Purpose. Migraine is a disabling condition with underlying neuronal mechanisms that remain elusive. Migraineurs experience hyperresponsivity to visual stimuli and frequently experience visual disturbances. In the present study, the equivalent input noise approach was used to reveal abnormalities of visual processing and to isolate factors responsible for any such deficits. This approach partitions visual sensitivity into components that represent the efficiency of using the available stimulus information, the background internal noise due to irregular neuronal fluctuations, and the neuronal noise induced by the external stimulation. Methods. Ten migraine with aura, ten migraine without aura, and ten age-matched headache-free subjects participated. Performance in detecting luminance targets embedded in visual noise, resembling grainy photographs, was measured at various noise levels. Results. Contrast thresholds of the three subject groups were similar in the absence of noise, but both migraine groups performed worse in the presence of high noise levels, with performance of migraineurs with aura significantly poorer (P < 0.05) than that of control subjects. Data were fitted with a perceptual template model that showed that the model parameter determining the internal (neuronal) noise triggered by the external (stimulus) noise was significantly higher (P < 0.001) in both migraine groups than in the non-migraineur group. Migraineurs without aura also showed a significant (P < 0.05) though weak reduction of sampling efficiency (0.12 +/- 0.02) compared with control subjects (0.17 +/- 0.02). Conclusions. The results revealed substantial external noise-exclusion deficits in migraine with aura and a minor impairment of noise exclusion in migraine without aura. Migraineurs appeared prone to abnormally high variability of neuronal activity. This result provides a promising explanation of observed visual deficits in migraine.

THERMAL COMFORT IS ONE DIMENSION of overall patient comfort, and it usually is addressed by covering the patient with warmed cotton blankets. WARMING HELPS A PATIENT maintain normothermia and appears to decrease patient anxiety. AN STUDY WAS CONDUCTED in a preoperative setting to compare the effects of preoperative warming with warmed cotton blankets versus patient-controlled warming gowns on patients' perceptions of thermal comfort and anxiety. BOTH WARMING INTERVENTIONS had a positive effect on patients' thermal comfort and sense of well-being. Patients who used the patient-controlled warming gown also experienced a significant reduction in preoperative anxiety.

The risk of developing an intraoperatively acquired pressure ulcer (IAPU), which is recognized as a significant complication of deep tissue injury occurrence, is associated with duration of surgery and patient positioning. There is a strong association between hypothermia, tissue viability, and surgical site infections; however, the relationship between hypothermia and pressure ulcers has not been fully explored. We examined the incidence of pressure ulcers in surgical patients and determined that there is a relationship between maintaining perioperative normothermia and a reduction in IAPU development. We used a retrospective, explanatory, nonexperimental design, and we fit a binary logistic model to the data. This study shows that patients at higher risk for developing an IAPU include those who are critically ill, have a low Braden Scale skin assessment score, are thin, and are male with at least a 1° F (1.8° C) drop in temperature. These are important risks for perioperative nurses to take into account during care of surgical patients. More perioperative research is needed to identify ways to reduce risk, provide close assessment of high-risk patients, and implement the identified risk-reduction strategies.

The authors report the history of two patients treated with CAPD who developed a progressive calcifying peritonitis (PCP). The symptoms include abdominal pain, impairment of bowel movements, sterile effluent dialysate and progressive development of peritoneal calcifications. The etiology of the PCP remains elusive, but dialysate with acetate, high peritonitis incidence and continuous lavage as treatment for peritonitis are suspected to play a role in its evolution.

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Enhanced excitation of noise-activated neurons in migraineurs would produce stronger rebound activity and longer after-image durations, while weakened inhibitory mechanisms would diminish the rebound activity and shorten the after-image durations compared to control subjects. The results suggest that cortical inhibitory mechanisms might be impaired in migraineurs with and without aura.

Japanese rat chow and cerebral sympathetic denervation increase the incidence of stroke in stroke-prone spontaneously hypertensive rats. The purpose of this study was to determine if Japanese rat chow and sympathetic denervation would result in a high incidence of stroke in Dahl salt-sensitive (DS) rats, which have not been reported to be stroke prone. At 3 to 4 weeks of age, DS rats of both sexes began consumption of a high salt Japanese or American chow and underwent unilateral superior cervical sympathetic ganglionectomy. The rats fed American chow were found to have a high incidence of stroke (46%). Rats fed Japanese chow had shorter survival and a higher incidence of stroke (78%) than rats fed American chow (p less than 0.05). Blood pressure increased faster in DS rats fed Japanese chow (p less than 0.05). Metabolic studies indicated that increased sodium consumption accounted for only part of the acceleration of hypertension by Japanese rat chow. In DS rats grouped for equal levels of blood pressure, those fed Japanese chow had modestly reduced survival (p less than 0.05) compared with those fed American chow and had a greater incidence of stroke (85% vs 38%; p less than 0.05). Location of stroke was not influenced by removal of sympathetic nerves.(ABSTRACT TRUNCATED AT 250 WORDS)

The purpose of this study was to investigate associations between postoperative delirium (POD) and unplanned perioperative hypothermia (UPH) among adults undergoing noncardiac surgery. Design: A retrospective, exploratory design was used. Methods: A retrospective, exploratory study was conducted using electronic medical record data abstracted from a purposive convenience sample of adult patients undergoing noncardiac surgery from January 2014 to June 2017. Findings:The analyzed data set included 22,548 surgeries, of which 9% experienced POD. Logistic regression indicated that American Society of Anesthesiologists (ASA) class was the strongest predictor of POD (c 2 ¼ 1,207.11, df ¼ 4, inclusive of all ASA class terms). A significant relationship between UPH and POD (c 2 ¼ 54.94, df ¼ 4, inclusive of all UPH terms) and a complex relationship among UPH, patient age, ASA class, and POD were also found. Conclusions:Results support a relationship between UPH and POD. Notably, there is also a complex relationship in the noncardiac surgery population among UPH, age, ASA class, and POD. Preliminary understanding of this relationship is based on the pathophysiological response to surgical stress. Further research is indicated.