PURPOSEIt is becoming increasingly clear that genetic factors play a role in traumatic brain injury (TBI), whether in modifying clinical outcome after TBI or determining susceptibility to it. MicroRNAs are small RNA molecules involved in various pathophysiological processes by repressing target genes at the post- transcriptional level, and TBI alters microRNA expression levels in the hippocampus and cortex. This study was designed to detect differentially expressed microRNAs in the cerebrospinal fluid (CSF) of TBI patients remaining unconscious two weeks after initial injury and to explore related single nucleotide polymorphisms (SNPs).

METHODSWe used a microarray platform to detect differential microRNA expression levels in CSF samples from patients with post-traumatic coma compared with samples from controls. A bioinformatic scan was performed covering microRNA gene promoter regions to identify potential functional SNPs.

RESULTSTotally 26 coma patients and 21 controls were included in this study, with similar distribution of age and gender between the two groups. Microarray showed that fourteen microRNAs were differentially expressed, ten at higher and four at lower expression levels in CSF of traumatic coma patients compared with controls (p<0.05). One SNP (rs11851174 allele: C/T) was identified in the motif area of the microRNA hsa-miR-431-3P gene promoter region.

CONCLUSIONThe altered microRNA expression levels in CSF after brain injury together with SNP identified within the microRNA gene promoter area provide a new perspective on the mechanism of impaired consciousness after TBI. Further studies are needed to explore the association between the specific microRNAs and their related SNPs with post-traumatic unconsciousness.

Adult ; Brain Injuries, Traumatic ; cerebrospinal fluid ; genetics ; Computational Biology ; Humans ; Male ; MicroRNAs ; cerebrospinal fluid ; genetics ; Middle Aged ; Polymorphism, Single Nucleotide ; Unconscious (Psychology)

BACKGROUND/AIMS: Upper gastrointestinal symptoms are more frequent and severe in female than in male outpatients in Japan. This study compared the upper gastrointestinal symptoms between healthy male and female young adult volunteers using a questionnaire. METHODS: In total, 581 third-grade medical students at Saga Medical School aged 22 to 30 years underwent upper gastrointestinal endoscopy and completed a questionnaire (frequency scale for symptoms of gastroesophageal reflux disease) from 2007 to 2013. Of these 581 students, 298 who were negative for Helicobacter pylori infection and had no particular lesions on endoscopic examination were enrolled in the present evaluation. A symptom was defined as positive when the subject evaluated the frequency of the symptom as sometimes, often, or always. RESULTS: The subjects comprised of 163 males (average age, 23.7 years) and 135 females (average age, 23.1 years). Upper gastrointestinal symptoms were more frequent in the females (75 of 135, 55.6%) than males (69 of 163, 42.3%; P < 0.05), with a high score for 4 symptoms (bloated stomach, heavy feeling in the stomach after meals, subconscious rubbing of the chest with the hand, and feeling of fullness while eating meals). Of the 144 subjects (69 males and 75 females) who complained of these symptoms, the females complained of dysmotility symptoms more often than did the males, but this was not true for reflux symptoms. CONCLUSIONS: This study suggests that females develop upper gastrointestinal symptoms more frequently than do males among the young healthy Japanese population.
Asian Continental Ancestry Group* ; Dyspepsia ; Eating ; Endoscopy ; Endoscopy, Gastrointestinal ; Esophagitis ; Female* ; Gastroesophageal Reflux ; Gastrointestinal Motility ; Hand ; Helicobacter pylori ; Humans ; Japan ; Male* ; Meals ; Outpatients ; Schools, Medical ; Stomach ; Students, Medical ; Thorax ; Unconscious (Psychology) ; Volunteers* ; Young Adult

No abstract available.
Learning* ; Social Media* ; Unconscious (Psychology)*

Acute compartment syndrome of the lower leg and foot is a surgical emergency. The clinical symptoms is an important clue to diagnose compartment syndrome. In cases of ambiguous diagnosis, unconscious patients and children additionally need a intracompartmental pressure measuring. Immediate fasciotomy should be performed when clinical signs are obvious or when delta pressure is less than 30 mmHg or intracompartmental pressure is greater than 30 mmHg. Fasciotomy of the lower leg can be performed either by one lateral single incision or double incision, which of the foot mainly has a dorsal or medial incision. A delayed in diagnosis that leads to a delay in treatment can result in devastating disability. Acute compartment syndrome of the lower leg and foot is a relative rare but serious complication of which a surgeon should be aware.
Child ; Compartment Syndromes ; Emergencies ; Foot ; Humans ; Leg ; Unconscious (Psychology)

Fisting is an uncommon sexual activity, and death due to fisting is very rare. In the present report, we describe a case of a woman who died from fisting by her male partner. A 38-year-old woman went to a motel with a man after consuming alcohol, and there they kissed each other. As desired by woman, the man inserted his fingers into her vagina and anus, and later inserted his fist and forearm into her vagina and anus. After 20-30 minutes of fisting, the woman became unconscious and died. The autopsy confirmed the presence of perineal and vaginal lacerations with massive internal pelvic soft tissue injury with uterine artery rupture. A partial tear was noted at the rectosigmoid junction. The cause of death was hypovolemic shock due to uterine artery rupture. Following court trials, the assailant was sentenced to 4 years of imprisonment for the felony of inflicting bodily injury resulting in death.
Anal Canal ; Autopsy ; Cause of Death ; Female ; Fingers ; Forearm ; Humans ; Lacerations ; Male ; Rupture ; Sexual Behavior ; Shock ; Soft Tissue Injuries ; Unconscious (Psychology) ; Uterine Artery ; Vagina

Takayasu's arteritis (TA) is a chronic inflammatory disease involving the aorta. Because TA sometimes involves cerebral arteries, anesthetic debates focus on cerebral monitoring. There is limited evidence as to which cerebral monitoring method is most adequate. Furthermore, there is insufficient evidence to determine which anesthetic technique is better for TA parturients. We experienced the case of a TA parturient who developed transient cerebral ischemia during cesarean section. The patient's TA involved her cerebral arteries, and her regional cerebral oxygen saturation (rSO2) was lower in the left side than in the right side. She complained of speech impairment, tinnitus, and stiffness of the posterior neck when the rSO2 levels dropped. The FloTrac/Vigileo(TM) system did not correlate with clinical symptoms, but the cerebral oximeter displayed the low oxygen saturation. We recommend the cerebral oximetry for cerebral monitoring in TA parturients who undergo cesarean sections, especially in hemodynamically unstable patients under regional anesthesia or unconscious patients under general anesthesia.
Anesthesia, Conduction ; Anesthesia, Epidural ; Anesthesia, General ; Aorta ; Cerebral Arteries ; Cesarean Section ; Female ; Humans ; Ischemic Attack, Transient ; Neck ; Oximetry ; Oxygen ; Pregnancy ; Spectroscopy, Near-Infrared ; Takayasu Arteritis ; Tinnitus ; Unconscious (Psychology)

Insulinoma is a rare endocrine tumor that frequently causes neurologic symptoms. We report a case of a 17-year-old man with hypersomnia and abnormal behavior lasting for 10 months. He had recurrent attacks of hypersomnia that lasted for up to 36 hours and of unconscious wandering mimicking an ictal or postictal state. Hypoglycemia was documented (30 mg/dL) and insulinoma was found at the most-recent episode. Clinicians should be aware that hypersomnia and unconscious wandering can present in association with hypoglycemia.
Adolescent ; Disorders of Excessive Somnolence ; Humans ; Hypoglycemia ; Insulinoma ; Neurologic Manifestations ; Unconscious (Psychology)

PURPOSE: The purpose of this study is to understand family members' experience of deciding to withdraw life-sustaining treatments for terminally-ill patients in an unconscious state. METHODS: Data were collected by performing an in-depth interview with eight terminally-ill patients' family members who decided to withdraw life-sustaining treatments. Colaizzi's phenomenological method was used for data analysis. RESULTS: Questions were classified into 12 groups and finally into five categories. The five categories were about family members' frustration with patient's condition, emotional preparation for the patient's death upon medical professionals' recommendation, patient's wishes, exhaustion due to caring and past experiences related to life-sustaining treatment. CONCLUSION: Using the five categories, hospice and palliative professionals could better understand family members' decision making experience of withdrawing life-sustaining treatments for terminally-ill patients. Based on that, the family members could be provided with appropriate counseling and care, which in turn could improve hospice and palliative care intervention.
Counseling ; Decision Making ; Frustration ; Hospices ; Humans ; Palliative Care ; Qualitative Research ; Terminally Ill ; Unconscious (Psychology) ; Unconsciousness ; Withholding Treatment

PURPOSE: Rapid and noninvasive detection of increased intracranial pressure (IICP) is important in evaluating a clinically unstable, unconscious patient. The purpose of this study was to measure the mean intraocular pressure (IOP) of patients with intracranial hemorrhage and correlate the results to the variable clinical features associated with intracranial hemorrhage. METHODS: Patients admitted to the emergency department were sorted into two groups based on their IOP results as measured using a Tono-Pen. The hemorrhage group consisted of patients suffering with intracranial hemorrhage and the normal group consisted of patients without intracranial hemorrhage. Patients with glaucoma or trauma of the ocular or facial area were excluded from this study. RESULTS: Mean IOP (30.45+/-9.13 mmHg) of the hemorrhage group (52 patients, 34 male, 18 female, mean age 58.28+/-14.39 years) was higher than the mean IOP (16.14+/-2.24 mmHg) of the normal group (39 patients, 23 male, 16 female, mean age 52.69+/-17.79 years) (p<0.001). Whether or not the intracranial hemorrhage was traumatic or nontraumatic, severe, or mild to moderate, accompanied with IICP or non-IICP, requiring an emergency or non-emergency operation, the IOP measured did not show any statistical significance. CONCLUSION: The IOP of the hemorrhage group was higher than the IOP of the normal group, but to determine the clinical usefulness of this measurement when accompanying presentation of headache or traumatic brain injury in the emergency department will require further investigation.
Brain ; Brain Injuries ; Emergencies ; Female ; Glaucoma ; Headache ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Intracranial Pressure ; Intraocular Pressure ; Male ; Manometry ; Stress, Psychological ; Unconscious (Psychology)

PURPOSE: Rapid and noninvasive detection of increased intracranial pressure (IICP) is important in evaluating a clinically unstable, unconscious patient. The purpose of this study was to measure the mean intraocular pressure (IOP) of patients with intracranial hemorrhage and correlate the results to the variable clinical features associated with intracranial hemorrhage. METHODS: Patients admitted to the emergency department were sorted into two groups based on their IOP results as measured using a Tono-Pen. The hemorrhage group consisted of patients suffering with intracranial hemorrhage and the normal group consisted of patients without intracranial hemorrhage. Patients with glaucoma or trauma of the ocular or facial area were excluded from this study. RESULTS: Mean IOP (30.45+/-9.13 mmHg) of the hemorrhage group (52 patients, 34 male, 18 female, mean age 58.28+/-14.39 years) was higher than the mean IOP (16.14+/-2.24 mmHg) of the normal group (39 patients, 23 male, 16 female, mean age 52.69+/-17.79 years) (p<0.001). Whether or not the intracranial hemorrhage was traumatic or nontraumatic, severe, or mild to moderate, accompanied with IICP or non-IICP, requiring an emergency or non-emergency operation, the IOP measured did not show any statistical significance. CONCLUSION: The IOP of the hemorrhage group was higher than the IOP of the normal group, but to determine the clinical usefulness of this measurement when accompanying presentation of headache or traumatic brain injury in the emergency department will require further investigation.
Brain ; Brain Injuries ; Emergencies ; Female ; Glaucoma ; Headache ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Intracranial Pressure ; Intraocular Pressure ; Male ; Manometry ; Stress, Psychological ; Unconscious (Psychology)