Affective priming and cognitive load: Event-related potentials suggest an interplay of implicit affect misattribution and strategic inhibition

Abstract

Prior research suggests that the affective priming effect denoting prime-congruent evaluative judgments about neutral targets preceded by affective primes increases when the primes are processed less deeply. This has been taken as evidence for greater affect misattribution. However, no study so far has combined an experimental manipulation of the depth of prime processing with the benefits of ERPs. Forty-seven participants made like/dislike responses about Korean ideographs following 800-ms affective prime words while 64-channel EEG was recorded. In a randomized within-subject design, three levels of working-memory load were applied specifically during prime processing. Affective priming was significant for all loads and even tended to decrease over loads, although efficiency of the load manipulation was confirmed by reduced amplitudes of posterior attention-sensitive prime ERPs. Moreover, ERPs revealed greater explicit affective discrimination of the prime words as load increased, with strongest valence effects on central/centroparietal N400 and on the parietal/parietooccipital late positive complex under high load. This suggests that (a) participants by default tried to inhibit the processing of the prime's affect, and (b) inhibition more often failed under cognitive load, thus causing emotional breakthrough that resulted in a binding of affect to the prime and, hence, reduced affect misattribution to the target. As a correlate of affective priming in the target ERP, medial-frontal negativity, a well-established marker of (low) stimulus value, increased with increasing negative affect of the prime. Findings support implicit prime-target affect transfer as a major source of affective priming, but also point to the role of strategic top-down processes.

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Dietary sodium induces a redistribution of the tubular metabolic workload

Abstract

Na⁺ excretion by the kidney varies according to dietary Na⁺ intake. We undertook a systematic study on the effects of dietary salt intake on glomerular filtration rate (GFR) and tubular Na⁺ reabsorption. We examined the renal adaptive response in mice subjected to 7 days of a low sodium diet (LSD) containing 0.01% Na⁺, a normal sodium diet (NSD) containing 0.18% Na⁺, as well as a moderately high sodium diet (HSD) containing 1.25% Na⁺. As expected, LSD did not alter measured GFR and increased the abundance of total and cell-surface NHE3, NKCC2, NCC, α-ENaC, and cleaved γ-ENaC compared to NSD. Mathematical modelling predicted that tubular Na⁺ reabsorption increased in the proximal tubule but decreased in the distal nephron because of diminished Na⁺ delivery. This prediction was confirmed by the natriuretic response to diuretics targeting the thick ascending limb, the distal convoluted tubule or the collecting system. On the other hand, HSD did not alter measured GFR but decreased the abundance of the aforementioned transporters compared to NSD. Mathematical modelling predicted that tubular Na⁺ reabsorption decreased in the proximal tubule but increased in distal segments with lower transport efficiency with respect to O₂ consumption. This prediction was confirmed by the natriuretic response to diuretics. The activity of the metabolic sensor AMPK was related to the changes in tubular Na⁺ reabsorption. Our data show that fractional Na⁺ reabsorption is distributed differently according to dietary Na⁺ intake and induces changes in tubular O₂ consumption and sodium transport efficiency.

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Measurement of Active and Sedentary Behavior in Context of Large Epidemiologic Studies.

Introduction/Purpose: To assess the utility of measurement methods that may be more accurate and precise than traditional questionnaire-based estimates of habitual physical activity and sedentary behavior we compared the measurement properties of a past year questionnaire (AARP) and more comprehensive measures: an internet-based 24-hour recall (ACT24), and a variety of estimates from an accelerometer (ActiGraph). Methods: Participants were 932 adults (50-74 y) in a 12-month study that included reference measures of energy expenditure from doubly labeled water (DLW) and active and sedentary time via activPAL. Results: Accuracy at the group level (mean differences) was generally better for both ACT24 and ActiGraph than the AARP questionnaire. AARP accuracy for energy expenditure ranged from -4 to -13% lower than DLW, but its accuracy was poorer for physical activity duration (-48%) and sedentary time (-18%) vs. activPAL. In contrast, ACT24 accuracy was within 3 to 10% of DLW expenditure measures and within 1 to 3% of active and sedentary time from activPAL. For ActiGraph, accuracy for energy expenditure was best for the Crouter 2-regression method (-2 to -7%), and for active and sedentary time the 100 count/minute cut-point was most accurate (-1% to 2%) at the group level. One administration of the AARP questionnaire was significantly correlated with long-term average from the reference measures ([rho]XT=0.16-0.34) overall, but 4 ACT24 recalls had higher correlations ([rho]XT=0.48-0.60), as did 4-days of ActiGraph assessment ([rho]XT=0.54-0.87). Conclusion: New exposure assessments suitable for use in large epidemiologic studies (ACT24, ActiGraph) were more accurate and had higher correlations than a traditional questionnaire. Use of better more comprehensive measures in future epidemiologic studies could yield new etiologic discoveries and possibly new opportunities for prevention. (C) 2017 American College of Sports Medicine

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Neural Correlates to the Increase in Maximal Force after Dexamethasone Administration.

Purpose: This study investigated the effects of short-term glucocorticoid administration on voluntary activation and intracortical inhibitory and facilitatory circuits. Methods: Seventeen healthy men participated in a pseudo randomized double-blind study to receive either dexamethasone (8 mg[middle dot]d-1, n = 9 subjects) or placebo (n = 8 subjects) for 7 days. The ankle dorsiflexion torque, corresponding electromyography (EMG) of the tibialis anterior, and voluntary activation assessed by the interpolated twitch method using transcranial magnetic stimulation (TMS) were measured during a maximal voluntary contraction (MVC). Short-latency intracortical inhibition (SICI) and intracortical facilitation (ICF) were assessed at rest and during submaximal contraction (50% MVC torque) by paired-pulse TMS with the conditioning stimulus set at 0.8x of motor threshold (0.8x MT) and delivered 2 ms (SICI) and 13 ms (ICF) prior to the test stimulus (1.2x MT). Results: The MVC torque (+14%), tibialis anterior EMG (+31%) and voluntary activation (+3%) increased after glucocorticoid treatment (p

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An Innovative Ergometer to Measure Neuromuscular Fatigue Immediately after Cycling.

Purpose: When assessing neuromuscular fatigue (NMF) from dynamic exercise using large muscle mass (e.g. cycling), most studies have delayed measurement for 1-3 min after task failure. This study aimed to determine the reliability of an innovative cycling ergometer permitting the start of fatigue measurement within 1 s after cycling. Methods: Twelve subjects participated in two experimental sessions. Knee-extensor NMF was assessed by electrical nerve and transcranial magnetic stimulation with both a traditional chair set-up (PRE and POST-Chair, 2 min post-exercise) and the new cycling ergometer (PRE, every 3 min during incremental exercise and POST-Bike, at task failure). Results: The reduction in maximal voluntary contraction (MVC) force POST-Bike (63 +/- 12% PRE; P 0.05). Vastus lateralis and rectus femoris M-wave and motor-evoked potential areas showed fair to excellent reliability (ICC = 0.45 to 0.88). The reduction in MVC and Db100 was greater on the cycling ergometer than the isometric chair. Conclusion: The innovative cycling ergometer is a reliable tool to assess NMF during and immediately post-exercise. This will allow fatigue etiology during dynamic exercise with large muscle mass to be revisited in various populations and environmental conditions. (C) 2017 American College of Sports Medicine

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Movement-related activity in the periarcuate cortex of monkeys during coordinated eye and hand movements

To determine the role of the periarcuate cortex during coordinated eye and hand movements in monkeys, the present study examined neuronal activity in this region during movement with the hand, eyes, or both as effectors toward a visuospatial target. Similar to the primary motor cortex (M1), the dorsal premotor cortex contained a higher proportion of neurons that were closely related to hand movements, whereas saccade-related neurons were frequently recorded from the frontal eye field (FEF). Interestingly, neurons that exhibited activity related to both eye and hand movements were recorded most frequently in the ventral premotor cortex (PMv), located between the FEF and M1. Neuronal activity in the periarcuate cortex was highly modulated during coordinated movements compared to either eye or hand movement only. Additionally, a small number of neurons were active specifically during one of the three task modes, which could be dissociated from the effector activity. In this case, neuron onset was either ahead of or behind the onset of eye and/or hand movement, and some neuronal activity lasted until reward delivery signaled successful completion of reaching. The present findings indicate that the periarcuate cortex, particularly the PMv, plays important roles in orchestrating coordinated movements from the initiation to the termination of reaching.

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Feature-coding transitions to conjunction-coding with progression through human visual cortex

Identifying an object and distinguishing it from similar items depends upon the ability to perceive its component parts as conjoined into a cohesive whole, but the brain mechanisms underlying this ability remain elusive. The ventral visual processing pathway in primates is organized hierarchically: Neuronal responses in early stages are sensitive to the manipulation of simple visual features whereas neuronal responses in subsequent stages are tuned to increasingly complex stimulus attributes. It is widely assumed that feature-coding dominates in early visual cortex whereas later visual regions employ conjunction-coding in which object representations are different from the sum of their simple-feature parts. However, no study in humans has demonstrated that putative object-level codes in higher visual cortex cannot be accounted for by feature-coding and that putative feature-codes in regions prior to ventral temporal cortex are not equally well characterized as object-level codes. Thus the existence of a transition from feature- to conjunction-coding in human visual cortex remains unconfirmed, and, if a transition does occur, its location remains unknown. By employing multivariate analysis of functional imaging data, we measure both feature-coding and conjunction-coding directly, using the same set of visual stimuli, and pit them against each other to reveal the relative dominance of one versus the other throughout cortex. Our results reveal a transition from feature-coding in early visual cortex to conjunction-coding in both inferior temporal and posterior parietal cortices. This novel method enables the use of experimentally controlled stimulus features to investigate population-level feature- and conjunction-codes throughout human cortex.

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Phase-Dependent deficits during Reach-to-Grasp after Human Spinal Cord Injury

Most cervical spinal cord injuries result in asymmetrical functional impairments in hand and arm function. However, the extent to which reach-to-grasp movements are affected in humans with incomplete cervical spinal cord injury (SCI) remains poorly understood. Using kinematics and electromyographic (EMG) recordings in hand and arm muscles we studied the different phases of unilateral self-paced reach-to-grasp movements (arm acceleration, hand opening and closing) to a small cylinder in the more and less affected arms of individuals with cervical SCI and age-matched controls. We found that SCI subjects showed prolonged movement duration during arm acceleration, hand opening and closing compared with controls in both arms. Notably, the more affected arm showed an additional increase in movement duration at the time to close the hand compared with the less affected arm. Also, the time at which the index finger and thumb contacted the object and the variability of finger movement trajectory were increased in the more compared with the less affected arm of SCI participants. Participants with prolonged movement duration during hand closing were those with more pronounce deficits in sensory function. The muscle activation ratio between the first dorsal interosseous and abductor pollicis brevis muscles decreased during hand closing in the more compared with the less affected arm of SCI participants. Our results suggest that deficits in movement kinematics during reach-to-grasp movements are more pronounced at the time to close the hand in the more affected arm of SCI participants, likely related to deficits in EMG muscle activation and sensory function.

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Cue-induced changes in the stability of finger force-production tasks revealed by the uncontrolled-manifold analysis

A motor system configured to maximize the stability of its current state cannot dexterously transition between states. Yet, we routinely resolve the stability-dexterity conflict and rapidly change our current behavior without allowing it to become unstable prior to the desired transition. The phenomenon called anticipatory synergy adjustment (ASA) partly describes how the central nervous system handles this conflict. ASA is a continuous decrease in the stability of the current motor state beginning 150-400 ms prior to a rapid state transition accomplished using redundant sets of motor inputs (more input variables than task-specific output variables). So far, ASAs have been observed only when the timing of the upcoming transition is known. We utilized a multi-finger, isometric force production task to demonstrate that compared to a condition where no state transition is expected, the stability of the current state is lower by about 12% when a participant is cued to make a transition - even when the nature and timing of that transition are unknown. This result (stage-1 ASA) is distinct from its traditional version (stage-2 ASA), and it describes early destabilization that occurs solely in response to the expectation to move. Stage-2 ASA occurs later, only if the timing of the transition is known sufficiently in advance. Stage-1 ASA lasts much longer (~ 1.5 seconds), and may scale in response to the perceived difficulty of the upcoming task. Therefore, this work reveals a much-refined view of the processes that underlie the resolution of the stability-dexterity conflict.

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Interacting networks of brain regions underlie human spatial navigation: A review and novel synthesis of the literature

Navigation is an inherently dynamic and multimodal process, making isolation of the unique cognitive components underlying it challenging. The assumptions of much of the literature on human spatial navigation are that: 1) spatial navigation involves modality independent, discrete metric representations (i.e., egocentric vs. allocentric) 2) such representations can be further distilled to elemental cognitive processes 3) these cognitive processes can be ascribed to unique brain regions. Here, we argue that modality independent spatial representations, instead of providing exact metrics about our surrounding environment, more often involve heuristics for estimating spatial topology useful to the current task at hand. We also argue that egocentric (body-centered) and allocentric (world-centered) representations are better conceptualized as involving a continuum rather than as discrete. We propose a neural model to accommodate these ideas, arguing that such representations also involve a continuum of network interactions centered on retrosplenial and posterior parietal cortex, respectively. Our model thus helps explain both behavioral and neural findings otherwise difficult to account for with classic models of spatial navigation and memory, providing a testable framework for novel experiments.

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The coupling of synaptic inputs to local cortical activity differs among neurons and adapts following stimulus onset

Cortical activity contributes significantly to the high variability of sensory responses of interconnected pyramidal neurons, which has crucial implications for sensory coding. Yet, largely because of technical limitations of in vivo intracellular recordings, the coupling of a pyramidal neuron's synaptic inputs to the local cortical activity has evaded full understanding. Here, we obtained excitatory synaptic conductance (g) measurements from putative pyramidal neurons and local field potential (LFP) recordings from adjacent cortical circuits during visual processing in the turtle whole-brain ex vivo preparation. We found a range of g-LFP coupling across neurons. Importantly, for a given neuron, g-LFP coupling increased at stimulus onset, and then relaxed towards intermediate values during continued visual stimulation with naturalistic movies. A model network with clustered connectivity and synaptic depression reproduced both the diversity and the dynamics of g-LFP coupling. In conclusion, these results establish a rich dependence of single-neuron responses on anatomical, synaptic, and emergent network properties.

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Non-uniform surround suppression of visual responses in mouse V1

Complex receptive field characteristics, distributed across a population of neurons, are thought to be critical for solving perceptual inference problems that arise during motion and image segmentation. For example, in a class of neurons referred to as 'end-stopped', increasing the length of stimuli outside of the bar-responsive region into the surround suppresses responsiveness. It is unknown whether these properties exist for receptive field surrounds in the mouse. We examined surround modulation in layer 2/3 neurons of the primary visual cortex in mice using two-photon calcium imaging. We found that surround suppression was significantly asymmetric in 17% of the visually responsive neurons examined. Furthermore, the magnitude of asymmetry was correlated with orientation selectivity. Our results demonstrate that neurons in mouse primary visual cortex are differentially sensitive to the addition of elements in the surround and that individual neurons can be described as being either uniformly suppressed by the surround, end-stopped, or side-stopped.

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Evidence for the representation of movement kinematics in the discharge of F5 mirror neurons during the observation of transitive and intransitive actions.

Mirror neurons (MirNs) are sensorimotor neurons that fire both when an animal performs a goal-directed action and when the same animal observes another agent performing the same or a similar transitive action. It has been claimed that the observation of intransitive actions does not activate MirNs in a monkey's brain. Prompted by recent evidence indicating that the discharge of MirNs is modulated also by non object-directed actions, we investigated thoroughly the efficacy of intransitive actions to trigger MirNs' discharge. Using representational similarity analysis, we also studied whether the elements constituting the visual scene presented to the monkey during the observation of actions (both transitive and intransitive) are represented in the discharge of MirNs. For this purpose, the moving hand was modelled by its kinematics and the object by features of its geometry. We found that MirNs respond to the observation of both transitive and intransitive actions and that the discharge differences evoked by the observation of object- and non object-directed actions are correlated more with the kinematic differences of these actions than with the differences of the objects' features. These findings support the view that observed action kinematics contribute to action mirroring.

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Anesthesia and Perioperative Care for Organ Transplantation.

No abstract available

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Acute Lung Injury and Repair: Scientific Fundamentals and Methods.

No abstract available

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Factors Influencing the Choice of Anesthesia as a Career by Undergraduates of the University of Rwanda.

No abstract available

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Administration of Hypertonic Solutions for Hemorrhagic Shock: A Systematic Review and Meta-analysis of Clinical Trials.

BACKGROUND: Several clinical trials on hypertonic fluid administration have been completed, but the results have been inconclusive. The objective of this study is to summarize current evidence for treating hypovolemic patients with hypertonic solutions by performing a systematic review and meta-analysis. METHODS: Major electronic databases were searched from inception through June 2014. We included only randomized controlled trials involving hemorrhagic shock patients treated with hypertonic solutions. After screening 570 trials, 12 were eligible for the final analysis. Pooled effect estimates were calculated with a random effect model. RESULTS: The 12 studies included 6 trials comparing 7.5% hypertonic saline (HS) with 0.9% saline or Ringer's lactate solution and 11 trials comparing 7.5% hypertonic saline with dextran (HSD) with isotonic saline or Ringer's lactate. Overall, there were no statistically significant survival benefits for patients treated with HS (relative risk [RR], 0.96; 95% confidence interval [CI], 0.82-1.12) or HSD (RR, 0.92; 95% CI, 0.80-1.06). Treatment with hypertonic solutions was also not associated with increased complications (RR, 1.03; 95% CI, 0.78-1.36). Subgroup analysis on trauma patients in the prehospital or emergency department settings did not change these conclusions. There was no evidence of significant publication bias. Metaregression analysis did not find any significant sources of heterogeneity. CONCLUSIONS: Current evidence does not reveal increased mortality when the administration of isotonic solutions is compared to HS or HSD in trauma patients with hemorrhagic shock. HS or HSD may be a viable alternative resuscitation fluid in the prehospital setting. Further studies are needed to determine the optimum volume and regimen of intravenous fluids for the treatment of trauma patients. (C) 2017 International Anesthesia Research Society

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The Little ICU Book, 2nd ed.

No abstract available

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Preventing Mistransfusions: An Evaluation of Institutional Knowledge and a Response.

BACKGROUND: Blood product mistransfusions occur when a process error causes transfusion of incompatible blood products. These events are known sources of negative patient outcomes. One such event demonstrated an institutional knowledge gap and an opportunity to reduce this source of transfusion errors. The focus of this study was to evaluate the application of point of care cognitive aids to bridge potentially lethal knowledge gaps in blood product to patient compatibility. METHODS: A patient-donor ABO antigen compatibility grid for red blood cells (RBC) and fresh frozen plasma (FFP) was developed for creation of a cognitive aid and a blood product safety quiz. Participants included 117 registered nurses and postgraduate medical interns who were given 2 minutes to complete the quiz for establishing institutional controls. A separate group of 111 registered nurses and interns were given the same timed quiz twice, without and then with a blood product compatibility cognitive aid. An analysis of covariance was used to evaluate without cognitive aid versus with cognitive aid quiz results while taking the specialty (nurse versus interns) and baseline score into consideration. The blood bank adopted the grid as a forcing function to be completed before release of blood products. RESULTS: The correct RBC answer percentage increased from 84.7% to 98.3% without and with cognitive aid (average improvement 13.6%, standard deviation [SD] = 18.3%, 95% confidence interval, 10.1%-17.1%, P

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The Relationship Between Women's Intention to Request a Labor Epidural Analgesia, Actually Delivering With Labor Epidural Analgesia, and Postpartum Depression at 6 Weeks: A Prospective Observational Study.

BACKGROUND: Postpartum depression (PPD) is associated with pain during and after delivery, with studies showing reduced rates among women delivering with labor epidural analgesia (LEA). We hypothesized that women who intend to deliver with LEA but do not receive it are at higher risk for PPD at 6 weeks due to the combined experience of untreated labor pain and unmatched expectations during labor, and evaluated the interaction between labor plans related to LEA, satisfaction with pain control when actually delivering with LEA, and PPD at 6 weeks after delivery. METHODS: A total of 1497 women with a vaginal delivery were enrolled into this prospective longitudinal study. Women's initial intention to deliver with or without LEA, how they subsequently delivered, and satisfaction with pain relief were recorded on postpartum day 1. Primary aim was selected as PPD at 6 weeks among women intending to deliver with but subsequently delivering without LEA compared with the rest of the cohort. Primary outcome was PPD at 6 weeks using the Edinburgh Postnatal Depression Scale; PPD was defined with a score >=10 (scale from 0 to 30). Demographic and obstetric data were recorded. Fisher exact test was used for comparisons between groups. The interaction between intention and actual delivery with regard to LEA and PPD was tested. RESULTS: Overall, 87 of 1326 women completing the study at 6 weeks had PPD (6.6%). For the primary aim, 439 (29.3%) delivered without LEA, of which 193 (12.9%) had intended to deliver with LEA; the PPD rate among these women was 8.1%, which was not statistically different from the rest of the cohort (6.3%; odds ratio [OR], 1.30; 95% confidence interval [CI], 0.72-2.38; P = .41). A total of 1058 women (70.7%) delivered with LEA and 439 (29.3%) delivered without; therefore, 1169 (78.1%) delivered as intended and 328 (21.9%) did not (unmatched expectations). Evaluating the interaction between effects, there was a strong negative additive interaction between intending to deliver without LEA and actually delivering with LEA (risk difference = -8.6%, 95% CI, 16.2%-1.6%; P = .014) suggesting that unmatched intention effect is significantly associated with negative outcome. In multiple regression analysis, while intending to deliver with LEA (OR, 1.06; 95% CI, 1.01-1.11; P = .029) and actually delivering with LEA (OR, 1.07; 95% CI, 1.01-1.13; P = .018) both increased the odds for PPD, the multiplicative interaction was protective (OR, 0.92; 95% CI, 0.86-0.99; P = .022), after adjusting for cofactors. CONCLUSIONS: Our study results did not demonstrate a significant increase in the odds for PPD at 6 weeks among women who intended to deliver with LEA but subsequently delivered without. However, we identified a protective interaction between intended LEA use and actual use on the incidence of PPD. Our data suggest an increased risk when women do not deliver as intended, particularly when not initially intending to deliver with LEA. The relationship between unplanned LEA and PPD may be mediated by a physically difficult delivery rather than or in addition to negative emotions related to unmet expectations or a sense of personal failure; therefore, counseling women after delivery to address any negative perceptions may be useful. (C) 2017 International Anesthesia Research Society

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Other Specialties Might Have a GPS.

No abstract available

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Erratum to: Gait characteristics and their discriminative power in geriatric patients with and without cognitive impairment

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Poly-ADP ribosylation in DNA damage response and cancer therapy

Publication date: Available online 20 September 2017
Source:Mutation Research/Reviews in Mutation Research
Author(s): Wei-Hsien Hou, Shih-Hsun Chen, Xiaochun Yu
Poly(ADP-ribosyl)ation (aka PARylation) is a unique protein post-translational modification (PTM) first described over 50 years ago. PARylation regulates a number of biological processes including chromatin remodeling, the DNA damage response (DDR), transcription, apoptosis, and mitosis. The subsequent discovery of poly(ADP-ribose) polymerase-1 (PARP-1) catalyzing DNA-dependent PARylation spearheaded the field of DDR. The expanding knowledge about the poly ADP-ribose (PAR) recognition domains prompted the discovery of novel DDR factors and revealed crosstalk with other protein PTMs including phosphorylation, ubiquitination, methylation and acetylation. In this review, we highlight the current knowledge on PAR-regulated DDR, PAR recognition domain, and PARP inhibition in cancer therapy.



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Utilising physiological principles of motor unit recruitment to reduce fatigability of electrically-evoked contractions: A narrative review

Publication date: Available online 19 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Trevor S. Barss, Emily N. Ainsley, Francisca C. Claveria-Gonzalez, M John Luu, Dylan J. Miller, Matheus J. Wiest, David F. Collins
Neuromuscular electrical stimulation (NMES) is used to produce contractions to restore movement and reduce secondary complications for individuals experiencing motor impairment. NMES is conventionally delivered through a single pair of electrodes over a muscle belly or nerve trunk using short pulse durations and frequencies between 20–40 Hz (conventional NMES). Unfortunately, the benefits and widespread use of conventional NMES are limited by contraction fatigability, which is due in large part to the non-physiological way that contractions are generated. This review provides a summary of approaches designed to reduce fatigability during NMES, by utilising physiological principles that help minimise fatigability of voluntary contractions. First, relevant principles of the recruitment and discharge of motor units (MUs) inherent to voluntary contractions and conventional NMES are introduced and the main mechanisms of fatigability for each contraction type are briefly discussed. A variety of NMES approaches are then described which were designed to reduce fatigability by generating contractions that more closely mimic voluntary contractions. These approaches include altering stimulation parameters, to recruit MUs in their physiological order, and stimulating through multiple electrodes, to reduce MU discharge rates. Although each approach has unique advantages and disadvantages, approaches that minimise MU discharge rates hold the most promise for imminent translation into rehabilitation practice. The way that NMES is currently delivered limits its utility as a rehabilitative tool. Reducing fatigability by delivering NMES in ways that better mimic voluntary contractions holds promise for optimizing the benefits and widespread use of NMES-based programs.



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Effects of esketamine sedation compared to morphine analgesia on hydrostatic reduction of intussusception: A case-cohort comparison study

Summary

Background

Hydrostatic or pneumatic reduction of intussusception is an invasive procedure that is stressful and may be painful for a child. Resistance of the child may increase the duration of the procedure and decrease success rate of reduction. Analgesia can help to reduce pain, but not necessarily resistance. General anesthesia increases success rate of reduction. However, it requires the presence of an anesthesiologist, and may lead to anesthesia-related complications. Procedural sedation with esketamine could be a safe alternative.

Aim

The aim of this study was to compare hydrostatic reduction using morphine analgesia compared to procedural sedation with esketamine in terms of success rate, adverse events, and duration of reduction.

Methods

A retrospective case-cohort comparison study was performed with two groups of patients who had undergone hydrostatic reduction for ileocolic intussusception and received morphine analgesia (n = 37) or esketamine sedation (n = 20). Until July 2013, reduction was performed after intravenously administered morphine. Hereafter, a new protocol for procedural sedation was implemented and reduction was performed after administration of esketamine. Cases were matched for age and duration of symptoms.

Results

No adverse events requiring intervention other than administration of oxygen were reported for either group. Success rate of reduction using esketamine sedation was 90% vs 70% using morphine analgesia, risk ratio (RR) 1.29, 95% CI[0.93-1.77]. Recurrence rate using esketamine sedation was 10% vs 15% using morphine analgesia, RR 0.67, 95% CI[0.12-3.57]. Reduction time was shorter using esketamine sedation (Median 5 minutes, IQR 9 minutes) vs morphine analgesia (Median 8 minutes, IQR 16 minutes, P = .04, Median difference 3, 95% CI[−1.50-8.75]). Median hospital stay in the esketamine group was 1.5 days (IQR 1.8) vs 2 days (IQR 5.3) in the morphine group.

Conclusion

No serious adverse events were recorded. In comparison to morphine analgesia, with esketamine there was weak evidence for a higher success rate, lower recurrence rate, shorter duration, and shorter length of hospital stay.

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Can noninvasive hemoglobin measurement reduce the need for preoperative venipuncture in pediatric outpatient surgery?

Summary

Background

Noninvasive measurements of hemoglobin in the pediatric perioperative setting could be helpful to avoid venipunctures in children. The present study aims to evaluate this by using a noninvasive device for hemoglobin determination. We compared noninvasively obtained hemoglobin with laboratory hemoglobin concentrations in children during their preoperative assessment.

Methods

In an observational study, 122 nonanemic children (age 4.2 ± 1.6 years) who were scheduled to undergo different surgical procedures under general anesthesia were included. In their preoperative preparations, single invasive blood samples for laboratory hemoglobin concentrations were routinely taken following hospital policy and compared to simultaneous noninvasive determinations of hemoglobin. A preoperative invasive value ≤9 g/dL would have caused cancelation of surgery and implied further investigations.

Results

A Bland-Altman plot showed that the average difference between noninvasively obtained hemoglobin and laboratory hemoglobin concentration was −0.44 g/dL (bias) with a standard deviation of the mean bias of 1.04 g/dL. A hemoglobin error grid showed that the noninvasive device could identify almost all invasive hemoglobin values >9 g/dL. In total, there were 4 false-positive values where noninvasively obtained hemoglobin observations were below while the paired invasive values were above 9 g/dL.

Conclusion

The data in this pediatric setting suggest that the device may eliminate the need for venipuncture in nonanemic children.

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N1366S mutation of human skeletal muscle sodium channel causes paramyotonia congenita

Abstract

Paramyotonia congenita is an autosomal dominant skeletal muscle channelopathy caused by missense mutations in SCN4A, the gene encoding the α subunit of the human skeletal muscle voltage-gated sodium channel NaV1.4. Here, we report a three-generation family in which six members present clinical symptoms of paramyotonia congenita characterized by a marked worsening of myotonia by cold and by the presence of clear episodes of paralysis. We identified a novel mutation in SCN4A (Asn-1366-Ser, N1366S) in all patients in the family but not in healthy relatives or in 500 normal control subjects. Functional analysis of the channel protein expressed in HEK293 cells by whole-cell patch-clamp recording revealed that the N1366S mutation led to significant alterations in the gating process of the NaV1.4 channel. The N1366S mutant displayed a cold-induced hyperpolarizing shift in the voltage dependence of activation and a depolarizing shift in fast inactivation, as well as a reduced rate of fast inactivation and accelerated recovery from fast inactivation. In addition, homology modelling and molecular dynamic simulation of N1366S and wild-type NaV1.4 channels indicated that the N to S substitution disrupted the hydrogen bond formed between N1366 and R1454. Together, our results suggest that N1366S is a gain-of-function mutation of NaV1.4 at low temperature and the mutation may be responsible for the clinical symptoms of paramyotonia congenita in the affected family and constitute a basis for studies into its pathogenesis.

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Median effective dose of intranasal dexmedetomidine sedation for transthoracic echocardiography in pediatric patients with noncyanotic congenital heart disease: An up-and-down sequential allocation trial

Summary

Background

Intranasal dexmedetomidine can provide adequate sedation during short procedures. However, previous literature investigating the single-dose use of intranasal dexmedetomidine for sedation during transthoracic echocardiography in younger children is scarce, and the effects of age on sedation with intranasal dexmedetomidine remain controversial.

Objective

This study was to determine the 50% effective dose and estimate the 95% effective dose of single-dose intranasal dexmedetomidine to induce sedation in pediatric patients with noncyanotic congenital heart disease, and also determine the effect of age on the dose required for sedation.

Methods

Patients were stratified into three age groups of 1-6 months, 7-12 months, and 13-36 months. Intranasal dexmedetomidine started at a dose of 2 μg kg⁻¹ on the first patient. The dose of dexmedetomidine for each subsequent patient was determined by the previous patient's response using Dixon's up-and-down method with an interval of 0.25 μg kg⁻¹. Sedation scale and recovery were assessed by the Modified Observer Assessment of Alertness and Sedation Scale and Modified Aldrete Recovery Score. The 50% effective dose was determined by Dixon's up-and-down method. In addition, both 50% effective dose and 95% effective dose were obtained using a probit regression approach. Other variables included sedation onset time, echocardiography time, wake-up time, discharge time, heart rate, blood pressure, oxygen saturation, respiratory rate, and adverse events such as vomiting, regurgitation, and apnea.

Results

The study population was comprised of 70 patients. The 50% effective dose (95% confidence interval) and the 95% effective dose (95% confidence interval) of intranasal dexmedetomidine for sedation were 1.8 (1.58-2.00) μg kg⁻¹ and 2.2 (1.92-5.62) μg kg⁻¹ in patients aged 1-6 months, 1.8 (1.61-1.95) μg kg⁻¹ and 2.1 (1.90-2.85) μg kg⁻¹ in patients aged 7-12 months, 2.2 (1.92-2.37) μg kg⁻¹ and 2.7 (2.34-6.88) μg kg⁻¹ in patients aged 13-36 months, respectively. The 50% effective dose in age group 13-36 months was higher than those of age group 1-6 months (P = .042) and 7-12 months (P = .043). There were no differences in sedation onset time, echocardiography time, wake-up time, and discharge time between groups. None of the patients experienced oxyhemoglobin desaturation, hypotension, or bradycardia during the procedure. No significant adverse events occurred.

Conclusions

Single-dose of intranasal dexmedetomidine was an effective agent for patients under the age of 3 years requiring sedation for transthoracic echocardiography. The 50% effective dose of intranasal dexmedetomidine for transthoracic echocardiography sedation in children aged 13-36 months was higher than in children <13 months.

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Effect of availability of video laryngoscopy on the use of fiberoptic intubation in school-aged children with microtia

Summary

Background

With the increasing popularity of video laryngoscopy during intubation of pediatric patients with normal or difficult airways, fiberoptic-assisted tracheal intubation, traditionally considered the gold standard for difficult intubation, may become underused.

Aim

We aimed to assess the use of airway management techniques before and after introduction of video laryngoscopy in a cohort of school-aged children with microtia, who are at increased risk of difficult intubation.

Methods

We retrospectively reviewed intubation devices used for all pediatric patients with microtia who had undergone reconstructive ear surgery at a single institution during the period January 2008 to December 2012. In each case, we identified the original airway management technique and success rate, as well as success rate for subsequent rescue techniques. The use of fiberoptic-assisted tracheal intubation was compared before and after introduction of a pediatric blade for the Pentax-AWS video laryngoscope.

Results

This study included 537 consecutive intubation procedures; 264 before and 273 after introduction of the pediatric airway scope. Elective use of fiberoptic-assisted tracheal intubation for anticipated difficult intubation was significantly less after introduction of the pediatric airway scope (before: 19 of 79, 24% vs after: 3 of 79, 4%; odds ratio 8.02; 95% confidence interval, 2.27 to 28.39; P = .0003), which achieved a 100% success rate when used as the primary technique in both routine and difficult airways. All 5 cases of failed direct laryngoscopy were rescued by the pediatric airway scope, thus eliminating emergency use of fiberscopy.

Conclusions

Introduction of a pediatric video laryngoscope resulted in a substantial decrease in the use of fiberoptic-assisted tracheal intubation. This change in intubation method might not influence the success rate of intubation in experienced hands but could be relevant for novice users.

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VRAC: unravelling the complexity of LRRC8 subunits regulation by oxidation

Abstract

To maintain ion homeostasis, cells must regulate their volume. Water flux is controlled through the exchange of ions and osmolytes between the cytosol and the extracellular compartment.

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Laminar specific encoding of texture elements in rat barrel cortex

Abstract

Texture discrimination by rats is exquisitely guided by fine-grain mechanical stick-slip motions of the face whiskers as they encounter, stick to, and slip past successive texture-defining surface features like bumps and grooves. Neural encoding of successive stick-slip texture events will be shaped by adaptation, common to all sensory systems, whereby receptor and neural responses to a stimulus are affected by responses to preceding stimuli, allowing resetting to signal novel information. Additionally, when a whisker is actively moved to contact and brush over surfaces, that motion itself generates neural responses that could cause adaptation of responses to subsequent stick-slip events. Nothing is known about encoding in the rat whisker system of stick-slip events defining textures of different grain or the influence of adaptation from whisker protraction or successive texture-defining stick-slip events. Here we recorded responses from Halothane anaesthetised rats in response to texture defining stimuli applied to passive whiskers. We now demonstrate that, across the columnar network of the whisker-recipient barrel cortex, that adaptation in response to repetitive stick-slip events is strongest in uppermost layers and equally lower thereafter; that neither whisker protraction speed or stick-slip frequency impede encoding of stick-slip events at rates to 34.08 Hz; and that layer 2 normalizes responses to whisker protraction to resist effects on texture signalling. Thus, within laminar-specific response patterns, barrel cortex reliably encodes texture-defining elements even to high frequencies.

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Occipital alpha power reveals fast attentional inhibition of incongruent distractors

Abstract

Recent associative models of cognitive control hypothesize that cognitive control can be learned (optimized) for task-specific settings via associations between perceptual, motor, and control representations, and, once learned, control can be implemented rapidly. Midfrontal brain areas signal the need for control, and control is subsequently implemented by biasing sensory representations, boosting or suppressing activity in brain areas processing task-relevant or task-irrelevant information. To assess the timescale of this process, we employed EEG. In order to pinpoint control implementation in specific sensory areas, we used a flanker task with incongruent flankers shown in only one hemifield (congruent flankers in the other hemifield) isolating their processing in the contralateral hemisphere. ERPs revealed fast modulations specifically in visual processing areas contralateral to the incongruent flankers. To test whether these modulations reflect increased or decreased processing of incongruent flankers, we investigated alpha power, a marker for attentional inhibition. Importantly, we show increased alpha power over visual areas processing incongruent flankers from 300 to 500 ms poststimulus onset. This suggests fast cognitive control by attentional inhibition for information disrupting goal-oriented actions. Additionally, we show that midfrontal theta earlier in the trial is also modulated by incongruency, and that theta power predicts subsequent alpha power modulations. This supports the hypothesis that midfrontal incongruency detection leads to control implementation, and reveals that these mechanisms take place on a fast, within-trial timescale.

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Repetitive transcranial magnetic stimulation over inferior frontal cortex impairs the suppression (but not expression) of action impulses during action conflict

Abstract

In the recent literature, the effects of noninvasive neurostimulation on cognitive functioning appear to lack consistency and replicability. We propose that such effects may be concealed unless dedicated, sensitive, and process-specific dependent measures are used. The expression and subsequent suppression of response capture are often studied using conflict tasks. Response-time distribution analyses have been argued to provide specific measures of the susceptibility to make fast impulsive response errors, as well as the proficiency of the selective suppression of these impulses. These measures of response capture and response inhibition are particularly sensitive to experimental manipulations and clinical deficiencies that are typically obfuscated in commonly used overall performance analyses. Recent work using structural and functional imaging techniques links these behavioral outcome measures to the integrity of frontostriatal networks. These studies suggest that the presupplementary motor area (pre-SMA) is linked to the susceptibility to response capture whereas the right inferior frontal cortex (rIFC) is associated with the selective suppression of action impulses. Here, we used repetitive transcranial magnetic stimulation (rTMS) to test the causal involvement of these two cortical areas in response capture and inhibition in the Simon task. Disruption of rIFC function specifically impaired selective suppression of conflicting action tendencies, whereas the anticipated increase of fast impulsive errors after perturbing pre-SMA function was not confirmed. These results provide a proof of principle of the notion that the selection of appropriate dependent measures is perhaps crucial to establish the effects of neurostimulation on specific cognitive functions.

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Successful Treatment of Gluteal Pain from Obturator Internus Tendinitis and Bursitis with Ultrasound-Guided Injection

Abstract: This case report describes what the authors believe is the first case of a patient with obturator internus tendinitis and bursitis successfully treated with a corticosteroid injection using a trans-tendinous lateral to medial approach. The patient presented with right gluteal pain not relieved by physical therapy or right hip and ischial bursa corticosteroid injections. Pelvic and lumbar spine MRIs and EMG/NCS findings were unremarkable. Physical examination demonstrated tenderness to palpation at the right middle lower gluteal region. Ultrasound imaging with sonopalpation identified the maximal local tender point as the right obturator internus muscle and/or its underlying bursa. A 22-gauge 3.5-inch needle was inserted in-plane to the transducer and longitudinal to the obturator internus from a lateral to medial direction, an approach previously described in cadavers.1 The obturator internus tendon sheath and bursa were injected with 2.5 ml of 0.5% lidocaine combined with 10 mg of triamcinolone. The patient reported immediate complete relief of pain with continued relief at 2 and 6 months post-injection. This case report demonstrates an injection of the obturator internus tendon sheath and bursa using a trans-tendinous approach, which may be successful for treatment of patients presenting with persistent gluteal pain from obturator internus tendinitis and bursitis.

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Entrustable Professional Activities For Residency Training in Physical Medicine and Rehabilitation

Abstract: Entrustable professional activities are observable units of professional practice that can potentially provide a link between competency-based medical education and clinical practice. The authors, part of a subcommittee of the Association of Academic Physiatrists Education Committee, identified a set of entrustable professional activities that would serve residency training programs in the specialty of physical medicine and rehabilitation. Using a modified Delphi process, residency program directors in the field reviewed and validated a set of entrustable professional activities. The final set of 19 entrustable professional activities is presented in this article.

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Progression of Core Stability Exercises Based on the Extent of Muscle Activity

Objective: The aim of this cross-sectional study was to evaluate a variety of isometric plank exercises. Design: Twenty university students performed the following eight different variants of plank exercises in random order and with 1-min rest intervals: stable prone plank, suspended prone plank, stable roll-out plank, suspended roll-out plank, unilateral stable prone plank, unilateral suspended prone plank, stable lateral plank, and suspended lateral plank. Surface electromyography signals were recorded for the upper rectus abdominis, lower rectus abdominis, external oblique, lumbar erector spinae, and normalized to the maximum voluntary isometric contraction. Results: The suspended prone plank and the suspended roll-out plank provided the greatest upper rectus abdominis activity. The greatest lower rectus abdominis activity was induced by the suspended roll-out plank. The highest lumbar erector spinae activity was provided by the suspended and stable lateral planks. The suspended prone plank and the suspended roll-out plank provided the greatest external oblique activity, although not significantly different from the suspended lateral plank. Conclusions: Muscle activity could be progressed using the different exercises. Although suspended prone plank and the suspended roll-out plank were most efficient for the abdominal muscles, suspended and stable lateral planks were most efficient for the lumbar muscles.

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Motor Execution Problem Due to Injured Corticofugal Tracts from the Supplementary Motor Area in a Patient with Mild Traumatic Brain Injury

No abstract available

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Cognitive Correlates of Timed Up and Go Subtasks in Older People With Preserved Cognition, Mild Cognitive Impairment, and Alzheimer’s Disease

Objective: To determine whether impaired Timed Up and Go Test (TUG) subtask performances are associated with specific cognitive domains among older people with preserved cognition (PC), mild cognitive impairment (MCI), and mild Alzheimer's disease (AD). Design: TUG subtasks performances were assessed by the Qualisys motion system. Cognition was assessed by Addenbrooke's Cognitive Examination and the Frontal Assessment Battery (FAB). Results: The highest correlations with transition subtasks were with aspects of executive function, i.e. the fluency domain in the PC group (n = 40), FAB scores in the MCI group (n = 40), and the visuospatial domain in the AD group (n = 38). No significant associations were found between the walking subtasks and cognition in any group. Multivariate linear regression models identified the fluency domain as an independent predictor of turn-to-walk and turn-to-sit measures in the PC group, and the visuospatial domain as an independent predictor of turn-to-walk and turn-to-sit measures in the AD group, adjusted for age and sex. Conclusions: Poorer executive functioning was associated with impaired transition mobility in all groups. The significant associations between visuospatial impairment and poor transition mobility in the AD participants may provide insight into why this group has an elevated fall risk.

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The Potential for Gabapentinoid Abuse in Pain Management

No abstract available

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Tai Chi Exercise for Patients with Chronic Heart Failure: A Meta-analysis of Randomized Controlled Trials

Aim: This meta-analysis aimed to update and evaluate evidence from randomized controlled trials of tai chi for patients with chronic heart failure. Method: Both English and Chinese databases were searched from their inception to June 2, 2016 (PubMed, EMBASE, Cochrane Central Register of Controlled Trials for English publications and China Knowledge Resource Integrated, Wanfang, and Weipu databases for Chinese publication). Titles, abstracts, and full-text articles were screened against study inclusion criteria: randomized controlled trials studying tai chi intervention for patients with chronic heart failure. The meta-analysis was conducted with Revman 5.3 or STATA 12. Result: Thirteen randomized controlled trials were included. Tai chi induced significant improvement in 6-min walking distance (51.01 m; 30.49–71.53; P

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Ultrasound-Guided Selective Cervical Root Injection for Postherpetic Neuralgia

No abstract available

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Therapeutic Effects of Horseback Riding Interventions: A Systematic Review and Meta-analysis

Objective: Equine-assisted therapies, such as therapeutic riding and hippotherapy, are believed to have positive physical and emotional effects in individuals with neuromotor, developmental, and physical disabilities. The purpose of this review was to determine whether therapeutic riding and hippotherapy improve balance, motor function, gait, muscle symmetry, pelvic movement, psychosocial parameters, and the patients' overall quality of life. Design: In this study, a literature search was conducted on MEDLINE, CINAHL, MBASE, SportDiscus, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, PEDro, DARE, Google Scholar, and Dissertation Abstracts. Only studies with a control/comparison group or self-controlled studies performing preintervention and postintervention assessment were included. Excluded were (1) studies not providing data on baseline score or end-point outcome, (2) single-subject studies, (3) studies providing only qualitative data, and (4) studies that used a mechanical horse. Sixteen trials were included. The methodologic quality of each study was evaluated using Downs and Black quality assessment tool. Results: Most of the studies showed a trend toward a beneficial effect of therapeutic riding and hippotherapy on balance and gross motor function. The meta-analysis showed improvement in both the Berg Balance Scale and the Gross Motor Function Measure in therapeutic riding and hippotherapy programs. Conclusion: Programs such as therapeutic riding and hippotherapy are a viable intervention option for patients with balance, gait, and psychomotor disorders.

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Corticomotor Excitability Effects of Peripheral Nerve Electrical Stimulation to the Paretic Arm in Stroke

Objective: This study aimed to examine the corticomotor excitability changes after peripheral nerve electrical stimulation (PNS) on the stroke-impaired arm. Design: This randomized cross-over study included 32 subjects with chronic stroke. They received a 1-hr PNS or placebo PNS by random order to the ulnar and radial nerves of the paretic arm in separate sessions. The primary outcome was excitability of the corticospinal projections for the contralateral first dorsal interosseous hand muscle in terms of slope of the recruitment curve, peak motor-evoked potential amplitude, and duration of the cortical silent period, measured with transcranial magnetic stimulation on both cerebral hemispheres. Seventeen of the subjects were measured for their paretic hand dexterity (using Purdue Pegboard Test) and pinch strength as secondary outcomes. Results: Peripheral nerve electrical stimulation, but not placebo PNS, increased recruitment curve slope and peak motor-evoked potential amplitude in both the lesioned and nonlesioned hemispheres and lengthened the cortical silent period duration in the nonlesioned hemisphere. Peripheral nerve electrical stimulation significantly improved hand dexterity scores compared with placebo PNS. Pinch strength was not changed by the interventions. Conclusions: A 1-hr PNS alone to the paretic arm could increase corticomotor excitability in both hemispheres, together with hand dexterity improvement in people presented with mild-to-moderate motor impairment in the paretic upper limb after stroke. To Claim CME Credits: Complete the self-assessment activity and evaluation online at http://ift.tt/1l80W45 CME Objectives: Upon completion of this article, the readers should be able to: (1) Understand the effects of a stroke on the corticomotor excitability of the lesioned and intact hemisphere; (2) Describe the effect of peripheral nerve electrical stimulation on the lesioned and intact hemisphere corticomotor excitability following stroke; and (3) Understand the effect of peripheral nerve electrical stimulation on dexterity of the paretic hand following stroke. Level: Advanced Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.75 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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Effectiveness of Different Deep Dry Needling Dosages in the Treatment of Patients With Cervical Myofascial Pain: A Pilot RCT

Objective: To assess the effectiveness of different dosages of local twitch responses (LTRs) elicited by deep dry needling (DDN) in relation to pain intensity, pressure pain threshold (PPT), cervical range of movement (CROM), and disability degree in cervical myofascial pain patients. Design: A randomized, double-blind clinical trial. Participants: Eighty-four patients (21 males, 63 females; 27.18 ± 10.91 yrs) with cervical pain. Interventions: DDN in active myofascial trigger points (MTrPs) in the upper trapezius. Patients were randomly divided into four groups: (a) no LTRs elicited, (b) four LTRs elicited, (c) six LTRs elicited, and (d) needling until no more LTRs were elicited. Outcome Measures: Pain intensity, PPT, CROM, and disability degree were assessed before treatment, post-immediate, 48 hrs, 72 hrs, and 1 wk after treatment. Results: Significant differences were found in the time factor for all the variables (P 0.05). Conclusions: DDN in the upper trapezius MTrP improved pain at a 1-wk follow-up, but improvements were not significantly different among DDN dosages. A higher number of patients with neck pain improvements superior to the moderate clinically important differences were observed when eliciting 6 LTRs and LTRs until exhaustion compared with not eliciting LTRs.

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Comment on “Stories of an Emigrant Physician: What It Has Been Like to Practice in Canada Compared With the United States”

No abstract available

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The Effect of Sleep Disturbances on the Functional Recovery of Rehabilitation Inpatients Following Mild and Moderate Stroke

Objective: The aim of the study was to explore the impact of insomnia and sleep disturbance on the functional outcomes of mild and moderated stroke. Design: A multicenter-observational and correlation study was performed. Two hundred eighty patients with mild-moderate severity stroke admitted to three acute hospitals rehabilitation departments. DiagnosticStatistical Manual of Mental Disorders, Fourth Edition, criteria were used to define patients with insomnia and any sleep disturbance. Patient's initial and final functions were evaluated using the Korean version of the Berg Balance Scale, the Korean version of Modified Barthel Index, the Korean version of Mini–Mental State Examination, the Korean version of the Frontal Assessment Battery, and the Korean version of National Institute of Health Stroke Scale. Sleep disturbance and function were assessed with respect to stroke severity as defined by the Korean version of National Institute of Health Stroke Scale. Results: The prevalence of Diagnostic Statistical Manual of Mental Disorders, Fourth Edition insomnia and any sleep disturbance were 26.9% and 56.7%, respectively. After adjusting for age, sex, depression, anxiety, length of stay, and hypnotic usage, the improvement of Korean version of the Berg Balance Scale was significantly lower in the any sleep disturbance group. In the moderate stroke group, the Korean version of the Berg Balance Scale improvement was significantly lower in the any sleep disturbance group, whereas in the mild stroke group, the Korean version of the Berg Balance Scale improvement was not significant. Conclusions: Sleep disturbance after stroke was found to have negative effects on functional recovery, especially balance improvement in moderate stroke group.

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Delayed-Onset Central Pain due to Degeneration of Ischemic Transcallosal Fibers After Corpus Callosum Hemorrhage

Aims: A patient developed delayed-onset central pain due to degeneration of the spinothalamic tract resulting from degeneration of the ischemic transcallosal fibers, in the aftermath of a corpus callosum (CC) hemorrhage. The detection and diagnosis of these lesions using diffusion tensor tractography are described. Methods: A 59-yr-old man underwent conservative management for hemorrhages in the CC and lateral ventricle that resulted from hitting his head against a wall while falling. He began to feel pain in his right upper and lower extremities approximately 1½ yrs after the initial injury. The pain was characterized as constant tingling, numb, and cool sensation without allodynia or hyperalgesia (visual analogue scale score, 5). Results: Disruption of transcallosal fibers in the genu and isthmus of the CC was observed on diffusion tensor tractography 1 mo after the initial injury. By 3 yrs, the diffusion tensor tractography showed that transcallosal fibers in the isthmus (67.8%–77.9%) of the CC had disappeared, and the left spinothalamic tract had become thinner. Conclusion: The results suggest that central pain can occur without direct injury of the spinothalamic tract and point up the need for evaluation of the spinothalamic tract and transcallosal fibers in patients with a CC lesion who complain of central pain.

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A Longitudinal Study of Social Participation After Dysvascular Lower Extremity Amputation

Objective: This study examined patterns of social participation among individuals experiencing their first dysvascular lower extremity amputation. We identified the types of social participation valued by this population and explored factors that were associated with individuals' levels of participation and their subjective satisfaction with participation. Design: A prospective cohort was recruited from four Veterans Administration Medical Centers and followed for 1 yr after amputation. Social participation was measured with a modified version of the Community Integration Questionnaire. Potential correlates included the Patient Health Questionnaire-9, Modified Social Support Survey, Locomotor Capability Index 5, Short Portable Mental Status Questionnaire, and self-rated health. Results: At 1-yr postamputation, participants indicated that the most valued aspects of social participation were maintaining close friendships, visiting loved ones, and managing finances. Levels of social participation and satisfaction with participation were modest at 1-yr postamputation. Higher levels of social participation at 1 yr were related to better baseline mental status, better premorbid mobility, and lower amputation level. Higher satisfaction with participation was related to greater baseline social support. Conclusions: Individuals' social participation may be influenced by physical and cognitive factors, whereas their satisfaction with participation may be influenced by psychosocial factors. Rehabilitation specialists are encouraged to address both aspects of social participation when formulating and pursuing rehabilitation goals.

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Ultrasound-Guided Fenestration of the Carpal Ligament Using a Double-Needle Approach

Abstract: Injection techniques for carpal tunnel syndrome have evolved from landmark palpation injection techniques to more accurate ultrasound-guided approaches. Presented is a case report describing a technique serendipitously discovered during a carpal ligament fenestration. The case involved a 66-year-old man with a diagnosis of carpal tunnel syndrome. After a failed attempt at treatment using a wrist splint and activity modification, he was treated by median nerve hydrodissection with 100% temporary pain relief. When his symptoms recurred, a carpal tunnel combined hydrodissection/fenestration technique was performed. Because of difficulty extricating the carpal ligament from the median nerve with the first needle, which was placed longitudinal to the median nerve, a second needle was placed transverse to the median nerve to aid in hydrodissection. The second needle was left in because it was found to be helpful in maintaining a safe distance between the median nerve and the carpal ligament by intermittent injection through the second needle. The patient reported 70% relief of his symptoms at 2-week follow-up and 50% sustained relief at 3 months. A 2-needle technique is feasible and can be helpful during median nerve hydrodissection/carpal ligament fenestration when technical or anatomical issues arise preventing treatment using the traditional single needle approach. This double needle approach allows for use of injectate to maintain separation between the median nerve and the ligament during the fenestration.

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Current Trends in Exercise Intervention Research, Technology, and Behavioral Change Strategies for People With Disabilities: A Scoping Review

Abstract: This review synthesized physical activity and exercise intervention literature for the past 10 yrs for people with physical and cognitive disabilities including intervention characteristics, behavior change strategies, and types of technologies used to improve targeted outcomes. Systematic searches yielded 132 eligible studies. The major disability groups were multiple sclerosis (41%), stroke (15%), and spinal cord injury (12%). Research designs primarily involved randomized controlled trials (61%) versus quasi-experimental designs (39%). Approximately 20% of the interventions used some form of the following technology: information and communication technology (48%), interactive technology (37%), or electronic gauges (30%). Eighteen percent of studies used intervention strategies based on behavioral theory, which was typically combined with technology to promote activity and increase adherence in generally larger study samples. The three prevailing theories included social cognitive theory (58%), supportive accountability theory (21%), and transtheoretical model (21%). Upon completing the intervention, studies reported primarily significant outcomes (80%). Exercise research for PWD has grown in both quantity and quality, but several gaps remain. Study findings provide a roadmap for future exercise trials on understudied populations and highlight technology and behavior change theory as drivers of future intervention research.

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Ultrasound Imaging for Dorsal Ulnar Cutaneous Neuropathy With Extensor Carpi Ulnaris Tendinopathy

No abstract available

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Expression of Concern

No abstract available

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Independent Walking Despite Almost Whole Cerebral Injury of One Hemisphere

No abstract available

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Cytokine single-nucleotide polymorphisms and risk of non-small-cell lung cancer.

Objective: Lung cancer, particularly the non-small-cell lung cancer (NSCLC) subtype, is the leading cause of cancer-related death worldwide. Several functional polymorphisms in inflammatory cytokine genes, such as IL1B, IL6, IL12A, IL13 and IL16, have been associated with the risk of NSCLC. The aim of this study was to evaluate the association between ILs gene polymorphisms and the risk of developing NSCLC. Participants and methods: A retrospective case-control study was carried out, including 174 NSCLC cases and 298 controls of Spanish origin. IL1B (rs1143634), IL1B (rs12621220), IL1B (rs1143623), IL1B (rs16944), IL1B (rs1143627), IL12A (rs662959), IL13 (rs1881457), IL6 (rs1800795) and IL16 (rs7170924) gene polymorphisms were analysed by TaqMan. Results: The genotypic logistic regression model adjusted by smoking status showed that the IL1B rs1143634-TT genotype was associated with a lower risk of NSCLC (P=0.04312; odds ratio=0.226; 95% confidence interval=0.044-0.840). No other gene polymorphisms showed an association with NSCLC in any of the models tested. Conclusion: In conclusion, IL1B rs1143634 was significantly associated with a higher risk of NSCLC. No influence of IL1B rs12621220, rs1143623, rs16944, rs1143627, IL12A rs662959, IL13 rs1881457 and IL16 rs7170924 on the risk of developing NSCLC was found in our study. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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ABCG2 regulatory single-nucleotide polymorphisms alter in-vivo enhancer activity and expression.

Objectives: The expression and activity of the breast cancer resistance protein (ABCG2) contributes toward the pharmacokinetics of endogenous and xenobiotic substrates. The effect of genetic variation on the activity of cis-regulatory elements and nuclear response elements in the ABCG2 locus and their contribution toward ABCG2 expression have not been investigated systematically. In this study, the effect of genetic variation on the in-vitro and in-vivo enhancer activity of six previously identified liver enhancers in the ABCG2 locus was examined. Methods: Reference and variant liver enhancers were tested for their ability to alter luciferase activity in vitro in HepG2 and HEK293T cell lines and in vivo using a hydrodynamic tail vein assay. Positive in-vivo single-nucleotide polymorphisms (SNPs) were tested for association with gene expression and for altered protein binding in electrophoretic mobility shift assays. Results: Multiple SNPs were found to alter enhancer activity in vitro. Four of these variants (rs9999111, rs12508471, ABCG2RE1*2, and rs149713212) decreased and one (rs2725263) increased enhancer activity in vivo. In addition, rs9999111 and rs12508471 were associated with ABCG2 expression in lymphoblastoid cell lines, lymphocytes, and T cells, and showed increased HepG2 nuclear protein binding. Conclusion: This study identifies SNPs within regulatory regions of the ABCG2 locus that alter enhancer activity in vitro and in vivo. Several of these SNPs correlate with tissue-specific ABCG2 expression and alter DNA/protein binding. These SNPs could contribute toward reported tissue-specific variability in ABCG2 expression and may influence the correlation between ABCG2 expression and disease risk or the pharmacokinetics and pharmacodynamics of breast cancer resistance protein substrates. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Behavior of radioactive cesium during incineration of radioactively contaminated wastes from decontamination activities in Fukushima

Publication date: November 2017
Source:Journal of Environmental Radioactivity, Volumes 178–179
Author(s): Hiroshi Fujiwara, Hidetoshi Kuramochi, Kazutaka Nomura, Tomoharu Maeseto, Masahiro Osako
Large volumes of decontamination wastes (DW) generated by off-site decontamination activities in Fukushima Prefecture have been incinerated since 2015. The behavior of radioactive cesium during incineration of DW was investigated at a working incineration plant. The incineration discharged bottom ash (BA) and fly ash (FA) with similar levels of radiocesium, and the leachability of the radiocesium from both types of ash was very low (<1%). These results are significantly different from those obtained for the incineration of contaminated municipal solid waste (CMSW) reported in earlier studies. The source of radiocesium in DW-FA is chiefly small particles derived from DW and DW-BA blown into the flue gas, not the deposition of gaseous synthesized radiocesium compounds on the surfaces of ash particles in the flue gas as observed in CMSW incineration. This source difference causes the behavior of radiocesium during waste incineration to differ between DW and CMSW.

Graphical abstract

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