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. Contexte : Le traitement anormal de l'information somatosensitive pourrait contribuer à l'altération de la motricité observée dans la maladie de Parkinson (MP). Il a été démontré que les médicaments dopaminergiques modifient le traitement de l'information somatosensitive de telle sorte que la perception tactile en est améliorée. Dans la MP, nous ne savons pas si la séquence temporelle des stimuli tactiles est modifiée et si les médicaments dopaminergiques modifient cette perception. Méthode : La perception tactile somatosensitive a été étudiée au moyen du test de discernement de l'ordre de succession de stimuli chez des patients atteints de la MP avec et sans effet de la médication dopaminergique et chez des témoins en bonne santé appariés pour l'âge. L'évaluation du discernement de l'ordre temporel de stimuli a été effectuée au moyen de la stimulation contrôlée par ordinateur des 2e et 3e doigts de la main droite. Les sujets devaient déterminer quel stimulus était appliqué le premier. Deux tâches expérimentales ont été comparées : le discernement de l'ordre temporel sans et avec synchronisation, soit l'application au préalable d'une vibration synchrone aux les 2e et 3e doigts. Résultats : Le discernement de l'ordre temporel chez les patients atteints de la MP sans et avec l'effet des médicaments était semblable à celui des témoins. Lorsque le test de discernement de l'ordre temporel était précédé par les vibrations synchrones, l'acuité tactile chez les témoins et les patients sans l'effet de la médication était perturbée à des degrés semblables, mais cette perturbation perceptuelle due aux vibrations synchrones n'était pas présente chez les patients sous l'effet de la médication. Conclusions : Ces constatations suggèrent que, chez les patients atteints de la MP, la dopamine diminue la connectivité cortico-corticale dans l'aire somatosensitive SI, ce qui provoque des changements dans la sensibilité tactile.

In non-human primates, Brodmann's area 5 (BA 5) has direct connectivity with primary motor cortex (M1), is largely dedicated to the representation of the hand and may have evolved with the ability to perform skilled hand movement. Less is known about human BA 5 and its interaction with M1 neural circuits related to hand control. The present study examines the influence of BA 5 on excitatory and inhibitory neural circuitry within M1 bilaterally before and after continuous (cTBS), intermittent (iTBS), and sham theta-burst stimulation (sham TBS) over left hemisphere BA 5. Using single and paired-pulse TMS, measurements of motor evoked potentials (MEPs), short interval intracortical inhibition (SICI), and intracortical facilitation (ICF) were quantified for the representation of the first dorsal interosseous muscle. Results indicate that cTBS over BA 5 influences M1 excitability such that MEP amplitudes are increased bilaterally for up to one hour. ITBS over BA 5 results in an increase in MEP amplitude contralateral to stimulation with a delayed onset that persists up to one hour. SICI and ICF were unaltered following TBS over BA 5. Similarly, F-wave amplitude and latency were unaltered following cTBS over BA 5. The data suggest that BA 5 alters M1 output directed to the hand by influencing corticospinal neurons and not interneurons that mediate SICI or ICF circuitry. Targeting BA 5 via cTBS and iTBS is a novel mechanism to powerfully modulate activity within M1 and may provide an avenue for investigating hand control in healthy populations and modifying impaired hand function in clinical populations.

Renal cell carcinoma (RCC) usually presents clinically in the advanced stage including bone metastasis. However metastatic RCC without evidence of a primary tumor in the kidney is extremely rare. We herein report a case of a 70-year-old male initially evaluated for bone lesion and diagnosed with biopsy-proven metastatic clear cell RCC without a renal primary. Given the rare nature of the disease, there is no standardized course of treatment that has yet been established. We believe that our case will add to the body of knowledge about uncommon oncologic instances and consolidate the information that has already been published.

Introduction: Hypoglycemia is known to cause cardiac arrhythmias and even sudden cardiac death by inducing oxidative stress, QT prolongation, and myocardial injury. Chromosomal deletion of 1p36 is associated with learning difficulty, progressive renal disease, and cardiomyopathy. To our knowledge, this is the first case of a patient with 1p36 deletion syndrome and end-stage renal disease (ESRD) who developed cardiac arrest due to hypoglycemia. Case Presentation: A 26-year-old female presented to the emergency department with generalized itching, weakness, and progressive dyspnea after missing multiple hemodialysis (HD) sessions. She was admitted for HD and her stay was complicated by an episode of coffee-ground emesis and she was nil per oral (NPO) for an endoscopy. That night, the patient became bradycardic and had a cardiac arrest with pulseless electrical activity (PEA). Fingerstick blood glucose was undetectable during resuscitation and ROSC was achieved instantaneously after dextrose administration. The patient had no history of diabetes and was refusing glucose checks while NPO. She had a remarkable neurological recovery post-cardiac arrest. However, her glucose levels remained persistently low despite maximally tolerated feeds. An extensive workup for persistent hypoglycemia including peptide C levels, hba1c, and insulin level were within normal limits. Her cortisol level was appropriately raised. CT scan of the head performed was normal. Cardiac catheterization revealed no coronary artery disease. Discussions: Hypoglycemia was removed from the Advanced Cardiovascular Life Support (ACLS) algorithm as a reversible cause of cardiac arrest in 2010. Our case is a reminder of a life-threatening yet quickly reversible cause of cardiac arrest. Conclusions: ESRD increases the risk of hypoglycemia due to decreased insulin clearance and must be carefully monitored while NPO. Physicians have to be aware that routine dextrose administration during cardiac resuscitation does not improve survival and neurological outcomes.

Objective: Poor adherence to smoke-free policies on hospital property is an ongoing challenge. This study introduced novel anti-smoking signage onto hospital property with the aim of evaluating its effectiveness on reducing the incidence of smoking in designated areas.Methods: This prospective ecological study used cigarette butt count as a proxy to measure smoking prevalence at a single hospital’s three exit sites between October–December 2013. A pre-analysis of cigarette butt count at each site was conducted and the site with the highest count was selected for intervention; the two remaining sites were controls. The intervention signs featured a pair of stern male eyes with a forward gaze with “Don’t Smoke” written in black font and “We Are Watching” in red font below. Pre- and post-intervention cigarette butt counts were collected over 18 days and 14 days respectively. Climate was included in the analysis.Results: The number of cigarette butts decreased at the intervention site across 11 of the 14 post- intervention monitored days (29.8% decrease). Cigarette butt counts increased across both control sites (32.9% and 58.8%). One-way ANOVA revealed a significant interaction (p = .000) between location and pre-/post-intervention periods. A two-way ANOVA evaluating location, intervention period, and climate temperature change (± 10 degrees Celsius) revealed statistical significance (p < .05). Interaction between location and climate was not significant.Conclusions: This study demonstrated a decrease in cigarette butts at the hospital exit where the “watching eyes” signs were implemented. Simple, low-cost anti-smoking interventions such as this may assist in creating healthier, smoke-free environments on hospital properties.