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Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This case report presents the case of a 49-year-old man who presented to our level I trauma center after sustaining injuries in an altercation with local law enforcement in which he was shot with a less lethal bean bag and tased. In a primary survey, a penetrating left supraclavicular wound was noted in addition to a taser dart lodged in his flank. No other traumatic findings were noted in a secondary survey. Given hemodynamic stability, completion imaging was obtained, revealing a foreign body in the left lung, a left open clavicle fracture, a C5 tubercle fracture, a possible grade I left vertebral injury, and a left first rib fracture. Soft tissue gas was seen around the left subclavian and axillary arteries, although no definitive arterial injury was identified. The bean bag projectile was embedded in the parenchyma of the left lung on cross-sectional imaging. The patient underwent thoracotomy for removal of the projectile and hemostasis. A thoracotomy was chosen as the operative approach due to concerns about significant bleeding upon foreign body removal. A chest tube was placed and subsequently removed on postoperative day 5. The patient was discharged on postoperative day 7. At a 2-week outpatient follow-up visit, the patient was doing well. This case report is the first to describe this outcome for a drag-stabilized bean bag. Although law enforcement officers utilize bean bag projectiles as a "less lethal" means of crowd control and protection, these ballistics pose significant risk and can result in serious injury., Competing Interests: Conflicts of interest The authors have no conflicts of interest to declare., (© 2023 The Korean Society of Traumatology.)

Introduction: Choledocholithiasis is most often managed in a two-procedure pathway including endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC). In contrast, a single-stage, surgery-first approach consisting of LC, cholangiogram, and laparoscopic common bile duct exploration (LCBDE) is associated with reduced hospital stays and equivalent morbidity. Despite this, nationwide referral patterns heavily favor ERCP, obscuring those undergoing ERCP with obstructions amenable to simple intraoperative interventions. We hypothesized that most patients had endoscopic findings consistent with simple sludge or small-to-medium stones, which could have been cleared by basic LCBDE maneuvers., Methods: We retrospectively reviewed 294 patients > 18 years old who underwent preoperative ERCP for the management of suspected choledocholithiasis. Exclusion criteria included: failed ERCP, cholangitis, prior cholecystectomy, patient refusal of surgery, or medical conditions precluding surgical candidacy. Stone size was categorized as small (0-4 mm), medium (5-7 mm), and large (≥ 8 mm)., Results: At the time of ERCP, 37 (20.1%) patients had sludge only, 96 (52.2%) had stones only, 42 (22.8%) had sludge and stones, and 9 (4.8%) had no stones. Of the 138 patients with any stones, 37 (26.8%) had small stones, 41 (29.7%) medium, 43 (31.2%) large, and 17 (12.3%) had uncharacterizable stones. Overall, 74.3% of patients had findings of sludge, stones (0-7 mm), or negative ERCP., Conclusion: The majority of patients who underwent preoperative ERCP for suspected choledocholithiasis had findings that are amenable to simple intraoperative interventions. In fact, over a quarter of the patients had a negative ERCP, sludge, or small stones which would likely be cleared by flushing/glucagon precluding any further instrumentation. While large stones may require more advanced techniques, this represents a small percentage of patients. Surgery-first management for suspected choledocholithiasis can offer an efficient alternative for the majority of patients., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Functional (un-)coupling (task-related change of functional connectivity) between different sites of the brain is a mechanism of general importance for cognitive processes. In Alzheimer's disease (AD), prior research identified diminished cortical connectivity as a hallmark of the disease. However, little is known about the relation between the amount of functional (un-)coupling and cognitive performance and decline in AD. Method: Cognitive performance (based on CERAD-Plus scores) and electroencephalogram (EEG)-based functional (un-)coupling measures (connectivity changes from rest to a Face-Name-Encoding task) were assessed in 135 AD patients (age: M  = 73.8 years; SD  = 9.0). Of these, 68 patients ( M  = 73.9 years; SD  = 8.9) participated in a follow-up assessment of their cognitive performance 1.5 years later. Results: The amounts of functional (un-)coupling in left anterior-posterior and homotopic interhemispheric connections in beta1-band were related to cognitive performance at baseline (β = .340; p  < .001; β = .274; P  = .001, respectively). For both markers, a higher amount of functional coupling was associated with better cognitive performance. Both markers also were significant predictors for cognitive decline. However, while patients with greater functional coupling in left anterior-posterior connections declined less in cognitive performance (β = .329; P  = .035) those with greater functional coupling in interhemispheric connections declined more (β = -.402; P  = .010). Conclusion: These findings suggest an important role of functional coupling mechanisms in left anterior-posterior and interhemispheric connections in AD. Especially the complex relationship with cognitive decline in AD patients might be an interesting aspect for future studies.

Purpose: Although the literature has shown that the cross-sectional area (CSA) of the carpal tunnel on ultrasound is enlarged in patients with carpal tunnel syndrome, it does not provide information regarding whether proximal nerve pathology, such as that seen in cervical radiculopathy, increases the CSA of the median nerve., Methods: In this study, 15 patients were enrolled who had a clinical diagnosis of cervical radiculopathy but not carpal tunnel syndrome. All patients underwent electrodiagnostic studies and ultrasound measurement of the CSA of the median nerve., Results: Increased median nerve CSA was seen in 1 of 15 patients (7%). Positive findings of cervical radiculopathy were found in 7 patients (47%) by electrodiagnostic studies., Conclusions: In patients clinically diagnosed with isolated cervical radiculopathy, the vast majority have normal median nerve CSA measured on ultrasound., Type of Study/level of Evidence: Prognostic IV., (© 2020 The Authors.)

Background: Comprehensive studies on caregiver burden (CB) of persons caring for dementia patients differ methodologically and show variable results., Objective: Analysis of known and hypothesized factors of CB in home care of dementia patients., Methods: Multicenter longitudinal study comprising 585 persons caring mostly for Alzheimer's disease patients (age median 77.25 years, Mini-Mental State Examination raw score median 23) using the Zarit Caregiver Burden Interview (CBI). Known patient-related determinants of CB were studied, such as dementia severity (Clinical Dementia Rating, CDR), neuropsychological deficits (CERAD-Plus), neuropsychiatric symptoms (Neuropsychiatric Inventory, NPI), disability (Disability Assessment for Dementia, DAD), dependency (Dependency Scale, DS), and moreover, unclarified potential factors (age, sex, education of patients; age, sex, occupational status of the caregivers; family relationship). Psychological and somatic effects of CB were analyzed (factor analysis)., Results: Caregiver age was median 61. Female caregivers prevailed (67.8%). Median CBI sum score (CBIss) was 16 at baseline. After two years, CBIss was 22 and 37% of the caregivers reported mild to moderate (CBIss 21-40), 16.8% moderate to severe or severe (≥41), and 46.2% absent to little CB (CBIss ≤ 20). CB correlated positively with NPI, CDR, DS scores, disability (DAD), years of education of the patients, and proximity of patient and caregiver sex (female), and negatively with caregiver age. Caregivers reported restrictions of time, health problems, and negative emotions., Conclusion: The findings are applicable to identify persons at risk for substantial CB and its consequences. There is demand for personal, psychological, and medical support of caregivers and increasing male participation.

We analyzed the relation of several synchrony markers in the electroencephalogram (EEG) and Alzheimer's disease (AD) severity as measured by Mini-Mental State Examination (MMSE) scores. The study sample consisted of 79 subjects diagnosed with probable AD. All subjects were participants in the PRODEM-Austria study. Following a homogeneous protocol, the EEG was recorded both in resting state and during a cognitive task. We employed quadratic least squares regression to describe the relation between MMSE and the EEG markers. Factor analysis was used for estimating a potentially lower number of unobserved synchrony factors. These common factors were then related to MMSE scores as well. Most markers displayed an initial increase of EEG synchrony with MMSE scores from 26 to 21 or 20, and a decrease below. This effect was most prominent during the cognitive task and may be owed to cerebral compensatory mechanisms. Factor analysis provided interesting insights in the synchrony structures and the first common factors were related to MMSE scores with coefficients of determination up to 0.433. We conclude that several of the proposed EEG markers are related to AD severity for the overall sample with a wide dispersion for individual subjects. Part of these fluctuations may be owed to fluctuations and day-to-day variability associated with MMSE measurements. Our study provides a systematic analysis of EEG synchrony based on a large and homogeneous sample. The results indicate that the individual markers capture different aspects of EEG synchrony and may reflect cerebral compensatory mechanisms in the early stages of AD.

Objective: To investigate which single quantitative electro-encephalographic (QEEG) marker or which combination of markers correlates best with Alzheimer's disease (AD) severity as measured by the Mini-Mental State Examination (MMSE)., Methods: We compared quantitative EEG markers for slowing (relative band powers), synchrony (coherence, canonical correlation, Granger causality) and complexity (auto-mutual information, Shannon/Tsallis entropy) in 118 AD patients from the multi-centric study PRODEM Austria. Signal spectra were determined using an indirect spectral estimator. Analyses were adjusted for age, sex, duration of dementia, and level of education., Results: For the whole group (39 possible, 79 probable AD cases) MMSE scores explained 33% of the variations in relative theta power during face encoding, and 31% of auto-mutual information in resting state with eyes closed. MMSE scores explained also 25% of the overall QEEG factor. This factor was thus subordinate to individual markers. In probable AD, QEEG coefficients of determination were always higher than in the whole group, where MMSE scores explained 51% of the variations in relative theta power., Conclusions: Selected QEEG markers show strong associations with AD severity. Both cognitive and resting state should be used for QEEG assessments., Significance: Our data indicate theta power measured during face-name encoding to be most closely related to AD severity., (Copyright © 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.)

Background: Alzheimer's disease (AD) is one of the most common age-related diseases in the western world. Gender differences in neuropsychological functions are seldom evaluated in AD., Objective: Recent investigations suggested that gender may be an important modifying factor in the development and progression of AD. We examined gender-specific differences in the pattern of cognitive dysfunction of patients with mild to moderate AD., Methods: We examined 113 males (mean age 78) and 173 females (mean age 80) of the prospective registry on dementia in Austria (PRODEM). We analyzed differences in the cognitive profile between male and female AD patients on the CERAD-Plus test battery., Results: We found gender-related differences in the neuropsychological domains of verbal learning; the women tended to perform worse than men. Controlling for depression, stage and duration of dementia, and the level of education, there was still a significant effect of gender on verbal episodic memory., Conclusion: There is an interaction between gender and cognitive function, most notable in verbal episodic memory; female patients in the early stage of AD performed worse on verbal episodic memory than men. This indicates that the gender-specificities of neuropsychological functions should be given careful consideration in clinical diagnosis of dementia.

Background: Patient dependence has rarely been studied in mild-to-moderate Alzheimer's disease (AD)., Objective: To identify factors which predict patient dependence in mild-to-moderate AD., Methods: We studied 398 non-institutionalized AD patients (234 females) of the ongoing Prospective Registry on Dementia (PRODEM) in Austria. The Dependence Scale (DS) was used to assess patient dependence. Patient assessment comprised functional abilities, neuropsychiatric symptoms and cognitive functions. A multiple linear regression analysis was performed to identify predictors of patient dependence., Results: AD patients were mildly-to-moderately impaired (mean scores and SDs were: CDR 0.84 ± 0.43; DAD 74.4 ± 23.3, MMSE = 22.5 ± 3.6). Psychopathology and caregiver burden were in the low range (mean NPI score 13.2, range 0 to 98; mean ZBI score 18, range 0-64). Seventy five percent of patients were classified as having a mild level of patient dependence (DS sum score 0 to 6). Patient dependence correlated significantly and positively with age, functional measures, psychopathology and depression, disease duration, and caregiver burden. Significant negative, but low correlations were found between patient dependence, cognitive variables, and global cognition. Activities of daily living, patient age, and disease severity accounted for 63% of variance in patient dependence, whereas cognitive variables accounted for only 11%., Conclusion: Dependence in this cohort was mainly related to age and functional impairment, and less so to cognitive and neuropsychiatric variables. This differs from studies investigating patients in more advanced disease stages which found abnormal behavior and impairments of cognition as main predictors of patient dependence.

Background: Quantitative electroencephalogram (qEEG) recorded during cognitive tasks has been shown to differentiate between patients with Alzheimer's disease (AD) and healthy individuals. However, the association between various qEEG markers recorded during mnestic paradigms and clinical measures of AD has not been studied in detail., Objective: To evaluate if 'cognitive' qEEG is a useful diagnostic option, particularly if memory paradigms are used as cognitive stimulators., Methods: This study is part of the Prospective Registry on Dementia in Austria (PRODEM), a multicenter dementia research project. A cohort of 79 probable AD patients was included in a cross-sectional analysis. qEEG recordings performed in resting states were compared with recordings during cognitively active states. Cognition was evoked with a face-name paradigm and a paired-associate word list task, respectively. Relative band powers, coherence and auto-mutual information were computed as functions of MMSE scores for the memory paradigms and during rest. Analyses were adjusted for the co-variables age, sex, duration of dementia and educational level., Results: MMSE scores explained 36-51% of the variances of qEEG-markers. Face-name encoding with eyes open was superior to resting state with eyes closed in relative theta and beta1 power as well as coherence, whereas relative alpha power and auto-mutual information yielded more significant results during resting state with eyes closed. The face-name task yielded stronger correlations with MMSE scores than the verbal memory task., Conclusion: qEEG alterations recorded during mnestic activity, particularly face-name encoding showed the highest association with the MMSE and may serve as a clinically valuable marker for disease severity., (Copyright © 2014 Elsevier B.V. All rights reserved.)

We analyzed the relation between Alzheimer's disease (AD) severity as measured by Mini-Mental State Examination (MMSE) scores and quantitative electroencephalographic (qEEG) markers that were derived from canonical correlation analysis. This allowed an investigation of EEG synchrony between groups of EEG channels. In this study, we applied the data from 79 participants in the multi-centric cohort study PRODEM-Austria with probable AD. Following a homogeneous protocol, the EEG was recorded both in resting state and during a cognitive task. A quadratic regression model was used to describe the relation between MMSE and the qEEG synchrony markers. This relation was most significant in the δ and θ frequency bands in resting state, and between left-hemispheric central, temporal and parietal channel groups during the cognitive task. Here, the MMSE explained up to 40% of the qEEG marker's variation. QEEG markers showed an ambiguous trend, i.e. an increase of EEG synchrony in the initial stage of AD (MMSE>20) and a decrease in later stages. This effect could be caused by compensatory brain mechanisms. We conclude that the proposed qEEG markers are closely related to AD severity. Despite the ambiguous trend and the resulting diagnostic ambiguity, the qEEG markers could provide aid in the diagnostics of early-stage AD.

Background: Few studies have investigated in detail which factors influence activities of daily (ADL) in Alzheimer's disease (AD)., Objective: To assess the influence of cognitive, gender, and other factors on ADL in patients with mild to moderate AD., Methods: This study is part of the Prospective Registry on Dementia in Austria (PRODEM) project, a multicenter dementia research project. A cohort of 221 AD patients (130 females; means: age 76 years, disease duration 34.4 months, MMSE 22.3) was included in a cross-sectional analysis. Everyday abilities were assessed with the Disability Assessment for Dementia scale, and cognitive functions with the CERAD plus neuropsychological test battery. Two models of multiple linear regressions were performed to find factors predicting functional decline, one entering demographical and disease related factors, and a joint model combining demographical and disease variables with neuropsychological scores., Results: Non-cognitive factors explained 18%, whereas the adding of neuropsychological variables explained 39% of variance. Poor figural and verbal memory, constructional abilities, old age, longer disease duration, depression, and male gender were independent risk factors for reduced ADL. Instrumental and basic ADL were predicted by similar factors, except gender (predicting only instrumental ADL) and phonological fluency (predictor of basic ADL)., Conclusion: In addition to demographical factors, disease duration, and depression, neuropsychological variables are valuable predictors of the functional status in AD in an early disease stage.

Objective: To assess the influence of cognitive, functional and behavioral factors, co-morbidities as well as caregiver characteristics on driving cessation in dementia patients., Methods: The study cohort consists of those 240 dementia cases of the ongoing prospective registry on dementia in Austria (PRODEM) who were former or current car-drivers (mean age 74.2 (±8.8) years, 39.6% females, 80.8% Alzheimer's disease). Reasons for driving cessation were assessed with the patients' caregivers. Standardized questionnaires were used to evaluate patient- and caregiver characteristics. Cognitive functioning was determined by Mini-Mental State Examination (MMSE), the CERAD neuropsychological test battery and Clinical Dementia Rating (CDR), activities of daily living (ADL) by the Disability Assessment for Dementia, behavior by the Neuropsychiatric Inventory (NPI) and caregiver burden by the Zarit burden scale., Results: Among subjects who had ceased driving, 136 (93.8%) did so because of "Unacceptable risk" according to caregiver's judgment. Car accidents and revocation of the driving license were responsible in 8 (5.5%) and 1(0.7%) participant, respectively. Female gender (OR 5.057; 95%CI 1.803-14.180; p = 0.002), constructional abilities (OR 0.611; 95%CI 0.445-0.839; p = 0.002) and impairment in Activities of Daily Living (OR 0.941; 95%CI 0.911-0.973; p<0.001) were the only significant and independent associates of driving cessation. In multivariate analysis none of the currently proposed screening tools for assessment of fitness to drive in elderly subjects including the MMSE and CDR were significantly associated with driving cessation., Conclusion: The risk-estimate of caregivers, but not car accidents or revocation of the driving license determines if dementia patients cease driving. Female gender and increasing impairment in constructional abilities and ADL raise the probability for driving cessation. If any of these factors also relates to undesired traffic situations needs to be determined before recommendations for their inclusion into practice parameters for the assessment of driving abilities in the elderly can be derived from our data.

In plexus of isolated segments of pyloric and ileo-caecal sphincters of the cat, three types of spontaneously active cells were revealed: 1) with single, 2) with fast, and 3) with slow burst type of discharges, as well as a group of silent neurons only responding to mechanical stimulation with electrode or application of acetylcholine. The data obtained indicated the qualitative unity of neuronal organization of submucous plexus along the alimentary canal, the neurons of the sphincters' plexus included. However, an increasing number of the silent cells and neurons with the single burst activity were revealed in the vicinity of mesenteric border and in the central belt of the segment which, probably, reflected the functional specifics of sphincters.

Extracellular recording of neuronal activity of the submucosal plexus of isolated pyloric and ileocecal sphincteric regions of cat intestine revealed both spontaneously active and silent neurons. The spontaneously active neurons consisted of fast- and slow-burst-type units and single-spike units. The silent neurons generated trains of spikes in response to deformation of the ganglion by the recording electrode or in response to local application of acetylcholine (Ach, 6 X 10(-5) -6 X 10(-2) microM/l) on the ganglion surface. Interactions of the excitatory type were made manifest by the synchronous activity of cells in the forms of a "driver-follower" interaction. Even more complex interactions of an excitatory and inhibitory character were observed when the beginning of discharge of one neuron caused activation of another which was followed by a pause as in the first neuron discharge. Analysis of the obtained data indicated a qualitative similarity of the neuronal organization of the submucosal plexus along the entire length of the alimentary canal. It is concluded that neurons of the plexus in sphincteric regions are interconnected in a single functional ensemble. However, the results of the study show that silent cells and single-spike neurons predominate and are located mainly at the mesenteric border and in the central band of the segment. This is evidently a reflection of the functional significance of the sphincters which prevent reflux within the alimentary canal.