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At least 721 records · Page 40Linked to original sources
PubMed2006

A personal experience with coronary artery bypass grafting, carotid patching, and other factors influencing the outcome of carotid endarterectomy.

OBJECTIVE: This study was conducted to investigate the influence of coronary artery bypass grafting (CABG), carotid patching, and other factors on the outcome of all carotid endarterectomies (CEAs) performed by a single surgeon at a tertiary referral center. METHODS: The series includes 2262 CEAs (335 bilateral) in 1521 men and 741 women (33%) with median ages of 66 and 68 years, respectively. Surgical indications were asymptomatic stenosis for 1503 procedures (66%), retinal ischemia or cerebral transient ischemic attacks each for 271 (12%), and prior stroke for 217 (9.6%). CEA was done as an isolated operation in 1959 patients and was performed in conjunction with simultaneous CABG in 303 (13%). Primary arteriotomy closure was used for 783 CEAs (35%), vein patching for 1232 (54%), and synthetic patching for 247 (11%). Outcome event rates were assessed by logistic regression analysis, proportional hazards models, and Kaplan-Meier estimations. RESULTS: Postoperative mortality (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.7 to 7.5; P = .001), stroke (OR, 3.2; 95% CI, 1.6 to 6.4; P = .001), and combined stroke and mortality rates (OR, 3.4; 95% CI, 2.0 to 5.8; P < .001) were significantly higher for simultaneous CEA/CABG than for isolated CEA. Ipsilateral postoperative stroke rates were similar (2.6% vs 1.7%, P = .41) in both settings. Vein patching had a lower risk for ipsilateral stroke (OR, 0.42; 95% CI, 0.21 to 0.86; P = .015) than primary closure, but was not significantly different from synthetic patching (P = .10). The documented incidence of postoperative carotid thrombosis was 1.5% with primary closure, 0.6% with vein patching, and 2.0% with synthetic patching (P = .088). Overall Kaplan-Meier survival was 92% at 1 year, 71% at 5 years, 41% at 10 years, and 20% at 15 years, but long-term mortality rates were higher after simultaneous CEA/CABG (hazard ratio, 1.3; 95% CI, 1.1 to 1.5; P = .002) than after CEA alone. Late strokes or retinal infarctions have been reported after 97 (5.0%) of the 1923 operations for which follow-up was available, 51 (2.3%) of which were ipsilateral to CEA. The incidence of > or = 60% recurrent stenosis was independently influenced by carotid patching (OR, 0.61; 95% CI, 0.40 to 0.92; P = .019) but not by the choice of patch material (P = .11). CONCLUSIONS: These results substantiate the common observation that patients who require simultaneous CEA/CABG have a higher risk for adverse outcomes than patients who undergo isolated CEA. Carotid patching provided significant benefit with respect to the risks for ipsilateral postoperative stroke and > or = 60% recurrent stenosis.

Aged↗
PubMed2005

Magnetic resonance for fluids in porous media at the University of Bologna.

The magnetic resonance in porous media (MRPM) community is now a vast community of scientists from all over the world who recognize magnetic resonance as an instrument of choice for the characterization of pore space and of the distribution, diffusion and flow of fluids inside a vast range of different materials. The MRPM conferences are the occasions in which this community gets together, compares notes and grows. The scene was different in 1990, when this series of conferences was promoted at Bologna. I will go briefly over the history of these events, showing the role played by the University of Bologna and in particular by the intuition, ingenuity and passion of Giulio Cesare Borgia. The MRPM work at Bologna began in the mid-1980s. New correlations were found among parameters from NMR relaxation measurements and oil field parameters such as porosity, permeability to fluid flow, irreducible water saturation, residual oil saturation and pore-system surface-to-volume ratio, and fast algorithms were developed to give the different NMR parameters. Interest in valid interpretation of data led to extensive work also on the inversion of multiexponential relaxation data and the effects of inhomogeneous fields from susceptibility differences on distributions of relaxation times. In the last few years, extensive developments were made of combined magnetic resonance imaging and relaxation measurements in different fields.

Algorithms↗
PubMed2004

Re-experiencing old memories via hippocampus: a PET study of autobiographical memory.

The time-scale of medial temporal lobe (MTL) involvement in storage and retrieval of episodic memory is keenly debated. To test competitive theories of long-term memory consolidation, the present work aimed at characterizing which cerebral regions are involved during retrieval of recent and remote strictly episodic autobiographical memory. Using positron emission tomography (PET), we examined mental retrieval of recent (0-1 year) and remote (5-10 years) autobiographical memories, controlling for the nature of the autobiographical memories (i.e., specificity, state of consciousness, vividness of mental visual imagery, emotion) retrieved during scanning by behavioral measures assessed at debriefing for each event recalled. Cognitive results showed that specificity and emotion did not change with time interval although both autonoetic consciousness and mental image quality were significantly higher for recent memories, suggesting an underlying shift in the phenomenal experience of remembering with the passage of time. The SPM analysis revealed common activations during the recollection of recent and remote memories that involved a widespread but mainly left-sided cerebral network, consistent with previous studies. Subtraction analysis demonstrated that the retrieval of recent (relative to remote) autobiographical memories principally activated the left dorsolateral prefrontal cortex whereas the retrieval of remote (relative to recent) autobiographical memories activated the inferior parietal cortex bilaterally. ROIs analysis revealed more hippocampal activity for remote memories than for recent ones and a preferentially right-sided involvement of the hippocampal responses whatever the remoteness of autobiographical memories. New insights based on higher hippocampal response to the remoteness of episodic autobiographical memories challenge the standard model and are less discrepant with the multiple trace theory.

Adult↗
PubMed2005

Intentional false responding shares neural substrates with response conflict and cognitive control.

The ability to deceive others is a high-level social and cognitive function. It has been suggested that response conflict and cognitive control increase during deceptive acts but this hypothesis has not been evaluated directly. Using fMRI, we tested this prediction for the execution of an intentional false response. Subjects were instructed to respond truthfully or falsely to a series of yes/no questions that were also varied in autobiographical and nonautobiographical content to further examine the influence of personal relevance when lying. We observed an interference effect (longer reaction times for false versus true responses) that was accompanied by increased activation within the anterior cingulate, caudate and thalamic nuclei, and dorsolateral prefrontal cortex (DLPFC), a circuit that has been implicated in response conflict and cognitive control. Behavioral and neural effects were more robust when falsifying autobiographical responses relative to nonautobiographical responses. Furthermore, a correlation between reaction time and left caudate activity supported the presence of increased response inhibition when falsifying responses. When presented with self-relevant (autobiographical) stimuli regardless of response condition, the mesial prefrontal and posterior cingulate cortices were recruited. Neural activity within these two regions and the anterior cingulate cortex (ACC) also showed correlations with self-report personality measures from the Psychopathic Personality Inventory (PPI). Overall, we conclude that the process of interference is inherent to the act of falsifying information and that the amount of conflict induced and cognitive control needed to successfully execute false responses is greater when dealing with personal information.

Adult↗
PubMed2005

Ecphory of autobiographical memories: an fMRI study of recent and remote memory retrieval.

Ecphory occurs when one recollects a past event cued by a trigger, such as a picture, odor, or name. It is a central component of autobiographical memory, which allows us to "travel mentally back in time" and re-experience specific events from our personal past. Using fMRI and focusing on the role of medial temporal lobe (MTL) structures, we investigated the brain bases of autobiographical memory and whether they change with the age of memories. Importantly, we used an ecphory task in which the remote character of the memories was ensured. The results showed that a large bilateral network supports autobiographical memory: temporal lobe, temporo-parieto-occipital junction, dorsal prefrontal cortex, medial frontal cortex, retrosplenial cortex and surrounding areas, and MTL structures. This network, including MTL structures, changed little with the age of the memories.

Adult↗
PubMed2006

Autobiographical memory in semantic dementia: implication for theories of limbic-neocortical interaction in remote memory.

We examined autobiographical memory performance in two patients with semantic dementia using a novel measure, the Autobiographical Interview [Levine, Svoboda, Hay, Winocur, & Moscovitch (2002). Aging and autobiographical memory: Dissociating episodic from semantic retrieval. Psychology and Aging, 17, 677-689], that is capable of dissociating episodic and personal semantic recall under varying levels of retrieval support. Earlier reports indicated that patients with semantic dementia demonstrate autobiographical episodic memory loss following a "reverse gradient" by which recent memories are preserved relative to remote memories. We found limited evidence for this pattern at conditions of low retrieval support. When structured probing was provided, patients' autobiographical memory performance was similar to that of controls. Retesting of one patient after 1 year indicated that retrieval support was insufficient to bolster performance following progressive prefrontal volume loss, as documented with quantified structural neuroimaging. These findings are discussed in relation to theories of limbic-neocortical interaction in autobiographical memory.

Adolescent↗
PubMed2006

The functional neuroanatomy of autobiographical memory: a meta-analysis.

Autobiographical memory (AM) entails a complex set of operations, including episodic memory, self-reflection, emotion, visual imagery, attention, executive functions, and semantic processes. The heterogeneous nature of AM poses significant challenges in capturing its behavioral and neuroanatomical correlates. Investigators have recently turned their attention to the functional neuroanatomy of AM. We used the effect-location method of meta-analysis to analyze data from 24 functional imaging studies of AM. The results indicated a core neural network of left-lateralized regions, including the medial and ventrolateral prefrontal, medial and lateral temporal and retrosplenial/posterior cingulate cortices, the temporoparietal junction and the cerebellum. Secondary and tertiary regions, less frequently reported in imaging studies of AM, are also identified. We examined the neural correlates of putative component processes in AM, including, executive functions, self-reflection, episodic remembering and visuospatial processing. We also separately analyzed the effect of select variables on the AM network across individual studies, including memory age, qualitative factors (personal significance, level of detail and vividness), semantic and emotional content, and the effect of reference conditions. We found that memory age effects on medial temporal lobe structures may be modulated by qualitative aspects of memory. Studies using rest as a control task masked process-specific components of the AM neural network. Our findings support a neural distinction between episodic and semantic memory in AM. Finally, emotional events produced a shift in lateralization of the AM network with activation observed in emotion-centered regions and deactivation (or lack of activation) observed in regions associated with cognitive processes.

Autobiographies as Topic↗
PubMed2006

Remembering the past and imagining the future: common and distinct neural substrates during event construction and elaboration.

People can consciously re-experience past events and pre-experience possible future events. This fMRI study examined the neural regions mediating the construction and elaboration of past and future events. Participants were cued with a noun for 20s and instructed to construct a past or future event within a specified time period (week, year, 5-20 years). Once participants had the event in mind, they made a button press and for the remainder of the 20s elaborated on the event. Importantly, all events generated were episodic and did not differ on a number of phenomenological qualities (detail, emotionality, personal significance, field/observer perspective). Conjunction analyses indicated the left hippocampus was commonly engaged by past and future event construction, along with posterior visuospatial regions, but considerable neural differentiation was also observed during the construction phase. Future events recruited regions involved in prospective thinking and generation processes, specifically right frontopolar cortex and left ventrolateral prefrontal cortex, respectively. Furthermore, future event construction uniquely engaged the right hippocampus, possibly as a response to the novelty of these events. In contrast to the construction phase, elaboration was characterized by remarkable overlap in regions comprising the autobiographical memory retrieval network, attributable to the common processes engaged during elaboration, including self-referential processing, contextual and episodic imagery. This striking neural overlap is consistent with findings that amnesic patients exhibit deficits in both past and future thinking, and confirms that the episodic system contributes importantly to imagining the future.

Adolescent↗
PubMed2004

Stress, hormones and disease.

My postdoctoral training under Dr. Gerard Smith began me on a lifetime of investigation on the role of stress, hormones, and disease. The first set of experiments asked what hormone, if any, best reflected the range of aroused behaviors. We found that catecholamines performed substantially better than glucocorticoids did, despite the belief that glucocorticoids were sensitive indices of stress. But we also learned that hormones themselves were nowhere near as good in monitoring stress than motor behaviors were. In a second set of experiments, we tried to understand how stress affected medical disease. We learned that stress can produce disease in a healthy organism but has its most profound effects when disease already exists. Finally, in the early 1990s, I shifted my focus on stress and disease to a broader problem in behavioral medicine, namely, medically unexplained fatigue and pain. Among the studies we have done investigating these disorders, we looked specifically at veterans of the first Gulf War--many of whom developed problems with severe fatigue. A critical question in the literature asked if unexplained fatigue was simply a physical component of concurrent posttraumatic stress disorder (PTSD). In a large epidemiological study, we found that PTSD tracked stressor intensity in a stepwise fashion, while fatiguing illness increased with stressor intensity only on the milder side of the intensity spectrum. This result indicated that the two ailments are both stress sensitive but dissimilar.

Animals↗
PubMed2006

Is chronic widespread pain biographically disruptive?

This article draws on findings from a study of eight people (aged 40-60) with chronic widespread pain and their families, living in the West Midlands area of the UK. Data were generated through a series of in-depth interviews, based on a lifegrid and on participants' diaries. We explore the experience of chronic widespread pain in the context of sufferers' biographies, examining how people attempt to account for and give meaning to their pain onset and development and how they remake identity following disruption to their lives. We use these accounts to consider whether chronic widespread pain is biographically disruptive, or whether any of the alternative notions better describe the experience. We conclude that the consideration of context in biographical disruption should extend to lifestage and perceived life expectancy.

Adaptation, Psychological↗
PubMed2004

Historical review: Deciphering the genetic code--a personal account.

This is an autobiographical description of the events that led to the breaking of the genetic code and the subsequent race to decipher the code. The code was deciphered in two stages over a five-year period between 1961 and 1966. During the first stage, the base compositions of codons were deciphered by the directing cell-free protein synthesis with randomly ordered RNA preparations. During the second phase, the nucleotide sequences of RNA codons were deciphered by determining the species of aminoacyl-tRNA that bound to ribosomes in response to trinucleotides of known sequence. Views on general topics such as how to pick a research problem and competition versus collaboration also are discussed.

Genetic Code↗
PubMed2003

Nursing abroad stirs the soul.

After establishing herself in her career as a perioperative nurse and ensuring her grown children were settled, this author pursued her dream of working abroad as a nurse. She chose to work in Pakistan, which is where her father was born. Her experiences there gave her a new appreciation for the help that perioperative nurses can offer to the citizens of developing countries.

Culture↗