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The black stallion returns
When his rightful owner repossesses the Black, eighteen-year-old Alec travels across the deserts of Arabia to find the great stallion and helps to solve a tribal feud.
Book
Ideas of monarchical reform
This book examines the political works of Andrew Michael Ramsay (1683–1743) within the context of early eighteenth-century British and French political thought. In the first monograph on Ramsay in English for over sixty years, the author uses Ramsay to engage in a broader evaluation of the political theory in the two countries and the exchange between them. At the beginning of the eighteenth century, Britain and France were on divergent political paths. Yet in the first three decades of that century, the growing impetus of mixed government in Britain influenced the political theory of its long-standing enemy. Shaped by experiences and ideologies of the seventeenth century, thinkers in both states exhibited a desire to produce great change by integrating past wisdom with modern knowledge. A Scottish Jacobite émigré living in Paris, Ramsay employed a synthesis of British and French principles to promote a Stuart restoration to the British throne that would place Britain at the centre of a co-operative Europe. Mansfield reveals that Ramsay was an important intellectual conduit for the two countries, whose contribution to the history of political thought has been greatly under appreciated. Including extensive analysis of the period between the 1660s and 1730s in Britain and France, this book will be of interest to scholars and students with an interest in political, religious, intellectual, and cultural history, as well as the early Enlightenment.
eBook
The spectral exponent of the resting EEG indexes the presence of consciousness during unresponsiveness induced by propofol, xenon, and ketamine
Despite the absence of responsiveness during anesthesia, conscious experience may persist. However, reliable, easily acquirable and interpretable neurophysiological markers of the presence of consciousness in unresponsive states are still missing. A promising marker is based on the decay-rate of the power spectral density (PSD) of the resting EEG.
We acquired resting electroencephalogram (EEG) in three groups of healthy participants (n = 5 each), before and during anesthesia induced by either xenon, propofol or ketamine. Dosage of each anesthetic agent was tailored to yield unresponsiveness (Ramsay score = 6). Delayed subjective reports assessed whether conscious experience was present (‘Conscious report’) or absent/inaccessible to recall (‘No Report’). We estimated the decay of the PSD of the resting EEG—after removing oscillatory peaks—via the spectral exponent β, for a broad band (1–40 Hz) and narrower sub-bands (1–20 Hz, 20–40 Hz). Within-subject anesthetic changes in β were assessed. Furthermore, based on β, ‘Conscious report’ states were discriminated against ‘no report’ states. Finally, we evaluated the correlation of the resting spectral exponent with a recently proposed index of consciousness, the Perturbational Complexity Index (PCI), derived from a previous TMS-EEG study.
The spectral exponent of the resting EEG discriminated states in which consciousness was present (wakefulness, ketamine) from states where consciousness was reduced or abolished (xenon, propofol). Loss of consciousness substantially decreased the (negative) broad-band spectral exponent in each subject undergoing xenon or propofol anesthesia—indexing an overall steeper PSD decay. Conversely, ketamine displayed an overall PSD decay similar to that of wakefulness—consistent with the preservation of consciousness—yet it showed a flattening of the decay in the high-frequencies (20–40 Hz)—consistent with its specific mechanism of action. The spectral exponent was highly correlated to PCI, corroborating its interpretation as a marker of the presence of consciousness. A steeper PSD of the resting EEG reliably indexed unconsciousness in anesthesia, beyond sheer unresponsiveness.
•Unconsciousness does not imply unresponsiveness.•Consciousness is abolished during xenon and propofol, yet preserved during ketamine.•EEG Spectral exponent indexes the 1/f-like decay of non-oscillatory PSD background.•Xenon and propofol steepen broad-band decay; ketamine flattens high-frequency decay.•Spectral exponent separates un/consciousness in anesthesia-induced unresponsiveness.
Journal Article
(Post)traumatic Oscillations: A Preliminary Exploration of an Affective Dynamic
Recent decades have witnessed a renewed interest in trauma, both as a subject of scholarly inquiry and as a theme in film and popular culture. A significant portion of contemporary cinema, particularly mainstream productions, focus on how trauma shapes the character’s backstory – a ubiquitous and reductive approach that treats trauma as a mere plot device, replacing nuanced character development with a simplified ‘trauma plot.’ In contrast, Lynne Ramsay’s films offer a different approach, portraying characters in the aftermath of trauma and exploring their experiences not only through narrative but also through a unique cinematic style. The author of the article employs Jill Bennett’s framework for analysing images of trauma to examine how the formal elements of the film We Need to Talk about Kevin (2011) reflect the (post)traumatic experience through the affective dynamic of oscillation. Furthermore, she explores how this oscillatory dynamic facilitates particular modes of empathic engagement, recreating in the audience an affective experience structurally akin to that of trauma.
Journal Article
Successful treatment of intractable neuralgia in patients with typical and atypical Ramsay Hunt syndrome by transcutaneous facial nerve stimulation: a case series study
Typical Ramsay Hunt syndrome (RHS) is a rare peripheral facial neuropathy associated with reactivation of latent varicella-zoster virus in the geniculate ganglion. Atypical RHS is characterized by the involvement of multiple cranial nerves and cervical roots, leading to more complex manifestations. The primary goal of treatment is to reduce the occurrence of late complications, especially in patients with devastating postherpetic neuralgia (PHN). To date, there is no definitive effective treatment. We present a case series of patients with typical and atypical RHS and severe PHN, who were successfully treated with transcutaneous facial nerve stimulation (FNS).
This is a retrospective case series including two atypical RHS cases and one typical RHS case. The first patient with atypical RHS suffered from persistent otalgia with severe paroxysmal radiation to the dermatome of fifth cranial nerve (CN V) and IX lesion. The second atypical RHS patient with CN V and VII lesions had persistent frontotemporal neuralgia and otalgia, with severe paroxysmal radiation to the CN V and IX dermatome. The third typical patient had persistent otalgia with severe paroxysmal exacerbations. An FNS in the stylomastoid foramen was successfully performed under ultrasound guidance in combination with DSA. Pain assessment was performed during treatment and follow-up, including the type of pain (persistent pain, breakthrough pain, and tactile allodynia) and pain distribution. Pain intensity was assessed using the Number Rate Scale (NRS) and the Verbal Rating Scale (VRS). The therapeutic effect was assessed using the Pain Relief Scale (PRS). In addition, the Pain Relief Ratio (PRR) was calculated as (NRS
-T - NRS
-T)/NRS
-T × 100%, and the treatment was considered effective if the PRR was greater than 50%.
The t-FNS showed excellent pain relief, particularly for breakthrough pain. The breakthrough pain completely ceased before the FNS was turned off, and the persistent pain decreased from moderate to mild intensity before the patients were discharged. The mild persistent pain of the first patient on the 3-month follow-up and the third patient on the 2-month follow-up had completely disappeared, but the mild persistent pain of the second patient was still felt in the temporal region for 1 year.
For the first time, transcutaneous FNS was successfully used to treat intractable PHN in patients with typical and atypical RHS. However, further research is needed to determine the optimal procedure and specific stimulation parameters.
Journal Article
Comparison of Intranasal Dexmedetomidine and Midazolam as Premedication in Children Undergoing Cardiac Surgeries and Procedures
Aims and Objectives. To compare premedication with intranasal dexmedetomi-dine and intranasal midazolam for their sedative effects and ease of parental separation in children undergoing cardiac surgeries.Materials and Methods. This prospective, interventional study was conducted on 40 children aged 1-10 years undergoing cardiac procedures, who were randomized into two groups of 20 each. Group D received 2 mcg/kg intranasal dexmedetomidine, and Group M received 0.2 mg/kg intranasal midazolam 30 minutes before the surgery. The sedation levels were assessed by the Ramsay Sedation Scale (RSS), and ease of separation from parents by Child-Parent Separation Score (CPSS) in both groups.Results. The CPSS score was significantly lower with group D as compared to group M (scores 1 vs 2, p = 0.0002 prior to shifting of children to OT). Ramsay Sedation Scale value was significantly higher in group D compared to group M after 15, 25 and 30 minutes (scores 3 vs 2, p < 0.0001).Conclusion. Intranasal dexmedetomidine achieved significant as well as satisfactory sedation, lower levels of anxiety, and better parent separation than intranasal midazolam in pediatric patients undergoing cardiac surgeries.
Journal Article
Two cases of Ramsay-Hunt syndrome following varicella zoster viral meningitis in young immunocompetent men: case reports
Background
Ramsay-Hunt syndrome (RHS) due to varicella zoster virus (VZV) infection is commonly reported in individuals aged at least 50 years or immunocompromised individuals. VZV infection may invade the central nervous system (CNS) and cause meningitis or encephalitis, which are more likely to occur in patients with chronic diseases such as diabetes and chronic renal failure. However, cases with VZV-induced concurrent RHS and CNS infections are rare.
Case presentation
Two young male patients, aged 32 and 43 years, with no underlying disease developed VZV meningitis, followed by RHS involving cranial nerves VII and VIII. Both patients presented with symptoms of peripheral facial palsy, and dizziness accompanied by tinnitus and hearing loss, which appeared several days after the onset of fever and headache. These symptoms were documented as facial neuropathy and sensorineural hearing loss in the electrophysiologic studies. Lymphocyte-dominant pleocytosis and VZV positivity were confirmed from cerebrospinal fluid examination and polymerase chain reaction, respectively. The patients were treated with intravenous acyclovir and oral steroids simultaneously. Following the treatment completion, both patients were relieved of their headaches and fever; however, facial palsy, dizziness, and tinnitus persisted. They were followed up at the outpatient clinic.
Conclusion
These cases confirmed that RHS and CNS infections can co-exist even in young adults with normal immune function and more importantly, that CNS infection can precede RHS. Since early detection and treatment of RHS improve the prognosis, it is critical to closely monitor patients with VZV meningitis or encephalitis considering the possible superimposition of RHS.
Journal Article
Differential diagnosis of peripheral facial nerve palsy: a retrospective clinical, MRI and CSF-based study
BackgroundFacial nerve palsy is the most common cranial nerve disorder. There is no consensus on a single diagnostic tool deemed as the ‘gold standard’ for distinguishing between idiopathic (Bell’s palsy) and symptomatic causes. The diagnosis is one of exclusion and most often made on physical examination. In the present study, we describe the etiological background of peripheral facial palsy in N = 509 patients and evaluate the relevance of cerebrospinal fluid (CSF) analysis and magnetic resonance imaging (MRI) in differential diagnosis.MethodsWe carried out a retrospective data analysis of 509 patients with the clinical diagnosis of peripheral facial palsy admitted to our emergency unit between January 2006 and January 2017. All patients were seen clinically; their CSF was analyzed and MRI was performed.ResultsOf N = 526 patients with isolated facial palsy, 17 patients were excluded because they did not consent to CSF analysis. Of the remaining N = 509 patients, 383 patients (75.2%) were diagnosed with idiopathic facial palsy. In the remaining 126 patients (24.8%), the following etiologies for facial palsy could be found: Ramsay-Hunt-Syndrome (N = 34), Lyme Neuroborreliosis (N = 32), other viral/bacterial central nervous system (CNS) infections (N = 8), neoplasias (N = 18), autoimmune disease (N = 12), otogenous processes (N = 6), or other etiologies (N = 16). Analysis of the CSF showed 85% sensitivity for Ramsay-Hunt-Syndrome and 100% for Lyme Neuroborreliosis and other viral/bacterial CNS infections. CSF analysis proved a reliable diagnostic tool for identifying these subgroups. MRI with contrast compounds, as performed in 409 patients, was the most important tool in diagnosing neoplasias (88% sensitivity) and otogenous processes (83% sensitivity). MRI with contrast-enhancing compounds did not reveal additional information concerning inflammatory facial nerve lesions when performed the same day as hospital admission.ConclusionsAlthough peripheral facial palsy was predominantly idiopathic (75.3%) in our cohort, the disease was caused in approximately 25% of the patients by factors which require specific treatment. In the present study, CSF analysis proved to be the leading method for the diagnosis of Ramsay-Hunt-Syndrome, Lyme Neuroborreliosis, and other CNS infections. These subgroups made up approximately 15% of our cohort. To detect these subgroups reliably, routine use of CSF analysis in peripheral facial palsy may be advisable, whereas MRI proved to be useful for exclusion of otogenic and neoplastic processes with a sensitivity of 83% and 88%. We found that the use of MRI with contrast-enhancing compounds does not provide additional diagnostic information on the day of hospital admission. Hence, the potential benefits of routine use of MRI in patients with facial nerve palsy should be weighed against health care cost factors.
Journal Article