platoon employed the continuous running method in use at the school. Both groups significantly improved their time in the three-mile run, but thee was no significant difference in the improvement of the two groups. The physical activity required in the overall program may have affected this portion of it. (Author)

One company at an officer candidate school was conditioned by use of physical fitness circuit training techniques, while a control company employed the standard methods in use at the school. The document discusses the post-training scores of the circuit-trained company in the squat thrust, the mile run, and the standing broad jump.

Observations were made on serum glutamio oxalacetic transaminase (SGOT), serum lactic dehydrogenase (SLDH), and serum creatine phosphokinase (SCPK) levels of dogs before, during, and after a vigorous program of training and 'overtraining.' It was not possible to determine changes due to training by measurement of SGOT or SLDH levels, but further investigation of the value of SCPK for this purpose is indicated. (Author)

Acute respiratory disease associated with adenovirus type 4 occurred in recruits vaccinated with low titered living adenovirus type 4 vaccine (LAV). Only 29% of the vaccinees had neutralizing antibodies two months postvaccination. Upon revaccination with higher titered LAV, there was an 86% response in men vaccinated for the first time but only a 47% response in men who were revaccinated. (Author)

Students in a physical training platoon, were administered the Marine Corps physical fitness test. Half of them were then given a protein dietary supplement and half were given placebos each day for four weeks on a double-blind basis. The physical fitness test was then readministered. There was no evidence that the group which received the supplement performed better on the retest than did the control group. (Author)

Test-retest coefficients of reliability were determined for the measurements in the proposed new physical readiness test for Women Marines. The four-block shuttle run was included for comparison with the two-block shuttle run, and selected anthropometric data were recorded on the subjects. The coefficients of reliability were satisfactorily high. The four-block shuttle run gives a better distribution of the data and a higher reliability coefficient than does the two-block shuttle run and it is recommended that the former replace the latter in the test battery. The subjects were found to have proportionately larger waist and hip girths than are considered 'ideal' at the present time. (Author)

Studies were conducted to determine whether 33.1 MHz or 143.52 MHz provided better transmission for the telemetering of physiological data through dense forest growth. It was determined that 33.1 MHz was definitely superior. Problems encountered and the steps which will be taken to overcome them are reported. (Author)

This study in unacclimatized individuals is part of an overall plan of investigation designed to give to the field commanders a reasonable method of predicting heat casualties in their men, knowing conditions of climate, load, terrain, and the presence or absence of body armor. (Author)

A conference, The Military Importance of the Mediterranean Snail Complex, was attended by military, U.S. Department of Agriculture, and invited malacologists from various universities. The conference included a review of the action taken by the military units to prevent the introduction of quarantinable snails and the need for a more dependable technique as well as a less expensive method. The lack of adequate biological data became obvious. Details of mechanical, biological and chemical controls were presented. (Author)

Serum uric acid levels were determined in men graduating from O.C.S., men dropped from O.C.S., enlisted men with good records and enlisted men who were serving sentences in the brig. There were no significant differences in the mean serum uric acid levels of O.C.S. graduates and of men dropped, or of enlisted men with good records and enlisted men in the brig. However, there was a significant difference between the mean levels of officers and of enlisted men. The literature suggests that this may indicate a higher level of motivation in the officers. (Author)

A study of alterations in selected serum enzymes after physical exertion by young males is reported. Mean serum concentrations of glutamic oxalacetic transaminase (SGOT), lactate dehydrogenase and amylase all increase after the performance of vigorous exercise. SGOT concentrations in the abnormal range are often reached both immediately after exertion to near exhaustion and on the day following vigorous performance of calisthenics. These evaluations appear to represent two distinct SGOT peaks. Increments in SGOT concentrations found immediately after exercise correlate highly with alterations in blood lactate, blood pyruvate and blood pH, but not with changes in serum potassium. Thus, the initial peak is associated in some unknown manner with anaerobic glycolysis. The second SGOT peak is probably related to the destruction of skeletal muscle. Low resting SGOT concentrations correlate significantly with better performances in physical fitness tests. Also, the later SGOT rise is abolished by a 10-week period of physical conditioning. Thus, the measurement of serum enzyme concentrations appears to be potentially useful in the assessment of physical fitness. (Author)

Forty-one men of unacceptably low physical performance ability were given four weeks training in the Physical Training Platoon (PTP) before being assigned to Officer Candidate School (OCS). Thirty-nine men completed the PTP program. Of these, 36 were assigned to OCS Class No. 50. Twenty-one of them successfully completed OCS. Data on the three assigned to a later class were not available at the time of writing. Statistical analysis of the test items raised certain questions regarding their suitability for the test battery. (Author)

A method of water purification has been evaluated. The method of treatment involves sterilization, coagulation and sedimentation. This method is bacteriologically effective; however, the concentration of dissolved solids remaining after treatment was greater than the limits set by the Navy. This method of water purification would be impractical for the individual in the field. (Author)

Approximately 250 Marines, aged 18-45 years, were administered a proposed new Physical Readiness Test, consisting of pull-ups; push-ups; rope climb; bent knee sit-ups in 2 minutes, feet held; leg raises in 2 minutes, elbows held; squat thrusts in 2 minutes; standing broad jump (best of three attempts); jump and reach (best of three attempts); and 3-mile forced march. Means, standard deviations, and intercorrelations of test scores are reported, together with observations and recommendations. Particular attention is drawn to the possibility of cardiac damage to older men subjected to such tests. (Author)

A group of Marine infantrymen were trained for six weeks on a Universal Gym and a Marcy Isometric Power Rack in order to determine the value of these pieces of apparatus for use in maintaining the physical fitness of Marines confined to shipboard for an extended period. The subjects displayed improved performance in certain tests of muscular strength, but did not demonstrate improved performance in events requiring cardiorespiratory fitness and/or speed of movement of large muscle masses. (Author)

The purpose of this study was to determine whether there is a difference in the body heat build-up under the standard Marine Corps upper torso body armor versus the NMFRL lightweight prototype body armor. Twenty young adult Marines made two forced marches of 3 mi each, one with each of the above armors. Mean chest skin temperature under the prototype armor was 2F. less than under the standard armor. No difference was observed in rectal, arm, or abdominal temperatures. (Author)

Thirty-eight young adult males were exercised daily for 2 weeks on a motor-driven treadmill at 3.5 mph located in a heat chamber maintained at 98F. dry bulb and 90F. wet bulb. Twelve subjects walked for 50 minutes followed by 10 minutes rest in the heat; 13 subjects walked 50 minutes, rested 10 minutes, walked 30 more minutes and rested a final 10 minutes; 13 subjects walked 50 minutes, rested 10 minutes, walked 50 more minutes and rested a final 10 minutes. A modified Balke performance test was administered before heat exposure and at the end of each week. Physiological parameters including rectal temperatures, heart rates, sweat loss and sweat electrolytes were used as measures of acclimatization. It was found that the daily exposure to heat for 1 hour did not produce acclimatization as seen in the latter groups. Several differences between physiologic adjustment to a hot-wet as contrasted with hot-dry climates were observed and are discussed. (Author)

The role of Mycoplasma (pleuropneumonia-like organisms) in human disease is reviewed and discussed. Continuing studies for more than two decades, initiated by the Commission on Acute Respiratory Diseases in World War II, extended by Eaton, Liu, et al., and resolved by Chanock and his associates, have established the Mycoplasma as true pathogens for human beings. Mycoplasma pneumoniae has been identified as the agent of cold-agglutinin-positive primary atypical pneumonia. Investigations in a different field of human disease - nongonococcal urethritis - give promise of selectively identifying still another member of the Mycoplasma group as a human pathogen. (Author), Pub. in New England Journal of Medicine v272 p848-51 Apr 22 1965.