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PubMed2003

Intraoperative parathyroid hormone testing: what have we learned?

OBJECTIVES/HYPOTHESIS: The development of rapid, sensitive assays for measuring the intact parathyroid hormone (iPTH) molecule has the potential to allow the surgeon to determine the success of parathyroid surgery intraoperatively. The purpose of the study was to review our results in the context of currently held beliefs regarding the ability of the intraoperative iPTH to predict resolution of hyperparathyroidism. STUDY DESIGN: Retrospective review. METHODS: The study series is a retrospective review of 107 consecutive parathyroidectomies performed by a single surgeon. Patients with primary, secondary, and tertiary hyperparathyroidism were included. RESULTS: The intraoperative assay allowed an overall success rate of 93.4% across all patient categories. The success rate in patients with primary hyperparathyroidism was 95.7%. Measuring the iPTH level at 10 versus 15 minutes after the removal of tissue did not significantly affect the predictive value of the test. A decrease of 50% in the iPTH level after the resection of hyperfunctioning tissue was prognostic of successful treatment of the hyperparathyroid state. By contrast, a postexcision iPTH level that was within the normal range was not always predictive of cure. CONCLUSIONS: The intraoperative iPTH assay is particularly useful in the treatment of primary hyperparathyroidism. The assay eliminates the need for intraoperative frozen-section analysis in most cases and allows the surgeon to perform limited resections with confidence. This is especially true in complicated parathyroid surgeries, such as revision surgeries or those requiring concomitant thyroid surgery. The assay is also useful in secondary hyperparathyroidism, although it appears that the inability to identify small nonfunctional or hypofunctional supernumerary parathyroid glands means that long-term normocalcemia may not be assured.

Adenoma↗
PubMed2003

Differential cortical and subcortical activations in learning rotations and gains for reaching: a PET study.

Previous studies suggest that horizontal reaching movements are planned vectorially with independent specification of direction and extent. The transformation from visual to hand-centered coordinates requires the learning of a task-specific reference frame and scaling factor. We studied learning of a novel reference frame by imposing a screen-cursor rotation and learning of a scaling factor by imposing a novel gain. Previous work demonstrates that rotation and gain learning have different time courses and patterns of generalization. Here we used PET to identify and compare brain areas activated during rotation and gain learning, with a baseline motor-execution task as the subtracted control. Previous work has shown that the time courses of rotation and gain adaptation have a short rapid phase followed by a longer slow phase. We therefore also sought to compare activations associated with the rapid and slower phases of adaptation. We isolated the rapid phase by alternating opposite values of the rotation or gain every 16 movements. The rapid phase of rotation adaptation activated the preSMA. More complete adaptation to the rotation activated right ventral premotor cortex, right posterior parietal cortex, and the left lateral cerebellum. The rapid phase of gain learning only activated subcortical structures: bilateral putamen and left cerebellum. More complete gain learning failed to show any significant activation. We conclude that the time course of rotation adaptation is paralleled by a frontoparietal shift in activated cortical regions. In contrast, early gain adaptation involves only subcortical structures, which we suggest reflects a more automatic process of contextual recalibration of a scaling factor.

Adaptation, Physiological↗
PubMedDate not supplied

Neuromotor profiles: what are they and what can we learn from them?

Eye movements, alternating movements, rapid pointing movements, and various tremors were measured on patients with Parkinson's disease (n = 21), on Cree subjects exposed to methylmercury (n = 36), and on healthy control subjects (n = 30). Neuromotor profiles were created according to thirty characteristics extracted from test results of four subgroups matched for age and composed of six subjects each. Z scores were calculated with respect to the mean and standard deviation of the control group for each of the 30 characteristics. The subgroup with the lower methylmercury blood level had larger z scores than the control subgroup and with a few positive values above one standard deviation. The subgroup with the higher methylmercury blood level had several z scores above two standard deviations. Interestingly, the abnormal values for the subgroup with Parkinson's disease were mostly limited to static tremor recorded with no visual feedback and reached up to 5 standard deviations. These results indicate that neuromotor profiles can be used to summarize information extracted from different neuromotor tests and to differentiate neurological conditions.

Eye Movements↗
PubMedDate not supplied

[Is there a learning curve for laparoscopic cholecystectomy ?].

UNLABELLED: The use of laparoscopic surgery it is growing rapidly in Romania. We have tried to find if a learning curve for laparoscopic cholecystectomy exists and we have evaluated our training program to insure the quality of health care. METHODS: There where analyzed 2585 procedures performed by 22 surgeons. The relationship between operative incidents/accidents and laparoscopic experience was evaluated. With a regression model we have find the tendency of these relationship. RESULTS: Surgeons appear to learn this procedure rapidly. CONCLUSIONS: Training curses with hands-on experience with animal models and proctoring from an experienced laparoscopist at the first 30 operations is needed, for each individual surgeon, to insure the quality of health care.

Animals↗
PubMed1989

REM sleep modifications following a Morse code learning session in humans.

Various experimental data indicate that rapid eye movement (REM) sleep is involved in learning processes. In animals, any complex task in a learning environment leads to an increase of the consecutive total REM sleep time, especially just before learning completion. In humans, the oculomotor activity during REM sleep seems to constitute an interesting marker of learning performance. In this work, we focus on the qualitative analysis of REM sleep characteristics after a Morse code learning session. Eight male subjects were polygraphically recorded during three consecutive nights. A computer aided teaching session was performed just before bedrest onset of the experimental night. The learning performance (percentage of saving) was checked on awakening. The Morse code learning led to some modifications in REM sleep components, particularly increases of REM sleep time and number of REM episodes. We did not observe any significant modification in the total number of REMs in the experimental night. However, the correlative analysis between learning performance and sleep parameters indicates a superior r for the oculomotor activity than for the tonic components. This is consistent with the information processing hypothesis in which the temporal distribution of REMs reflects the subject's ability to increase the signal-noise ratio from environmental information intake.

Adolescent↗
PubMed2004

Infants can rapidly form new categorical representations.

Young infants learn common categorical distinctions, such as animals versus vehicles. But can they, like adults, rapidly form new categories, such as black-and-white animals? To answer this question, 6-, 10-, and 13-month-old infants were familiarized with four land animals that were black and white in coloring (e.g., a zebra and a black-and-white tiger) and then were tested with novel animals and a truck. The infants responded to an exclusive category that apparently included only black-and-white animals, suggesting that they formed a new categorical representation during familiarization. A comparison group of infants familiarized with a set of land animals that were more variable in coloring (e.g., a pale yellow horse and a yellow-and-brown tiger) formed a very general categorical representation that included many different kinds of animals, regardless of coloring. Therefore, like adults, infants rapidly form new categorical representations in response to the context.

Child Development↗
PubMed1978

Visual discrimination following partial telencephalic ablations in nurse sharks (Ginglymostoma cirratum).

An instrumental conditioning task was used to examine the role of the nurse shark telencephalon in black-white (BW) and horizontal-vertical stripes (HV) discrimination performance. In the first experiment, subjects initially received either bilateral anterior telencephalic control lesions or bilateral posterior telencephalic lesions aimed at destroying the central telencephalic nuclei (CN), which are known to receive direct input from the thalamic visual area. Postoperatively, the sharks were trained first on BW and then on HV. Those with anterior lesions learned both tasks as rapidly as unoperated subjects. Those with posterior lesions exhibited visual discrimination deficits related to the amount of damage to the CN and its connecting pathways. Severe damage resulted in an inability to learn either task but caused no impairments in motivation or general learning ability. In the second experiment, the sharks were first trained on BW and HV and then operated. Suction ablations were used to remove various portions of the CN. Sharks with 10% or less damage to the CN retained the preoperatively acquired discriminations almost perfectly. Those with 11-50% damage had to be retrained on both tasks. Almost total removal of the CN produced behavioral indications of blindness along with an inability to perform above the chance level on BW despite excellent retention of both discriminations over a 28-day period before surgery. It appears, however, that such sharks can still detect light. These results implicate the central telencephalic nuclei in the control of visually guided behavior in sharks.

Animals↗
PubMed1981

An impulse-timing theory for reciprocal control of muscular activity in rapid, discrete movements.

Much remains to be learned about how agonist and antagonist muscles are controlled during the production of rapid, voluntary movements. In an effort to summarize a wide body of existing knowledge and stimulate future research on this subject, an impulse-timing theory is presented which attempts to predict the activity of reciprocal muscles based on certain characteristics of a movement. The basic tenet of the theory is that variables of movement time, movement distance and inertial load have fairly predictable effects on the underlying muscular activity of the agonist and antagonist muscles during the production of rapid and discrete, voluntary movements. The theory is derived from the kinematic work of Schmidt, Zelaznik, Hawkins, Frank and Quinn (1979) and supporting evidence from studies which have used electromyographic (EMG) recordings of agonist and antagonist muscles during rapid movements. Issues related to synergistic muscle control, central and peripheral control of reciprocal muscle activity, muscle control, and neurological disorder and the relationship between impulse-timing and mass-spring control are discussed in the final section.

Journal Article↗
PubMed2006

Learning in context: linguistic and attentional constraints on children's color term learning.

Three experiments investigated whether linguistic and/or attentional constraints might account for preschoolers' difficulties when learning color terms. Task structure and demands were equated across experiments, and both speed and degree of learning were compared. In Experiment 1, 3-year-olds who were matched on vocabulary score were taught new secondary color terms by corrective, semantic, or referential linguistic contrast. Corrective contrast produced more rapid and more extensive learning than did either semantic or referential contrast, supporting the hypothesis that targeted linguistic feedback facilitates learning. Experiment 2 replicated and extended the first experiment with Italian children and found cross-cultural differences in the amount learned about colors named differently in the two languages. In Experiment 3, some of the children were introduced to the new terms within a context of enhanced perceptual salience. These children learned as fast and performed as accurately as those given corrective linguistic feedback in Experiment 1.

Attention↗
PubMed2025

Rapid assessment of clinical severity for salmonellosis cases via protein family domain analysis and machine learning.

Salmonella is a common pathogen, infecting more than a million people yearly. Rapid assessment of clinical case severity is essential for improving patient outcomes and optimizing healthcare resources. Advancements in genome sequencing technologies have enabled the analysis of bacterial genomes from many clinical cases, opening up new opportunities for precise and timely diagnosis. This study proposes a genome-based framework for identifying critical Salmonella cases before the onset of critical symptoms and facilitating early medical intervention. By leveraging protein family (Pfam) domains as the representation for genomic data, the complex genetic profiles of Salmonella cases are simplified into interpretable features. The severity levels of cases were investigated through rigorous data analysis, resulting in a set of 70 Pfam domains that could be potentially used as biomarkers. Machine Learning was employed to assess the predictive power of the curated Pfam biomarkers, achieving high accuracy (~93%) in sorting cases into critical, moderate, and mild categories. The results demonstrate the efficacy of the proposed approach. This framework highlights the potential of using bacterial genomic data in clinical decision-making, opening the window for timely personalized interventions for Salmonella infection management.

Domains of unknown function (DUFs)↗
PubMed1996

Assessment of technical competence during ERCP training.

BACKGROUND: Successful performance of diagnostic and therapeutic ERCP requires skillful manipulation of the duodenoscope and accessories. The evaluation process for assessing competency is still in evolution. Recommendations for the number of examinations has ranged from 35 to 200, made without the benefit of prospective data. METHODS: Pancreatic and common bile duct cannulation rates were prospectively recorded for 21 trainees and 9 proctors over 6 years in a large university-based training program. Trainee success rates were compared to those of the proctor and learning curves were constructed. RESULTS: Trainees performed 641 examinations over 6 years. Each did an average of 31 examinations (range, 10 to 96). For both pancreatic duct and common bile duct cannulation, there was a rapid linear rise of the success curve extending up to the fortieth procedure. Pancreatic duct cannulation rates exceeded those of the common bile duct. CONCLUSIONS: This is the first prospective evaluation of acquisition of skills in ERCP. Although the rapid rise of the learning curve ends at the fortieth examination, the 85% level of selective cannulation is not reached for the pancreas duct until the seventieth procedure and is not reached for the common bile duct even at 100 procedures. These data suggest a threshold of at least 100 procedures.

Biliary Tract Diseases↗
PubMed1983

Information processed from brief visual displays by learning-disabled boys.

The spans of apprehension of learning-disabled and normal boys were compared by means of a forced-choice letter-recognition task involving tachistoscopic exposures of letter displays. This task provides an estimate of the span that is relatively insensitive to memory or motivational influences. In Experiment 1, the spans of learning-disabled and normal boys were compared under 4 information conditions: with no noise letters present or with 2, 4, or 8 noise letters present. Experiments 2-4 examined 3 possible interpretations of the deficit in the span of apprehension observed for learning-disabled boys in Experiment 1. In Experiment 2, the possibility that the noise letters were more distracting for learning-disabled boys was examined by varying the amount of physical similarity and redundancy between the signal and noise letters. In Experiment 3, the possibility that the visual afterimage of the letter displays faded more rapidly for the learning-disabled boys was examined. In Experiment 4, the possibility that the learning-disabled boys were slower to pick up information from the decaying afterimages was examined. The results of these three experiments indicated that the decreased spans of apprehension observed for the learning-disabled boys in Experiment 1 resulted either from greater distractiveness or from the slower pickup of information, or both. The implications for visual training are discussed.

Attention↗
PubMed2006

A rapid review of rapid HIV antibody tests.

Rapid HIV antibody tests recently approved by the Food and Drug Administration can help reduce unrecognized infections by improving access to testing in both clinical and nonclinical settings and increase the proportion of those tested who learn their results. Four rapid HIV antibody tests are now available in the United States; two are approved for use at point-of-care sites outside a traditional laboratory. All four tests are interpreted visually. Sites offering rapid HIV testing must periodically run external controls (known HIV-positive and HIV-negative specimens) and provide persons who undergo rapid testing a subject information sheet. This paper reviews the operating and performance characteristics, quality assurance and laboratory requirements, and HIV counseling implications of the currently available rapid HIV tests.

Journal Article↗
PubMed1981

Hidden memory: a rapid method for the study of amnesia using perceptual learning.

Performance on finding hidden figures in a set of picture-puzzles is shown to separate out autobiographical memory and perceptual learning in a group of male neurosurgical patients. Two traumatic amnesics had normal perceptual learning without ability to recognize which pictures they had seen before. The method may be used in the study of transient amnesias of very short duration.

Adolescent↗
PubMed1998

Facilitation of acquisition and performance of operant and spatial learning tasks in self-stimulation experienced rats.

Adult male Wistar rats were implanted bilateraly with bipolar electrodes in substantia nigra-ventral tegmental area (SN-VTA) to experience intracranial self-stimulation (ICSS) for 15 min per day over a period of 10 days. These rats were then assessed for the acquisition and performance of the operant and the spatial learning tasks. ICSS experienced rats showed rapid acquisition of both the operant and the spatial learning tasks. Both the lever press performance for 7 sessions in the operant learning task and mean number of alternations per session in the spatial learning task were significantly higher (p < .001) in ICSS experienced rats compared with controls. The results suggest that prior ICSS experience facilitates the acquisition and performance in both the operant and the spatial learning tasks, which may be due to the structural and neurochemical alterations in the hippocampus induced by ICSS experience.

Analysis of Variance↗
PubMed2006

Brain structure predicts the learning of foreign speech sounds.

Previous work has shown a relationship between parietal lobe anatomy and nonnative speech sound learning. We scanned a new group of phonetic learners using structural magnetic resonance imaging and diffusion tensor imaging. Voxel-based morphometry indicated higher white matter (WM) density in left Heschl's gyrus (HG) in faster compared with slower learners, and manual segmentation of this structure confirmed that the WM volume of left HG is larger in the former compared with the latter group. This finding was replicated in a reanalysis of the original groups tested in Golestani and others (2002, Anatomical correlates of learning novel speech sounds. Neuron 35:997-1010). We also found that faster learners have a greater asymmetry (left > right) in parietal lobe volumes than slower learners and that the right insula and HG are more superiorly located in slower compared with faster learners. These results suggest that left auditory cortex WM anatomy, which likely reflects auditory processing efficiency, partly predicts individual differences in an aspect of language learning that relies on rapid temporal processing. It also appears that a global displacement of components of a right hemispheric language network, possibly reflecting individual differences in the functional anatomy and lateralization of language processing, is predictive of speech sound learning.

Adolescent↗
PubMed2005

Distinguishable brain activation networks for short- and long-term motor skill learning.

The acquisition of a new motor skill is characterized first by a short-term, fast learning stage in which performance improves rapidly, and subsequently by a long-term, slower learning stage in which additional performance gains are incremental. Previous functional imaging studies have suggested that distinct brain networks mediate these two stages of learning, but direct comparisons using the same task have not been performed. Here we used a task in which subjects learn to track a continuous 8-s sequence demanding variable isometric force development between the fingers and thumb of the dominant, right hand. Learning-associated changes in brain activation were characterized using functional MRI (fMRI) during short-term learning of a novel sequence, during short-term learning after prior, brief exposure to the sequence, and over long-term (3 wk) training in the task. Short-term learning was associated with decreases in activity in the dorsolateral prefrontal, anterior cingulate, posterior parietal, primary motor, and cerebellar cortex, and with increased activation in the right cerebellar dentate nucleus, the left putamen, and left thalamus. Prefrontal, parietal, and cerebellar cortical changes were not apparent with short-term learning after prior exposure to the sequence. With long-term learning, increases in activity were found in the left primary somatosensory and motor cortex and in the right putamen. Our observations extend previous work suggesting that distinguishable networks are recruited during the different phases of motor learning. While short-term motor skill learning seems associated primarily with activation in a cortical network specific for the learned movements, long-term learning involves increased activation of a bihemispheric cortical-subcortical network in a pattern suggesting "plastic" development of new representations for both motor output and somatosensory afferent information.

Adult↗
PubMed2005

Cortisol, contingency learning, and memory in preterm and full-term infants.

Cortisol plays an important role in learning and memory. An inverted-U shaped function has been proposed to account for the positive and negative effects of cortisol on cognitive performance and memory in adults, such that too little or too much impair but moderate amounts facilitate performance. Whether such relationships between cortisol and mental function apply to early infancy, when cortisol secretion, learning, and memory undergo rapid developmental changes, is unknown. We compared relationships between learning/memory and cortisol in preterm and full-term infants and examined whether a greater risk for adrenal insufficiency associated with prematurity produces differential cortisol-memory relationships. Learning in three-month old (corrected for gestational age) preterm and full-term infants was evaluated using a conjugate reinforcement mobile task. Memory was tested by repeating the same task 24h later. Salivary cortisol samples were collected before and 20 min after the presentation of the mobile. We found that preterm infants had lower cortisol levels and smaller cortisol responses than full-term infants. This is consistent with relative adrenal insufficiency reported in the neonatal period. Infants who showed increased cortisol levels from 0 to 20 min on Day 1 had significantly better memory, regardless of prematurity, than infants who showed decreased cortisol levels.

Female↗