Plasma Exchange for Hemolytic Crisis and Acute Liver Failure in Wilson Disease

Wilson disease (WD) is a rare autosomal recessive disorder of copper metabolism which primarily involves the liver and the central nervous system. Rarely, WD can present as acute liver failure (ALF) and this disease is universally fatal in the absence of liver transplantation. The authors report a young girl with WD ALF, who showed signs of recovery after prompt initiation of plasma exchange (PE) and chelation therapy. Though liver transplantation could not be done in this child and the child died 8 d after stopping PE, this case highlights that PE can be a successful medical treatment in WD ALF and should be considered as a therapeutic measure to stabilize a patient by decreasing serum copper, reducing hemolysis, and helping to prevent renal tubular injury from copper and copper complexes until liver transplantation is possible.     

Bodily maps of emotions

Emotions are often felt in the body, and somatosensory feedback has been proposed to trigger conscious emotional experiences. Here we reveal maps of bodily sensations associated with different emotions using a unique topographical self-report method. In five experiments, participants (n = 701) were shown two silhouettes of bodies alongside emotional words, stories, movies, or facial expressions. They were asked to color the bodily regions whose activity they felt increasing or decreasing while viewing each stimulus. Different emotions were consistently associated with statistically separable bodily sensation maps across experiments. These maps were concordant across West European and East Asian samples. Statistical classifiers distinguished emotion-specific activation maps accurately, confirming independence of topographies across emotions. We propose that emotions are represented in the somatosensory system as culturally universal categorical somatotopic maps. Perception of these emotion-triggered bodily changes may play a key role in generating consciously felt emotions.We often experience emotions directly in the body. When strolling through the park to meet with our sweetheart we walk lightly with our hearts pounding with excitement, whereas anxiety might tighten our muscles and make our hands sweat and tremble before an important job interview. Numerous studies have established that emotion systems prepare us to meet challenges encountered in the environment by adjusting the activation of the cardiovascular, skeletomuscular, neuroendocrine, and autonomic nervous system (ANS) (1). This link between emotions and bodily states is also reflected in the way we speak of emotions (2): a young bride getting married next week may suddenly have “cold feet,” severely disappointed lovers may be “heartbroken,” and our favorite song may send “a shiver down our spine.”Both classic (3) and more recent (4, 5) models of emotional processing assume that subjective emotional feelings are triggered by the perception of emotion-related bodily states that reflect changes in the skeletomuscular, neuroendocrine, and autonomic nervous systems (1). These conscious feelings help the individuals to voluntarily fine-tune their behavior to better match the challenges of the environment (6). Although emotions are associated with a broad range of physiological changes (1, 7), it is still hotly debated whether the bodily changes associated with different emotions are specific enough to serve as the basis for discrete emotional feelings, such as anger, fear, or happiness (8, 9), and the topographical distribution of the emotion-related bodily sensations has remained unknown.Here we reveal maps of bodily sensations associated with different emotions using a unique computer-based, topographical self-report method (emBODY, Fig. 1). Participants (n = 701) were shown two silhouettes of bodies alongside emotional words, stories, movies, or facial expressions, and they were asked to color the bodily regions whose activity they felt to be increased or decreased during viewing of each stimulus. Different emotions were associated with statistically clearly separable bodily sensation maps (BSMs) that were consistent across West European (Finnish and Swedish) and East Asian (Taiwanese) samples, all speaking their respective languages. Statistical classifiers discriminated emotion-specific activation maps accurately, confirming independence of bodily topographies across emotions. We propose that consciously felt emotions are associated with culturally universal, topographically distinct bodily sensations that may support the categorical experience of different emotions.Open in a separate windowFig. 1.The emBODY tool. Participants colored the initially blank body regions (A) whose activity they felt increasing (left body) and decreasing (right body) during emotions. Subjectwise activation–deactivation data (B) were stored as integers, with the whole body being represented by 50,364 data points. Activation and deactivation maps were subsequently combined (C) for statistical analysis.     

A Comparative Evaluation of Static and Functional Methods for Recording Centric Relation and Condylar Guidance: A Clinical Study

To evaluate and compare the centric relation and horizontal condylar guidance using interocclusal wax and extra oral Gothic arch methods and subjective evaluation of dentures thus fabricated. Centric relation and horizontal condylar guidance was recorded by using interocclusal wax and gothic arch tracing in 28 completely edentulous patients. These records were transferred to the articulator and difference in both values was recorded. After that patients were divided in two groups according to the centric relation and horizontal condylar guidance recording method used to achieve balanced occlusion. Response of the dentures was subjectively evaluated using “Woelfel subjective evaluation criteria”. Centric relation recorded by both the methods did coincide in 7.14 % of patients. Centric relation recorded by interocclusal wax was posterior to Gothic centric relation in 21.43 % of patients, and anterior to Gothic centric relation in 71.42 % patients. Gothic arch tracings gave higher mean guidance values on both the sides as compared to protrusive wax record in all the subjects, although the difference was statistically insignificant (P > 0.05). Subjective evaluation showed statistical insignificance for all the parameters in both groups. Gothic arch method records the centric relation at a more posterior position than the Static method, but it does not make any difference in clinical performance of the complete denture. Horizontal condylar guidance angle was approximately similar by both the methods.     

Evaluation of the efficacy of a prosthodontic stent in determining the position of dental implants

Purpose: To evaluate the efficacy of a dual purpose (diagnostic and surgical) acrylic resin stent with gutta percha marker used in conjunction with 3D imaging in determination of the position and inclination of dental implants. Materials and Methods: This study was performed as a case control study. A total of 41 implants, of which 20 had been placed without the use of stents and 3D imaging (control group) and 21 were placed using stents and 3D imaging (study group), were studied. A diagnostic and surgical stent with radio‐opaque indicator (gutta percha) was fabricated to determine the planned prosthetic position and inclination of the implant. Computed tomography images were obtained and were analyzed using Denta Scan software. The position of the implant was analyzed in mesiodistal and buccolingual dimensions in terms of both position and angulation. SPSS v15.0 was used for statistical analysis (p < 0.05 was considered statistically significant). Results: The study group demonstrated an overall 98.9% efficacy of the test technique being used in the study. On qualitative assessment, the results obtained were within the defined ideal threshold level for four of five parameters (distance from buccal and lingual cortical plate, inter‐implant distance, and buccolingual angulation of the implant relative to underlying alveolar bone). For mesiodistal distance from adjacent teeth, the observation was not above threshold value for only one case. For the control group, the overall efficacy was 66.9%. Conclusion: The technique of combined use of a prosthodontic stent and 3D imaging is an efficacious and better technique in achieving an ideal position of dental implants as compared to conventional techniques using periapical and panoramic radiographs and a cast.     

Left anterior descending coronary artery stenosis: in a patient with takotsubo cardiomyopathy

Takotsubo cardiomyopathy is characterized by chest pain, electrocardiographic abnormalities such as ST-segment elevation or depression, and elevated cardiac enzyme levels. Left ventriculography reveals transient akinesis of the involved segment of the myocardial wall (usually the left ventricular apex) and compensatory hyperkinesis of the noninvolved myocardium, which appears as apical ballooning during systole. Existing criteria for the diagnosis of takotsubo cardiomyopathy include the absence of obstructive coronary artery disease. Indeed, previous investigators have found incidental stenosis in only a minority of patients.Herein, we present the unusual case of an 84-year-old woman who sustained 4 episodes of takotsubo cardiomyopathy in 18 years. At the time of the initial episode, coronary angiography revealed no substantial stenosis. Concomitant with the 2nd episode, stenosis in the 1st obtuse marginal branch was treated with stenting. No new lesions were apparent after the patient's 3rd presentation, and the previously placed stent was patent. During the 4th (current) presentation, we detected and percutaneously treated severe stenoses in the patient's left anterior descending coronary artery and 2nd obtuse marginal branch.Although this report is of a single patient only, it definitively illustrates that severe coronary artery disease can occur in patients who have takotsubo cardiomyopathy. We recommend the thorough evaluation of possible coronary artery disease in high-risk patients, even upon the strong clinical suspicion of takotsubo cardiomyopathy.     

Enhancement in the performance of nanostructured CuO–ZnO solar cells by band alignment

In this study, we investigated the effect of cobalt doping on band alignment and the performance of nanostructured ZnO/CuO heterojunction solar cells. ZnO nanorods and CuO nanostructures were fabricated by a low-temperature and cost-effective chemical bath deposition technique. The band offsets between Zn_1−xCo_xO (x = 0, 0.05, 0.10, 0.15, and 0.20) and CuO nanostructures were estimated using X-ray photoelectron spectroscopy and it was observed that the reduction of the conduction band offset with CuO. This also results in an enhancement in the open-circuit voltage. It was demonstrated that an optimal amount of cobalt doping could effectively passivate the ZnO related defects, resulting in a suitable conduction band offset, suppressing interface recombination, and enhancing conductivity and mobility. The capacitance–voltage analysis demonstrated the effectiveness of cobalt doping on enhancing the depletion width and built-in potential. Through impedance spectroscopy analysis, it was shown that recombination resistance increased up to 10% cobalt doping, thus decreased charge recombination at the interface. Further, it was demonstrated that the insertion of a thin layer of molybdenum oxide (MoO₃) between the active layer (CuO) and the gold electrode hinders the formation of a Schottky junction and improved charge extraction at the interface. The ZnO/CuO solar cells with 10% cobalt doped ZnO and 20 nm thick MoO₃ buffer layer achieved the best power conversion efficiency of 2.11%. Our results demonstrate the crucial role of the band alignment on the performance of the ZnO/CuO heterojunction solar cells and could pave the way for further progress on improving conversion efficiency in oxide-based heterojunction solar cells.

Nanostructured ZnO/CuO photovoltaic cell with power conversion efficiency of 2.11%.