Database : MEDLINE
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[PMID]: 28743752
[Au] Autor:Flores FJ; Hartnack KE; Fath AB; Kim SE; Wilson MA; Brown EN; Purdon PL
[Ad] Address:Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114; patrickp@nmr.mgh.harvard.edu fjflores@neurostat.mit.edu enb@neurostat.mit.edu.
[Ti] Title:Thalamocortical synchronization during induction and emergence from propofol-induced unconsciousness.
[So] Source:Proc Natl Acad Sci U S A;114(32):E6660-E6668, 2017 Aug 08.
[Is] ISSN:1091-6490
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:General anesthesia (GA) is a reversible drug-induced state of altered arousal required for more than 60,000 surgical procedures each day in the United States alone. Sedation and unconsciousness under GA are associated with stereotyped electrophysiological oscillations that are thought to reflect profound disruptions of activity in neuronal circuits that mediate awareness and cognition. Computational models make specific predictions about the role of the cortex and thalamus in these oscillations. In this paper, we provide in vivo evidence in rats that alpha oscillations (10-15 Hz) induced by the commonly used anesthetic drug propofol are synchronized between the thalamus and the medial prefrontal cortex. We also show that at deep levels of unconsciousness where movement ceases, coherent thalamocortical delta oscillations (1-5 Hz) develop, distinct from concurrent slow oscillations (0.1-1 Hz). The structure of these oscillations in both cortex and thalamus closely parallel those observed in the human electroencephalogram during propofol-induced unconsciousness. During emergence from GA, this synchronized activity dissipates in a sequence different from that observed during loss of consciousness. A possible explanation is that recovery from anesthesia-induced unconsciousness follows a "boot-up" sequence actively driven by ascending arousal centers. The involvement of medial prefrontal cortex suggests that when these oscillations (alpha, delta, slow) are observed in humans, self-awareness and internal consciousness would be impaired if not abolished. These studies advance our understanding of anesthesia-induced unconsciousness and altered arousal and further establish principled neurophysiological markers of these states.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1707
[Cu] Class update date: 170928
[Lr] Last revision date:170928
[St] Status:In-Data-Review
[do] DOI:10.1073/pnas.1700148114

  2 / 5878 MEDLINE  
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[PMID]: 28720183
[Au] Autor:Kim S; Cho T; Lee Y; Koo H; Choi B; Kim D
[Ti] Title:G-LOC Warning Algorithms Based on EMG Features of the Gastrocnemius Muscle.
[So] Source:Aerosp Med Hum Perform;88(8):737-742, 2017 Aug 01.
[Is] ISSN:2375-6314
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: G-induced loss of consciousness (G-LOC) is mainly caused by failure to sustain an oxygenated blood supply to the pilot's brain because of the sudden acceleration in the direction of the +Gz axis, and is considered a critical safety issue. The purpose of this study was to develop G-LOC warning algorithms based on monitoring electromyograms (EMG) of the gastrocnemius muscle on the calf. METHODS: EMG data was retrieved from a total of 67 pilots and pilot trainees of the Korean Air Force during high-G training on a human centrifugal simulator. Seven EMG features were obtained from root mean square (RMS), integrated absolute value (IAV), and mean absolute value (MAV) for muscle contraction, slope sign changes (SSC), waveform length (WL), zero crossing (ZC), and median frequency (MF) for muscle contraction and fatigue. RESULTS: Out of seven EMG features, IAV and WL showed a rapid decay before G-LOC. Based on these findings, this study developed two algorithms which can detect G-LOC during flight and provide warning signals to the pilots. The probability of G-LOC occurrence was detected through monitoring the decay trend for representing muscle endurance and climb rate of the IAV and WL value during sudden acceleration above 6 G, representing muscle power. The sensitivity of the algorithms using IAV and WL features was 100% and the specificity was 66.7%. DISCUSSION: This study suggests that a G-LOC detecting and warning system may be a customized, real-time countermeasure by improving the accuracy of detecting G-LOC.Kim S, Cho T, Lee Y, Koo H, Choi B, Kim D. G-LOC warning algorithms based on EMG features of the gastrocnemius muscle. Aerosp Med Hum Perform. 2017; 88(8):737-742.
[Mh] MeSH terms primary: Acceleration/adverse effects
Algorithms
Gravitation
Hypergravity/adverse effects
Military Personnel
Muscle, Skeletal/physiopathology
Pilots
Unconsciousness/physiopathology
[Mh] MeSH terms secundary: Adult
Aerospace Medicine
Electromyography
Humans
Simulation Training
Unconsciousness/etiology
Young Adult
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1709
[Cu] Class update date: 170926
[Lr] Last revision date:170926
[Js] Journal subset:IM; S
[Da] Date of entry for processing:170719
[St] Status:MEDLINE
[do] DOI:10.3357/AMHP.4781.2017

  3 / 5878 MEDLINE  
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[PMID]: 28655133
[Au] Autor:Tripodis Y; Alosco ML; Zirogiannis N; Gavett BE; Chaisson C; Martin B; McClean MD; Mez J; Kowall N; Stern RA
[Ad] Address:Boston University School of Public Health, Boston, MA, USA.
[Ti] Title:The Effect of Traumatic Brain Injury History with Loss of Consciousness on Rate of Cognitive Decline Among Older Adults with Normal Cognition and Alzheimer's Disease Dementia.
[So] Source:J Alzheimers Dis;59(1):251-263, 2017.
[Is] ISSN:1875-8908
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:Traumatic brain injury (TBI) is thought to be a risk factor for dementia, including dementia due to Alzheimer's disease (AD). However, the influence of TBI history on the neuropsychological course of AD is unknown and, more broadly, the effect of TBI history on age-related cognitive change is poorly understood. We examined the relationship between history of TBI with loss of consciousness (LOC) history and cognitive change in participants with normal cognition and probable AD, stratified by APOEÉ›4 allele status. The sample included 706 participants (432 with normal cognition; 274 probable AD) from the National Alzheimer's Coordinating Center (NACC) dataset that completed the Uniform Data Set evaluation between 2005 and 2014. Normal and probable AD participants with a history of TBI were matched to an equal number of demographically and clinically similar participants without a TBI history. In this dataset, TBI with LOC was defined as brain trauma with brief or extended unconsciousness. For the normal and probable AD cohorts, there was an average of 3.2±1.9 and 1.8±1.1 years of follow-up, respectively. 30.8% of the normal cohort were APOEÉ›4 carriers, whereas 70.8% of probable AD participants were carriers. Mixed effects regressions showed TBI with LOC history did not affect rates of cognitive change in APOEÉ›4 carriers and non-carriers. Findings from this study suggest that TBI with LOC may not alter the course of cognitive function in older adults with and without probable AD. Future studies that better characterize TBI (e.g., severity, number of TBIs, history of subconconcussive exposure) are needed to clarify the association between TBI and long-term neurocognitive outcomes.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1706
[Cu] Class update date: 170928
[Lr] Last revision date:170928
[St] Status:In-Process
[do] DOI:10.3233/JAD-160585

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[PMID]: 28514842
[Au] Autor:Yang Y; Yang W; Wang TJ
[Ad] Address:Department of Radiation Oncology, The Second Hospital of Jilin University, Changchun, P.R. China
[Ti] Title:Gender difference in radiotherapy-induced carotid stenosis.
[So] Source:J Biol Regul Homeost Agents;31(3):631-637, 2017 Jul-Sep,.
[Is] ISSN:0393-974X
[Cp] Country of publication:Italy
[La] Language:eng
[Ab] Abstract:Radiotherapy (RT) is often the first choice of treatment for cancer of the larynx. Studies have shown that the incidence of carotid stenosis (CS) after radiotherapy of laryngeal cancer is increasing, and that gender difference in radiotherapy-induced side effects exist. Thus, we examined the gender difference in the incidence of CS and the impact of microinflammatory factors after radiotherapy. We reported this study on patients who received radiotherapy as part of the treatment for laryngeal cancer in the Jilin Province in China. One hundred sixty-four males and 152 females were treated with radiotherapy between 2006 and 2016. The carotid diameter was determined by measuring carotid intima-media thickness in the common, external and internal carotid artery. Microinflammatory conditions were assessed by measuring the level of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α). Other studied risk factors included age, treatment modalities, radiation dose and energy, the height of the radiation field, and the follow-up time. CS was detected in 161 (50.9%) of the 316 patients. Carotid stenosis was mainly clinically unsuspected, two patients had anamnesis of unconsciousness. Importantly, fewer women (36.1%) had CS than men (64.6%) (p=0.004). Furthermore, male patients showed higher serum levels of hs-CRP, IL-6, and TNF-α. Taken together, our study suggested that women underoing radiotherapy of laryngeal cancer are less likely to have CS than men. Therefore, routine assessment after irradiation of laryngeal cancer seems necessary for clinical detection of asymptomatic CS, particularly in male patients.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1705
[Cu] Class update date: 170927
[Lr] Last revision date:170927
[St] Status:Publisher

  5 / 5878 MEDLINE  
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[PMID]: 28938889
[Au] Autor:Madah-Amiri D; Myrmel L; Brattebø G
[Ad] Address:The Norwegian Centre for Addiction Research, The University of Oslo, Oslo, Norway. desireem@medisin.uio.no.
[Ti] Title:Intoxication with GHB/GBL: characteristics and trends from ambulance-attended overdoses.
[So] Source:Scand J Trauma Resusc Emerg Med;25(1):98, 2017 Sep 22.
[Is] ISSN:1757-7241
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Overdoses from so-called "club drugs" (GHB/GBL) have become a more frequent cause of overdoses attended by ambulance services. Given its availability, affordability, and lack of awareness of risks, there is a common misconception among users that the drug is relatively safe. METHODS: This study reviewed ambulance records in Bergen, Norway between 2009 and 2015 for cases of acute poisonings, particularly from suspected GHB/GBL intoxication. RESULTS: In total, 1112 cases of GHB and GBL poisoning were identified. GHB was suspected for 995 (89%) of the patients. Men made up the majority of the cases (n = 752, 67.6%) with a median age of 27 years old. Temporal trends for GHB/GBL overdoses displayed a late-night, weekend pattern. The most frequent initial symptoms reported were unconsciousness, or reduced consciousness. Most of the patients required further treatment and transport. During the period from 2009 to 2015, there was a nearly 50% decrease in GHB/GBL overdoses from 2013 to 2014. DISCUSSION: The characteristics of GHB/GBL overdose victims shed light on this patient group. The decrease in incidence over the years may be partly due to a legal ban on GBL in Norway, declared in 2010. It may also be due to an increase in the use of MDMA/ecstasy. CONCLUSION: The review of ambulance records on the prehospital treatment of overdoses can be beneficial in monitoring, preparing, and prevention efforts aimed to benefit this vulnerable group.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1709
[Cu] Class update date: 170923
[Lr] Last revision date:170923
[St] Status:In-Process
[do] DOI:10.1186/s13049-017-0441-6

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[PMID]: 28938276
[Au] Autor:Benveniste H; Lee H; Ding F; Sun Q; Al-Bizri E; Makaryus R; Probst S; Nedergaard M; Stein EA; Lu H
[Ad] Address:From the Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut (H.B., H.L.); Center for Translational Neuromedicine, University of Rochester, Rochester, New York (F.D., Q.S., M.N.); Department of Anesthesiology, Stony Brook Medicine, Stony Brook, New York (E.A.-B., R.M., S.P.); National Institute on Drug Abuse, Intramural Research Program, Baltimore, Maryland (E.A.S., H.L.).
[Ti] Title:Anesthesia with Dexmedetomidine and Low-dose Isoflurane Increases Solute Transport via the Glymphatic Pathway in Rat Brain When Compared with High-dose Isoflurane.
[So] Source:Anesthesiology;, 2017 Sep 22.
[Is] ISSN:1528-1175
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: The glymphatic pathway transports cerebrospinal fluid through the brain, thereby facilitating waste removal. A unique aspect of this pathway is that its function depends on the state of consciousness of the brain and is associated with norepinephrine activity. A current view is that all anesthetics will increase glymphatic transport by inducing unconsciousness. This view implies that the effect of anesthetics on glymphatic transport should be independent of their mechanism of action, as long as they induce unconsciousness. We tested this hypothesis by comparing the supplementary effect of dexmedetomidine, which lowers norepinephrine, with isoflurane only, which does not. METHODS: Female rats were anesthetized with either isoflurane (N = 8) or dexmedetomidine plus low-dose isoflurane (N = 8). Physiologic parameters were recorded continuously. Glymphatic transport was quantified by contrast-enhanced magnetic resonance imaging. Cerebrospinal fluid and gray and white matter volumes were quantified from T1 maps, and blood vessel diameters were extracted from time-of-flight magnetic resonance angiograms. Electroencephalograms were recorded in separate groups of rats. RESULTS: Glymphatic transport was enhanced by 32% in rats anesthetized with dexmedetomidine plus low-dose isoflurane when compared with isoflurane. In the hippocampus, glymphatic clearance was sixfold more efficient during dexmedetomidine plus low-dose isoflurane anesthesia when compared with isoflurane. The respiratory and blood gas status was comparable in rats anesthetized with the two different anesthesia regimens. In the dexmedetomidine plus low-dose isoflurane rats, spindle oscillations (9 to 15 Hz) could be observed but not in isoflurane anesthetized rats. CONCLUSIONS: We propose that anesthetics affect the glymphatic pathway transport not simply by inducing unconsciousness but also by additional mechanisms, one of which is the repression of norepinephrine release.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1709
[Cu] Class update date: 170922
[Lr] Last revision date:170922
[St] Status:Publisher
[do] DOI:10.1097/ALN.0000000000001888

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[PMID]: 28938106
[Au] Autor:Meichtry C; Glauser U; Glardon M; Ross SG; Lechner I; Kneubuehl BP; Gascho D; Spadavecchia C; von Rotz A; Stojiljkovic A; Stoffel MH
[Ad] Address:Division of Veterinary Anatomy, University of Berne, Berne, Switzerland.
[Ti] Title:Assessment of a specifically developed bullet casing gun for the stunning of water buffaloes.
[So] Source:Meat Sci;135:74-78, 2017 Sep 14.
[Is] ISSN:1873-4138
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Water buffaloes and cattle differ considerably with respect to the anatomy of the head. As a result, captive bolt stunners often fail to reliably produce adequate loss of consciousness in water buffaloes and, thus, do not fulfill animal welfare requirements. The goal of the present study was to assess and validate a new stunning device for water buffaloes meeting animal welfare and occupational safety requirements. The newly designed bullet casing gun uses .357Mag/10.2g hollow point bullets and has additional safety features. Its effectiveness and usability were assessed under practical conditions in an abattoir as based on widely accepted criteria. Stunning resulted in deep unconsciousness in 19 out of 20 water buffaloes. One 9-year old male did not immediately collapse. Except for very old bulls, the device presented herewith provides a means to stun water buffaloes of both sexes effectively and reliably while keeping occupational hazards to a minimum.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1709
[Cu] Class update date: 170922
[Lr] Last revision date:170922
[St] Status:Publisher

  8 / 5878 MEDLINE  
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[PMID]: 28936756
[Au] Autor:Khipal J; Sankhyan N; Singhi SC; Singhi P; Khandelwal N
[Ad] Address:Pediatric Neurology and Neurodevelopement Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
[Ti] Title:Clinical Utility of MRI Brain in Children with Non-traumatic Coma.
[So] Source:Indian J Pediatr;, 2017 Sep 22.
[Is] ISSN:0973-7693
[Cp] Country of publication:India
[La] Language:eng
[Ab] Abstract:OBJECTIVES: To determine characteristics that help identify children with acute encephalopathy who benefit from an MRI (magnetic resonance imaging) of the brain. The secondary objective was to determine the adverse events associated with the MRI procedure. METHODS: In this single center, prospective, observational study. Children (2 mo - 12 y) presenting with impaired consciousness were screened. Those with acute non-traumatic encephalopathy (Glasgow Coma Score of 12 or less) undergoing their first in-patient MRI brain were included. The decision regarding MRI brain was taken by the treating unit. The clinician taking care of the child was requested to categorize the information obtained from MRI into one of the following categories (as per definition): Contributory MRI [Diagnostic and/or Therapeutic, Suggestive or Additive and/or Prognostic (as per definitions)] OR Non-contributory MRI (If results of the MRI did not alter the management of the child in any manner). RESULTS: During the study period, 16,667 children presented to the pediatric emergency, of which 496 children were admitted with a diagnosis of acute encephalopathy and100 children were enrolled for this study. Ninety-two children had a febrile encephalopathy. Seventy-seven (77%, 95% CI 69-85%) children had an MRI that was contributory. In 64(78%) out of 82 children who underwent both CT and MRI, the MRI showed additional findings. Those with abnormal CT were significantly more likely to have a contributory MRI (65.6% vs. 22.2%, P = 0.001). There were 18 adverse events during the MRI procedure. CONCLUSIONS: MRI contributes in management decisions in over three-fourth of children presenting with non-traumatic coma and should be the neuroimaging of choice in acute non-traumatic coma. There are no pre-MRI clues to identify which child is likely to benefit from the MRI. However, if CT detects an abnormality, MRI is likely to significantly add to the information, contributing directly to the management.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1709
[Cu] Class update date: 170922
[Lr] Last revision date:170922
[St] Status:Publisher
[do] DOI:10.1007/s12098-017-2465-3

  9 / 5878 MEDLINE  
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[PMID]: 28915898
[Au] Autor:Pakkanen T; Kämäräinen A; Huhtala H; Silfvast T; Nurmi J; Virkkunen I; Yli-Hankala A
[Ad] Address:FinnHEMS Ltd, Research and Development Unit, Vantaa, Finland. toni.pakkanen@fimnet.fi.
[Ti] Title:Physician-staffed helicopter emergency medical service has a beneficial impact on the incidence of prehospital hypoxia and secured airways on patients with severe traumatic brain injury.
[So] Source:Scand J Trauma Resusc Emerg Med;25(1):94, 2017 Sep 15.
[Is] ISSN:1757-7241
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: After traumatic brain injury (TBI), hypotension, hypoxia and hypercapnia have been shown to result in secondary brain injury that can lead to increased mortality and disability. Effective prehospital assessment and treatment by emergency medical service (EMS) is considered essential for favourable outcome. The aim of this study was to evaluate the effect of a physician-staffed helicopter emergency medical service (HEMS) in the treatment of TBI patients. METHODS: This was a retrospective cohort study. Prehospital data from two periods were collected: before (EMS group) and after (HEMS group) the implementation of a physician-staffed HEMS. Unconscious prehospital patients due to severe TBI were included in the study. Unconsciousness was defined as a Glasgow coma scale (GCS) score ≤ 8 and was documented either on-scene, during transportation or by an on-call neurosurgeon on hospital admission. Modified Glasgow Outcome Score (GOS) was used for assessment of six-month neurological outcome and good neurological outcome was defined as GOS 4-5. RESULTS: Data from 181 patients in the EMS group and 85 patients in the HEMS group were available for neurological outcome analyses. The baseline characteristics and the first recorded vital signs of the two cohorts were similar. Good neurological outcome was more frequent in the HEMS group; 42% of the HEMS managed patients and 28% (p = 0.022) of the EMS managed patients had a good neurological recovery. The airway was more frequently secured in the HEMS group (p < 0.001). On arrival at the emergency department, the patients in the HEMS group were less often hypoxic (p = 0.024). In univariate analysis HEMS period, lower age and secured airway were associated with good neurological outcome. CONCLUSION: The introduction of a physician-staffed HEMS unit resulted in decreased incidence of prehospital hypoxia and increased the number of secured airways. This may have contributed to the observed improved neurological outcome during the HEMS period. TRIAL REGISTRATION: ClinicalTrials.gov IDNCT02659046. Registered January 15th, 2016.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1709
[Cu] Class update date: 170922
[Lr] Last revision date:170922
[St] Status:In-Process
[do] DOI:10.1186/s13049-017-0438-1

  10 / 5878 MEDLINE  
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[PMID]: 28821646
[Au] Autor:Minert A; Yatziv SL; Devor M
[Ad] Address:Department of Cell and Developmental Biology, Institute of Life Sciences, and Center for Research on Pain, The Hebrew University of Jerusalem, Jerusalem 91904, Israel.
[Ti] Title:Location of the Mesopontine Neurons Responsible for Maintenance of Anesthetic Loss of Consciousness.
[So] Source:J Neurosci;37(38):9320-9331, 2017 Sep 20.
[Is] ISSN:1529-2401
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:The transition from wakefulness to general anesthesia is widely attributed to suppressive actions of anesthetic molecules distributed by the systemic circulation to the cerebral cortex (for amnesia and loss of consciousness) and to the spinal cord (for atonia and antinociception). An alternative hypothesis proposes that anesthetics act on one or more brainstem or diencephalic nuclei, with suppression of cortex and spinal cord mediated by dedicated axonal pathways. Previously, we documented induction of an anesthesia-like state in rats by microinjection of small amounts of GABA -receptor agonists into an upper brainstem region named the mesopontine tegmental anesthesia area (MPTA). Correspondingly, lesioning this area rendered animals resistant to systemically delivered anesthetics. Here, using rats of both sexes, we applied a modified microinjection method that permitted localization of the anesthetic-sensitive neurons with much improved spatial resolution. Microinjected at the MPTA hotspot identified, exposure of 1900 or fewer neurons to muscimol was sufficient to sustain whole-body general anesthesia; microinjection as little as 0.5 mm off-target did not. The GABAergic anesthetics pentobarbital and propofol were also effective. The GABA-sensitive cell cluster is centered on a tegmental (reticular) field traversed by fibers of the superior cerebellar peduncle. It has no specific nuclear designation and has not previously been implicated in brain-state transitions. General anesthesia permits pain-free surgery. Furthermore, because anesthetic agents have the unique ability to reversibly switch the brain from wakefulness to a state of unconsciousness, knowing how and where they work is a potential route to unraveling the neural mechanisms that underlie awareness itself. Using a novel method, we have located a small, and apparently one of a kind, cluster of neurons in the mesopontine tegmentum that are capable of effecting brain-state switching when exposed to GABA -receptor agonists. This action appears to be mediated by a network of dedicated axonal pathways that project directly and/or indirectly to nearby arousal nuclei of the brainstem and to more distant targets in the forebrain and spinal cord.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1708
[Cu] Class update date: 170921
[Lr] Last revision date:170921
[St] Status:In-Process
[do] DOI:10.1523/JNEUROSCI.0544-17.2017


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