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All you need to read in the other general journals

BMJ 2010; 340 doi: (Published 09 February 2010) Cite this as: BMJ 2010;340:c754

MRI reveals potentially conscious brain activity in unresponsive patients

An international team of researchers used functional brain imaging to look for residual consciousness in unresponsive patients with severe brain injury. Five of the 54 patients tested seemed able to “think” on demand, producing brain images that matched those of healthy controls given the same instruction. Four of them were in a persistent vegetative state after traumatic brain injury. The fifth was in a minimally conscious state—a label given to patients with minimal and inconsistent signs of awareness.

During magnetic resonance imaging (MRI), they were able to imagine a motor task (playing tennis) or a spatial task (navigating around their home or familiar streets) apparently at will, producing characteristic changes in the supplementary motor area of the brain or in the parahippocampal gyrus.

One of the five patients also seemed able to answer simple yes or no questions, by imagining one or other of the images during scanning—tennis for yes, and navigation for no. His doctors were unable to establish any kind of consistent communication at the bedside, although they upgraded his clinical diagnosis to minimally conscious (from persistently vegetative) after the scans and further behavioural testing.

The authors hope their technique will help evaluate people who are unresponsive after severe brain injuries and cut the risk of misdiagnosis. A linked comment (doi:10.1056/NEJMe0909667) hopes so too, but it cautions against giving false hope to relatives and friends. Cortical activation was rare, even in these handpicked patients. We still have little idea what kind of consciousness, if any, it signified.

Proteinuria predicts outcome at all stages of chronic kidney disease

Chronic kidney disease is currently classified and staged using an estimate of the glomerular filtration rate (eGFR). Proteinuria matters too, according to a large observational study from Canada.

The authors had data on nearly one million adults, classified by the eGFR into four strata. Within each one, heavier …

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