The adage, “the sun should never set on an untapped pleural effusion,” was instilled in physicians for generations. However, anyone who practices medicine currently knows the sun often rises and sets several times before a pleural effusion is tapped. Why the change in mindset? Since the American Board of Internal Medicine removed the requirement for internal medicine residents to perform a minimum number of bedside procedures for certification, fewer graduating residents feel comfortable performing thoracentesis.

Additionally, the fear of litigation and institutional persecution from a postprocedure complication has caused many frontline clinicians to shy away from performing thoracentesis. Most important, we now appreciate that not all pleural effusions need to be tapped immediately, and the clinical decision making about the timing and technique to drain a pleural effusion is more complex than previously thought.

In recent years, the availability of portable ultrasound for bedside diagnostics and procedural guidance has revolutionized the practice of medicine, including the management of pleural effusions. When confronted with an obscured lower lobe on chest radiograph (Figure, left), clinicians were previously relegated to primitive bedside maneuvers, such as percussion or auscultation, to make critical decisions about the clinical management. Now, clinicians are able to look inside the body with point-of-care ultrasound and visually assess a pleural effusion before making any decisions. Point-of-care ultrasound has shifted the paradigm in the management of pleural effusions in several ways.

Ultrasound allows rapid detection and differentiation of pleural effusions from other pathologic findings.

Chest radiographs cannot accurately differentiate a pleural effusion from other common conditions, such as pneumonia, atelectasis, or an elevated hemidiaphragm. Ultrasound is the only bedside diagnostic modality that can rapidly differentiate these conditions within seconds and may reveal unsuspected findings, such as a mass or pericardial effusion.

For example, the pleural ultrasound exam of a patient in the confirmed the presence of a large, left-sided pleural effusion (Figure, right) but also revealed an unsuspected large pericardial effusion (asterisk) that was causing hemodynamic compromise. The management of this patient shifted focus from the pleural effusion to the pericardial effusion, and urgent pericardiocentesis was performed. The sensitivity of ultrasound to detect a pleural effusion is proportional to the volume of fluid, reaching 100% with as little as 100 mL of fluid (Kalokairinou-Motogna et al. Med Ultra. 2010;12[1]:12). The diagnostic accuracy of ultrasound for detection of pleural effusions is comparable to CT scans of the chest and superior to portable chest radiographs (Lichtenstein et al. Anesthesiology. 2004;100[1]:9).

Ultrasound characterizes pleural effusions to determine the most appropriate management strategy.

Any clinician with basic ultrasonography skills can learn to evaluate pleural effusions and categorize them as simple or complex based on the sonographic appearance. Visualization of fibrinous stranding or loculations increases the probability of pleural fluid being exudative and often drives the decision to drain the fluid. The density and distribution of loculations can guide decisions about the most appropriate type of drainage procedure – thoracentesis versus tube thoracostomy versus surgical intervention. Use of color flow Doppler ultrasound allows clinicians to assess whether or not pleural fluid is free flowing and amenable to drainage, potentially saving the patient from an unnecessary attempt at drainage.

Ultrasound affords frontline clinicians the ability to streamline consultation with the most appropriate specialist based on the type of drainage procedure indicated and potentially prevent duplicate procedures on the same patient from different specialists.

Ultrasound reduces the risk of postprocedure complications from thoracentesis.

The risk of postthoracentesis pneumothorax was reported to be as high as 20%-39% before the routine use of point-of-care ultrasound (Grogan et al. Arch Int Med. 1990;150:873). Ultrasound guidance has been shown to increase procedural success rates and decrease the risk of postprocedure pneumothorax (2.7%), cost of hospitalization, and length of stay (Mercaldi et al. Chest. 2015;143[2]:532).

Regardless of the chest radiograph or CT scan findings, if the ultrasound exam reveals a scant volume of pleural fluid, or densely loculated pleural fluid, clinicians can avoid unnecessary attempts at bedside drainage, which likely partly accounts for the reduction in postprocedure pneumothorax. Use of ultrasound for needle site selection may prevent up to 10% of potential accidental organ punctures and increases accurate site selection by 26%, compared with chest radiograph and physical examination findings combined (Diacon et al. Chest. 2003;123:436).

Ultrasound facilitates patient-centered care.

Point-of-care ultrasound is the only new technology that has taken clinicians back to the bedside to spend more time with patients. Clinicians can simultaneously perform an ultrasound exam and converse with patients to gather a medical history. The ultrasound image serves as a tool to help patients understand their condition and facilitates shared decision making with clinicians at the bedside.

As more specialties have gained expertise in thoracic ultrasonography, the use of ultrasound guidance for thoracentesis has evolved to become the standard of care in many hospitals in the United States. Besides pulmonary specialists, several acute care specialists, including hospitalists, intensivists, and emergency medicine physicians, are routinely using point-of-care ultrasound to guide diagnostic decision making and procedures. Over the past 10 years, nearly a dozen procedure services led by internal medicine-trained hospitalists have been created at academic institutions that are routinely performing ultrasound-guided thoracenteses with low complication rates (Franco-Sadud et al. SGIM Forum. 2016;39[5]:13). More important, ultrasound is being used on the front lines to expeditiously evaluate pleural effusions and perform a diagnostic thoracentesis or consult with the appropriate subspecialist. Even though demonstration of competency in bedside procedures is no longer required for board certification in internal medicine, many internal medicine residency programs have incorporated diagnostic and procedural point-of-care ultrasound training into their education curriculum (Schnobrich et al. JGME. 2013;5[3]:498). Further, approximately 62% of medical schools report integrating ultrasound education in their medical student curriculum, and in coming years, most medical students will likely graduate with a basic skill set in point-of-care ultrasonography (Bahner et al. Academic Med. 2014;89[12]:1681). As point-of-care ultrasound education becomes integrated in training of physicians and other health-care providers, use of ultrasound to guide management of pleural effusions could become universally practiced and accepted as the new standard of care. Thus, it is plausible that a day will come in the near future when the sun will not set on an “un-ultrasound-ed” pleural effusion.

Dr. Franco-Sadud is with the section of hospital medicine/division of general internal medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Dr. Soni is with the section of hospital medicine and the section of pulmonary and critical care medicine, South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio.

The adage, “the sun should never set on an untapped pleural effusion,” was instilled in physicians for generations. However, anyone who practices medicine currently knows the sun often rises and sets several times before a pleural effusion is tapped. Why the change in mindset? Since the American Board of Internal Medicine removed the requirement for internal medicine residents to perform a minimum number of bedside procedures for certification, fewer graduating residents feel comfortable performing thoracentesis.

Additionally, the fear of litigation and institutional persecution from a postprocedure complication has caused many frontline clinicians to shy away from performing thoracentesis. Most important, we now appreciate that not all pleural effusions need to be tapped immediately, and the clinical decision making about the timing and technique to drain a pleural effusion is more complex than previously thought.

In recent years, the availability of portable ultrasound for bedside diagnostics and procedural guidance has revolutionized the practice of medicine, including the management of pleural effusions. When confronted with an obscured lower lobe on chest radiograph (Figure, left), clinicians were previously relegated to primitive bedside maneuvers, such as percussion or auscultation, to make critical decisions about the clinical management. Now, clinicians are able to look inside the body with point-of-care ultrasound and visually assess a pleural effusion before making any decisions. Point-of-care ultrasound has shifted the paradigm in the management of pleural effusions in several ways.

Ultrasound allows rapid detection and differentiation of pleural effusions from other pathologic findings.

Chest radiographs cannot accurately differentiate a pleural effusion from other common conditions, such as pneumonia, atelectasis, or an elevated hemidiaphragm. Ultrasound is the only bedside diagnostic modality that can rapidly differentiate these conditions within seconds and may reveal unsuspected findings, such as a mass or pericardial effusion.

For example, the pleural ultrasound exam of a patient in the confirmed the presence of a large, left-sided pleural effusion (Figure, right) but also revealed an unsuspected large pericardial effusion (asterisk) that was causing hemodynamic compromise. The management of this patient shifted focus from the pleural effusion to the pericardial effusion, and urgent pericardiocentesis was performed. The sensitivity of ultrasound to detect a pleural effusion is proportional to the volume of fluid, reaching 100% with as little as 100 mL of fluid (Kalokairinou-Motogna et al. Med Ultra. 2010;12[1]:12). The diagnostic accuracy of ultrasound for detection of pleural effusions is comparable to CT scans of the chest and superior to portable chest radiographs (Lichtenstein et al. Anesthesiology. 2004;100[1]:9).

Ultrasound characterizes pleural effusions to determine the most appropriate management strategy.

Any clinician with basic ultrasonography skills can learn to evaluate pleural effusions and categorize them as simple or complex based on the sonographic appearance. Visualization of fibrinous stranding or loculations increases the probability of pleural fluid being exudative and often drives the decision to drain the fluid. The density and distribution of loculations can guide decisions about the most appropriate type of drainage procedure – thoracentesis versus tube thoracostomy versus surgical intervention. Use of color flow Doppler ultrasound allows clinicians to assess whether or not pleural fluid is free flowing and amenable to drainage, potentially saving the patient from an unnecessary attempt at drainage.

Ultrasound affords frontline clinicians the ability to streamline consultation with the most appropriate specialist based on the type of drainage procedure indicated and potentially prevent duplicate procedures on the same patient from different specialists.

Ultrasound reduces the risk of postprocedure complications from thoracentesis.

The risk of postthoracentesis pneumothorax was reported to be as high as 20%-39% before the routine use of point-of-care ultrasound (Grogan et al. Arch Int Med. 1990;150:873). Ultrasound guidance has been shown to increase procedural success rates and decrease the risk of postprocedure pneumothorax (2.7%), cost of hospitalization, and length of stay (Mercaldi et al. Chest. 2015;143[2]:532).

Regardless of the chest radiograph or CT scan findings, if the ultrasound exam reveals a scant volume of pleural fluid, or densely loculated pleural fluid, clinicians can avoid unnecessary attempts at bedside drainage, which likely partly accounts for the reduction in postprocedure pneumothorax. Use of ultrasound for needle site selection may prevent up to 10% of potential accidental organ punctures and increases accurate site selection by 26%, compared with chest radiograph and physical examination findings combined (Diacon et al. Chest. 2003;123:436).

Ultrasound facilitates patient-centered care.

Point-of-care ultrasound is the only new technology that has taken clinicians back to the bedside to spend more time with patients. Clinicians can simultaneously perform an ultrasound exam and converse with patients to gather a medical history. The ultrasound image serves as a tool to help patients understand their condition and facilitates shared decision making with clinicians at the bedside.

As more specialties have gained expertise in thoracic ultrasonography, the use of ultrasound guidance for thoracentesis has evolved to become the standard of care in many hospitals in the United States. Besides pulmonary specialists, several acute care specialists, including hospitalists, intensivists, and emergency medicine physicians, are routinely using point-of-care ultrasound to guide diagnostic decision making and procedures. Over the past 10 years, nearly a dozen procedure services led by internal medicine-trained hospitalists have been created at academic institutions that are routinely performing ultrasound-guided thoracenteses with low complication rates (Franco-Sadud et al. SGIM Forum. 2016;39[5]:13). More important, ultrasound is being used on the front lines to expeditiously evaluate pleural effusions and perform a diagnostic thoracentesis or consult with the appropriate subspecialist. Even though demonstration of competency in bedside procedures is no longer required for board certification in internal medicine, many internal medicine residency programs have incorporated diagnostic and procedural point-of-care ultrasound training into their education curriculum (Schnobrich et al. JGME. 2013;5[3]:498). Further, approximately 62% of medical schools report integrating ultrasound education in their medical student curriculum, and in coming years, most medical students will likely graduate with a basic skill set in point-of-care ultrasonography (Bahner et al. Academic Med. 2014;89[12]:1681). As point-of-care ultrasound education becomes integrated in training of physicians and other health-care providers, use of ultrasound to guide management of pleural effusions could become universally practiced and accepted as the new standard of care. Thus, it is plausible that a day will come in the near future when the sun will not set on an “un-ultrasound-ed” pleural effusion.

Dr. Franco-Sadud is with the section of hospital medicine/division of general internal medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Dr. Soni is with the section of hospital medicine and the section of pulmonary and critical care medicine, South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio.

The adage, “the sun should never set on an untapped pleural effusion,” was instilled in physicians for generations. However, anyone who practices medicine currently knows the sun often rises and sets several times before a pleural effusion is tapped. Why the change in mindset? Since the American Board of Internal Medicine removed the requirement for internal medicine residents to perform a minimum number of bedside procedures for certification, fewer graduating residents feel comfortable performing thoracentesis.

Additionally, the fear of litigation and institutional persecution from a postprocedure complication has caused many frontline clinicians to shy away from performing thoracentesis. Most important, we now appreciate that not all pleural effusions need to be tapped immediately, and the clinical decision making about the timing and technique to drain a pleural effusion is more complex than previously thought.

In recent years, the availability of portable ultrasound for bedside diagnostics and procedural guidance has revolutionized the practice of medicine, including the management of pleural effusions. When confronted with an obscured lower lobe on chest radiograph (Figure, left), clinicians were previously relegated to primitive bedside maneuvers, such as percussion or auscultation, to make critical decisions about the clinical management. Now, clinicians are able to look inside the body with point-of-care ultrasound and visually assess a pleural effusion before making any decisions. Point-of-care ultrasound has shifted the paradigm in the management of pleural effusions in several ways.

Ultrasound allows rapid detection and differentiation of pleural effusions from other pathologic findings.

Chest radiographs cannot accurately differentiate a pleural effusion from other common conditions, such as pneumonia, atelectasis, or an elevated hemidiaphragm. Ultrasound is the only bedside diagnostic modality that can rapidly differentiate these conditions within seconds and may reveal unsuspected findings, such as a mass or pericardial effusion.

For example, the pleural ultrasound exam of a patient in the confirmed the presence of a large, left-sided pleural effusion (Figure, right) but also revealed an unsuspected large pericardial effusion (asterisk) that was causing hemodynamic compromise. The management of this patient shifted focus from the pleural effusion to the pericardial effusion, and urgent pericardiocentesis was performed. The sensitivity of ultrasound to detect a pleural effusion is proportional to the volume of fluid, reaching 100% with as little as 100 mL of fluid (Kalokairinou-Motogna et al. Med Ultra. 2010;12[1]:12). The diagnostic accuracy of ultrasound for detection of pleural effusions is comparable to CT scans of the chest and superior to portable chest radiographs (Lichtenstein et al. Anesthesiology. 2004;100[1]:9).

Ultrasound characterizes pleural effusions to determine the most appropriate management strategy.

Any clinician with basic ultrasonography skills can learn to evaluate pleural effusions and categorize them as simple or complex based on the sonographic appearance. Visualization of fibrinous stranding or loculations increases the probability of pleural fluid being exudative and often drives the decision to drain the fluid. The density and distribution of loculations can guide decisions about the most appropriate type of drainage procedure – thoracentesis versus tube thoracostomy versus surgical intervention. Use of color flow Doppler ultrasound allows clinicians to assess whether or not pleural fluid is free flowing and amenable to drainage, potentially saving the patient from an unnecessary attempt at drainage.

Ultrasound affords frontline clinicians the ability to streamline consultation with the most appropriate specialist based on the type of drainage procedure indicated and potentially prevent duplicate procedures on the same patient from different specialists.

Ultrasound reduces the risk of postprocedure complications from thoracentesis.

The risk of postthoracentesis pneumothorax was reported to be as high as 20%-39% before the routine use of point-of-care ultrasound (Grogan et al. Arch Int Med. 1990;150:873). Ultrasound guidance has been shown to increase procedural success rates and decrease the risk of postprocedure pneumothorax (2.7%), cost of hospitalization, and length of stay (Mercaldi et al. Chest. 2015;143[2]:532).

Regardless of the chest radiograph or CT scan findings, if the ultrasound exam reveals a scant volume of pleural fluid, or densely loculated pleural fluid, clinicians can avoid unnecessary attempts at bedside drainage, which likely partly accounts for the reduction in postprocedure pneumothorax. Use of ultrasound for needle site selection may prevent up to 10% of potential accidental organ punctures and increases accurate site selection by 26%, compared with chest radiograph and physical examination findings combined (Diacon et al. Chest. 2003;123:436).

Ultrasound facilitates patient-centered care.

Point-of-care ultrasound is the only new technology that has taken clinicians back to the bedside to spend more time with patients. Clinicians can simultaneously perform an ultrasound exam and converse with patients to gather a medical history. The ultrasound image serves as a tool to help patients understand their condition and facilitates shared decision making with clinicians at the bedside.

As more specialties have gained expertise in thoracic ultrasonography, the use of ultrasound guidance for thoracentesis has evolved to become the standard of care in many hospitals in the United States. Besides pulmonary specialists, several acute care specialists, including hospitalists, intensivists, and emergency medicine physicians, are routinely using point-of-care ultrasound to guide diagnostic decision making and procedures. Over the past 10 years, nearly a dozen procedure services led by internal medicine-trained hospitalists have been created at academic institutions that are routinely performing ultrasound-guided thoracenteses with low complication rates (Franco-Sadud et al. SGIM Forum. 2016;39[5]:13). More important, ultrasound is being used on the front lines to expeditiously evaluate pleural effusions and perform a diagnostic thoracentesis or consult with the appropriate subspecialist. Even though demonstration of competency in bedside procedures is no longer required for board certification in internal medicine, many internal medicine residency programs have incorporated diagnostic and procedural point-of-care ultrasound training into their education curriculum (Schnobrich et al. JGME. 2013;5[3]:498). Further, approximately 62% of medical schools report integrating ultrasound education in their medical student curriculum, and in coming years, most medical students will likely graduate with a basic skill set in point-of-care ultrasonography (Bahner et al. Academic Med. 2014;89[12]:1681). As point-of-care ultrasound education becomes integrated in training of physicians and other health-care providers, use of ultrasound to guide management of pleural effusions could become universally practiced and accepted as the new standard of care. Thus, it is plausible that a day will come in the near future when the sun will not set on an “un-ultrasound-ed” pleural effusion.

Dr. Franco-Sadud is with the section of hospital medicine/division of general internal medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Dr. Soni is with the section of hospital medicine and the section of pulmonary and critical care medicine, South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio.

Patients with epilepsy seem to have difficulty recognizing certain emotional states, according to a recent study that used video simulations to evaluate patients’ social cognition skills. When researchers administered the Awareness of Social Inference Test to 43 patients with focal epilepsy and 22 controls, using a video format, they found that neither group had trouble identifying positive emotional states like happiness; but patients with epilepsy had difficulty recognizing negative emotions such as anger, fear, and disgust. The study suggests that standard psychometric tools used to measure cognitive abilities in patients with epilepsy may need to be supplemented with a vehicle that evaluates social cognition.

Bujarski KA, Flashman L, Li Z, et al. Investigating social cognition in epilepsy using a naturalistic task. Epilepsia. 2016;57(9):1515-1520.

Patients with epilepsy seem to have difficulty recognizing certain emotional states, according to a recent study that used video simulations to evaluate patients’ social cognition skills. When researchers administered the Awareness of Social Inference Test to 43 patients with focal epilepsy and 22 controls, using a video format, they found that neither group had trouble identifying positive emotional states like happiness; but patients with epilepsy had difficulty recognizing negative emotions such as anger, fear, and disgust. The study suggests that standard psychometric tools used to measure cognitive abilities in patients with epilepsy may need to be supplemented with a vehicle that evaluates social cognition.

Bujarski KA, Flashman L, Li Z, et al. Investigating social cognition in epilepsy using a naturalistic task. Epilepsia. 2016;57(9):1515-1520.

Patients with epilepsy seem to have difficulty recognizing certain emotional states, according to a recent study that used video simulations to evaluate patients’ social cognition skills. When researchers administered the Awareness of Social Inference Test to 43 patients with focal epilepsy and 22 controls, using a video format, they found that neither group had trouble identifying positive emotional states like happiness; but patients with epilepsy had difficulty recognizing negative emotions such as anger, fear, and disgust. The study suggests that standard psychometric tools used to measure cognitive abilities in patients with epilepsy may need to be supplemented with a vehicle that evaluates social cognition.

Bujarski KA, Flashman L, Li Z, et al. Investigating social cognition in epilepsy using a naturalistic task. Epilepsia. 2016;57(9):1515-1520.

The default mode network (DMN), which connects brain regions such as precuneus/posterior cingulate cortex, medial prefrontal cortex, and medial, lateral, and inferior parietal cortex, plays an important role in temporal lobe epilepsy (TLE), according to a recent literature review. Among patients with TLE, the amplitude of the blood oxygenation-level dependent (BOLD) signal decreases during the interval between seizures. Investigators have also found that TLE patients have less anterograde connectivity from the anterior to the posterior DMN. Changes in the activity of the DMN in people with epilepsy, as well as several other neurological disorders, suggest that assessment of the network may help improve early detection and treatment, according to the researchers.  

Mohan A, Roberto AJ, Mohan A, et al. The significance of the default mode network (DMN) in neurological and neuropsychiatric disorders: A review. Yale J Biol Med. 2016;89(1):49-57.

The default mode network (DMN), which connects brain regions such as precuneus/posterior cingulate cortex, medial prefrontal cortex, and medial, lateral, and inferior parietal cortex, plays an important role in temporal lobe epilepsy (TLE), according to a recent literature review. Among patients with TLE, the amplitude of the blood oxygenation-level dependent (BOLD) signal decreases during the interval between seizures. Investigators have also found that TLE patients have less anterograde connectivity from the anterior to the posterior DMN. Changes in the activity of the DMN in people with epilepsy, as well as several other neurological disorders, suggest that assessment of the network may help improve early detection and treatment, according to the researchers.  

Mohan A, Roberto AJ, Mohan A, et al. The significance of the default mode network (DMN) in neurological and neuropsychiatric disorders: A review. Yale J Biol Med. 2016;89(1):49-57.

The default mode network (DMN), which connects brain regions such as precuneus/posterior cingulate cortex, medial prefrontal cortex, and medial, lateral, and inferior parietal cortex, plays an important role in temporal lobe epilepsy (TLE), according to a recent literature review. Among patients with TLE, the amplitude of the blood oxygenation-level dependent (BOLD) signal decreases during the interval between seizures. Investigators have also found that TLE patients have less anterograde connectivity from the anterior to the posterior DMN. Changes in the activity of the DMN in people with epilepsy, as well as several other neurological disorders, suggest that assessment of the network may help improve early detection and treatment, according to the researchers.  

Mohan A, Roberto AJ, Mohan A, et al. The significance of the default mode network (DMN) in neurological and neuropsychiatric disorders: A review. Yale J Biol Med. 2016;89(1):49-57.

To help distinguish patients with Rasmussen encephalitis from patients with epilepsy not suffering from the syndrome, researchers performed quantitative volumetric MR imaging on 42 patients with Rasmussen syndrome and compared the readings to MRIs performed on 42 controls and 42 unaffected patients with epilepsy. Their analysis found that interhemispheric and frontal lobe ratios were the most effective way to differentiate Rasmussen encephalitis from the other 2 groups. They also found that the insula of Rasmussen encephalitis patients was significantly more atrophic, when compared with other cortical regions of the brain.

Wang Z, Krishnan B, Shattuck DW, et al. Automated MRI volumetric analysis in patients with Rasmussen syndrome [published online ahead of print September 8, 2016]. AJNR Am. J. Neuroradiol. 2016.

To help distinguish patients with Rasmussen encephalitis from patients with epilepsy not suffering from the syndrome, researchers performed quantitative volumetric MR imaging on 42 patients with Rasmussen syndrome and compared the readings to MRIs performed on 42 controls and 42 unaffected patients with epilepsy. Their analysis found that interhemispheric and frontal lobe ratios were the most effective way to differentiate Rasmussen encephalitis from the other 2 groups. They also found that the insula of Rasmussen encephalitis patients was significantly more atrophic, when compared with other cortical regions of the brain.

Wang Z, Krishnan B, Shattuck DW, et al. Automated MRI volumetric analysis in patients with Rasmussen syndrome [published online ahead of print September 8, 2016]. AJNR Am. J. Neuroradiol. 2016.

To help distinguish patients with Rasmussen encephalitis from patients with epilepsy not suffering from the syndrome, researchers performed quantitative volumetric MR imaging on 42 patients with Rasmussen syndrome and compared the readings to MRIs performed on 42 controls and 42 unaffected patients with epilepsy. Their analysis found that interhemispheric and frontal lobe ratios were the most effective way to differentiate Rasmussen encephalitis from the other 2 groups. They also found that the insula of Rasmussen encephalitis patients was significantly more atrophic, when compared with other cortical regions of the brain.

Wang Z, Krishnan B, Shattuck DW, et al. Automated MRI volumetric analysis in patients with Rasmussen syndrome [published online ahead of print September 8, 2016]. AJNR Am. J. Neuroradiol. 2016.

Using the NeuroPace RNS system to monitor long-term epileptic-like activity, researchers have confirmed that there is a uniform circadian pattern to this brain activity. Studying 134 subjects, Spencer et al found the epileptiform activity peaked during normal sleeping hours. They also discovered a monophasic, nocturnally dominant rhythm in the neocortical areas of the brain and a more complex pattern, with a diurnal peak, in limbic sections of the brain.  Some volunteers were also found to have a dual oscillator pattern to the brain activity, displaying a circadian and ultradian pattern.

Spencer D, Sun F, Brown S, Jobst, B, Wong V, Mirro E et al. Circadian and ultradian patterns of epileptiform discharges differ by seizure-onset location during long-term ambulatory intracranial monitoring. Epilepsia. 2016;57(9):1495-1502.

Using the NeuroPace RNS system to monitor long-term epileptic-like activity, researchers have confirmed that there is a uniform circadian pattern to this brain activity. Studying 134 subjects, Spencer et al found the epileptiform activity peaked during normal sleeping hours. They also discovered a monophasic, nocturnally dominant rhythm in the neocortical areas of the brain and a more complex pattern, with a diurnal peak, in limbic sections of the brain.  Some volunteers were also found to have a dual oscillator pattern to the brain activity, displaying a circadian and ultradian pattern.

Spencer D, Sun F, Brown S, Jobst, B, Wong V, Mirro E et al. Circadian and ultradian patterns of epileptiform discharges differ by seizure-onset location during long-term ambulatory intracranial monitoring. Epilepsia. 2016;57(9):1495-1502.

Using the NeuroPace RNS system to monitor long-term epileptic-like activity, researchers have confirmed that there is a uniform circadian pattern to this brain activity. Studying 134 subjects, Spencer et al found the epileptiform activity peaked during normal sleeping hours. They also discovered a monophasic, nocturnally dominant rhythm in the neocortical areas of the brain and a more complex pattern, with a diurnal peak, in limbic sections of the brain.  Some volunteers were also found to have a dual oscillator pattern to the brain activity, displaying a circadian and ultradian pattern.

Spencer D, Sun F, Brown S, Jobst, B, Wong V, Mirro E et al. Circadian and ultradian patterns of epileptiform discharges differ by seizure-onset location during long-term ambulatory intracranial monitoring. Epilepsia. 2016;57(9):1495-1502.

Patients with tuberous sclerosis complex (TSC) are at higher than average risk of developing epilepsy if they exhibit several systemic disease manifestations, according to a recent analysis of the TSC Natural History Database. After factoring out confounding variables like age, gender, and TSC mutation, Anna Jeong and Michael Wong of Washington University School of Medicine found that cardiac rhabdomyomas, retinal hamartomas, renal cysts, renal angiomyolipomas, shagreen patches, and facial angiofibromas increased the likelihood of TSC patients developing epilepsy.

Jeong A, Wong M. Systemic disease manifestations associated with epilepsy in tuberous sclerosis complex. Epilepsia. 2016;57(9):1443-1449.

Patients with tuberous sclerosis complex (TSC) are at higher than average risk of developing epilepsy if they exhibit several systemic disease manifestations, according to a recent analysis of the TSC Natural History Database. After factoring out confounding variables like age, gender, and TSC mutation, Anna Jeong and Michael Wong of Washington University School of Medicine found that cardiac rhabdomyomas, retinal hamartomas, renal cysts, renal angiomyolipomas, shagreen patches, and facial angiofibromas increased the likelihood of TSC patients developing epilepsy.

Jeong A, Wong M. Systemic disease manifestations associated with epilepsy in tuberous sclerosis complex. Epilepsia. 2016;57(9):1443-1449.

Patients with tuberous sclerosis complex (TSC) are at higher than average risk of developing epilepsy if they exhibit several systemic disease manifestations, according to a recent analysis of the TSC Natural History Database. After factoring out confounding variables like age, gender, and TSC mutation, Anna Jeong and Michael Wong of Washington University School of Medicine found that cardiac rhabdomyomas, retinal hamartomas, renal cysts, renal angiomyolipomas, shagreen patches, and facial angiofibromas increased the likelihood of TSC patients developing epilepsy.

Jeong A, Wong M. Systemic disease manifestations associated with epilepsy in tuberous sclerosis complex. Epilepsia. 2016;57(9):1443-1449.

Performing resting state functioning MRIs can help distinguish temporal lobe epilepsy that’s accompanied by mesial temporal sclerosis (TLE-MTS) from temporal lobe epilepsy without the sclerosis. That conclusion was dreached by researchers who compared 34 TLE patients to 34 controls who were matched for age and gender and in whom the presence of mesial temporal sclerosis was definitively established by means of histologic examination of surgical tissue. More specifically, the investigators found that the fractional amplitude of low-frequency fluctuations (fALFF) in the blood oxygen level-dependent resting state fMRI was reduced in the ipsilateral amygdala and hippocampus among TLE patients with mesial temporal sclerosis. By contrast, among TLE patients without sclerosis, there was only marginally reduced fALFF in the ipsilateral amygdala but none in the hippocampus. 

Reyes A, Thesen D, Wang X, Hahn D, Yoo D, Kuzniecky R et al.  Resting-state functional MRI distinguishes temporal lobe epilepsy subtypes. Epilepsia. 2016;57(9):1475-1484.  

Performing resting state functioning MRIs can help distinguish temporal lobe epilepsy that’s accompanied by mesial temporal sclerosis (TLE-MTS) from temporal lobe epilepsy without the sclerosis. That conclusion was dreached by researchers who compared 34 TLE patients to 34 controls who were matched for age and gender and in whom the presence of mesial temporal sclerosis was definitively established by means of histologic examination of surgical tissue. More specifically, the investigators found that the fractional amplitude of low-frequency fluctuations (fALFF) in the blood oxygen level-dependent resting state fMRI was reduced in the ipsilateral amygdala and hippocampus among TLE patients with mesial temporal sclerosis. By contrast, among TLE patients without sclerosis, there was only marginally reduced fALFF in the ipsilateral amygdala but none in the hippocampus. 

Reyes A, Thesen D, Wang X, Hahn D, Yoo D, Kuzniecky R et al.  Resting-state functional MRI distinguishes temporal lobe epilepsy subtypes. Epilepsia. 2016;57(9):1475-1484.  

Performing resting state functioning MRIs can help distinguish temporal lobe epilepsy that’s accompanied by mesial temporal sclerosis (TLE-MTS) from temporal lobe epilepsy without the sclerosis. That conclusion was dreached by researchers who compared 34 TLE patients to 34 controls who were matched for age and gender and in whom the presence of mesial temporal sclerosis was definitively established by means of histologic examination of surgical tissue. More specifically, the investigators found that the fractional amplitude of low-frequency fluctuations (fALFF) in the blood oxygen level-dependent resting state fMRI was reduced in the ipsilateral amygdala and hippocampus among TLE patients with mesial temporal sclerosis. By contrast, among TLE patients without sclerosis, there was only marginally reduced fALFF in the ipsilateral amygdala but none in the hippocampus. 

Reyes A, Thesen D, Wang X, Hahn D, Yoo D, Kuzniecky R et al.  Resting-state functional MRI distinguishes temporal lobe epilepsy subtypes. Epilepsia. 2016;57(9):1475-1484.  

A total of 8,333 dermatologists – 73% of those practicing in the United States – received $34.8 million from industry in 2014, mostly from pharmaceutical companies, according to an Oct. 5 report in JAMA Dermatology.

The bulk of the money went to a fraction of the dermatologists. Just 10% – 833 – collected $31.2 million. Eighty-three dermatologists – 1% of the total – pulled in about $15 million, each receiving at least $93,622. The 10 highest-paid dermatologists were mostly in private practice, not academia, and three were women (JAMA Dermatol. 2016 Oct 5. doi: 10.1001/jamadermatol.2016.3037).

Speaker fees accounted for 32% of the total payment amount, consulting fees for 22%, research payments for 17%, and food and beverage payments for 13%. Lesser amounts went towards travel and honoraria, among other things.

Almost $29 million came from pharmaceutical companies. AbbVie and Allergan led the way with payments of nearly $6 million each. Pharmaceutical company largesse is “not surprising” since companies have “financial incentives to promote their medications,” and having “thought leaders being advocates and spokespersons may help shift clinical practices,” said lead investigator Hao Feng, MD, a dermatology resident at New York University, and his colleagues. Recent studies “show that receipt of industry payments and industry-sponsored meals was associated with an increased rate of prescribing several class[es] of brand-name medications.”

©Kativ/iStockphoto.com

aotto@frontlinemedcom.com
 

A total of 8,333 dermatologists – 73% of those practicing in the United States – received $34.8 million from industry in 2014, mostly from pharmaceutical companies, according to an Oct. 5 report in JAMA Dermatology.

The bulk of the money went to a fraction of the dermatologists. Just 10% – 833 – collected $31.2 million. Eighty-three dermatologists – 1% of the total – pulled in about $15 million, each receiving at least $93,622. The 10 highest-paid dermatologists were mostly in private practice, not academia, and three were women (JAMA Dermatol. 2016 Oct 5. doi: 10.1001/jamadermatol.2016.3037).

Speaker fees accounted for 32% of the total payment amount, consulting fees for 22%, research payments for 17%, and food and beverage payments for 13%. Lesser amounts went towards travel and honoraria, among other things.

Almost $29 million came from pharmaceutical companies. AbbVie and Allergan led the way with payments of nearly $6 million each. Pharmaceutical company largesse is “not surprising” since companies have “financial incentives to promote their medications,” and having “thought leaders being advocates and spokespersons may help shift clinical practices,” said lead investigator Hao Feng, MD, a dermatology resident at New York University, and his colleagues. Recent studies “show that receipt of industry payments and industry-sponsored meals was associated with an increased rate of prescribing several class[es] of brand-name medications.”

©Kativ/iStockphoto.com

aotto@frontlinemedcom.com
 

A total of 8,333 dermatologists – 73% of those practicing in the United States – received $34.8 million from industry in 2014, mostly from pharmaceutical companies, according to an Oct. 5 report in JAMA Dermatology.

The bulk of the money went to a fraction of the dermatologists. Just 10% – 833 – collected $31.2 million. Eighty-three dermatologists – 1% of the total – pulled in about $15 million, each receiving at least $93,622. The 10 highest-paid dermatologists were mostly in private practice, not academia, and three were women (JAMA Dermatol. 2016 Oct 5. doi: 10.1001/jamadermatol.2016.3037).

Speaker fees accounted for 32% of the total payment amount, consulting fees for 22%, research payments for 17%, and food and beverage payments for 13%. Lesser amounts went towards travel and honoraria, among other things.

Almost $29 million came from pharmaceutical companies. AbbVie and Allergan led the way with payments of nearly $6 million each. Pharmaceutical company largesse is “not surprising” since companies have “financial incentives to promote their medications,” and having “thought leaders being advocates and spokespersons may help shift clinical practices,” said lead investigator Hao Feng, MD, a dermatology resident at New York University, and his colleagues. Recent studies “show that receipt of industry payments and industry-sponsored meals was associated with an increased rate of prescribing several class[es] of brand-name medications.”

©Kativ/iStockphoto.com

aotto@frontlinemedcom.com
 

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NEW YORK – “All psychology works through biology,” said the new head of the National Institute of Mental Health, Joshua A. Gordon, MD, PhD. “The divide is artificial at the level of neurocircuits.” All treatments for mental illness, from antidepressants to psychotherapy to emerging therapies, can be viewed through that lens.

In this video interview, conducted just days before he stepped into his new role, Dr. Gordon discusses how this biological view of the mind and brain will inform his approach to use of the Research Domain Criteria (RDoC) when reviewing grant applications, a process he said he is aware some researchers still resist.

“One thing that is important is that we really try to quantify and objectively evaluate behavior in the way that RDoC tries to do. RDoC essentially is a way to try to categorize behavior into its component building blocks, and then try to understand, yes, the biology underneath it,” Dr. Gordon said.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

NEW YORK – “All psychology works through biology,” said the new head of the National Institute of Mental Health, Joshua A. Gordon, MD, PhD. “The divide is artificial at the level of neurocircuits.” All treatments for mental illness, from antidepressants to psychotherapy to emerging therapies, can be viewed through that lens.

In this video interview, conducted just days before he stepped into his new role, Dr. Gordon discusses how this biological view of the mind and brain will inform his approach to use of the Research Domain Criteria (RDoC) when reviewing grant applications, a process he said he is aware some researchers still resist.

“One thing that is important is that we really try to quantify and objectively evaluate behavior in the way that RDoC tries to do. RDoC essentially is a way to try to categorize behavior into its component building blocks, and then try to understand, yes, the biology underneath it,” Dr. Gordon said.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

NEW YORK – “All psychology works through biology,” said the new head of the National Institute of Mental Health, Joshua A. Gordon, MD, PhD. “The divide is artificial at the level of neurocircuits.” All treatments for mental illness, from antidepressants to psychotherapy to emerging therapies, can be viewed through that lens.

In this video interview, conducted just days before he stepped into his new role, Dr. Gordon discusses how this biological view of the mind and brain will inform his approach to use of the Research Domain Criteria (RDoC) when reviewing grant applications, a process he said he is aware some researchers still resist.

“One thing that is important is that we really try to quantify and objectively evaluate behavior in the way that RDoC tries to do. RDoC essentially is a way to try to categorize behavior into its component building blocks, and then try to understand, yes, the biology underneath it,” Dr. Gordon said.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight