Portable EEG-Based Music Effects

Music, by any definition, has been part of human life since the beginning of bipedalism, and maybe even before that. Now, in our 21st Century, there is not a day that goes by without music and without the myriad of technologies to help even an infant be exposed to this aesthetic form of communication. Music is energy, emotion, vibration, infiltrating our sensorysystems, emotions, and whole bodies. And, with the development of current technologies, music has a far reaching effect for composers developing unimaginable sounds and expressions and listener seeking the best devices for enjoying music.

Research on music in the sciences and medicine is finally reaching the forefront of attempts to understand the brain, cognition, physiology, and emotional behaviors. As a result of the birth of such scientific and engineering music explorations, this unique Journal of Biomusical Engineering has been put forth as a new platform for researchers and philosophers in and about music in human adaptation, to publish their thoughts and findings and reach a whole new, cross-modal audience of readers. 

This Journal especially provides an opportunity for younger researchers to present their work in an International journal that welcomes and nurtures fresh new ideas, thoughts, approaches to understanding the phenomenon of music in human existence. From Music Anthropology to Musicology, from Music Composition and expression to Music-based Treatment modalities, the Journal of Biomusical Engineering is the only on-line, free-access publication giving voice to an amalgam of researchers in Music and Physiologic Function, Music and Technology, Music in Treatment, Music in Cultural Expression, Music and Emotion, Music in history, and all areas of music in human behaviors.Read more......

New Models in Clinical Education: A Call for Evidence

Regardless of practice setting, the demands on new practitioners include not only clinical competence in evidence-based methods of prevention, assessment, and treatment but additional skill sets. Clinical education, whether in graduate preparation programs or as a component of continuing education, must develop and implement new methodologies for effective clinical training to provide adequate opportunities for acquisition of new skill sets.

Among the skills that have received increased attention in graduate preparation programs are competencies in interprofessional practice. The Core Competencies for Interprofessional Practice were established by Interprofessional Education Collaborative in 2011. The core competencies include: values/ethics for interprofessional practice, roles/responsibilities, interprofessional communication, and teams/teamwork. According to the American Speech-Language Hearing Association research has indicated “the benefits of interprofessional collaborations in health care that require continuous interaction, coordinated efforts, and knowledge sharing among health care professionals”. The accreditation standards for master’s degree programs in occupational therapy include IPE language and now require that students be able to “effectively communicate and work interprofessionally with those who provide services to individuals, organizations, and/or populations in order to clarify each member’s responsibility in executing an intervention plan”.

In 2013, as ASHA President, Dr. Patricia Prelock summarized that graduate programs in communication disorders varied in the incorporation of IPE into the curriculum. While some programs were beginning to assess how to best address the IPE skill set, others were successfully implementing new models of preparation. While there is emerging evidence on successful methods of incorporating IPE into clinical training in communication disorders, more evidence is needed. 

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Medical Nutrition Therapy delays Dialysis and Improves Biomarkers

There is a high economic burden for kidney disease. Healthy People 2020 has a major goal of reducing new cases of kidney disease and its related complications, disability and early death. The basic function of the kidney is the removal of waste products from the blood while regulating body water and electrolytes. As kidney disease progresses, altered nutrition biomarkers are observed which may be related to poor dietary habits. Patients with kidney disease are often prescribed diets that are low in potassium and provided handouts that focus on limiting fruits and vegetables. Patients become confused and frustrated as this recommendation is at odds with prevention diets such as heart healthy and diabetes diets which emphasize fruits, vegetables and whole grains.

The typical North American diet is high in protein and processed foods which can affect the balance of the body’s electrolytes, minerals and contributes to the uremic environment of the digestive system. Evolving evidence has found a link between the gut and kidney health suggesting a need for emphasis on nutrition for the care of a patient with compromised kidney function.

A poor diet is a major contributor to disease and early death. Nutrition has become a mainstream social issue and the public’s interest in nutrition and wellness has exploded. In response, the Affordable Care Act supports preventative health services and has included access to wellness programs [6] including Medical Nutrition Therapy (MNT). The key practitioners of MNT are the registered dietitian (RD) and registered dietitian nutritionist (RDN). 

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Interactions of EGFR and the Hippo Pathway

Diabetes mellitus (DM) is a growing worldwide epidemic health problem. More than 350 million people worldwide are affected by DM, and one in three U.S. adults could have DM in 2050, if the current trends continue. Diabetic nephropathy (DN) is one of the most important DM complications, and it continues to rank as the leading cause of end-stage renal disease (ESRD) in the U.S. Patients must undergo either dialysis or a kidney transplantation once DN progress to ESRD, which produces a huge economic burden for society.

There is a pressing need to develop novel therapeutics for preventing or delaying the progression of DN. Progressive glomerulosclerosis and renal interstitial fibrosis are two characteristic pathological changes in the kidney in DN. Glomerular sclerosis has been at the center of attention for nephrologists.

however, increasing evidence suggests the renal tubule is a primary site of injury during DN progression, and a significant positive correlation between development of interstitial fibrosis and subsequent loss of renal function is seen in DN patients. Activation of the EGFR (Epidermal Growth Factor Receptor) has been implicated in diabetic kidney injury,  studies by us and others have found that chronic EGFR activation in diabetic kidney is detrimental, and inhibition of EGFR activation by pharmacologic or genetic strategies markedly preserved renal function and slowed DN progression.

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Prolonged QT Intervals in Isolated ACTH Deficiency

Isolated adrenocorticotropic hormone deficiency (IAD) is a rare disorder, characterized by secondary adrenal insufficiency with low or absent cortisol production, normal secretion of pituitary hormones except ACTH and the absence of structural pituitary defects. The clinical features include various symptoms such as vomiting, abdominal pain, myalgia, joint pain, severe hypotension, and hypovolemic shock due to glucocorticoid deficiency. Glucocorticoid replacement is required for the symptomatic patients. Since the reports in the 1950s, ECG abnormalities such as flat or inverted T waves, prolonged QT intervals are known to occur in adrenal insufficiency.

 There are six reports suggesting that sudden cardiac arrest occurs in IAD due to prolonged QT intervals. Although ECG abnormalities are modulated after hydrocortisone replacement, the mechanism by which hydrocortisone may affect ECG still remains unclear. Here we report a case of IAD whose ECG abnormalities were reversed with hydrocortisone replacement, suggesting a role played by glucocorticoids in the modulation of QT intervals. Also we show the characteristics of the six cases of IAD with QT prolonged intervals causing lethal arrhythmia.

Long QT syndrome is one of the symptoms of isolated ACTH deficiency. Long QT syndrome is known to be a risk factor for cardiovascular events, and prolonged QTs can be reversed by glucocorticoid replacement. We point out the possible mechanism whereby hydrocortisone may contribute to QT intervals.

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A Cortisol Study; Facial Hair and Nails

In recent years, the scientific community's interest in stress related cortisol has increased dramatically, along with the stresses of Westernized day-to day life. The effects of prolonged exposure to stress in our daily routines results in what we call allostatic load. When there is an increase in the allostatic load, it can result in receptor desensitization, tissue damage, and other physical and mental maladies. For these reasons and more, it is of vital importance to accurately measure short term cortisol levels caused by both mental and physical stress.

Under conditions of physical and psychological stress  the cortisol hormone is released by the zona fasciculate of the adrenal cortex in the kidneys and periphery- which is stimulated by an HPA-like axis (Hypothalamus Pituitary Axis) within the hair follicle. Moreover, it is well documented that blood-borne substances are able to diffuse from capillaries into the cells of hair follicles and subsequently become deposited into the hair shaft and fingernails.

Recently  it has been hypothesized that cortisol is incorporated into both hair and nails via similar cellular mechanisms. In this study, we build upon this hypothesis, theorizing that cortisol within facial hair is incorporated in the same fashion. Saliva and serum cortisol levels are subject to major physiological circadian fluctuations. Additionally, the collection method used with these mediums is invasive and costly. Alternatively, hair and nail analysis presents a longer history of cortisol levels, as well as a non-invasive, cost effective means of collecting samples.

A pilot study by Warnock et al.was the first to find cortisol in finger nails. The data showed the feasibility of cortisol assessment in fingernails and significant correlations between cortisol and DHEA in subjects. A follow-up study done by Izawa et al.confirmed these results. Yet, to date, no existing study has investigated potential variations in cortisol levels between fingernails and toenails.

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An Entry for Personalized Medical Practice in Primary Care

The successful practice of personalized medicine in primary care depends upon understanding a patient’s individual disease risk and anticipating the best course of treatment with the goal of maintaining good health. A personalized disease risk assessment leads to recommendations for evidence-based interventions that can delay/prevent disease onset or reduce the severity of disease. As the sophistication of medical diagnoses develops and new interventions become available, the value of collecting and analyzing family health history (FHH) for maintaining patient wellness by determining ‘the right treatment, at the right time, for the right patient’ is more apparent than ever. FHH remains underutilized in primary care.

however, because of numerous barriers. Ironically, the introduction of genetic tests and genomic methods that identify carriers who might be vulnerable to a variety of medical conditions and diseases has simply raised the importance of collecting and utilizing FHH to guide patient management in primary care.

FHH is perhaps the most cost-effective and robust means to obtain information about a patient’s disease risk. A complete FHH includes the health information of a patient’s blood-related first (parents, siblings, children) and second degree (half-siblings, aunts, uncles, grandparents) relatives over three generations. To be optimally useable for analysis, FHH will denote both affected and unaffected family members, the age of disease onset, disease severity, any recurrences, and cause of death. Even partial FHH information can be useful.

 however, especially if two or more first or second degree relatives are affected from either the maternal or paternal side of a family, since two occurrences of a disease or condition within a lineage usually is sufficient to conclude that an elevated disease risk exists.

Endoscopic Repair of Carotid Artery Injury

Intraoperative injury to the Internal Carotid Artery (ICA) during Endoscopic Endonasal Surgery (EES) of the skull base is a rare and well recognized complication which can potentially be associated with high rates of morbidity and mortality. In the event of a traumatic injury to the ICA during EES, hemorrhage might be massive, difficult to control as the access to the sphenoid sinus is limited and the visual field becomes quickly obscured. Bleeding from this vital artery can become lethal within minutes and even when the bleeding is controlled, permanent neurological deficits frequently persist. 

According to the literature, the risk for injury to the ICA following endoscopic tumor resection is around 1%. Many techniques have been developed to manage ICA injury including controlled hypotension, ipsilateral and contralateral neck pressure, proximal control through neck dissection and distal control, with varying degrees of success.

A 57 years old otherwise healthy woman was referred to our institution due to complaints of intense headaches, speech difficulties and dysphagia for 2 weeks. At physical examination the patient demonstrated slurred speech with tongue deviation towards the left. Neck examination and endoscopic flexible fiber optic were normal, and no other neurological deficits were observed.

The operation was performed under general anesthesia using an intraoperative frameless navigation. The surgery was conducted under electrophysiological monitoring. After inferior turbinate lateralization, middle turbinectomy, middle antrostomy, anterior and posterior ethmoidectomy, posterior septectomy and elevation of a nasoseptal flap, the tumor was exposed in the sphenoid sinus. Using a high speed coarse drill, the rostrum and clival tumor extensions were drilled out. The anterior wall of the sphenoid sinus was removed in order to provide a better access.

Longevity has no National Boundaries or Race Limitations

Worldwide, the developed countries, such as the United States and Japan, in general have the most centenarians due to their advanced health care provisions. However, this does not mean people in the developing countries do not have this privilege. Let us begin from the most populated countries in the world, China and India. Li Ching- Yuen (or Li Ching-Yun) was supposedly known for his extreme longevity claim and spiritual practices by means of herbs, lived either for 256 years or 197 years, reportedly to be born in 1677 or 1736 in the Sichuan province of southwest China. Most of his life was spent in the mountains working as a herbalist selling lingzhi (Ganoderma lucidum), goji berry (Lycium barbarum), wild gingseng, heshouwu (Polygonum multiflorum thunb) and gotu kola (Centella asiatica), and his diet was these herbs and rice wine.

 He was a martial arts teacher and a tactical advisor to the provincial commander-in-chief Yeuh Jong Chyi. So the take home message from his life is a low calorie diet and physical activity. There is extreme skepticism of the age claim due to alleged fabrication. The Guinness world records is trying to confirm that a woman, Alimihan Seyiti, from a town near Kashgar in Xinjiang Province, China has been identified as the oldest ever living person in China and the world at 127 [2]. China’s remote Bapan village, sometimes called longevity village where there is a high concentration of Chinese centenarians is the home to Boxin Huang, the oldest resident at 115 [3,4]. The people from Bapan village attribute their long life to eating vegetables with every meal. They also eat a lot of fruits, nuts, legumes and fish. The villagers of Bapan have no exercise culture but they stay physically active doing chores around the house. In India, there are 27,985 people aged 100 and above in Andhra, 12,654 in Tamil Nadu, and 5,431 in Kerala 5,431 (http://timesofindia.indiatimes.com/india/ Andhra-Pradesh-has-highest-number-of-centenarians-in-south- India/articleshow/22998325.cms). The National Geographic named Kerala, a southwestern city in India, as one of the “fifty places to visit in lifetime”. In these places, even the poorest interview subjects have valuable traits within their lifestyles, which allow them to live healthy lives. In eastern cultures such as India, respecting elders and their “practice wisdom” is very much a factor in the day-to-day activities of the people .

We would like to conclude that longevity is an equal opportunity phenomenon and that no matter where you live or what race or ethnic group you belong to, with a right combination of normal genes, healthy calorie-restricted diet, practice hygiene, infection control, exercise, and good connectivity with others, any person could potentially live to 100 and beyond.

Efficacy and Safety of Slowly Infused Propofol Sedation in Pediatric Oncology Procedures

Invasive procedures such as bone marrow aspiration and lumbar puncture are essential components for pediatric hematology and oncology patients. Pediatric patients who undergo invasive procedures often require sedation to prevent excessive motion, pain, and anxiety. 

Although several pharmacological agents have been used for these procedures, a standard has not yet been established. Ideal pharmacological agents have a rapid-onset of action, easily adjustable level of sedation, maintain cardiorespiratory function, and a short duration of activity once their administration is discontinued. Midazolam and ketamine (midazolam/ketamine) have traditionally been used for childhood invasive procedures in our hospital. 

Although midazolam and ketamine effectively achieve the desired sedation levels for childhood invasive procedures, both of those drugs have a long half-life such that sedation may persist for an excessively long time after the procedure has been completed.

Functional Appliances in the Treatment of Sleep Apnea in Children

OSA has a negative impact on child growth, affecting their quality of life. If the condition persists, it may affects the quality of life in their adulthood. Tonsil hypertrophy is considered the leading cause of OSA and tonsillar removal is the optional treatment. Common diseases such as oral breathing and primary snoring are related to OSA and if there is an association with craniofacial abnormalities, this may lead to the recurrence of the OSA after adenotonsillectomy. The literature showed the most frequent complaints of patients with OSA were PS and troubled sleep. Allergic rhinitis RA was the most frequent comorbidity accompanying OSA, followed by hypertrophy of the tonsils. The most severe apnea indexes were found in younger children, and African descendants had a higher prevalence of the disease. One study reported that the tonsillectomy surgery was effective for the treatment of OSA in a group of children aged between 3 to 6 years old, who returned to a normal growth pattern. On the other hand, other studies reported that adolescents aged between 11 and 14 years old, continued with OB after the removal of the tonsils, presented the worst AHI and reduction of UA lumen. The causal effect between tonsil hypertrophy and OSA has not been established yet.

Treatments for persistent apnea are not completely known yet. Treatment approaches must be better evaluated. Anti-inflammatory therapies, masks for ventilation and oral appliances are offered to the treatment of recurrent OSA but the disease remains a challenge due to its multifactorial nature. Some authors consider as the best form of clinical treatment of OSA the use of CPAP or BPAP but such treatment does not get a good patients cooperation and the discontinuance is large.

Two reports of clinical case studies demonstrated OSA improvement with the use of FA. In both studies, high AHI were reported, but the patients did not have tonsillar hypertrophy and craniofacial deformities were treated with FA. The treatment improved the OSA and normalized the craniofacial deformities. Reports of clinical cases do not represent a high level of evidence and do not show statistical significance, but can be considered a warning about the clinical need of new approaches. Isolated cases, out of average, should be considered for further investigation. Early intervention of the orthodontist with FA in patients with disorders of the craniofacial structures in cooperation with other specialists should be considered. The FA promotes an increase in mandibular growth and permanently changes in the craniofacial structure, facilitating the breathing mode and preventing obstructions of the UA.Orthodontists are professionals trained to recognize and treat OSA with FA in patients with craniofacial anomalies promoting a harmonious facial growth and avoid aggressive surgery in adulthood and cardiovascular comorbidities resulting from sleep disorders

Family Health History: An Entry for Personalized Medical Practice in Primary Care

Generally, actual risk assessment algorithms derived from FHH information vary for different diseases, especially when other factors, such as age of onset, severity, recurrence, and environmental risk factors are known to be involved. For some diseases, FHH-based risk is described primarily for first degree relatives. In such cases, individual risk is elevated substantially if an immediate (first degree) family member is affected, and the additional risk revealed by affected second degree relatives may not be necessary for generating additional recommendations, and/or treatment interventions, though this information could be valuable if a genetic test is contemplated. 

For assessing a patient’s risk for developing diabetes mellitus, for example, having a first degree relative with type 2 diabetes significantly elevates personal risk (~2-5 fold), even without knowing exacerbating environmental risk factors and without information from more distant relatives. While specific genetic variants (any structural change in the nucleotide sequence of DNA will be referred to as a variant in this mini review) that occur commonly in the human population have been associated with a risk for type 2 diabetes, FHH remains a more robust predictor of T2D risk than the presence of predisposing genetic variants. For stroke, FHH is a well-established risk factor.

 According to one study, over 85% of strokes in persons less than 75 years old are concentrated in about 10% of all families, suggesting the risk-elevating effects of genetics and shared family environment. If one or both parents of a patient had a stroke, a patient’s risk for stroke or cardiovascular disease is significantly increased. Such information offers a simple and effective form of triage for evaluating a patient’s risk for stroke as well as possible interventions, including aggressive treatment of even modest hypertensive levels, which has been shown to reduce the risk of cardiovascular disease and stroke by one-fourth to one-third.

Several genetic associations have been tentatively made for a variety of specific types of stroke, precluding the utility of a simple genetic test for stroke risk [10]; the disease itself is heterogeneous in terms of cause and type, and these subtypes involve a variety of potential variants, none of which have been validated as predictors of stroke risk in the general population. As the relationship between specific types of stroke and predisposing genetic and environmental factors becomes more defined however, it is plausible that more precise diagnoses, preventive interventions, and treatments will be forthcoming.