Contributions of rapid neuromuscular transmission to the fine control of acoustic parameters of birdsong

Neural control of complex vocal behaviors, such as birdsong and speech, requires integration of biomechanical nonlinearities through muscular output. Although control of airflow and tension of vibrating tissues are known functions of vocal muscles, it remains unclear how specific muscle characteristics contribute to specific acoustic parameters. To address this gap, we removed heparan sulfate chains using heparitinases to subtly perturb neuromuscular transmission in the syrinx of adult male zebra finches (Taeniopygia guttata). Infusion of heparitinases into ventral syringeal muscles altered their excitation threshold and reduced neuromuscular transmission changing their ability to modulate airflow. The changes in muscle activation dynamics caused a reduction in frequency modulation rates and elimination of many high frequency syllables, but did not alter the fundamental frequency of syllables. Sound amplitude was reduced and sound onset pressure was increased, suggesting a role of muscles in the induction of self-sustained oscillations under low airflow conditions, thus enhancing vocal efficiency. These changes were reversed to pre-infusion levels by 7 days post-infusion. These results illustrate complex interactions between the control of airflow and tension and further define the importance of syringeal muscle in the control of a variety of acoustic song characteristics. In summary, the findings reported here show that altering neuromuscular transmission can lead to reversible changes to the acoustic structure of song. Understanding the full extent of muscle involvement in song production is critical in decoding the motor program for the production of complex vocal behavior, including our search for parallels between birdsong and human speech motor control.

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Modeling the detailed kinetics of mitochondrial cytochrome c oxidase: Catalytic mechanism and nitric oxide inhibition

Cytochrome c oxidase (CcO) catalyzes the exothermic reduction of O₂ to H₂O by using electrons from cytochrome c, and hence plays a crucial role in ATP production. Although details on the enzyme structure and redox centers involved in O₂ reduction have been known, there still remains a considerable ambiguity on its mechanism of action, e.g., the number of sequential electrons donated to O₂ in each catalytic step, the sites of protonation and proton pumping, and nitric oxide (NO) inhibition mechanism. In this work, we developed a thermodynamically constrained mechanistic mathematical model for the catalytic action of CcO based on available kinetic data. The model considers a minimal number of redox centers on CcO and couples electron transfer and proton pumping driven by proton motive force (PMF), and accounts for the inhibitory effects of NO on the reaction kinetics. The model is able to fit well all the available kinetic data under diverse experimental conditions with a physiologically realistic unique parameter set. The model predictions show that: 1) the apparent K_m of O₂ varies considerably and increases from fully reduced to fully oxidized cytochrome c depending on pH and the energy state of mitochondria, and 2) the intermediate enzyme states depend on pH and cytochrome c redox fraction and play a central role in coupling mitochondrial respiration to PMF. The developed CcO model can easily be integrated into existing mitochondrial bioenergetics models to understand the role of the enzyme in controlling oxidative phosphorylation in normal and disease conditions.

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Interstitial glucose concentrations and hypoglycemia during 2 days of caloric deficit and sustained exercise: a double-blind, placebo-controlled trial

Military personnel and some athlete populations endure short-term energy deficits from reduced energy intake and/or increased energy expenditure (EE) that may degrade physical and cognitive performance due to severe hypoglycemia (<3.1 mmol/l). The extent to which energy deficits alter normoglycemia (3.9–7.8 mmol/l) in healthy individuals is not known, since prior studies measured glucose infrequently, not continuously. The purpose of this study was to characterize the glycemic response to acute, severe energy deficit compared with fully fed control condition, using continuous glucose monitoring (CGM). For 2 days during a double-blind, placebo-controlled, crossover study, 23 volunteers (17 men/6 women; age: 21.3 ± 3.0 yr; body mass index: 25 ± 3 kg/m) increased habitual daily EE [2,300 ± 450 kcal/day [means ± SD)] by 1,647 ± 345 kcal/day through prescribed exercise (~3 h/day; 40–65% peak O₂ consumption), and consumed diets designed to maintain energy balance (FED) or induce 93% energy deficit (DEF). Interstitial glucose concentrations were measured continuously by CGM (Medtronic Minimed). Interstitial glucose concentrations were 1.0 ± 0.9 mmol/l lower during DEF vs. FED (P < 0.0001). The percentage of time spent in mild (3.1–3.8 mmol/l) hypoglycemia was higher during DEF compared with FED [mean difference = 20.5%; 95% confidence interval (CI): 13.1%, 27.9%; P = 0.04], while time spent in severe (<3.1 mmol/l) hypoglycemia was not different between interventions (mean difference = 4.6%; 95% CI: –0.6%, 9.8%; P = 0.10). Three of 23 participants spontaneously reported symptoms (e.g., nausea) potentially related to hypoglycemia during DEF, and an additional participant reported symptoms during both interventions. These findings suggest that severe hypoglycemia rarely occurs in healthy individuals enduring severe, short-term energy deficit secondary to heavy exercise and inadequate energy intake.

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Bouncing on Mars and the Moon--the role of gravity on neuromuscular control: correlation of muscle activity and rate of force development

On our astronomical neighbors Mars and the Moon, bouncing movements are the preferred locomotor techniques. During bouncing, the stretch-shortening cycle describes the muscular activation pattern. This study aimed to identify gravity-dependent changes in kinematic and neuromuscular characteristics in the stretch-shortening cycle. Hence, neuromuscular control of limb muscles as well as correlations between the muscles' pre-activation, reflex components, and force output were assessed in lunar, Martian, and Earth gravity. During parabolic flights, peak force (F_max), ground-contact-time, rate of force development (RFD), height, and impulse were measured. Electromyographic (EMG) activities in the m. soleus (SOL) and gastrocnemius medialis (GM) were assessed before (PRE) and during bounces for the reflex phases short-, medium-, and long-latency response (SLR, MLR, LLR). With gradually decreasing gravitation, F_max, RFD, and impulse were reduced, whereas ground-contact time and height increased. Concomitantly, EMG_GM decreased for PRE, SLR, MLR, and LLR, and in EMG_SOL in SLR, MLR, and LLR. For SLR and MLR, F_max and RFD were positively correlated to EMG_SOL. For PRE and LLR, RFD and F_max were positively correlated to EMG_GM. Findings emphasize that biomechanically relevant kinematic adaptations in response to gravity variation were accompanied by muscle- and phase-specific modulations in neural control. Gravitational variation is anticipated and compensated for by gravity-adjusted muscle activities. Importantly, the pre-activation and reflex phases were differently affected: in SLR and MLR, SOL is assumed to contribute to the decline in force output with a decreasing load, and, complementary in PRE and LLR, GM seems to be of major importance for force generation.

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Whole body heat stress attenuates the pressure response to muscle metaboreceptor stimulation in humans

The effects of whole body heat stress on sympathetic and cardiovascular responses to stimulation of muscle metaboreceptors and mechanoreceptors remains unclear. We examined the muscle sympathetic nerve activity (MSNA), blood pressure, and heart rate in 14 young healthy subjects during fatiguing isometric handgrip exercise, postexercise circulatory occlusion (PECO), and passive muscle stretch during PECO. The protocol was performed under normothermic and whole body heat stress (increase internal temperature ~0.6°C via a heating suit) conditions. Heat stress increased the resting MSNA and heart rate. Heat stress did not alter the mean blood pressure (MAP), heart rate, and MSNA responses (i.e., changes) to fatiguing exercise. During PECO, whole body heat stress accentuated the heart rate response [change () of 5.8 ± 1.5 to 10.0 ± 2.1 beats/min, P = 0.03], did not alter the MSNA response (16.4 ± 2.8 to 17.3 ± 3.8 bursts/min, P = 0.74), and lowered the MAP response (20 ± 2 to 12 ± 1 mmHg, P < 0.001). Under normothermic conditions, passive stretch during PECO evoked significant increases in MAP and MSNA (both P < 0.001). Of note, heat stress prevented the MAP and MSNA responses to stretch during PECO (both P > 0.05). These data suggest that whole body heat stress attenuates the pressor response due to metaboreceptor stimulation, and the sympathetic nerve response due to mechanoreceptor stimulation.

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The effect of body mass and sex on the accuracy of respiratory magnetometers for measurement of end-expiratory lung volumes

Respiratory magnetometers are increasingly being used in sleep studies to measure changes in end-expiratory lung volume (EELV), including in obese obstructive sleep apnea patients. Despite this, the accuracy of magnetometers has not been confirmed in obese patients nor compared between sexes. Thus we compared spirometer-measured and magnetometer-estimated lung volume and tidal volume changes during voluntary end-expiratory lung volume changes of 1.5, 1, and 0.5 l above and 0.5 l below functional respiratory capacity in supine normal-weight [body mass index (BMI) < 25 kg/m] and healthy obese (BMI > 30 kg/m) men and women. Two different magnetometer calibration techniques proposed by Banzett et al. [Banzett RB, Mahan ST, Garner DM, Brughera A, Loring SH. J Appl Physiol (1985) 79: 2169–2176, 1995] and Sackner et al. [Sackner MA, Watson H, Belsito AS, Feinerman D, Suarez M, Gonzalez G, Bizousky F, Krieger B. J Appl Physiol (1985) 66: 410–420, 1989] were assessed. Across all groups and target volumes, magnetometers overestimated spirometer-measured EELV by ~65 ml (<0.001) with no difference between techniques (0.07). The Banzett method overestimated the spirometer EELV change in normal-weight women for all target volumes except +0.5 l, whereas no differences between mass or sex groups were observed for the Sackner technique. The variability of breath-to-breath measures of EELV was significantly higher for obese compared with nonobese subjects and was higher for the Sackner than Banzett technique. On the other hand, for tidal volume, both calibration techniques underestimated spirometer measurements (<0.001), with the underestimation being more marked for the Banzett than Sackner technique (0.03), in obese than normal weight (<0.001) and in men than in women (0.003). These results indicate that both body mass and sex affect the accuracy of respiratory magnetometers in measuring EELV and tidal volume.

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The Correlation Between Recordable MEPs and Motor Function During Spinal Surgery for Resection of Thoracic Spinal Cord Tumor.

Background: Motor evoked potentials (MEPs) are commonly used during surgery for spinal cord tumor resection. However, it can be difficult to record reliable MEPs from the muscles of the lower extremities during surgery in patients with preoperative weakness due to spinal cord compression. In this study, motor function of patients' lower extremities and their association with intraoperative MEP recording were compared. Patients and Methods: Patients undergoing thoracic spinal cord tumor resection were studied. Patients' motor function was checked immediately before the surgical procedure. MEP responses were recorded from the tibialis anterior and foot muscles, and the hand muscles were used as control. Electrical current with train of eight pulses, 200 to 500 V was delivered through 2 corkscrews placed at C3' and C4' sites. Anesthesia was maintained by total intravenous anesthesia using a combination of propofol and remifentanil after induction with intravenous propofol, remifentanil, and rocuronium. Rocuronium was not repeated. Bispectral Index was maintained between 40 to 50. Results: From 178 lower limbs of 89 patients, myogenic MEPs could be recorded from 100% (105/105) of the patients with 5 of 5 motor strength in lower extremity; 90% (36/40) from the patients with 4/5 motor strength; only 25% (5/20) with 3/5; and 12.5% (1/8) with 2/5 motor strength; none (0/5) were able to be recorded if the motor strength was 1/5. Summary: The ability to record myogenic MEPs is closely associated with the patient's motor function. They are difficult to obtain if motor function is 3/5 motor strength in the lower extremity. They are almost impossible to record if motor function is worse than 3/5. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved

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Analgosedation With Dexmedetomidine in a Patient With Superior Vena Cava Syndrome in Neurosurgery.

No abstract available

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Cortical Arousal With Deep Brain Stimulation After General Anesthesia for Laparoscopic Cholecystectomy.

No abstract available

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Laparoscopic mesh repair of adult diaphragmatic hernia: A report of two cases

Abstract

Congenital diaphragmatic hernia is very rare in adults. The first choice of treatment is surgery, but the optimal surgical method remains unclear. We performed laparoscopic surgeries for two types of congenital diaphragmatic hernias using a novel mesh coated with a chemically modified substance. The first patient was a 65-year-old man with a Bochdalek hernia without a hernial sac, and the other patient was an 80-year-old woman with a Morgagni hernia with a hernial sac. The short-term outcomes of both cases were good, and laparoscopic repair seems to be a useful strategy regardless of the presence or absence of a hernial sac.

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Perforations and Angulations of 324 cervical medial cortical pedicle screws : a possible guide to avoid lateral perforations with use of pedicle screws in lower cervical spine

Context : More than half of the perforations reported with usage of cervical pedicle screws (CPS), are lateral perforations, endangering the vertebral artery. The medial cortical pedicle screw technique (MCPS) with partial drilling of the medial cortex, shifts the trajectory of pedicle screws medially, decreasing the lateral perforations.

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High resolution three-dimensional reconstruction of fibrotic skeletal muscle extracellular matrix

Abstract

Skeletal muscle extracellular matrix (ECM) structure and organisation are not well understood, yet the ECM plays an important role in normal tissue homeostasis and disease processes. Fibrosis is common to many muscle diseases and is typically quantified based on an increase in ECM collagen. Through the use of multiple imaging modalities and quantitative stereology, we describe the structure and composition of wild-type and fibrotic ECM, we show that collagen in the ECM is organised into large bundles of fibrils, or collagen cables, and the number of these cables (but not their size) increases in desmin knockout muscle (a fibrosis model). The increase in cable number is accompanied by increased muscle stiffness and an increase in the number of collagen producing cells. Unique interactions between ECM cells and collagen cables were also observed and reconstructed by serial block face scanning electron microscopy. These results demonstrate that the muscle ECM is more highly organised than previously reported. Therapeutic strategies for skeletal muscle fibrosis should consider the organisation of the ECM to target the structures and cells contributing to fibrotic muscle function.

This article is protected by copyright. All rights reserved

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Myoclonus subtypes in tertiary referral center. Cortical myoclonus and functional jerks are common

Publication date: Available online 16 November 2016
Source:Clinical Neurophysiology
Author(s): R. Zutt, J.W. Elting, J.H. van der Hoeven, F. Lange, M.A.J. Tijssen
ObjectiveTo evaluate the accuracy of clinical phenotyping of myoclonus patients and to determine differentiating clinical characteristics between cortical (CM), subcortical (SCM), spinal (SM), peripheral (PM) myoclonus, and functional jerks (FJ).MethodsClinical notes for all patients with myoclonus over an 8-year period (2006-2014) were reviewed retrospectively. We used the conclusion of electrophysiological testing as definite diagnosis of myoclonus or FJ.Results102 patients were identified suffering from CM (34%), SCM (11%), SM (6%), PM (2%), and 47% FJ. The clinical diagnosis of myoclonus was confirmed by electrophysiological testing in 74% and its subtype in 78% of cases. CM was characterized by an early age of onset, facial myoclonus, and provocation by action. Differentiating features of FJ were an abrupt onset, preceding contributing events and provocation by a supine position.ConclusionThe majority of clinical myoclonic jerk cases were functional in our heterogeneous tertiary clinic cohort. CM was the main anatomical myoclonic subtype. Clinical diagnosis was accurate in the majority of cases, although electrophysiological testing was important to verify the clinical classification.SignificanceIn patients with jerky movements a functional diagnosis should be considered. Determination of the myoclonic subtypes is important to initiate tailored treatment.



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Wrist Accelerometer Cut-points for Classifying Sedentary Behavior in Children.

Introduction: To examine the validity and accuracy of wrist accelerometers for classifying sedentary behavior (SB) in children. Methods: Fifty-seven children (5-8y and 9-12y) completed a ~170min protocol including 15 semi-structured activities and transitions. Nine ActiGraph (GT3X+) and two GENEActiv wrist cut-points were evaluated. Direct observation was the criterion measure. The accuracy of wrist cut-points was compared to that achieved by the ActiGraph hip cut-point (0.05) and classification accuracy (ROC-AUC = 0.79-0.80) was lower than for ActiGraph hip and activPAL3TM. Conclusion: The most accurate SB ActiGraph (Kim) and GENEActiv (Schaefer) wrist cut-points can be applied in children with similar confidence as the ActiGraph hip cut-point (

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Instability Resistance Training Improves Neuromuscular Outcome in Parkinson's Disease.

Purpose: This study compared the effects of resistance training (RT) and resistance training with instability (RTI) on neuromuscular and total training volume (TTV) outcomes obtained as part of the Instability Resistance Training Trial in Parkinson's disease (IRRT-PD). It also used a linear multiple regression (forward stepwise method) to identify the contribution of neuromuscular outcomes to previously published improvements in the timed-up-and-go-test and the Unified Parkinson's Disease Rating Scale, motor subscale score (UPDRS-III). Methods: Thirty-nine patients with moderate-to-severe PD were randomly assigned to three groups: control (C), RT, and RTI. RT and RTI groups performed resistance exercises twice a week for 12 weeks, only the RTI group used unstable devices to perform resistance exercises. The following neuromuscular outcomes were assessed: quadriceps muscle cross-sectional area; root mean square and mean spike frequency of electromyographic signal, peak torque, rate of torque development, and half relaxation time of the knee extensors and plantar flexors during maximum ballistic voluntary isometric contractions. Total training volume was calculated for lower limb exercises. Results: From pre to post-training, RTI improved all of the neuromuscular outcomes (P

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Myoclonus subtypes in tertiary referral center. Cortical myoclonus and functional jerks are common

Myoclonus is a hyperkinetic movement disorder caused by an abrupt muscle contraction (positive myoclonus) (Friedreich, 1881) or interruption of muscle activity (negative myoclonus).(Lance and Adams, 1963)

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Dependence of the Accuracy of Automatic Identification of Sleep and Waking States in Mice on the Spectral Characteristics of the Electroencephalogram

Computer programs for the automatic analysis of the electroencephalogram (EEG) from humans and animals have entered wide use and are successfully employed in many areas of physiological research. They are of particular value for sleep studies, as traditional expert analysis of polysomnograms (PSG) is very laborious. The aim of the present work was to investigate the relationship between the accuracy of automatic staging and the EEG spectral parameters characterizing activity specific for the waking and sleep states. This relationship can be used as an objective measure of the quality of PSG traces, i.e., the extent of signs providing for the identification and differentiation of waking and the various sleep phases. We found a statistically significant relationship (including linear) between the accuracy of automatic staging and various spectral EEG characteristics in mice. This approach to automated PSG analysis provides objective criteria for trace quality with a priori assessment of the accuracy of automatic staging.

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Experience in the Use of the β-Interferon-1a Biosimilars CinnoVex and Genfaxon-44 at the Moscow City Multiple Sclerosis Center

Objective: To study the efficacy and tolerability of the generic drugs (β-interferon-1a biosimilars) CinnoVex for i.m. administration and Genfaxon-44 for s.c. administration in multiple sclerosis (MS). Materials and methods: A total of 100 MS patients were treated with CinnoVex and 104 patients were treated with Genfaxon, in each case for one year. Status was assessed clinically using several scales, as well as by MRI scanning. Results and conclusions: High frequencies of treatment withdrawal due to lack of clinical efficacy and intolerability were noted. Positive effects in relation to stabilizing the course of MS were seen only in patients who had not previously been treated with MS disease-modifying drugs (DMD). Final resolution of the question of the equivalence of the original and "generic" drugs requires double-blind studies.

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Extending the Potential of the Treatment of Multiple Sclerosis with a New Agent for Oral Use – Teriflunomide (Aubagio)

Teriflunomide is a new oral agent for the treatment of the recurring-remitting form of multiple sclerosis, its efficacy being demonstrated as a reduction in the frequency of exacerbations. Data obtained by MRI scanning have also confirmed its clinical efficacy. Single daily doses of teriflunomide are safe and well tolerated, with the development of mild and transient side effects. Nonetheless, a risk management plan should be put in place with the aims of minimizing and monitoring adverse effects during treatment.

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Effects of Glycine and GABA on Monosynaptic EPSP in Frog Motoneurons

We report here our studies of the effects of the inhibitory transmitters glycine and GABA on monosynaptic EPSP recorded in response to microstimulation of presynaptic fibers (PF PSP) close to the bodies of motoneurons in the isolated frog spinal cord. Monosynaptic PF PSP had two components, mediated by AMPA/KA and NMDA receptors. Blockade of NMDA receptors was used to analyze the characteristics of the AMPA/KA and NMDA components of PF PSP. The amplitude of the NMDA component was 20% of PF PSP amplitude. The areas under the curves of the AMPA/KA and NMDA components were 78% and 22% respectively of the area of the PF PSP. Glycine and GABA had little effect on PF PSP, but significantly decreased the decay time constant (τ_decay), by an average of 33.4 ± 4.0% (n = 18) on application of glycine and by 40.2 ± 3.6% (n = 18) on application of GABA. Blockade of NMDA receptors with DL-2-amino-5-phosophonovaleric acid (AP5) decreased the effects of glycine and GABA on the time constant. Effects were reversible and the amplitude and time characteristics of responses recovered in normal solution. Assessment of the inhibitory influences of glycine and GABA on each of the components of PF PSP showed that suppression of the NMDA component produced a greater proportionate effect than suppression of the AMPA/KA component. These results show that the inhibitory effects of glycine and GABA on the monosynaptic EPSP of motoneurons are mediated mainly by the NMDA component, with a small influence from the AMPA/KA component.

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Distribution of Corticothalamic Projections from Various Somatotopic Representation Areas of the Primary Motor and Sensory Cortex

The locations and distribution of corticothalamic projections from various somatotopic representation areas of the primary motor (MI) and sensory (SI) areas of the cortex were studied in cats. Efferent fibers from MI neurons (fields 4y, 6ab) were found mainly to terminate in the ventral posterolateral and posteromedial (VPL, VPM), ventrolateral (VL), and reticular (R) nuclei, located in the rostral part of the thalamus, in contrast to the situation with the SI (fields 1, 2, 3a, 3b), which projected mainly to the caudal part of the thalamus, to the VPL, VPM, and R nuclei. A lateromedial organization was demonstrated for corticothalamic connections, with the cortical representation areas of the hindlimb being located mainly in the lateral part of the VPL nucleus, those of the forelimbs in the medial part, and those of the face and head being located not only in the VPL nucleus, but also in the VM and VPM nuclei. Quantitative comparison of the distributions of corticothalamic efferent fibers from different somatotopic representation areas in MI showed that the most extensive and massive connections with the thalamic nuclei (the VPL, VL, and R) bore the motor representation of the forelimbs, followed by the hindlimbs, trunk, and, finally, the face and head, which had the minimal level of representation. In contrast to the motor representation of the forelimbs and the face and head, which had a uniform distribution of fibers in the VPL, VL and R nuclei, the number of efferent fibers for the motor representation of the hindlimbs running to the VL nucleus was 2.5 times smaller than the numbers in the VPL and R nuclei, while the representation of the trunk projected mainly to the VL. The dominance of the corticothalamic connection is evidence for a greater level of involvement of the thalamic nuclei in supporting the functional specialization of particular somatotopic representations in the MI.

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The Pulvinar of the Cat: Structural-Functional Organization and Role in Cognitive Processes

This review addresses current concepts of the structure and function of posterior lateral nucleus/thalamic pulvinar complex (LP–Pul) in the cat. The LP–Pul is a subcortical structure and is part of the visual analyzer. During phylogeny, this complex appeared simultaneously with the lateral geniculate body (LGB) and visual cortex, increased in complexity, and in humans occupies about one third of the thalamus. The LP–Pul is one of the associative nuclei of the thalamus and is an anatomically and functionally complex structure. The LP–Pul complex has reciprocal connections with numerous cortical areas and may thus take part in controlling the flow of visual information to the cerebral cortex, exerting modulating influences on cortical processes. The function of this complex, however, remains incompletely studied. Existing data suggest that the LP–Pul is involved in cognitive processes such as attention and orientation to visual stimuli, in the visual control of behavior, and the spatial encoding of visual stimuli, which is required for extracting individual features from images and their synthesis into an integral whole, and, perhaps, in supporting short-term memory for analysis of visual stimuli.

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Localization and Quantitative Assessment of Oxygen-Sensitive Hypoxia-Inducible Factor 1α in the Brain of the Mitten Crab Eriocheir Japonica in Normal Conditions and Acute Anoxia (an immunohistochemical study)

Western immunoblotting and immunohistochemistry methods were used to study the expression of hypoxia-inducible factor 1α (HIF-1α) in the brain of the mitten crab Eriocheir japonica in normal conditions and anoxia lasting 2, 4, 6, and 12 h using a water deprivation model. The number of immunopositive neurons was small in intact crabs, and increased with increases in the duration of anoxia. There was a particularly marked increase in the proportion of neurons expressing HIF-1α in cells of group 6. In group 9/11, the highest values were seen at 2–6 h of anoxia. In group 17, significant changes in the proportion of immunopositive cells were noted only at 2 h of anoxia. After anoxia lasting 6 h, the proportion of neurons expressing HIF-1α decreased in all cell groups, though the reaction appeared in hemocytes. It is suggested that the increase in the proportion of immunopositive neurons and the suppression of HIF-1α expression in brain hemocytes in anoxia play important roles in mediating compensatory and protective processes, increasing the adaptive potential of the mitten crab in conditions of hypoxic stress.

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Reactive Changes to Astrocytes in the Nucleus Accumbens of the Forebrain after Restriction of Blood Flow in the Basins of Both Common Carotid Arteries in Rats

Studies on rats (n = 12) addressed reactive changes to astrocytes in the nucleus accumbens of the forebrain after global cerebral ischemia induced by bilateral occlusion of both common carotid arteries, this being a frequently used model for assessing the efficacies of pharmacological substances with antiischemic and neuroprotective properties. In these conditions, the nucleus accumbens is within the partial ischemia zone. Morphometric investigations of the nucleus accumbens were performed in three groups of rats (four animals in each group): after ligation of both common carotid arteries, after sham operation, and in intact animals. Astrocytes were detected on serial sections using the reaction for glial fibrillary acidic protein with hematoxylin counterstaining. At seven days after surgery, astrocyte counts were made for each animal using seven sequential squares (each of 0.01 mm²); the distances between astrocyte bodies and the walls of capillaries within a radius of 20 μm were measured, as were the areas of the cell bodies and the lengths of their main processes. Nucleus accumbens astrocytes in the seven-day bilateral common carotid artery occlusion model were exposed to a state of partial ischemia. Their reactive changes consisted of cytotoxic edema, with damage to intermediate filament proteins in the bodies, processes, and perivascular glial membranes. Concentration of astrocyte bodies close to blood capillaries operated as an adaptive mechanism and was a condition for cell survival in conditions of restricted brain blood flow.

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Effects of Musical Acoustic Signals Controlled by the Subject’s EEG Oscillators

We report here studies of the effects of two methods of musical EEG biocontrol in which the subject's dominant spectral EEG components (EEG oscillators) were transformed into music-like signals with flute-like timbre. In some cases, the pitches and intensities of these sound signals varied smoothly depending directly on the ongoing EEG amplitudes of the EEG oscillators. In other cases, variation in the pitch and intensity of flute sounds were supplemented by another musical characteristic – rhythm. Single exposures were found to produce modifications to the bioelectrical activity of the subject's brain, which were accompanied by improvements in the subjects' psychophysiological status. Effects were particularly marked when the musicality of exposures were increased by adding the property of rhythmicity.

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Mimicking the Phenomenon of Ischemic Preconditioning by Actions on Cannabinoid Receptors: The Roles of Protein Kinase C and NO Synthase

Stimulation of CB1 receptors was found to mimic the phenomenon of preconditioning. As the cardioprotective effect of the cannabinoid HU-210 is seen in both in vivo experiments and in vitro studies, there are grounds for suggesting that the protective effects of HU-210 are mediated by activation of cardiac CB1 receptors. The cardioprotective effect of the cannabinoid HU-210 was found to be linked with stimulation of protein kinase C, while NO synthase has no role in the protective action of stimulation of CB1 receptors.

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The Role of Capsaicin-Sensitive Nerves in Regulating Blood Dehydroepiandrosterone Sulfate Levels in Rats in Normal Conditions and in Metabolic Syndrome

The effects of stimulation of capsaicin-sensitive nerves (CSN, capsaicin 1 mg/kg, s.c.) and their deafferentation (capsaicin 150 mg/kg s.c.) on the blood dehydroepiandrosterone sulfate (DEAS) level in normal conditions and metabolic syndrome (MS) induced by consumption of fructose (12.5% solution, 10 weeks) were studied. The criterion for the development of MS was provided by data showing increased blood triglycerides, lipid peroxidation (LPO) products, and impaired glucose tolerance. Stimulation of CSN in rats with a normal diet led to an increased DEAS level, while deafferentation decreased the blood level of this hormone. The fructose diet decreased the DEAS level, induced triglyceridemia, increased LPO, and impaired glucose tolerance. The decreased blood DEAS concentration seen after consumption of fructose was eliminated by stimulation of CSN, with simultaneous reductions in indicators of metabolic syndrome. Preliminary deafferentation of CSN in fructose-consuming rats blocked the stimulation-induced restoration of DEAS. The authors suggest that CSN are involved in the mechanisms controlling the blood DEAS content in normal conditions and metabolic syndrome.

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Extinction and Reconsolidation of Memory

Extraction (reactivation) of memory on reminding can lead to the process of reconsolidation, in which memory retention occurs, or to extinction, leading to weakening of the existing memory trace or the formation of a competing memory. This review analyzes behavior and also the responses of identified neurons forming the neural network for feeding and aversive behavior in the common snail Helix; an attempt is made to describe the conditions in which reminding leads to extinction or reconsolidation. Studies using a neurotoxin specific for serotoninergic neurons – 5,7-dihydroxytryptamine - demonstrated that the serotoninergic system of the snail is required for formation of memories of dangerous stimuli, though it has no role in maintaining or reproducing these memories. This hypothesis raises the question of the activity of serotoninergic neurons as a key condition for selecting between extinction and reconsolidation triggered by reactivation. If a cell is "silent" as a result of adaptation, acclimation, changes in the surroundings, etc., extinction is observed; if the same neuron responds to the conditioned stimulus, reconsolidation occurs. Memory reconsolidation and extinction are evolutionarily conserved phenomena seen in most vertebrates and many invertebrates, suggesting that they reflect the major characteristics of memory formation and storage. The great variation in brain structure in different vertebrate and invertebrate species prevents the phenomena of reconsolidation and extinction from being regarded as systems properties of the brain; rather, they are the basic neural mechanisms which can be seen in any animal with a sufficiently developed nervous system, regardless of the actual architecture of the brain.

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Acoustic Characteristics of Vocalization Reflecting the States of Discomfort and Comfort in Babies Aged Three and Six Months

We report here the ability of adults to recognize the states of discomfort and comfort in babies aged three and six months by listening to their vocalizations. The acoustic characteristics of vocalizations significant for recognizing states from the characteristics of the baby's voice are described. Discomfort vocalizations were found to differ from babies' comfort signals in terms of the mean and maximum fundamental tone frequencies (FTF) and FTF values in the central and final parts of vocalizations. A mathematical model is presented and a function classifying signals as indicating discomfort or comfort is described. Babies' vocalizations attributed by adults to the comfort and discomfort categories with probabilities of 0.75 and above were very reliably recognized by the mathematical model based on the classification function.

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Academy News – November PM&R Journal

As the primary medical society for the specialty of PM&R, your Academy is focused on moving the specialty and you forward. Academy membership supports initiatives to assist our members with:

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Copyright Page

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Spanish Translated Abstracts

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Information for Authors

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Table of Contents

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Editorial Board

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Physical activity outside of structured therapy during inpatient spinal cord injury rehabilitation

Little information exists on the content of inpatient rehabilitation stay when individuals with spinal cord injury (SCI) are not engaged in structured rehabilitation therapy sessions. Investigation of inpatien...

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The airway device preference may affect the overlapping of the common carotid artery by the internal jugular vein

Summary

Background

Anatomical variation in the internal jugular vein (IJV), as well as its small size, tendency to collapse, and proximity to the common carotid artery (CCA) makes central venous cannulation via the IJV a technically challenging procedure, especially in pediatric patients.

Aim

We evaluated the effects of laryngeal mask airway insertion and endotracheal intubation (ETT) on the anatomical relationship between the IJV and the CCA in neutral and 40° head away positions.

Method

After parental consent 92 patients with ASA physical status I-II, aged 0–17, undergoing elective urological surgery were enrolled and divided into two groups according to the airway management device used for anesthesia: Group laryngeal mask airway (n = 63) and Group ETT (n = 29). An ultrasonographic evaluation was performed before and after airway instrumentation at neutral and 40° head rotation. The IJV position in relation to the CCA was noted, and the overlap percentage of the CCA was calculated as the ratio of the CCA length covering by the internal jugular vein to the transverse diameter of the CCA.

Results

With no airway device insertion, the position of the IJV was found to be anterolateral to the CCA in the majority of patients (48.8% vs 35.3%, right vs left IJV) in the neutral head position. While there was no significant change in the overlap percentages of the CCA after laryngeal mask airway insertion in the neutral head position [48.71% vs 57.30% for the right IJV (difference in median: −21.20; 95% confidence interval (CI) of difference: −56.92 to 14.52; P = 0.133); 52.54% vs 60.36% for the left IJV (difference in median: −10.3; 95% CI of difference: −41.49 to 20.89; P = 0.128)], it increased significantly in the 40° head away position on both sides [50.11% vs 64.83% for the right IJV (difference in median: −55; 95% CI of difference: −84 to −25.24; P = 0.01); 53.82% vs 71.20% for the left IJV (difference in median: −46; 95% CI of difference: −86.85 to −5.15; P = 0.004)]. However, the overlap percentages of CCA decreased significantly on the right side with patients in a neutral head position (31.23% vs 6.27%, difference in median: 19; 95% CI of difference: −5.68 to 43.68; P = 0.002) and on both sides in the 40° head away position [29.50% vs 16.19%, difference in median: 26; 95% CI of difference: 2.84 to 49.16; P = 0.03 and 47% vs 31.94%, difference in median: 9.50; 95% CI of difference: −40.87 to 59.87; P = 0.03 for the right and left sides, respectively] after ETT insertion.

Conclusions

Laryngeal mask airway with 40° head rotation increases, whereas ETT decreases, the overlap percentage of CCA by IJV. Both head position and airway management methods have an influence on the overlap of the CCA by the IJV in pediatric patients.

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Acupuncture may be an effective supplement treatment for dexamethasone in pediatric tonsillectomy

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Comment on: S. M. Moeen ‘Could acupuncture be an adequate alternative to dexamethasone in pediatric tonsillectomy?’

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Intravenous dexmedetomidine as an ‘adjuvant’ to the infant spinal anesthetic

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Issue Information

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In this issue: December 2016

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Response to comment “Cox: alternative therapies and postoperative vomiting”

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Reviewer list

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Boston ambulance, car collide; 2 hurt

An EMT and a civilian suffered minor injuries when the two vehicles collided at an intersection.

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Critical Care Transport Paramedic - VitaLink - New Hanover Regional Medical Center

Full-Time, Nights New Hanover Regional Medical Center Wilmington, NC The Critical Care Paramedic provides high quality patient care and safe medical transport to sick and injured patients in all age groups. Uses an interdisciplinary model to work with the AirLink/VitaLink Staff Nurse and other appropriate medical personnel to establish and prioritize a plan of care. Essential Responsibilities: Collaborates ...

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Staff Nurse – Vitalink - New Hanover Regional Medical Center

Full-Time, Rotating Schedule New Hanover Regional Medical Center Wilmington, NC The Staff RN provides high quality patient care and safe medical transport to sick and injured patients in all age groups. Essential Responsibilities: Collaborates with team and initiates care plan based on patient assessment and significant other input/data. Continuously reviews and revises plan as needed per patient's ...

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Paramedic – Vitalink - New Hanover Regional Medical Center

Full-Time, Evening New Hanover Regional Medical Center Wilmington, NC The Staff Paramedic provides high quality patient care and safe medical transport to sick and injured patients in all age groups. Develops a plan of care for each patient that is consistent with approved treatment protocols, policies and procedures. Responsible for the operation of emergency vehicles. Essential Responsibilities: Collaborates ...

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G-quadruplex formation in the Oct4 promoter positively regulates Oct4 expression

Publication date: Available online 15 November 2016
Source:Biochimica et Biophysica Acta (BBA) - Gene Regulatory Mechanisms
Author(s): Daniel Renčiuk, Jan Ryneš, Iva Kejnovská, Silvie Foldynová-Trantírková, Michael Andäng, Lukáš Trantírek, Michaela Vorlíčková
The Oct4 gene codes for a transcription factor that plays a critical role in the maintenance of pluripotency in embryonic and cancer stem cells. Its expression thus has to be tightly regulated. We performed biophysical characterization of the promoter region using a combination of UV absorption, CD, and NMR spectroscopies, native PAGE and chemical probing, which was followed by functional studies involving luciferase reporter assays performed in osteosarcoma and human embryonic stem cell lines.We have shown that the evolutionarily conserved G-rich region close to the Oct4 transcription start site in the non-template strand forms a parallel G-quadruplex structure. We characterized its structure and stability upon point mutations in its primary structure. Functional studies then revealed that whereas the wild type quadruplex sequence ensures high reporter gene expression, the expression of mutated variants is significantly decreased proportionally to the destabilizing effect of the mutations on the quadruplex. A ligand, N-mesoporphyrin IX that increases the stability of formed quadruplex rescued the reporter expression of single-mutated variants to the level of wild-type, but it has no effect on a mutated variant that cannot form quadruplex.These data indicate that the quadruplex acts as a strong, positive regulator of Oct4 expression and as such it might serve as a potential target for therapeutic intervention.



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Predicting Employment in the Mental Health Treatment Study: Do Client Factors Matter?

Abstract

For people with psychiatric disabilities, demographic characteristics and measures of clinical status are often used to allocate scarce employment services. This study examined a battery of potential client predictors of competitive employment, testing the hypothesis that evidence-based supported employment would mitigate the negative effects of poor work history, uncontrolled symptoms, substance abuse, and other client factors. In a secondary analysis of 2055 unemployed Social Security Disability Insurance beneficiaries with schizophrenia or affective disorders, we examined 20 baseline client factors as predictors of competitive employment. The analysis used logistic regression to identify significant client predictors and then examined interactions between significant predictors and receipt of evidence-based supported employment. Work history was a strong predictor of employment, and other client measures (fewer years on disability rolls, Hispanic ethnicity, and fewer physical health problems) were modestly predictive. Evidence-based supported employment mitigated negative client factors, including poor work history. Participants with a poor work history benefitted from supported employment even more than those with a recent work experience. Evidence-based supported employment helps people with serious mental illness, especially those with poor job histories, to obtain competitive employment. Factors commonly considered barriers to employment, such as diagnosis, substance use, hospitalization history, and misconceptions about disability benefits, often have little or no impact on competitive employment outcomes.

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Endoscopic ultrasonography in chronic asymptomatic pancreatic hyperenzimemia: The more we see, the less we know

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NOMENCLATURE AND DIAGNOSIS OF GLUTEN-RELATED DISORDERS: A POSITION STATEMENT BY THE ITALIAN ASSOCIATION OF HOSPITAL GASTROENTEROLOGISTS AND ENDOSCOPISTS (AIGO)

"Gluten-related disorders" is a term that encompasses different diseases induced by the ingestion of gluten-containing food. Because of their incidence the scientific community has been intensively studying them.

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Adalimumab dose escalation is effective and well tolerated in Crohn’s disease patients with secondary loss of response to adalimumab

Although adalimumab is effective in Crohn's disease, most patients experience a loss of response over time. The aim of the present study was to evaluate efficacy and safety of adalimumab dose escalation and identify predictors of a clinical response in Crohn's disease patients with a secondary loss of response.

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PREDICTORS OF TISSUE HEALING IN ULCERATIVE COLITIS PATIENTS TREATED WITH ANTI-TNF

To identify factors predicting mucosal healing in ulcerative colitis patients treated with anti-TNFα agents with or without azathioprine.

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Serum and urinary biomarkers that predict hepatorenal syndrome in patients with advanced cirrhosis

Prediction of hepatorenal syndrome (HRS) remains difficult in advanced cirrhotic patients.

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HUMAN PAPILLOMAVIRUSES IN COLORECTAL CANCERS: A CASE-CONTROL STUDY IN WESTERN PATIENTS

Colorectal cancer (CRC) is one of the most common cancers. As in other cancer locations, the involvement of Human papillomaviruses (HPV) has been suggested but remains highly debated with wide differences among reported prevalence of HPV infection in CRCs.

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Strong correlation between ASPM gene expression and HCV cirrhosis progression identified by co-expression analysis

Hepatitis C virus (HCV) cirrhosis is at a high risk of hepatocellular carcinoma (HCC), and its progression is influenced by a complex network of gene interactions. A weighted gene co-expression network was constructed to identify gene modules associated with the seven-stage disease progression from HCV cirrhosis to HCV-related HCC (n=65). In the significant module (R2=0.86), a total of 25 network hub genes were identified, half of which were also hub nodes in the protein-protein interaction network of the module genes.

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Consensus Conference on TIPS management: Techniques, Indications, Contraindications

The trans jugular intrahepatic Porto systemic shunt (TIPS) is no longer viewed as a salvage therapy or a bridge to liver transplantation and is currently indicated for a number of conditions related to portal hypertension with positive results in survival. Moreover, the availability of self-expandable polytetrafluoroethylene (PTFE)-covered endoprostheses has dramatically improved the long-term patency of TIPS. However, since the last updated International guidelines have been published (year 2009) new evidence have come, which have open the field to new indications and solved areas of uncertainty.

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An Evidence-based Approach to Training Pediatric Gastrointestinal Endoscopy Trainers.

Endoscopy training has evolved in recent years from the traditional model of "learning by doing" to the current skillful application of evidence-based educational principles. Endoscopy training should ideally be provided by individuals with the requisite skills and behaviors to teach endoscopy effectively and efficiently, including an awareness of principles of adult education, best practices in procedural skills education and appropriate use of beneficial educational strategies such as feedback. The aim of this article is to outline principles that underlie successful endoscopy training and describe the "Preparation - Training - Wrap-up" framework that can be used by pediatric endoscopy trainers to help guide an effective endoscopy training session. Looking to the future, application of content from well developed "train the trainer" courses to pediatric endoscopy practice would help to improve the quality of endoscopy training and facilitate the development of conscious competences amongst pediatric endoscopy trainers. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Prevalence and Patterns of Marijuana Use in Young Adults with Inflammatory Bowel Disease.

Objectives: Recent studies in adults report symptom relief with marijuana use in patients with inflammatory bowel disease (IBD). We assessed the prevalence, pattern, effects and adverse effects of marijuana use in young adults with IBD. Methods: We conducted a prospective questionnaire survey study at a pediatric IBD clinic. All patients (18 to 21 years of age) answered anonymous questionnaires about demographics, IBD, medications and marijuana use. Results: Fifty-three patients (Mean age 18.7 years; 32 males) were enrolled. Thirty-seven patients (70%) reported using marijuana currently or in the past. There was no statistically significant difference between the users and non-users of marijuana regarding demographics, disease activity or medications. Despite prolonged use of marijuana, 70% of patients did not discuss it with their gastroenterologists. Twenty-four patients used marijuana medicinally for IBD symptoms in addition to medical therapy. While majority found marijuana to be moderately/very helpful, complete relief of symptoms such as abdominal pain, poor appetite, nausea and diarrhea was seen in 29%, 37%, 14% and 10% of patients respectively. Only half of patients reported knowledge of possible adverse effects of marijuana and 19% of patients reported mild neuropsychiatric adverse effects. Overall, 98% of patients supported legalization of marijuana and 85% were interested in using medical marijuana if it became legally available. Conclusions: We found a high rate of marijuana use in our cohort of young adults with IBD. Majority of users report symptom improvement but do not inform physicians. Future well controlled studies are necessary to assess role of marijuana in IBD therapy. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Detection of Sepsis in Preterm Infants by Fecal Volatile Organic Compounds Analysis: A Proof of Principle Study.

Objectives: Several studies associated altered gut microbiota composition in preterm infants with late-onset sepsis (LOS), up to days prior to clinical onset of sepsis. However, microbiota analysis as early diagnostic biomarker is in clinical practice currently not feasible because of logistic aspects and high costs. Therefore, we hypothesized that analysis of fecal volatile organic compounds (VOC) may serve as non-invasive biomarker to predict LOS at a preclinical stage, since VOC reflect the composition and activity of intestinal microbial communities. Methods: In a prospective multicenter study, fecal samples were collected daily from infants with a gestational age of

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The Role of Biopsies in Childhood Celiac Disease - do we need Less or More?.

No abstract available

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