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Background: The optimal antithrombotic therapy after transcatheter aortic valve replacement (TAVR) is controversial. We performed a systematic review and meta-analysis of randomized controlled trials comparing high-intensity vs. low-intensity antithrombotic therapy after TAVR in the absence of an established indication for anticoagulation. Methods: The primary efficacy and safety endpoints were a composite of death or thromboembolic events and Valve Academic Research Consortium 2–defined significant bleeding, respectively. All analyses were by intention to treat. Risk ratios (RRs) were calculated using the inverse variance random-effects model. Results: Four studies comprising 3358 patients (mean age 81 years, mean Society of Thoracic Surgery score 3.3%) were identified. Two studies compared anticoagulation vs. antiplatelet therapy after TAVR; the other 2 trials compared dual-antiplatelet therapy vs. mono-antiplatelet therapy after TAVR. The incidence of death or thromboembolic events (RR 0.66 [95% confidence interval (CI) 0.55-0.80], p < 0.0001, I2 = 0%), death (RR 0.68 [95% CI 0.51-0.92], I2 = 11%, p = 0.01), and Valve Academic Research Consortium 2–defined major bleeding (RR 0.69 [95% CI 0.48 - 1.00], p = 0.003, I2 = 44%) was significantly lower in patients on low-intensity antithrombotic therapy than in those on high-intensity antithrombotic therapy. Conclusions: In an elderly patient population undergoing TAVR, routine initiation of a high-intensity antithrombotic therapy in the absence of a clinical indication for anticoagulation was associated with increased risk of death or thromboembolic complications, increased risk of death, and increased risk of significant bleeding. Routine initiation of an anticoagulation therapy or dual-antiplatelet therapy after TAVR in the absence of an established indication for anticoagulation may not be advisable.

Background: Behavioral and psychological symptoms of dementia (BPSD) are present in most people with dementia (PwD), including Alzheimer's disease. There is consensus that non-pharmacological therapies represent the first line of treatment to address BPSD., Objective: We explore the efficacy of the use of a rocking chair (Nordic Sensi® Chair, NSC) in the treatment of BPSD in nursing home residents with moderate and severe dementia., Methods: We carried out a 16-week randomized, single-blind, controlled, clinical trial with PwD admitted to nursing homes. Participants were assigned to a treatment group (n = 40) that received three times a week one session per day of 20 minutes in the NSC and a control group (n = 37). The Neuropsychiatric Inventory-Nursing Home (NPI-NH) was used as primary efficacy outcome. Occupational distress for the staff was evaluated using the NPI-NH Occupational Disruptiveness subscale (NPI-NH-OD). Statistical analyses were conducted by means of a Mixed Effects Model Analysis., Results: Treatment with the NSC was associated with a beneficial effect in most of BPSD, as reflected by differences between the treatment and control group on the NPI-NH total score (mean change score -18.87±5.56 versus -1.74±0.67, p = 0.004), agitation (mean change score -2.32±2.02 versus -0.78±1.44, p = 0.003) and irritability (mean change score -3.35±2.93 versus -1.42±1.31, p = 0.004). The NPI-NH-OD total score also improved the most in the treatment group (mean change score -9.67±7.67 versus -7.66±6.08, p = 0.003)., Conclusions: The reduction in overall BPSD along with decreased caregiver occupational disruptiveness represent encouraging findings, adding to the potential of nonpharmacological interventions for nursing home residents living with dementia.

Purpose To assess the presence of control impairment (CI) of the lumbopelvic region in the axial plane in men without low back pain (LBP) with CI in the sagittal plane. Methods : Twenty-four males, between 18 and 23 of age, BMI = normal, who did not report episodes of LBP in the 12 months prior to the study, were studied. Assessment of the sagittal control of the lumbopelvic region was performed during stand to sit. Nine participants demonstrated CI in sagittal plane and 15 did not. An active hip lateral rotation (HLR) test was performed, in which lumbopelvic rotation during HLR was assessed using a three-dimensional motion analysis system. Results : Patients with CI in sagittal plane had a greater percentage of their total lumbopelvic pelvic rotation at 60% of HLR range compared to those without CI ( p  < 0.05; d = 0.93). No significant differences in the total lumbopelvic and HLR range of motion were found between the groups. Conclusion : Men without LBP who experience CI of the lumbopelvic region in the sagittal plane also show CI in the axial plane. The control deficiencies were not related to the total range of lumbopelvic or HLR range of motion.

Previously it has been shown that the concurrent presentation of a sound can improve processing of visual information at higher perceptual levels, for example, in letter identification tasks. Moreover, increasing the duration of the concurrent sounds can enhance performance in low-level tasks as contrast detection, which has been attributed to a sustained visual activation corresponding to the duration of the sound. Yet, the role of sound duration has so far not been investigated in higher-level visual processing. In a series of five Experiments, we again demonstrated that the mere presence of a concurrent sound can enhance the identification of a masked, centrally presented letter compared to unimodal presentation, even though this benefit was absent in one experiment for high-contrast letters yielding an especially high level of task-performance. In general, however, the sound-induced benefit was not modulated by a variation of target contrast or by the duration of the target-to-mask interstimulus interval. Taking individual performance differences into account, a further analysis suggested that the sound-induced facilitation effect may nevertheless be most pronounced at specific performance levels. Beyond this general sound-induced facilitation, letter identification performance was not further affected by the duration of the concurrent sounds, even though in a control experiment it could be established that letter identification performance improved with increasing letter duration, and perceived letter duration was prolonged with increasing auditory duration. The results and their interpretation with respect to the large observed interindividual performance differences are discussed in terms of potential underlying mechanisms of multisensory facilitation, as preparedness enhancement, signal enhancement, and object enhancement., (Copyright © 2018 Elsevier B.V. All rights reserved.)

In studies on temporal order perception, immediate as well as sustained effects of multisensory integration have been demonstrated repeatedly. Regarding duration perception, the corresponding literature reports clear immediate effects of multisensory integration, but evidence on sustained effects of multisensory duration integration is scarce. In fact, a single study [Heron, J. et al. (2013). A neural hierarchy for illusions of time: Duration adaptation precedes multisensory integration, J. Vis. 13, 1-12.] investigated adaptation to multisensory conflicting intervals, and found no sustained effects of the audiovisual conflict on perceived duration of subsequently presented unimodal visual intervals. In two experiments, we provide independent evidence in support of this finding. In Experiment 1, we demonstrate that adaptation to audiovisual conflict does not alter perceived duration of subsequently presented visual test intervals. Thus, replicating the results of Heron et al. (2013), we observed no sustained effect of multisensory duration integration. However, one might argue that the prolonged exposure to consistent multisensory conflict might have prevented or hampered multisensory integration per se. In Experiment 2, we rule out this alternative explanation by showing that multisensory integration of audiovisual conflicting intervals is still effective after exposure to audiovisual conflict. This further strengthens the conclusion that multisensory integration of interval duration affects perception in an immediate, but not in a sustained manner.

Objectives: The aim of the present study was to assess reproducibility and inter-rater reliability of 2 nutritional screening tools (NST): Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) and Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP)., Methods: Prospective observational multicentre study. Patients ages 1 month or older admitted to paediatric or surgical wards were tested within 24 hours of admission by 2 independent observers: experts specialized in paediatric nutrition (physicians or dieticians) and clinical staff nonexpert in nutrition. Diagnosis on admission, underlying diseases, and length of stay were registered., Statistical Analysis: Kappa index (κ) to evaluate agreement between observers., Results: A total of 223 patients were included (53.4% boys), with mean age of 5.59 (95% confidence interval 4.94-6.22) years. Experts classified 9.9% of patients at high risk with STRONGkids and 19.7% using STAMP, whereas nonexpert staff assigned 6.7% of patients to the high-risk category with STRONGkids and 21.9% with STAMP. Agreement between expert and nonexpert staff was good: 94.78% for STRONGkids (κ 0.72 [P < 0.001]); 92.55% for STAMP (κ 0.74 [P < 0.001]). The rate of malnutrition was significantly higher among high-risk patients with both NST, independent of examiner experience. After adjusting for age, both STRONGkids and STAMP high-risk scores predicted longer length of stay, whether assessed by experts or nonexperts, although differences were higher with STRONGkids., Conclusions: Agreement between experts and nonexpert staff in nutrition was good, producing a similar high-risk patient profile. Our results demonstrate that these NSTs are appropriate for nutritional screening in settings in which users have no previous experience in the field.

Background: The perceived pain on injection site caused by subcutaneous (SC) self-injection may negatively affect acceptance and adherence to treatment in patients with multiple sclerosis (MS). Pain on injection may be caused by inaccurate injection technique, inadequate needle length adjustment, or repeated use of the same injection body area. However, information is lacking concerning the optimal needle depth to minimize the injection pain., Objective: The purpose of this program was to characterize the perceived injection-site pain associated with the use of various injection depths of the autoinjector of glatiramer acetate (GA) based on SC tissue thickness (SCT) of the injection site., Methods: This was a pilot program performed by MS-specialized nurses in patients with MS new to GA. Patients were trained by MS nurses on the preparation and administration of SC injection and on an eight-site rotation (left and right arms, thighs, abdomen, and upper quadrant of the buttock). The needle length setting was selected based on SCT measures as follows: 4 or 6 mm for SCT < 25 mm, 6 or 8 mm for SCT between 25 and 50 mm, and 8 or 10 mm for SCT > 50 mm. Injection pain was rated using a visual analog scale (VAS) at 5- and 40-minute postinjection and during two 24-day treatment periods., Results: Thirty-eight patients with MS were evaluated. The mean SCT ranged from 15.5 mm in the upper outer quadrant of the buttocks to 29.2 mm in the thighs. The mean perceived pain on injection was below 3 for all the injection sites, at both time points (5 and 40 minutes) and during both 24-day evaluation periods. The mean VAS scores were significantly greater after 5 minutes of injection compared with that reported 40-minute postinjection during both 24-day treatment periods and for all the injection areas. Mean VAS measures at 5- and 40-minute postinjection significantly decreased during the second 24-day treatment period with respect to that reported during the first 24 SC injections for all injection sites., Conclusions: Our findings suggest that the adjustment of injection depth of SC GA autoinjector according to SCT of body injection areas is suitable to maintain a low degree of postinjection pain. Moreover, our results also may indicate that the use of needle lengths of 6 mm or shorter is appropriate with regard to injection pain for adult patients with MS with SCT < 50 mm.

Recent studies suggest that the accuracy of duration discrimination for visually presented intervals is strongly impaired by concurrently presented auditory intervals of different duration, but not vice versa. Because these studies rely mostly on accuracy measures, it remains unclear whether this impairment results from changes in perceived duration or rather from a decrease in perceptual sensitivity. We therefore assessed complete psychometric functions in a duration discrimination task to disentangle effects on perceived duration and sensitivity. Specifically, participants compared two empty intervals marked by either visual or auditory pulses. These pulses were either presented unimodally, or accompanied by task-irrelevant pulses in the respective other modality, which defined conflicting intervals of identical, shorter, or longer duration. Participants were instructed to base their temporal judgments solely on the task-relevant modality. Despite this instruction, perceived duration was clearly biased toward the duration of the intervals marked in the task-irrelevant modality. This was not only found for the discrimination of visual intervals, but also, to a lesser extent, for the discrimination of auditory intervals. Discrimination sensitivity, however, was similar between all multimodal conditions, and only improved compared to the presentation of unimodal visual intervals. In a second experiment, evidence for multisensory integration was even found when the task-irrelevant modality did not contain any duration information, thus excluding noncompliant attention allocation as a basis of our results. Our results thus suggest that audiovisual integration of temporally discrepant signals does not impair discrimination sensitivity but rather alters perceived duration, presumably by means of a temporal ventriloquism effect.

It has been recently shown that temporal orienting demands controlled attention (Capizzi et al., 2012). However, there is current debate on whether temporal preparation guided by regular rhythms also requires the generation of endogenous temporal expectancies or rather involves a mechanism independent of executive control processes. We investigated this issue by using a dual-task paradigm in two different experiments. In Experiment 1, the single-task condition measured reaction time to respond to the onset of an auditory stimulus preceded by either a regular or an irregular auditory rhythm. The dual-task condition additionally included a working memory task, which demanded mental counting and updating. In Experiment 2, the simultaneously WM task was a variant of the Sternberg Task. We hypothesized that, if temporal preparation induced by rhythms did not involve executive processing, it would not be interfered by the simultaneous working memory task. The results showed that participants could anticipate the moment of target onset on the basis of the regular rhythm and, more important, this ability resisted the interference from the double task condition in both experiments. This finding supports that temporal preparation induced by rhythms, in contrast to temporal orienting, does not require resources of executive control.

Introduction: Cerebral vasospasm is involved in the development of delayed ischemic lesions in patients with subarachnoid hemorrhage. We developed an integral theoretical model to explain the pathophysiology of cerebral vasospasm, in which endothelin-1 has a pivotal role in the development of both cerebral vasospasm and delayed ischemic neurological deficits (DIND)., Objective: The objective of this study is to analyze the relationship between temporal profile of plasma endothelin-1 levels and the development of cerebral vasospasm and DIND., Patients and Methods: We analyzed sequentially plasma endothelin-1 levels in 17 patients with aneurysmatic subarachnoid hemorrhage. All the patients had complete clinical and neuroradiological studies. Patients were classified according to Fisher's score., Results: Patients (4 males and 13 females, aged 48.1 +/- 20.3 years) had a good clinical condition (Hunt-Hess < 4, GCS > 10). Two weeks after bleeding, patients had higher plasma endothelin-1 levels than healthy volunteers (p = 0.024). Patients who developed DIND had higher plasma endothelin-1 levels (p = 0.034) and a different evolution (p = 0.0146) than patients without DIND. There is a significant correlation (p = 0.02) between basal plasma endothelin-1 levels and GOS score. Multiple regression analysis shows a significant dependence between plasma endothelin-1 levels and Fisher's score (p = 0.0195), development of DIND (p = 0.0095), and GOS score (p = 0.0319). Logistic regression analysis finds a predictive relation between Fisher's score and plasma endothelin-1 levels for the development of DIND (overall predicted = 74.24%; p = 0.0148)., Conclusions: Plasma endothelin-1 levels are increased in patients after subarachnoid hemorrhage and are associated with the development of cerebral vasospasm and DIND.