Τρίτη, 12 Σεπτεμβρίου 2017

Exercise Oscillatory Ventilation: Inter-reviewer Agreement and a Novel Determination.

Introduction: Determination of exercise oscillatory ventilation (EOV) is subjective and the inter-reviewer agreement has not been reported. The purpose of this study was, among patients with heart failure (HF): (1) determine the inter-reviewer agreement for EOV; and (2) describe a novel, objective, and quantifiable measure of EOV. Methods: This was a secondary analysis of the HEART Camp: Promoting Adherence to Exercise in Patients with Heart Failure study. EOV was determined through a blinded review by 6 individuals based on their interpretation of the EOV literature. Inter-reviewer agreement was assessed with Fleiss kappa ([kappa]). Final determination of EOV was based on agreement by 4 of the 6 reviewers. A new measure (ventilation dispersion index; VDI) was calculated for each test and its ability to predict EOV was assessed with the receiver operator characteristics curve (ROC). Results: Among 243 patients with HF (age=60+/-12 years; 45% women) the inter-reviewer agreement for EOV was fair ([kappa]=0.303) with 10-s discrete data averages and significantly better, but only moderate ([kappa]= 0.429) with 30-s rolling data averages. Prevalence of positive and indeterminate EOVs were 18% and 30% with the 10-s discrete averages and 14% and 13% with the 30-s rolling averages, respectively. VDI was strongly associated with EOV with area under the ROC= 0.852 to 0.890. Conclusions: Inter-reviewer agreement for EOV in patients with HF is fair to moderate which can negatively affect risk stratification. VDI has strong predictive validity with EOV; as such it might be a useful measure of prognosis in patients with HF. (C) 2017 American College of Sports Medicine

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The Influence of Foot-Strike Technique on the Neuromechanical Function of the Foot.

Purpose: The aim of this study was to investigate the influence of foot-strike technique on longitudinal arch mechanics and intrinsic foot muscle function during running. Methods: 13 healthy participants ran barefoot on a force-instrumented treadmill at 2.8ms-1 with a forefoot (FFS) and rear-foot (RFS, habitual) running technique, while kinetic, kinematic and electromyographic (EMG) data from the intrinsic foot muscles were collected simultaneously. The longitudinal arch was modeled as a single "mid-foot" joint representing motion of the rear-foot (calcaneus) relative to the forefoot (metatarsals). An inverse dynamic analysis was performed to estimate joint moments generated about the mid-foot, as well as mechanical work and power. Results: The mid-foot was more plantar flexed (higher arch) at foot contact when running with a forefoot running technique (RFS 0.2 +/- 1.8o v FFS 6.9 +/- 3.0o, ES = 2.7), however there was no difference in peak mid-foot dorsiflexion in stance (RFS -11.6 +/- 3.0o v FFS -11.4 +/- 3.4o, ES = 0.63). When running with a forefoot technique, participants generated greater moments about the mid-foot (27% increase, ES = 1.1) and performed more negative work (240% increase, ES = 2.2) and positive work (42% increase, ES = 1.1) about the mid-foot. Average stance phase muscle activation was greater for Flexor Digitorum Brevis (20% increase, ES = 0.56) and Abductor Hallucis (17% increase, ES = 0.63) when running with a forefoot technique. Conclusion: Forefoot running increases loading about the longitudinal arch and also increases the mechanical work performed by the intrinsic foot muscles. These findings have substantial implications in terms of injury prevention and management for runners who transition from a rear-foot to a forefoot running technique. (C) 2017 American College of Sports Medicine

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Persistent aberrant cortical phase-amplitude coupling following seizure treatment in absence epilepsy models

Abstract

In childhood absence epilepsy, cortical seizures are brief and intermittent; however there are extended periods without behavioural or electrographic ictal events. This genetic disorder is associated with variable degrees of cognitive dysfunction, but no consistent functional biomarkers that might provide insight into interictal cortical function have been described. Previous work in monogenic mouse models of absence epilepsy have shown that the interictal EEG displays augmented beta/gamma power in homozygous stargazer (stg/stg) mice bearing a presynaptic AMPA receptor defect, but not homozygous tottering (tg/tg) mice with a P/Q type calcium channel mutation. To further evaluate the interictal EEG, we quantified phase-amplitude coupling (PAC) in stg/stg, stg/+, tg/tg and wild type (+/+) mice. We found distinct gene-linked patterns of aberrant PAC in stg/stg and tg/tg mice compared to +/+ and stg/+ mice. Treatment with ethosuximide significantly blocks seizures in both stg/stg and tg/tg, however the abnormal PAC remains. Stg/+ mice are seizure free with normal baseline beta/gamma power and normal theta-gamma PAC, but like stg/stg mice, beta/gamma power is significantly reduced by NMDA receptor blockade, a treatment that paradoxically enhances seizures in stg/stg mice. Stg/+ mice, therefore, have a latent cortical network phenotype that is veiled by NMDA-mediated neurotransmission. Altogether, these findings reveal gene-linked quantitative electrographic biomarkers in the absence of epileptiform activity and provide a potential network correlate for persistent cognitive deficits in absence epilepsy despite effective treatment.

This article is protected by copyright. All rights reserved



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Cancer-Related Cognitive Changes

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Publication date: Available online 12 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Arash Asher, Kathleen Van Dyk, Sunita K. Patel, Robin Newman, Jessica Engle, Nancy Hutchinson, Lynne Padgett




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Epidemiology of Cervical Spine Injuries in High School Athletes Over a Ten-Year Period

Over 7 million athletes participate in high school (HS) sports annually, with both the benefits of physical activity and risks of injury. While catastrophic cervical spine injuries have been studied, limited data are available characterizing less severe cervical spine injuries in HS athletes.

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Non-surgical treatment of delayed onset brachial plexopathy due to hypertrophic clavicular callus- a case report

Clavicular fractures are common injuries which are traditionally managed non-surgically without clinically significant sequelae. However, they may develop hypertrophic callus formation that compresses the brachial plexus. These cases may present months to years after initial injury with varying degrees of pain, paresthesia and weakness on the affected side, and are usually treated by surgical resection of the hypertrophic callus. We present a case of brachial plexopathy due to hypertrophic clavicular callus causing weakness and paresthesia.

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Construction Site Paramedic - Medcor

Sick of riding in the back of an ambulance" Tired of the 24 hour shifts in the ER" Do you routinely engage in conversations with everyone you meet" Do you treat your patients as good, if not better than you would treat yourself" Do you like job perks, good pay, and great benefits" If so, this may very well be the last job application you'll ever have to fill out! Here's the top 5 reasons ...

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RN / LVN / LPN / Paramedic - Worksite Health Tech - Medcor

Sick of riding in the back of an ambulance" Tired of the 24 hour shifts in the ER" Do you routinely engage in conversations with everyone you meet" Do you treat your patients as good, if not better than you would treat yourself" Do you like job perks, good pay, and great benefits" If so, this may very well be the last job application you'll ever have to fill out! Here's the top 5 reasons ...

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Successful Integration of Pediatrics Into State Health Care Reform Efforts

Health care reform in Vermont promotes patient-centered medical homes (PCMH) and multi-disciplinary community health teams to support population health. This qualitative study describes the expansion of Vermont's health care reform efforts, initially focused on adult primary care, to pediatrics through interviews with project managers and facilitators, CHT members, pediatric practitioners and care coordinators, and community-based providers. Analyses used grounded theory, identifying themes confirmed by repeat occurrence across respondents.

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Diagnostic Errors: Impact of an Educational Intervention on Pediatric Primary Care

The purpose of our study was to determine the impact of an educational program on a provider's knowledge related to diagnostic errors and diagnostic reasoning strategies.

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Role of diuretics in the harmful effects of beta blockers in patients with ascites



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Role of diuretics in the harmful effects of beta blockers in patients with ascites



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Making Decisions About Medication Use During Pregnancy: Implications for Communication Strategies

Abstract

Objective To explore women's perceptions of the risks and benefits associated with medication use during pregnancy and to better understand how women make decisions related to medication use in pregnancy. Methods We conducted online focus groups with 48 women who used medication during pregnancy or while planning a pregnancy, and 12 in-depth follow-up interviews with a subset of these women. Results We found that women were aware of general risks associated with medication use but were often unable to articulate specific negative outcomes. Women were concerned most about medications' impact on fetal development but were also concerned about how either continuing or discontinuing medication during pregnancy could affect their own health. Women indicated that if the risk of a given medication were unknown, they would not take that medication during pregnancy. Conclusion This formative research found that women face difficult decisions about medication use during pregnancy and need specific information to help them make decisions. Enhanced communication between patients and their providers regarding medication use would help address this need. We suggest that public health practitioners develop messages to (1) encourage, remind, and prompt women to proactively talk with their healthcare providers about the risks of taking, not taking, stopping, or altering the dosage of a medication while trying to become pregnant and/or while pregnant; and (2) encourage all women of childbearing age to ask their healthcare providers about medication use.



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NLRP3 mutation and cochlear autoinflammation cause syndromic and nonsyndromic hearing loss DFNA34 responsive to anakinra therapy [Genetics]

The NLRP3 inflammasome is an intracellular innate immune sensor that is expressed in immune cells, including monocytes and macrophages. Activation of the NLRP3 inflammasome leads to IL-1β secretion. Gain-of-function mutations of NLRP3 result in abnormal activation of the NLRP3 inflammasome, and cause the autosomal dominant systemic autoinflammatory disease spectrum, termed...

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A-to-I RNA editing is developmentally regulated and generally adaptive for sexual reproduction in Neurospora crassa [Genetics]

Although fungi lack adenosine deaminase acting on RNA (ADAR) enzymes, adenosine to inosine (A-to-I) RNA editing was reported recently in Fusarium graminearum during sexual reproduction. In this study, we profiled the A-to-I editing landscape and characterized its functional and adaptive properties in the model filamentous fungus Neurospora crassa. A total...

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The molecular dynamics of long noncoding RNA control of transcription in PTEN and its pseudogene [Genetics]

RNA has been found to interact with chromatin and modulate gene transcription. In human cells, little is known about how long noncoding RNAs (lncRNAs) interact with target loci in the context of chromatin. We find here, using the phosphatase and tensin homolog (PTEN) pseudogene as a model system, that antisense...

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Human genetic variation in VAC14 regulates Salmonella invasion and typhoid fever through modulation of cholesterol [Genetics]

Risk, severity, and outcome of infection depend on the interplay of pathogen virulence and host susceptibility. Systematic identification of genetic susceptibility to infection is being undertaken through genome-wide association studies, but how to expeditiously move from genetic differences to functional mechanisms is unclear. Here, we use genetic association of molecular,...

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EMS Chief - City of Sun Prairie



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P 97 Individualized MRI are a valid alternative to individual MRI in navigated TMS studies

Navigated transcranial magnetic stimulation (nTMS) provides significant benefits over non-navigated TMS such as control for non-physiological TMS parameters and intracerebral electric field distribution (Ruohonen and Karhu, 2010; Schmidt et al., 2015). These benefits come at the cost of an often time consuming, expensive and not in all subjects feasible acquisition of individual structural magnetic resonance images (MRI). Spatial transformation is a well-established method that is used in functional neuroimaging to align individual MRI with template MRI (Friston, 1999).

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P 116 Methylphendiate effects on the coupling between attentional processes and motor cortex excitability

Event related potentials (ERPs) allow the examination of sensory, attentional and cognitive processes occurring as brain responses to stimuli while the excitability of motor pathways can be evaluated by transcranial magnetic stimulation (TMS).The interplay between both, attentional processes and motor cortex excitability has been rarely reported in the literature. So far, only two studies used ERP and TMS in combination, focused on inhibition processes and reported compensatory cognitive mechanisms in case of measurement of reduced activation of inhibitory intracortical interneurons in the motor cortex (Heinrich et al., 2014; Hoegl et al., 2011).

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P 106 Functional magnetic resonance imaging of appetitive aggression in martial artists

The direct execution as well as the visual perception of violence can have a hedonistic aspect and elicit positive arousal. (Elbert et al., 2010) So far, neurobiological correlates of this "appetitive" form of aggression have not been investigated in healthy subjects.Using functional magnetic resonance imaging (fMRI), we tested if subjects who act violently (martial artists) showed greater brain responses to violent images compared to controls in the subcortical reward-associated areas of the mesolimbic dopaminergic system.

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P 120 A machine learning approach to detecting sleep and sleep disorders in acceleration sensor data

The major diagnostic sleep laboratory tool for assessing excessive daytime sleepiness (EDS), the multiple sleep latency test (MSLT), is increasingly criticized for poor precision in the differentiation of idiopathic hypersomnia (IH) and narcolepsy (Trotti et al., 2013; Johns, 2000). Recent evidence suggests that actigraphy can supplement the diagnostic process by providing information about the sleep-wake rhythm (Kretzschmar et al., 2016; Filardi et al., 2015; Bruck et al., 2005). An actigraphy analysis tool is introduced that processes actigraphy recordings with machine learning methods.

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P 111 Clinical trials in neurological disorders causing vertigo

The German Center for Vertigo and Balance Disorders (DSGZ) is an interdisciplinary center for research and treatment of vertigo, balance and ocular motor disorders. The long-term aim is to establish a patient-oriented research institution that is networked with all involved disciplines and methods. This includes also the establishment of a study infrastructure for prospective multicenter clinical trials. With this abstract we would like to give an overview over the current clinical trials conducted in collaborations with other investigational sites throughout Germany.

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P 101 Quantitative Chemical Shift Spectroscopy (CSI) with respect to B0- and B1-inhomogeneities

CSI is a method to visualize brain metabolism of, which may be important in the diagnosis of diseases like Alzheimer, dementia, brain tumors etc. Despite the fact that signal strength increases linearly with higher B0-fields, there exist many confounding variables, which diminish the accuracy of quantitative measurements of a 3T-device in relation to 1.5T.Susceptibility artifacts caused by inhomogeneities in the B0- and B1-fields as well as digitalization artifacts represent a challenging obstacle to measure accurate quantitative values of metabolite concentrations in CSI.

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P 122 Stimulus-responsive myoclonic jerks of both levator palpebrae muscles in a comatose survivor of cardiopulmonary resuscitation may pretended awareness

Comatose survivors of cardiopulmonary resuscitation (CPR), who develop myoclonus within 1–2days after CPR, usually have a poor prognosis. Typically, such myoclonus occurs or increases on sensory stimuli like touching the patient or acoustic stimuli. Myclonic jerks mainly occur in the muscles of the face, shoulder girdle and diaphragm. Sometimes, such jerks may be restricted to one muscle like the diaphragm leading to hiccups. We report one comatose survivor of CPR with stimulus-sensitive myoclonus, which was restricted to both levator palpebrae muscles leading to eye opening on acoustic stimulation and by doing so pretending awareness.

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P 118 Unilateral polyradicular deficit from C4 to C6 as a symptom of a spontaneous extracranial vertebral artery dissection.

A 47-year old man with shoulder and neck pain of the right side presented sensory deficits and peripheral paresis of the proximal arm. The rare cause was a spontaneous extracranial vertebral artery dissection affecting C4 to C6 nerve roots diagnosed by cervical magnetic resonance imaging (MRI) and angiography. The treatment based on anticoagulation and physical therapy.

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P 113 The dynamics of human REM sleep investigated by the analysis of time dependent transition probabilities

Sleep can be conceptualized as a sequence of discernable vigilance states (sleep stages). When the polysomnogram is decomposed into bouts of subsequent epochs of the same sleep stage it can be shown from sufficiently large data bases that bout lengths follow a stochastic process characterized e.g. by exponential of power law distributions. A complementary method of analysis calculates the probability of transition to another stage dependent on the time spent in the initial stage (time dependent transition probabilities).

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P 108 Modified motor threshold criterion for intraoperative corticobulbar MEPs for prediction of postoperative facial nerve outcome

Intraoperatively, facial nerve (FN) function can be assessed with corticobulbar Motor Evoked Potentials (FN-coMEP). MEP-amplitude decrement and increase in motor threshold (MT) serve as warning criteria. A novel threshold criterion for extremity MEP additionally compared MT-increments to the non-operated side (bilateral final-to-baseline motor threshold level, BFB-MT). We applied BFB-MT for FN-coMEP with regard to postoperative FN-function.

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P 103 Aggressiveness of martial artists correlates with reduced temporal pole gray matter concentration

Perception and practice of violence have, aside from reactive components, also hedonistic aspects that are associated with positive arousal (appetitive aggression). Earlier studies have predominantly investigated the etiology of aggressive behavior in forensic and psychiatric patients. The present study examined structural brain abnormalities in healthy people inclined to violence (martial artists) compared to healthy controls not showing violent behavior.

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P 99 Additional diagnostic benefit of high resolution ultrasound of the peripheral nerv in addition to classical ENG 2 case reports of posttraumatic nerve injury from an interdisciplinary consultancy

Posttraumatic/post-surgery nerve injury is a frequent problem in surgical departments and has a grave impact on patients recovery and functionality.Exact diagnosis of nerve function and severity of the injury is often a demanding task for electrophysiology laboratories. Classical neurophysiological exams like EMG and ENG occasionally have limited only value in establishing the location and etiology of nerve injury. High resolution ultrasound is a valuable additional tool to plan further treatment.

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The Influence of Growth and Maturation on Stretch-Shortening Cycle Function in Youth

Abstract

Hopping, skipping, jumping and sprinting are common tasks in both active play and competitive sports. These movements utilise the stretch-shortening cycle (SSC), which is considered a naturally occurring muscle action for most forms of human locomotion. This muscle action results in more efficient movements and helps optimise relative force generated per motor unit recruited. Innate SSC development throughout childhood and adolescence enables children to increase power (jump higher and sprint faster) as they mature. Despite these improvements in physical performance, the underpinning mechanisms of SSC development during maturational years remain unclear. To the best of our knowledge, a comprehensive review of the potential structural and neuromuscular adaptations that underpin the SSC muscle action does not exist in the literature. Considering the importance of the SSC in human movement, it is imperative to understand how neural and structural adaptations throughout growth and maturation can influence this key muscle action. By understanding the factors that underpin functional SSC development, practitioners and clinicians will possess a better understanding of normal development processes, which will help differentiate between training-induced adaptations and those changes that occur naturally due to growth and maturation. Therefore, the focus of this article is to identify the potential underpinning mechanisms that drive development of SSC muscle action and to examine how SSC function is influenced by growth and maturation.



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5 practical steps to prevent medical errors

By Steve Wirth, Esq., EMT-P The National Institute of Medicine in its seminal 1999 report: To Err is Human: Building a Safer Health System estimated that up to 98,000 people per year die in hospitals due to preventable medical errors. Unfortunately, we don't have good estimates for the number of fatal medical errors in EMS. But with the significant number of fatal medical errors that occur in ...

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The 'I have a theory' approach to change management in EMS

A few weeks ago, I heard an annoyed EMS leader say, "Those 48-hour crews are killing us on no transports. When they are running calls on the second night of their 48, all they want to do is get back to bed, so they look for any excuse not to transport." He made this grand proclamation as if it were a fact engraved in stone. Only one person on his team, the QI officer, had the courage to ...

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How many field training officers should an EMS agency have?

By Skip Kirkwood, M.S., J.D, NRP, FACPE "How many field training officers should an EMS agency have"" is probably the most-often asked question of established EMS field training and evaluation programs. It is also the least-often answered question. EMS executives, training officers and operations chiefs want to know if there should be a certain percentage of the workforce that is designated ...

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Managing an aging EMS fleet

Every EMS unit poses the challenge of determining when it is no longer fiscally wise to continue maintaining the vehicle

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Researchers: New smartphone app can detect concussions

PupilScreen detects changes in a pupil's response to light using the phone's camera and a type of artificial intelligence

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FV 5 Quadri-pulse theta burst stimulation using ultra-high frequency bursts at I-wave periodicity induces direction dependent bi-directional plasticity in human primary motor cortex

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Publication date: October 2017
Source:Clinical Neurophysiology, Volume 128, Issue 10
Author(s): N. Jung, B. Gleich, N. Gattinger, C. Höss, C. Haug, H. Siebner, V. Mall
Background/QuestionLong-term potentiation (LTP) and long-term depression (LTD) are forms of cortical plasticity and are considered to be synaptic processes underlying learning and memory. Patterned transcranial magnetic stimulation (TMS) such as theta burst stimulation (TBS) or quadri-pulse stimulation (QPS) can induce LTP-like and LTD-like effects in human primary motor cortex (M1), displayed by an increase or decrease in cortico-spinal excitability. Here, we aimed to test the plasticity-inducing capabilities of a novel protocol that merged TBS and QPS – so called quadri-pulse theta burst stimulation (qTBS) – at interstimulus intervals (ISI) that mimic I-wave periodicity (i.e. 1.5ms/666Hz) with an effective anterior-posterior (AP) and posterior-anterior (PA) current flow in the brain.MethodsWe investigated healthy volunteers (n=12 per protocol) with 360 bursts of qTBS that was continuously given to M1 (i.e. 1440 full-sine pulses). QTBS consisted of repeated bursts of four biphasic TMS pulses (duration: 160μs) separated by ISI of 1.5ms (666Hz) and inter-burst intervals of 200ms. (5Hz). TMS was applied by a custom-made magnetic stimulator (IMETUM, Munich). Resting motor threshold (rMT), and motor evoked potential (MEP) amplitudes with stimulus intensities to target amplitudes of 1mv (SI1mV) were measured before (Pre) qTBS, directly after (Post1), after 15min (Post2), after 30min (Post3) and after 60min (Post4).ResultsPA-qTBS at 666Hz caused a decrease in mean MEP amplitudes, whereas AP-qTBS at 666Hz induced an increase in mean MEP amplitudes outlasting for approximately 60min. As expected, baseline data of rMT prior to qTBS differed significantly, with higher thresholds in AP direction.Discussion/ConclusionContinuous qTBS at 666Hz can induce lasting changes in cortico-spinal excitability. Induced current direction in the brain appears to be relevant when qTBS targets I-wave periodicity, corroborating that high-fidelity spike timing mechanisms are critical for inducing bi-directional plasticity in human M1.



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Contents

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Publication date: October 2017
Source:Clinical Neurophysiology, Volume 128, Issue 10





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FV 1 In vivo staging in ALS – A mono-centric cross-sectional and longitudinal DTI-based study

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Publication date: October 2017
Source:Clinical Neurophysiology, Volume 128, Issue 10
Author(s): J. Kassubek, H.P. Müller, K. Del Tredici, D. Lule, E.H. Pinkhardt, H. Braak, A.C. Ludolph
IntroductionNeuropathological studies in amyotrophic lateral sclerosis (ALS) have shown that ALS may disseminate in a regional sequence in four disease-related patterns (Braak et al., 2013). Recently, our group reported the diffusion tensor imaging (DTI)-based analysis of sequential spreading of disease in ALS (Kassubek et al., 2014; Müller et al., 2016). The aim of this study was to show that longitudinal data support the pathological findings and to establish DTI as an in vivo tool to image pathological ALS stages by testing for longitudinal consistency of the categorization results.MethodsThe application of in vivo DTI analysis to fiber structures that are prone to be involved at each neuropathological pattern of ALS was performed in a large-scale monocentre sample of ALS patients. A total of 584DTI datasets from ALS patients (N=425) and controls (N=159) were analyzed by tract of interest (TOI)-based fiber tracking; 52 ALS patients and 22 controls obtained at least one follow-ups can with different time-intervals of 10months (±9months) in average.ResultsAt the individual level, a categorization into ALS staging patterns was possible. At the group level, longitudinal ALS data showed significant differences for the stage-related tract systems (p<0.05, corrected for multiple comparisons).Out of the 52 longitudinally scanned ALS patients, 13 ALS patients showed an increase in ALS-stage, while the other ALS patients remained stable.ConclusionIn summary, in vivo imaging of the disease patterns in ALS has become feasible cross-sectionally and longitudinally and has potential to be used as a non-invasive readout in ALS trials.



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Editorial Board

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Publication date: October 2017
Source:Clinical Neurophysiology, Volume 128, Issue 10





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FV 3 Functional transcranial Doppler (fTCD) during cold-induced pain in the oral cavity and ice cream headache

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Publication date: October 2017
Source:Clinical Neurophysiology, Volume 128, Issue 10
Author(s): O. Hensel, S. Mages, T. Kraya, S. Zierz
BackgroundAn increase of mean flow velocity (MFV) in cerebral arteries can be monitored during processing of visual information (Aaslid, 1987; Rihs et al., 1999), while speaking (Cupini et al., 1996), memory tasks (Vollmer-Haase et al., 1998) and movements of one hand (Orlandi and Murri, 1996) by functional transcranial Doppler (fTCD). The processing of sensitive information (Duschek et al., 2012) or pain (Mages et al., 2016) also leads to an increase in blood flow. Drinking ice-cold water can cause pain in the oral cavity and an ice cream headache (Mages et al., 2016). In this study, it should be investigated whether the oral pain or the headache cause measurable changes of the MFV in the middle cerebral artery (MCA).MethodsThe MFV in both MCA were measured simultaneously during the drinking of 200ml of lukewarm (22°C) and 200ml of ice-cold (0°C) water in 77 young, healthy volunteers (see Fig. 1). After the experiments the occurrence of cold-induced pain in the oral cavity and ice cream headache was documented.ResultsSee Table 1.DiscussionDrinking of liquid leads to a slight increase in the MFV in the ACM (lukewarm water: 2.8%, ice cold water 3.3%). The occurrence of ice cream headache is associated with a MFV increase of about 5% (difference group III with I). The MFV changes during cold-induced pain in the oral cavity are not significant and small (difference group IV and III 1.3%, group II and I 1.5%). Significant increases of MFV in subjects with cold-induced pain in the oral cavity and concomitant ice cream headache were observed. If the diameter of the MCA was constant, it can be concluded that the increase in MFV upon cold ingestion corresponds to an increase in cerebral blood flow.



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FV 7 High-frequency anterior thalamus stimulation increases alertness in epilepsy patients during alert- and drowsy-wakefulness

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Publication date: October 2017
Source:Clinical Neurophysiology, Volume 128, Issue 10
Author(s): I. Bucurenciu, A.M. Staack, A. Gharabaghi, B. Steinhoff
ObjectiveDeep brain stimulation (DBS) of anterior thalamic nuclei (ANT) reduces frequency and intensity of epileptic partial and secondarily-generalized seizures. ANT-DBS disrupts sleep in epilepsy patients. We investigated the impact of ANT-DBS on alertness in wakeful epilepsy patients. This might help to better understand mechanisms of action of high frequency ANT-DBS in humans.MethodsFour patients with different structural epileptic pathology were included in this retrospective case-cohort study. We analysed physiological parameters of alertness during stimulation-ON and -OFF intervals in short- and long-term electroencephalograms (EEG) of patients in states of alert- and drowsy-wakefulness.ResultsWe demonstrate that ANT-DBS increases acutely and reproducible the alertness of wakeful patients during stimulation-ON intervals.SignificanceThis is the first demonstration of such an effect in humans. The enhanced alertness might contribute to the antiepileptic effect of ANT-DBS. Corroborated with the sleep-disruption effect of ANT-DBS in epilepsy patients, our results deliver circumstantial evidences that high-frequency ANT-DBS activates thalamo-cortical connections that promote wakefulness. In addition, our data suggest that ANT-DBS might improve the post-ictal recovery of epileptic patients and counterbalance the antiepileptic-drug induced fatigue.



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S 1 New methods for electrode optimization for high-definition transcranial electric stimulation (hd-tES)

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Publication date: October 2017
Source:Clinical Neurophysiology, Volume 128, Issue 10
Author(s): C.H. Wolters
Background/problem descriptiontES is a non-invasive brain stimulation technique which modifies neural excitability by providing weak currents through scalp electrodes. The aim of my presentation is to introduce and analyze new forward and inverse simulation methods for safe and well-targeted multi-electrode tES.MethodsContinuous Galerkin Finite Element Method (CG-FEM) simulations will be reviewed as current standard tES forward simulation approach (Wagner et al., 2014). The tES forward problem is then related to the Electroencephalography (EEG) forward problem using Helmholtz principle of reciprocity (Wagner et al., 2016) and a new Unfitted Discontinuous Galerkin FEM (UDG-FEM) approach for both EEG and tES forward problem will be presented (Nüßing et al., 2016). UDG-FEM combines the advantages of a FEM approach on a structured hexahedral mesh with implicit surface representations given by level set functions. Finally, a new multi-electrode tES optimization approach is presented that uses the alternating direction method of multipliers (ADMM) for optimizing the focality, orientation and intensity of current density at the target location, while minimizing current density in the remaining brain (Wagner et al., in press).ResultsCG-FEM simulations show that standard bipolar electrode montages induce a very widespread current flow field with the strongest intensities often located in non-target brain regions. The results will also point out the limitations of such standard CG-FEM simulation approaches with regard to so-called skull leakage problems, which are alleviated using UDG-FEM to appropriately model smooth tissue surfaces. The electrode optimization results in a highly realistic six-compartment geometry-adapted hexahedral head model reveal that the optimized current flow fields show significantly higher focality and, in most cases, higher directional agreement to the target vector in comparison to standard bipolar electrode montages. The new ADMM optimization approach will also be compared to other optimization approaches from the literature.Discussion/conclusionThe new ADMM hd-tES electrode optimization approach based on UDG-FEM realistic head modeling offers an innovative new approach to calculate individually optimized electrode currents. In combination with hd-tES hardware, it bears the potential to significantly increase effects of non-invasive tES stimulation.



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FV 2 Reduced spatial variability in cortical working memory networks after macro-anatomical alignment – Converging evidence from multiple fMRI studies

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Publication date: October 2017
Source:Clinical Neurophysiology, Volume 128, Issue 10
Author(s): R. Bittner, A. Seitz, P. Hahn, E. Raspor, C. Novak, D. Linden, R. Goebel, A. Reif
IntroductionReducing the spatial variability in group analyses is an important issue in functional neuroimaging studies. Commonly volume-based whole-brain alignment procedures are used to provide a common analysis space and to align brains across subjects. Inter-individual differences in the cortical folding pattern are an important source of spatial variability. However, volume based alignment methods do not take this factor into account. By contrast, surface based alignment procedures have been shown to significantly improve macro-anatomical alignment and increase the overlap of functional activation. However, this has primarily been demonstrated for sensory and motor paradigms, but not for higher cognitive functions such as working memory. However, working memory is particularly relevant for investigating the neurophysiological and genetic mechanisms of neuropsychiatric disorders such as schizophrenia.MethodsWe applied the same high-resolution, multiscale curvature driven cortex based alignment procedure to three separate fMRI data sets using Brain Voyager QX 2.8. Anatomical scans were segmented along the white–gray matter boundary. Cortical hemispheres were reconstructed and morphed into spherical representations. Each cortical folding pattern was aligned to a dynamically updated group average through iterative morphing following a coarse-to-fine matching strategy. In a spatial working memory study with 32 healthy participants (study 1), we studied the impact of this macroanatomical alignment procedure on spatial variability of functional activation in the working memory network. In a separate spatial working memory imaging genetics study with 112 healthy participants (study 2), we examined a panel of SNPs previously reported in imaging genetics studies, and investigated whether macroanatomical alignment increased the likelihood of detecting effects of these SNPs on activation of the cortical working memory network. In a study of visual working memory dysfunction in schizophrenia with 17 patients with schizophrenia and 17 matched controls (study 3), we investigated, whether macroanatomical alignment differentially affects patients with schizophrenia, which are characterized by increased interindividual cortical anatomical variability.ResultsIn study 1 we observed a reduction of spatial variability of functional activation by roughly 30% in key frontal and parietal areas of the working memory network and a small but robust increase in activation strength after macroanatomical alignment. In study 2 we observed, that macroanatomical alignment increased the likelihood to detect significant effects of individual SNPs on working memory related brain activation. In study 3 spatial variability of functional activation decreased in both groups, but this effect was more pronounced in patients.ConclusionsCortex based alignment substantially reduces the spatial variability of functional activation during working memory. This also improves the effect sizes of imaging genetics studies. Furthermore, our method appears to correct the increased interindividual cortical anatomical variability found in schizophrenia to a considerable degree, addressing an important confound in neuroimaging studies of this disorder. We conclude that the benefits of cortex based alignment warrant its more frequent use in fMRI studies of higher cognitive processes in healthy and patient populations.



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FV 4 The influence of Ketamine on the locus coeruleus and the noradrenerg system – a randomized fMRI study

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Publication date: October 2017
Source:Clinical Neurophysiology, Volume 128, Issue 10
Author(s): T. Liebe, M. Li, L. Colic, C.M. Sweeney-Reed, M. Walter
BackgroundKetamine and its potential antidepressant mechanism, which has been proposed to be related to the glutamatergic system of the brain, are of growing interest. Since ketamine modulates the norepinephrine transporter (NET), we investigated the influence of ketamine on the Locus coeruleus (LC), the brain area with the highest NET density, the source of the noradrenergic fibers and an arousal regulatory center identified on resting state fMRI.MethodsWe investigated the resting state functional connectivity (rs-fc) of the LC before and after subanesthetic ketamine in a double-blind, randomized, controlled, parallel design trial with 7T MRI. 75 young, healthy participants (mean age 26.04±5.375years) were examined. We additionally explored differences in the rs-fc associated with a common polymorphism in the NET gene.ResultsThe rs-fc of LC with the thalamus decreased significantly after ketamine administration. Thalamic nuclei including the mediodorsal, ventral anterior, ventral lateral, ventral posterolateral nucleus bilaterally and the right centromedian nucleus were decoupled from the LC following ketamine infusion. This decrease in rs-fc differed between the NET polymorphism carriers. Furthermore, we revealed an increase in rs-fc from LC to the right TPJ after ketamine administration.ConclusionsWe revealed an influence of ketamine on the central noradrenergic pathway. Moreover, the results suggest a potential influence of ketamine on the attention network. These findings could explain components of ketamine side-effects and may contribute to understanding its antidepressive effect.



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FV 6 Sustained GABA reduction induced by anodal Transcranial direct current stimulation (tDCS) in motor cortex – a proton magnetic resonance spectroscopy study

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Publication date: October 2017
Source:Clinical Neurophysiology, Volume 128, Issue 10
Author(s): H.J. Patel, S. Romanzetti, A. Pellicano, K. Reetz, F. Binkofski
BackgroundTranscranial direct current stimulation (tDCS) is a non-invasive technique that modulates excitability of neurons in the cerebral cortex. Anodal tDCS has been reported to modulate the activation of motor cortex as well as GABA concentration in motor cortex (Nitsche and Paulus, 2000).ObjectiveTo date very little is known about the nature and duration of tDCS induced effects. We aimed to investigate long-term effects of anodal tDCS on the primary motor cortex (M1). Repeated magnetic resonance spectroscopy (MRS) was employed to measure relative gamma-aminobutyric acid concentrations in M1 up to 60min after stimulation.Materials and methodsTwenty right-handed healthy volunteers were recruited in RWTH Aachen University. 1mA anodal and sham tDCS were applied for 10min, respectively. MRS scans were performed before and after stimulation on a 3T Siemens PRISMA whole-body scanner, GABA-edited spectra were acquired from a volume of interest of 3×3×3cm (27mL) carefully placed on the hand area of the left M1 (Fig. 1). MEGA-PRESS J-editing (Mescher et al., 1998) was used for GABA detection. Data processing and quantification of spectra was performed with TARQUIN (Wilson et al., 2011).ResultsAn ANOVA was performed on GABA concentrations with stimulation (sham vs. anodal) and measurement (12 measurements: 2 pre-stimulation and 10 post-stimulation measurements) as between- and within-participants factors, respectively. The main effects of stimulation and measurements were significant F (1,18)=9.200, p=.007 and F (11,198)=2.354, p=.010. Crucially, the interaction was significant F (11,198)=3.089, p<.001(Fig. 2). In other words, GABA signal showed no change over time in the sham group, whereas it decreased significantly in the anodal group and stayed at about the same level across the whole planned test measurements over 86min.Discussion and conclusionSuch a long-lasting (over 86min) decrease in GABA concentration corresponds not only to the reported behavioral effects of tDCS stimulation, such as increased motor learning capacity, but also, to the timeline of increased brain energy consumption following anodal tDCS as measured with Phosphorus spectroscopy (Binkofski et al., 2011). Our results are relevant for the understanding of the mechanism of motor cortical plasticity and neuropsychiatric diseases in humans.



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FV 8 An update on neurophysiological diagnostic in pediatric neurology

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Publication date: October 2017
Source:Clinical Neurophysiology, Volume 128, Issue 10
Author(s): P. Broser, O. Maier
Evoked potentials are an important neurophysiological method in pediatrics. Most commonly used are brainstem auditory evoked potentials (BAEP), visual evoked potentials (VEP) and somatosensory evoked potentials (SEP). BAEPs are useful in screening for hearing disorders and for evaluating brain stem function. VEPs are performed to evaluate visual functioning and for diagnosis of demyelinating diseases. SEPs allow evaluation of the functional integrity of the somatosensory system from the peripheral nerve to the cerebral cortex and can be a useful additional prognostic tool in determining coma and asphyxia outcome. In pediatrics, motor evoked potentials (MEP) are mainly used in scientific studies. During this presentation we will show recent developments in the use of neurophysiological diagnostic in pediatric neurology. Given that the spectrum of indication differs from that in adult neurology, maturation processes and age-related effects in focus of these techniques.



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HLX is a candidate gene for a pattern of anomalies associated with congenital diaphragmatic hernia, short bowel, and asplenia

Isolated congenital diaphragmatic hernia is often a sporadic event with a low recurrence risk. However, underlying genetic etiologies, such as chromosome anomalies or single gene disorders, are identified in a small number of individuals. We describe two fetuses with a unique pattern of multiple congenital anomalies, including diaphragmatic hernia, short bowel and asplenia, born to first-cousin parents. Whole exome sequencing showed that both were homozygous for a missense variant, c.950A>C, predicting p.Asp317Ala, in the H.20-Like Homeobox 1 (HLX1) gene. HLX is a homeobox transcription factor gene which is relatively conserved across species. Hlx homozygous null mice have a short bowel and reduced muscle cells in the diaphragm, closely resembling the anomalies in the two fetuses and we therefore suggest that the HLX mutation in this family could explain the fetal findings.



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Compound heterozygous TRPV4 mutations in two siblings with a complex phenotype including severe intellectual disability and neuropathy

TRPV4 encodes a polymodal calcium-permeable plasma membrane channel. Dominant pathogenic mutations in TRPV4 lead to a wide spectrum of abnormal phenotypes. This is the first report of biallelic TRPV4 mutations and we describe two compound heterozygous siblings presenting with a complex phenotype including severe neuromuscular involvement. In light of previously well described dominant inheritance for TRPV4-related neuromuscular disease, our study suggests a role for compound heterozygosity and loss-of-function as a potential novel disease mechanism for this group of disorders. Profound intellectual disability was also noted in both affected children, suggesting that TRPV4 may be necessary for normal brain development.



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Role of soil-to-leaf tritium transfer in controlling leaf tritium dynamics: Comparison of experimental garden and tritium-transfer model results

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Publication date: November 2017
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Masakazu Ota, Nana-Owusua A. Kwamena, Steve Mihok, Volodymyr Korolevych
Environmental transfer models assume that organically-bound tritium (OBT) is formed directly from tissue-free water tritium (TFWT) in environmental compartments. Nevertheless, studies in the literature have shown that measured OBT/HTO ratios in environmental samples are variable and generally higher than expected. The importance of soil-to-leaf HTO transfer pathway in controlling the leaf tritium dynamics is not well understood. A model inter-comparison of two tritium transfer models (CTEM-CLASS-TT and SOLVEG-II) was carried out with measured environmental samples from an experimental garden plot set up next to a tritium-processing facility. The garden plot received one of three different irrigation treatments – no external irrigation, irrigation with low tritium water and irrigation with high tritium water. The contrast between the results obtained with the different irrigation treatments provided insights into the impact of soil-to-leaf HTO transfer on the leaf tritium dynamics. Concentrations of TFWT and OBT in the garden plots that were not irrigated or irrigated with low tritium water were variable, responding to the arrival of the HTO-plume from the tritium-processing facility. In contrast, for the plants irrigated with high tritium water, the TFWT concentration remained elevated during the entire experimental period due to a continuous source of high HTO in the soil. Calculated concentrations of OBT in the leaves showed an initial increase followed by quasi-equilibration with the TFWT concentration. In this quasi-equilibrium state, concentrations of OBT remained elevated and unchanged despite the arrivals of the plume. These results from the model inter-comparison demonstrate that soil-to-leaf HTO transfer significantly affects tritium dynamics in leaves and thereby OBT/HTO ratio in the leaf regardless of the atmospheric HTO concentration, only if there is elevated HTO concentrations in the soil. The results of this work indicate that assessment models should be refined to consider the importance of soil-to-leaf HTO transfer to ensure that dose estimates are accurate and conservative.



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Long-term modelling of fly ash and radionuclide emissions as well as deposition fluxes due to the operation of large oil shale-fired power plants

Publication date: November 2017
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Taavi Vaasma, Marko Kaasik, Jüri Loosaar, Madis Kiisk, Alan H. Tkaczyk
Two of the world's largest oil shale-fired power plants (PPs) in Estonia have been operational over 40 years, emitting various pollutants, such as fly ash, SOx, NOx, heavy metals, volatile organic compounds as well as radionuclides to the environment. The emissions from these PPs have varied significantly during this period, with the maximum during the 1970s and 1980s. The oil shale burned in the PPs contains naturally occurring radionuclides from the 238U and 232Th decay series as well as 40K. These radionuclides become enriched in fly ash fractions (up to 10 times), especially in the fine fly ash escaping the purification system.Using a validated Gaussian-plume model, atmospheric dispersion modelling was carried out to determine the quantity and a real magnitude of fly ash and radionuclide deposition fluxes during different decades. The maximum deposition fluxes of volatile radionuclides (210Pb and 210Po) were around 70 mBq m−2 d−1 nearby the PPs during 1970s and 1980s. Due to the reduction of burned oil shale and significant renovations done on the PPs, the deposition fluxes were reduced to 10 mBq m−2 d−1 in the 2000s and down to 1.5 mBq m−2 d−1 in 2015. The maximum deposition occurs within couple of kilometers of the PPs, but the impacted area extends to over 50 km from the sources. For many radionuclides, including 210Po, the PPs have been larger contributors of radionuclides to the environment via atmospheric pathway than natural sources. This is the first time that the emissions and deposition fluxes of radionuclides from the PPs have been quantified, providing the information about their radionuclide deposition load on the surrounding environment during various time periods.

Graphical abstract

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Collateral impact: a dual role for climbing fibre collaterals to the cerebellar nuclei?

Abstract

The principal source of synaptic inputs to the cerebellum arise from mossy fibres and climbing fibres (CFs).

This article is protected by copyright. All rights reserved



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Sliding doors – heteromeric, volume-sensitive osmolyte channels

Abstract

Release of the organic osmolyte taurine from mammalian cells following osmotic cell swelling, impacts not only cell volume but also cellular membrane dynamics, antioxidative capacity, metabolism, as well as apoptotic progression.

This article is protected by copyright. All rights reserved



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Vestibular vertical: a balancing act between the upper and lower limbs

Abstract

Our vertical bipedal posture is one of the defining traits that separates us from our phylogenetic peers. Not surprisingly, the mechanisms underlying how we maintain this orientation have come under intense scientific scrutiny.

This article is protected by copyright. All rights reserved



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Reorganization of finger coordination patterns through motor exploration in individuals after stroke

Impairment of hand and finger function after stroke is common and affects the ability to perform activities of daily living. Even though many of these coordination deficits such as finger individuation have be...

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Biomechanics and neural control of movement, 20 years later: what have we learned and what has changed?

We summarize content from the opening thematic session of the 20th anniversary meeting for Biomechanics and Neural Control of Movement (BANCOM). Scientific discoveries from the past 20 years of research are co...

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A brain-computer interface driven by imagining different force loads on a single hand: an online feasibility study

Motor imagery (MI) induced EEG patterns are widely used as control signals for brain-computer interfaces (BCIs). Kinetic and kinematic factors have been proved to be able to change EEG patterns during motor ex...

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Estimates of individual muscle power production in normal adult walking

The purpose of this study was to determine the contribution of individual hip muscles to the net hip power in normal adult self-selected speed walking. A further goal was to examine each muscle's role in propu...

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Reply to the Comments by Mortazavi and Doss on “Solid Cancer Incidence among the Life Span Study of Atomic Bomb Survivors: 1958–2009” (Radiat Res 2017; 187:513–537)

Radiation Research, Volume 188, Issue 3, Page 370-371, September 2017.


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Desarda's technique versus Lichtenstein technique for the treatment of primary inguinal hernia: A systematic review and meta-analysis of randomized controlled trials

Hernia

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Lilly takes on Pfizer, Novartis with new breast cancer drug data

Reuters Health News

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Ca2+/calmodulin-dependent protein kinase II regulates colon cancer proliferation and migration via ERK1/2 and p38 pathways

World Journal of Gastroenterology

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CSR uncertainty could cause 9.4M uninsured, 37% premium increase, report says

Healthcare Finance News

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Role of 18F-FDG PET/CT in posttreatment evaluation of anal carcinoma

The Journal of Nuclear Medicine

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Breastfeeding and the risk of Crohn's disease and ulcerative colitis

Alimentary Pharmacology and Therapeutics

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Colectomy in refractory Crohn's colitis improves nutrition and reduces steroid use

Journal of Pediatric Surgery

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Predictors of early discontinuation of interferon-free direct antiviral agents in patients with hepatitis C virus and advanced liver fibrosis: Results of a real-life cohort

European Journal of Gastroenterology & Hepatology

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Understanding symptom appraisal and help-seeking in people with symptoms suggestive of pancreatic cancer: A qualitative study

BMJ Open

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Incidence of irritable bowel syndrome and chronic fatigue following GI infection: A population-level study using routinely collected claims data

Gut

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A pilot evaluation of a computer-based psychometric test battery designed to detect impairment in patients with cirrhosis

International Journal of General Medicine

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Characteristics of patients with sorafenib-treated advanced hepatocellular carcinoma eligible for second-line treatment

Investigational New Drugs

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Cancer mutation gains ground as test for immunotherapy drugs

Reuters Health News

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Rifaximin for the prevention of spontaneous bacterial peritonitis and hepatorenal syndrome in cirrhosis: A systematic review and meta-analysis

European Journal of Gastroenterology & Hepatology

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Examining colorectal cancer survivors' surveillance patterns and experiences of care: A SEER-CAHPS study

Cancer Causes and Control

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Direct-acting antivirals decreased tumor recurrence after initial treatment of hepatitis C virus-related hepatocellular carcinoma

Digestive Diseases and Sciences

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Bifidobacterium obtained from mothers milk and their infant stool; A comparative genotyping and antibacterial analysis

Microbial Pathogenesis

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Early menarche is associated with non-alcoholic fatty liver disease in adulthood

Pediatrics International

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Current use of MRI in patients with liver metastatic colorectal cancer: A population-based study

European Journal of Gastroenterology & Hepatology

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Systematic review with meta-analysis: The global recurrence rate of Helicobacter pylori

Alimentary Pharmacology and Therapeutics

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Drugs For Neuropathic Pain Are Promising in Treating Feed-Induced Dystonia in Central Nervous System Disabled Children.

No abstract available

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Bile Acid Synthesis Disorders in Arabs: A 10-Year Screening Study.

Objectives: Early diagnosis of bile acid synthesis disorders (BASD) is important because, untreated, these conditions can be fatal. Our objectives were to screen children with cholestasis or unexplained liver disease for BASD and in those with confirmed BASD to evaluate the effectiveness of cholic acid therapy. Methods: A routine serum total bile acid measurement was performed on children with cholestasis, liver cirrhosis, and liver failure. Patients were screened for BASD by fast atom bombardment ionization-mass spectrometry (FAB-MS) analysis of urine, and molecular analysis confirmed diagnosis. Treatment response to oral cholic acid (10-15 mg/kg bw/day) was assessed from liver function tests and fat-soluble vitamin levels. FAB-MS analysis of urine was used to monitor compliance and biochemical response. Results: Between 2007 and 2016, 626 patients were evaluated; 450 with infantile cholestasis. Fifteen cases of BASD were diagnosed: 12 presented with infantile cholestasis (2.7%, 7 males), an 8-year old boy presented with cirrhosis, and two 18-month old boys presented with hepatomegaly and rickets. Eleven were caused by 3[latin sharp s]-hydroxy-[DELTA]5-C27-steroid oxidoreductase dehydrogenase deficiency, three from [DELTA]4-3-oxosteroid 5[latin sharp s]-reductase deficiency, and one had Zellweger Spectrum Disorder. In all but one, serum total bile acids were normal or low. With cholic acid therapy, 10 are alive and healthy with their native liver. Liver failure developed in 3 infants despite therapy; 2 died, and one underwent liver transplantation. Conclusion: BASD are rare but treatable causes of metabolic liver disease in Saudi Arabia. BASD should be considered in infants with cholestasis and low or normal serum total bile acid concentrations. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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Neuropathic Pain as Potential Source of Feed-Induced Dystonia in Children with Severe Central Nervous System Disorders.

No abstract available

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European guidelines on perioperative venous thromboembolism prophylaxis: Surgery in the elderly.

: The risk for postoperative venous thromboembolism (VTE) is increased in patients aged more than 70 years and in elderly patients presenting with co-morbidities, for example cardiovascular disorders, malignancy or renal insufficiency. Therefore, risk stratification, correction of modifiable risks and sustained perioperative thromboprophylaxis are essential in this patient population. Timing and dosing of pharmacoprophylaxis may be adopted from the non-aged population. Direct oral anti-coagulants are effective and well tolerated in the elderly; statins may not replace pharmacological thromboprophylaxis. Early mobilisation and use of non-pharmacological means of thromboprophylaxis should be exploited. In elderly patients, we suggest identification of co-morbidities increasing the risk for VTE (e.g. congestive heart failure, pulmonary circulation disorder, renal failure, lymphoma, metastatic cancer, obesity, arthritis, post-menopausal oestrogen therapy) and correction if present (e.g. anaemia, coagulopathy) (Grade 2C). We suggest against bilateral knee replacement in elderly and frail patients (Grade 2C). We suggest timing and dosing of pharmacological VTE prophylaxis as in the non-aged population (Grade 2C). In elderly patients with renal failure, low-dose unfractionated heparin (UFH) may be used or weight-adjusted dosing of low molecular weight heparin (Grade 2C). In the elderly, we recommend careful prescription of postoperative VTE prophylaxis and early postoperative mobilisation (Grade 1C). We recommend multi-faceted interventions for VTE prophylaxis in elderly and frail patients, including pneumatic compression devices, low molecular weight heparin (and/or direct oral anti-coagulants after knee or hip replacement) (Grade 1C). (C) 2017 European Society of Anaesthesiology

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Risk Vessels of Retropharyngeal Hematoma During Stellate Ganglion Block.

Background and Objective: Bleeding into the retropharyngeal space is a potential complication in stellate ganglion block (SGB). Retropharyngeal hematoma formation is considered to be due to damage of small arteries in the region, although only scanty details of the region are available. The aim of this study was to map the risk blood vessels in the retropharyngeal space to avoid accidental damage during SGB. Methods: Contrast-enhanced 3-dimensional computed tomography images performed on 80 patients were reanalyzed retrospectively to construct detailed map of cervical blood vessels that are prone to damage and bleeding during SGB. Results: Of the 160 bilateral necks, 6 (3.8%) and 82 (51.3%) small arteries were identified in the medial portions of the ventral surface of the transverse processes of the sixth and seventh cervical vertebrae, respectively. In particular, 5 of the 6 small arteries detected in the medial portion of the ventral surface of the transverse process of the sixth cervical vertebra were the inferior thyroid artery (ITA). Of the 160 vertebral arteries, 2 arteries were missing, 4 (2.5%) entered the transverse foramen of the fifth cervical vertebra, whereas 1 artery (0.6%) entered the transverse foramen of the fourth cervical vertebra. Conclusions: Three-dimensional computed tomography identified the ITA in the medial portion of the ventral surface of the transverse process of the sixth cervical vertebra. The risk vessels of retropharyngeal hematoma during SGB could include the ITA. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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The complete genome sequence and phylogenetic analysis of the mitochondrial DNA of the wood-decaying fungus Fomitopsis palustris

Abstract

The complete mitochondrial genome sequence of the wood-decaying fungus Fomitopsis palustris (Basidiomycete, Agaricomycotina) was determined by next-generation sequencing technology. The complete sequence of the circular mitochondrial DNA of F. palustris was 63,479 bp in length with a 75.98% AT content. The mitochondrial genome encoded 14 conserved proteins, 2 ribosomal RNAs, 26 transfer RNAs, and 19 additional open reading frames. The coxI and cob genes contained six and one group I introns, respectively, and encoded eight open reading frames, including seven intron-encoded endonucleases. The complete mitochondrial genome of F. palustris presented herein represents the first such report for brown rot basidiomycetes. In addition, the BLAST score ratio and phylogenetic analysis may open new avenues to understanding the evolutionary status of this fungus .



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Effect of Stretching on Thoracolumbar Fascia Injury and Movement Restriction in a Porcine Model.

Objective: Stretching of fascia is an important component of manual and movement therapies. We previously showed that in pigs, a unilateral thoracolumbar fascia injury combined with movement restriction (hobble) produced contralateral loss of fascia mobility (shear strain during passive trunk flexion measured with ultrasound) similar to findings in human subjects with chronic low back pain. We now tested whether such abnormalities could be reversed by removing the hobble with or without daily stretching for 1 mo. Design: Thirty pigs were randomized to control, injury, or injury + hobble for 8 wks. The hobble restricted hip extension ipsilateral to the injury. At week 8, the injury + hobble group was subdivided into continued hobble, removed hobble, and removed hobble + stretching (passively extending the hip for 10 min daily). Results: Removing hobbles restored normal gait speed but did not restore fascia mobility. Daily passive stretching was not superior to removing hobbles, as there was no significant improvement in fascia mobility with either treatment group (removed hobble or stretching). Conclusions: Reduced fascia mobility in response to injury and movement restriction worsens over time and persists even when movement is restored. Reversing fascia abnormalities may require either longer than 1 mo or a different treatment "dose" or modality. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Paired associative stimulation goes spinal

Abstract

Efficiency, reliability and reproducibility of transcranial stimulation (TS) protocols have been refined repeatedly in the past and will continue to be in the future.

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