scientific-2016-2017

Scientific papers 2016 - 2017

The documents are classified chronologically from 2016 to 2017. Click on their descriptions to open and download them.

This article describes the various dermatoses that can be contracted during occupational and recreational diving.

23 - A comparative evaluation of two decompression procedures for technical diving using inflammatory responses: compartmental versus ratio deco. Authors: E. Spisni, C. Marabotti, S. Brambilla, M. C. Valerii, E. Cavazza, K. Hoxha ,L. De Fazio, A. L’Abbate, & P. Longobardi.

This study aimed to compare two decompression procedures commonly adopted by technical divers: The ZH-L16 algorithm, modified by 30/85 gradient factors (compartmental decompression model, CDM) versus the ‘ratio decompression strategy’ (RDS). The comparison was based on an analysis of changes in diver circulating inflammatory profiles caused by decompression from a single dive.

Authors: Yara Bernaldo de Quirós, Andreas Møllerløkken, Marianne B. Havnes, Alf O. Brubakk, Oscar González-Díaz, and Antonio Fernández. The pathophysiological mechanism of decompression sickness is not fully understood, but there is evidence that it can be caused by intravascular and autochthonous bubbles. Doppler ultrasound at a given circulatory location is used to detect and quantify the presence of intravascular gas bubbles as an indicator of decompression stress. In this manuscript, the team studied the relationship between the presence and quantity of gas bubbles by echosonography of the pulmonary artery of anesthetized, air-breathing.

Authors: Thijs T. Wingelaar, Pieter-Jan A. M. van Ooij, and Rob A. van Hulst. In Special Operations Forces (SOF) closed-circuit rebreathers with 100% oxygen are commonly utilized for covert diving operations. Exposure to high partial pressures of oxygen (PO2) could cause damage to the central nervous system (CNS) and pulmonary system. Longer exposure time and higher PO2 lead to faster development of more serious pathology.

Authors: Vincent Souday, Nick J. Koning, Bruno Perez, Fabien Grelon, Alain Mercat, Christa Boer, Valérie Seegers, Peter Radermacher, Pierre Asfar The objective of this study was to test the hypothesis of whether enriched air nitrox (EAN) breathing during simulated diving reduces decompression stress when compared to compressed air breathing as assessed by intravascular bubble formation after decompression.

This short article deals with useful and modern bubble models used to stage divers to the surface and correlations, if and when they exist, with actual data, usually decompression sickness (DCS) outcomes across a limited spectrum of exposures. Many of the early (wet) tests were carried out by world Navies, later by hyperbaric chamber testing, and today also by statistical inference from downloaded computer profiles.

In 2015, a workshop on ultrasound in diving research was held in Sweden, at which 27 participants from 12 countries hammered out guidelines to provide better standardisation of methods for both Doppler and echocardiography bubble counts. These guidelines and two papers from the meeting are published in this issue. The guidelines complement those developed in 2014 for the echocardiographic investigation of persistent foramen ovale in divers.

13 - Correlation between Patent Foramen Ovale, Cerebral “Lesions” and Neuropsychometric Testing in Experienced Sports Divers: Does Diving Damage the Brain?

Authors: Costantino Balestra and Peter Peter Germonpré SCUBA diving exposes divers to decompression sickness (DCS). There has been considerable debate whether divers with a Patent Foramen Ovale of the heart have a higher risk of DCS because of the possible right-to-left shunt of venous decompression bubbles into the arterial circulation. Symptomatic neurological DCS has been shown to cause permanent damage to the brain and spinal cord tissue; it has been suggested that divers with PFO may be at higher risk of developing subclinical brain lesions because of repeated asymptomatic embolization of decompression-induced nitrogen bubbles. These studies however suffer from several methodological faws, including self-selection bias.

Authors: Eugene V. Golanov, James M. Shiflett, Gavin W. Britz Diving response (DR) is a powerful integrative response targeted toward survival of the hypoxic/anoxic conditions. Being present in all animals and humans, it allows for surviving adverse conditions like diving. Earlier, the authors discovered that forehead stimulation affords a neuroprotective effect, decreasing infarction volume triggered by permanent occlusion of the middle cerebral artery in rats. The authors hypothesized that cold stimulation of the forehead induces DR in rats, which, in turn, exerts neuroprotection.

Authors: István Vadász & Jacob I. Sznajder This review discusses recent discoveries on the sensing and signaling events initiated by hypoxia and hypercapnia and the relevance of these results in the identification of potential novel therapeutic targets in the treatment of acute respiratory distress syndrome (ARDS).

Authors: Pierre Lafère, Costantino Balestra, Dirk Caers, Peter Germonpré. The authors have crossed information from Belgian Hyperbaric Centers, DAN. Emergency Hotline, the press, and Internet diving forums to consider the majority of decompression sickness (DCS) occurred in Belgium from January 1993 to June 2013. From the available 594 records, the authors excluded all cases with tentative diagnosis, medullary DCS, or unreliability of reported dive profile, leaving 209 divers records with cerebral DCS for analysis. Dive parameters and patent foramen ovale (PFO) were recorded. Twenty-three injured divers were tested using the Zuckerman’s Sensation Seeking Scale V and compared to a matched group not involved in risky activities.

Authors: Peter Germonpré, Costantino Balestra, Walter Hemelryck, Peter Buzzacott, Pierre Lafère. This double-blinded, randomized trial was designed to see if using Enriched Air Nitrox (EANx) could improve cognitive performance while diving. Eight volunteers performed two no-decompression dry dives breathing air or EANx for 20 min at 0.4 MPa. Their cognitive functions were assessed with a computerized test battery. Measurements were taken before the dive, upon arrival, after 15 min at depth, upon surfacing, and at 30 min postdive. After each dive, subjects were asked to identify the gas they had just breathed..

42 - Dive Risk Factors, Gas Bubble Formation, and Decompression Illness in Recreational SCUBA Diving: Analysis of DAN Europe DSL Data Base.

Authors: Danilo Cialoni, Massimo Pieri, Costantino Balestra, Alessandro Marroni The popularity of SCUBA diving is steadily increasing, together with the number of dives and correlated diseases per year. The rules that govern correct decompression procedures are considered well known even if the majority of Decompression Sickness (DCS) cases are considered unexpected, confirming a bias in the “mathematical ability” to predict DCS by the current algorithms. Furthermore, little is still known about diving risk factors and any individual predisposition to DCS. This study provides an in-depth epidemiological analysis of the diving community to includeadditional risk factors correlated with circulating bubbles and DCS development.

Authors: Heather Massey, John Leach, Michael Davis, & Vicki Vertongen. In most countries, immersion represents the second most common cause of accidental death in children and the third in adults. Between 2010 and 2013, 561 deaths worldwide involving recreational divers were recorded by the Divers Alert Network. Consequently, there is no room for complacency when diving. Being lost at sea is a diver’s worst nightmare. In 2006, a diver was lost at sea off the coast of New Zealand for 75 hours. It is unprecedented that, after such a long time immersed in temperate (16−17 ° C) waters, he was found and survived. His case is presented and utilized to illustrate the many physiological and psychological factors involved in prolonged immersion and what might determine survival under such circumstances. The authors also briefly review options for enhancing diver location at sea, and a few issues related to search and rescue operations are discussed.

Authors: Joost J. L. M. Bierens, Philippe Lunetta, Mike Tipton, & David S. Warner. Knowledge of drowning physiology is scarce. A better understanding may identify methods to improve survival, particularly hot-water immersion, cold shock, cold-induced physical incapacitation, and fear of drowning.

19 - Enriched Air Nitrox Breathing Reduces Venous Gas Bubbles after Simulated SCUBA Diving: A Double-Blind Cross-Over Randomized Trial.

Authors: Vincent Souday, Nick J. Koning, Bruno Perez, Fabien Grelon, Alain Mercat, Christa Boer, Valérie Seegers, Peter Radermacher, Pierre Asfar. This document relates tests performed regarding the hypothesis of whether enriched air nitrox (EAN) breathing during diving reduces decompression stress when compared to compressed air breathing as assessed by intravascular bubble formation after decompression.

Authors: Anne-Kathrin Brebeck, Andreas Deussen, Henning Schmitz-Peiffer, Ursula Ranged, Costantino Balestra, Sinclair Cleveland, and Jochen D. Schipke. This study compares the effects of nitrox28 and air on two psychometric tests. In this double-blind, open-water study, 108 advanced divers were randomized to air or a nitrox group for a 60-min dive to 24 m saltwater. Breathing gas effects on cognitive performances were assessed during the dive using a short and long-term memory test and a number connection test.

Authors: Alvhild Alette Bjørkum, Eystein Oveland, Linda Stuhr, Marianne Bjordal Havnes, Frode Berven, Marit Grønning, Arvid Hope. The main objective of the present study was to determine the effects on the brain proteome of fast decompression (1 bar/20 s) compared to controls (1 bar/10 min) after heliox saturation diving, using rats in a model system.

10 - Nutritional considerations during prolonged exposure to a confined, hyperbaric, hyperoxic environment: recommendations for saturation divers.

Authors: S. K. Deb 1,2 , P. A. Swinton 1 and E. Dolan Saturation diving is an occupation that involves prolonged exposure to a confined, hyperoxic, hyperbaric environment. The unique and extreme environment is thought to disrupt physiological and metabolic homeostasis, which may impact human health and performance. Appropriate nutritional intake has the potential to alleviate and/or support many of these physiological and metabolic concerns while enhancing health and performance in saturation divers. Therefore, this review aims to identify the physiological and practical challenges of saturation diving and provide evidence- based nutritional recommendations for saturation divers to promote health and performance within this challenging environment.

21 - Pre-dive whole-body vibration better reduces decompression- induced vascular gas emboli than oxygenation or a combination of both

Authors: Costantino Balestra, Sigrid Theunissen, Virginie Papadopoulou, Cedric Le Mener, Peter Germonpré, François Guerrero, and Pierre Lafère Since non-provocative dive profiles are no guarantor of protection against decompression sickness, novel means, including pre-dive “preconditioning” interventions, are proposed for its prevention. This study investigated and compared the effect of pre-dive oxygenation, pre-dive whole-body vibration, or a combination of both on post- dive bubble formation.

Authors: Shopov Nikola, VazharovIvaylo. The most likely factor initiating Decompression Sickness (DCS) is believed to be the formation of bubbles in the blood and the tissues. Bubbles form during decompression due to supersaturation of the dissolved gas from the gas nuclei present in the tissues even at normal atmospheric pressure and provoke the symptoms of DCS. Ascent rate is known to be a critical factor for DCS risk. Individual factors, such as age, weight, and fat tissues, are also recognized for their implication in DCS risk. This study aimed to contribute to enhanced safety of divers by measuring the rate of off-gassing utilizing Doppler after decompression and relating it to ascent rate and some individual factors.

Authors: Seol-Jung Kang, Gi-Chul Ha, & Kwang-Jun Ko. The present study aimed to investigate the association between metabolic syndrome and cardiorespiratory fitness according to the resting heart rate of Korean male adults..

Authors: Peter Germonpré & Costantino Balestra. Vascular gas emboli (VGE) are observed after asymptomatic scuba dives and are considered a key element in the potential development of decompression sickness (DCS). Diving is also accompanied by vascular dysfunction, as measured by flow-mediated dilation (FMD). Previous studies showed significant intersubject variability to VGE for the same diving exposure and demonstrated that VGE could be reduced with even a single pre-dive intervention. Several preconditioning methods have been reported recently, seemingly acting either on VGE quantity or inflammatory endothelial markers.

Authors: C. Walsh, N. Ovenden, E. Stride, & U. Cheemat. Understanding cell-bubble interactions is crucial for preventing bubble related pathologies and harnessing their potential therapeutic benefits. Bubbles can occur in the body as a result of therapeutic intravenous administration, surgery, infections or decompression. Subsequent interactions with living cells, may result in pathological responses such as decompression sickness (DCS). This work investigates the interactions that occur between bubbles formed during decompression and cells in a 3D engineered tissue phantom.

39 - Nanobubbles Form at Active Hydrophobic Spots on the Luminal Aspect of Blood Vessels: Consequences for Decompression Illness in Diving and Possible Implications for Autoimmune Disease - An Overview

Author: Ran Arieli It is known that nanobubbles form spontaneously when a smooth hydrophobic surface is submerged in water containing dissolved gas. These nanobubbles may be the long-sought-after gas micronuclei underlying decompression bubbles and DCI. The authors exposed hydrophobic and hydrophilic silicon wafers underwater to hyperbaric pressure. After decompression, bubbles appeared on the hydrophobic but not the hydrophilic wafers. In further experiments, the authors placed sizeable ovine blood vessels in a cooled high-pressure chamber at 1,000 kPa for about 20 h.

02 - Fluoxetine Protection in Decompression Sickness in Mice is Enhanced by Blocking TREK-1 Potassium Channel with the “spadin” Antidepressant

Authors: Nicolas Vallée, Kate Lambrechts, Sébastien De Maistre, Perrine Royal, Jean Mazella, Marc Borsotto, Catherine Heurteaux, Jacques Abraini, Jean-Jacques Risso, and Jean-Eric Blatteau This study was to analyze the states of mental fatigue based on electroencephalography (EEG) and investigate how physical activities affect mental fatigue. Fourteen healthy participants participated in an experiment including a 2-back mental task (the control) and the same mental task with cycling simultaneously (physical-mental task).

Authors: Br Vienke & T O’ Leary This short monogram details dive computers, operation, protocols, models, data, tests, risk and coupled applications. Basic diving principles are detailed with practical computer implementations. Topics are related to diving protocols and operational procedures. Tests and correlations of computer models with data are underscored. The exposition also links phase mechanics to decompression theory with equations used in computer syntheses.

Authors: Jacques H. Abraini, Hélène N. David, Nicolas Vallée, Jean- Jacques Risso The occurrence of paroxysmal narcotic episodes including psychotic-like symptoms in divers participating in experimental deep diving programs with various gas mixtures has constituted, beyond the classical symptoms of the high-pressure neurological syndrome, the major limitation for deep diving. With the development of new saturation deep diving programs and experiments by the eastern nations, such as India and China, the authors believed that it is of interest to examine what could be the ultimate depth that could be reached by saturation human divers.

08 - Symptomatic middle ear and cranial sinus Barotraumas as a complication of hyperbaric oxygen treatment.

Authors: Bengüsu Mirasoglu, Aslıcan Cakkalkurt, Maide Cimsit Hyperbaric oxygen therapy (HBOT) is applied to various diseases. It is generally considered safe but has some benign complications and adverse effects. The most common complication is middle ear barotrauma. This study aimed to collect data about the middle ear and cranial sinus barotraumas in our department and to evaluate factors affecting the occurrence of barotrauma.

Authors: Long Qing, Dinesh K. Ariyadewa, Hongjie Yi , Yewei Wang, Quan Zhou, and Weigang Xu. Skin lesions are visual clinical manifestations of decompression sickness (DCS). Comprehensive knowledge of skin lesions would give simple but strong clinical evidence to help diagnose DCS. The aim of this study was to systematically depict skin lesions and explore their pathophysiological basis in a swine DCS model.

Authors: Dor Vadas , Leonid Kalichman, Amir Hadanny , and Shai Efrati The Brain uses 20% of the total oxygen supply consumed by the entire body. Even though, < 10% of the brain is active at any given time, it utilizes almost all the oxygen delivered. In order to perform complex tasks or more than one task (multitasking), the oxygen supply is shifted from one brain region to another, via blood perfusion modulation. The aim of the present study was to evaluate whether a hyperbaric oxygen (HBO) environment, with increased oxygen supply to the brain, will enhance the performance of complex and/or multiple activities.

Authors: John P. Florian, Ki H. Chon, Luca Faes & Barbara E. Shykoff Physiological compensation to postural stress is weakened after long-duration water immersion (WI), thus predisposing individuals to orthostatic intolerance (*orthostatic refers to the inability to remain upright without symptoms). This study was conducted to compare hemodynamic responses to postural stress following exposure to WI alone (Air WI) and hyperbaric oxygen alone in a hyperbaric chamber (O 2 HC). WI combined with hyperbaric oxygen (O2 WI), all at a depth of 1.35 ATA, to determine whether hyperbaric oxygen is protective of orthostatic tolerance

27 - Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment

Authors: Daniel Mathieu, Alessandro Marroni and Jacek Kot The tenth European Consensus Conference on Hyperbaric Medicine took place in April 2016, attended by a large delegation of experts from Europe and elsewhere. The focus of the meeting was the revision of the European Committee on Hyperbaric Medicine (ECHM) list of accepted indications for hyperbaric oxygen treatment (HBOT), based on a thorough review of the best available research and evidence-based medicine (EBM)

Author: Barbara Shykoff This text has been published on the Shearwater website in May 2017 https://www.shearwater.com/ Direct link: https://www.shearwater.com/monthly-blog- posts/uptd-calculations-not-used/

Authors: Ruben Vandenbulcke, Bartel van Holsbeeck, Ilse Crevits, and Jesse Marrannes A 58-year-old woman visited our hospital’s emergency department because of severe and increasing pain over the right occipital region, irradiating over the right frontal area. The pain started during the descent of a jet airplane on a holiday trip. There were no visual or hearing deficits, head trauma, or epistaxis, and she experienced no difficulty clearing her ears during the flight. Only a minor respiratory tract infection was noted two weeks before this episode, and she had no history of sinus problems. The pain was nothing like the previous migraine headaches she had experienced.

Authors: Charles H. Van Wijk, Jarred H. Martin, Willem A.J. Meintjes This paper considers the relationship between measures of personality and mood states and susceptibility to inert gas narcosis. It briefly reviews the topics of inert gas narcosis affecting personality and personality affecting the susceptibility to inert gas narcosis. There appears to be a theoretical argument for a possible relationship between measures of personality, mood states, and susceptibility to narcosis. Practically, such a relationship may speak to selection, training and preparation issues, risk assessments, and even accident investigation in the diving and/or hyperbaric environment.

Authors: Sara Farshchi Zarabi, Matteo Parotto, Rita Katznelson, James Downar Air embolism into the systemic arterial circulation secondary to pulmonary barotrauma has rarely been reported. Herein, we report the clinical course of an extremely rare presentation of cerebral air embolism likely due to ruptured pulmonary bullae during commercial air travel.

Authors: Moritz F Meyer, Manuela Boor, Stefanie Jansen, Eberhard D Pracht , Moritz Felsch, Heinz D Klünter, Karl-Bernd Hüttenbrink, Dirk Beutner, Maria Grosheva In a prospective, observational trial, the authors investigated the feasibility of using the Eustachian tube function test (ETFT) to measure the effect of repetitive pressure exposure during open seawater dives on Eustachian tube function.

Authors: Moritz F Meyer, Manuela Boor, Stefanie Jansen, Eberhard D Pracht , Moritz Felsch, Heinz D Klünter, Karl-Bernd Hüttenbrink, Dirk Beutner, Maria Grosheva In a prospective, observational trial, the authors investigated the feasibility of using the Eustachian tube function test (ETFT) to measure the effect of repetitive pressure exposure during freshwater dives on Eustachian tube function.

Authors: Mark J Elder, John A Rawstron, Michael Davis Acute Retinal Artery Occlusion (ARAO) is a significant cause of sudden, painless visual loss, often leaving no useful vision in the affected eye. Its incidence is cited at 0.85 per 100,000 persons per year but may be higher because of under-reporting. The natural history is difficult to study, but a spontaneous resolution rate of < 1–8% for acute, non-arteritic ARAO has been cited. There is currently no consensus regarding the management of ARAO and little evidence to support any treatment modality. Despite only a limited case series, hyperbaric oxygen treatment (HBOT) is recommended for ARAO by the Undersea and Hyperbaric Medical Society (UHMS) and the European Committee for Hyperbaric Medicine.

Author: Charles H Van Wijk This paper provides a brief overview of the shift from studies describing the personality profiles of divers to studies exploring associations between personality variables and diving performance in terms of behavioural outcomes.

Author: Abraham L Querido Psychoactive drugs pose a risk to both the diver and his or her buddy. Little is known about the safety of diving with antidepressants. Amongst the potential interactions with the diving environment are: somnolence; convulsions; a bleeding tendency (potentially worsening decompression illness, DCI), alterations to glucose metabolism and psychiatric side effects. Fluoxetine may potentially reduce the inflammatory process associated with DCI. This article presents guidelines for recreational diving in combination with antidepressants.

Author: Michael FM Perez, Janet V Ongkeko-Perez, April R Serrano, Maravic P Andal, Maria CC Aldover Arterial gas embolism is a catastrophic event. Bubbles in the arterial circulation may lodge in the brain and cause infarction in the affected area and/or in a coronary vessel causing acute myocardial ischaemia. There is no well- defined window of time beyond which a response to hyperbaric oxygen is not expected. Major improvement may occur if the patient is treated as soon as possible, but is less likely in divers with severe decompression illness who have delayed intervention. We report on a 51-year- old, male rebreather diver who suffered loss of consciousness and cardiovascular collapse within minutes of a 30-metre deep dive at a remote Micronesian dive site.

Author: Jordan M Warchol, Jeffrey S Cooper, Thomas S Diesing Oxygen toxicity seizures are a well-known complication of hyperbaric oxygen treatment (HBOT). Until now, there have not been any reported cases of an acute ischaemic event (stroke) as the result of a HBOT-associated oxygen toxicity seizure. This document reports an event in which a seizure and stroke occurred together and consider that the stroke may have been caused by seizure-induced demand ischaemia.

Author: Lu Shi, Yan-meng Zhang, Katsuura Tetsuo, Zhong-yuan Shi, Yi-qun Fang, Petar J. Denoble, Yang-yang Li Experience with commercial heliox diving at high altitude is limited. The purpose of this study was to evaluate the effects of acute high-altitude exposure on fitness to dive and the safety of decompression after heliox diving while using U.S. Navy heliox decompression tables with Cross correction.

Authors: Jinqiang Zhu, Wanshan Song, Lin Li, and Xiang Fan. Endothelial nitric oxide (NO) is a significant signaling molecule that regulates cerebral blood flow (CBF), playing a pivotal role in the prevention and treatment of cerebrovascular diseases. However, achieving the expected therapeutic efficacy is difficult using direct administration of NO donors. Therefore, endothelial nitric oxide synthase (eNOS) becomes a potential therapeutic target for cerebrovascular diseases. This review summarizes the current evidence supporting the importance of CBF to cerebrovascular function, and the roles of NO and eNOS in CBF regulation.

Authors: Ben Aviner, Gideon Gradwohl, Alice Bliznyuk, Yoram Grossman Exposure to hyperbaric pressure (HP) exceeding 100 msw is known to cause a constellation of motor and cognitive impairments named high-pressure neurological syndrome (HPNS), considered to be the result of synaptic transmission alteration. Previous studies have indicated the modulation of presynaptic Ca2+ currents based on synaptic activity modified by HP. The authors shown that currents in genetically identified cellular voltage- dependent Ca2+ channels selectively affected by HP.

Authors: Jacky Lautridou, Vianney Pichereau, Sebastien Artigaud, Peter Buzzacott , Qiong Wang , Benoit Bernay, Sabrina Driad, Aleksandra Mazur, Kate Lambrechts, Michael Theron, & Francois Guerrero Decompression sickness (DCS) is a poorly understood systemic disease caused by inadequate desaturation following a reduction in ambient pressure. Although studies highlight the importance of circulating factors, the available data are still puzzling. In this study, we aimed to identify proteins and biological pathways involved in the development of DCS in rats.

Authors: D. Cialoni, M. Pieri, G. Giunchi, N. Sponsiello, A.M Lanzone, L. Torcello, G. Boaretto, A. Marroni Neurological symptoms after breath hold (BH) diving are often referred to as “Taravana” and considered a form of decompression sickness. However, the presence of “high” gas embolism after BH diving has never been clearly shown. This study showed high bubble formation after breath hold diving.

14 - Effects of heated and humidified high flow gases during high-intensity constant-load exercise on severe COPD patients with ventilatory limitation

Authors: Serena Cirio, Manuela Piran, Michele Vitacca, Giancarlo Piaggi, Piero Ceriana, Matteo Prazzoli, Mara Paneroni, Annalisa Carlucci) This document is to be read as support for the problem posed by too dry air and the importance of humidity in breathing.

17 - High Pressure and [Ca2+] Produce an Inverse Modulation of Synaptic Input Strength and Network Excitability in the Rat Dentate Gyrus

Authors: Thomas I. Talpalar, & Adolfo E. Talpalar Hyperbaric environments induce the high pressure neurological syndrome (HPNS) characterized by hyperexcitability of the central nervous system (CNS) and memory impairment. High pressure depresses synaptic transmission and alters its dynamics in various animal models. Medial perforant path (MPP) synapses connecting the medial entorhinal cortex with the hippocampal formation are suppressed by 50% at 10.1MPa. Reduction of synaptic inputs is paradoxically associated with enhanced ability of dentate gyrus (DG)’ granule cells (GCs) to generate spikes at high pressure.

Authors: Hilary F. Armstrong, Gina S. Lovasi, Elsayed Z. Soliman, Susan R. Heckbert, Bruce M. Psaty, John H.M. Austin, Jerry A. Krishnan, Eric A. Hoffman, Craig Johnson, Matthew J. Budoff, Karol E. Watson, R. Graham Barr Studies suggest an association between chronic obstructive pulmonary disease (COPD) and prolonged QT interval*. The authors tested the hypotheses that lower lung function and increased percent emphysema on computed tomography (CT) are associated with a prolonged QT interval in a general population sample and additionally in those with chronic obstructive pulmonary disease. *QT interval is a measurement made on an electrocardiogram (ECG) used to assess some of the electrical properties of the heart.

Authors: W. Oliver Tobin, Sean J. Pittock This article reviews the rapidly evolving spectrum of autoimmune neurologic disorders with a focus on those that involve the central nervous system, providing an understanding of how to approach the diagnostic workup of patients presenting with central nervous system symptoms or signs that could be immune mediated, either paraneoplastic or idiopathic, to guide therapeutic decision making.