Objectively Differentiating Movement Patterns between Elite and Novice Athletes

ABSTRACTIntroductionMovement screens are frequently used to identify abnormal movement patterns that may increase risk of injury or hinder performance. Abnormal patterns are often detected visually based on the observations of a coach or clinician. Quantitative, or data-driven methods can increase objectivity, remove issues related to inter-rater reliability and offer the potential to detect new and important features that may not be observable by the human eye. Applying principal components analysis (PCA) to whole-body motion data may provide an objective data-driven method to identify unique and statistically important movement patterns, an important first step to objectively characterize optimal patterns or identify abnormalities. Therefore, the primary purpose of this study was to determine if PCA could detect meaningful differences in athletes' movement patterns when performing a non-sport-specific movement screen. As a proof of concept, athlete skill level was selected a priori as a factor likely to affect movement performance.MethodsMotion capture data from 542 athletes performing seven dynamic screening movements (i.e. bird-dog, drop jump, T-balance, step-down, L-hop, hop-down, and lunge) were analyzed. A PCA-based pattern recognition technique and linear discriminant analysis with cross-validation were used to determine if skill level could be predicted objectively using whole-body motion data.ResultsDepending on the movement, the validated linear discriminate analysis models accurately classified 70.66-82.91% of athletes as either elite or novice.ConclusionWe have provided proof that an objective data-driven method can detect meaningful movement pattern differences during a movement screening battery based on a binary classifier (i.e. skill level in this case). Improving this method can enhance screening, assessment and rehabilitation in sport, ergonomics and medicine. Introduction Movement screens are frequently used to identify abnormal movement patterns that may increase risk of injury or hinder performance. Abnormal patterns are often detected visually based on the observations of a coach or clinician. Quantitative, or data-driven methods can increase objectivity, remove issues related to inter-rater reliability and offer the potential to detect new and important features that may not be observable by the human eye. Applying principal components analysis (PCA) to whole-body motion data may provide an objective data-driven method to identify unique and statistically important movement patterns, an important first step to objectively characterize optimal patterns or identify abnormalities. Therefore, the primary purpose of this study was to determine if PCA could detect meaningful differences in athletes' movement patterns when performing a non-sport-specific movement screen. As a proof of concept, athlete skill level was selected a priori as a factor likely to affect movement performance. Methods Motion capture data from 542 athletes performing seven dynamic screening movements (i.e. bird-dog, drop jump, T-balance, step-down, L-hop, hop-down, and lunge) were analyzed. A PCA-based pattern recognition technique and linear discriminant analysis with cross-validation were used to determine if skill level could be predicted objectively using whole-body motion data. Results Depending on the movement, the validated linear discriminate analysis models accurately classified 70.66-82.91% of athletes as either elite or novice. Conclusion We have provided proof that an objective data-driven method can detect meaningful movement pattern differences during a movement screening battery based on a binary classifier (i.e. skill level in this case). Improving this method can enhance screening, assessment and rehabilitation in sport, ergonomics and medicine. Corresponding Author: Ryan B. Graham, PhD, Assistant Professor, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, 125 University Private, Ottawa, ON K1N 6N5, E-mail: rgraham@uottawa.ca, Phone: +1 613 562 5800 x 1025, Fax: +1 613 562 5497 We would like to thank our funding sources: the Natural Sciences and Engineering Research Council (NSERC) of Canada, the Queen Elizabeth II Graduate Scholarships in Science and Technology (QEII-GSST), and the University of Ottawa School of Graduate Studies. In addition, we would like to thank the athletes who partook in the study. The results of the present study do not constitute endorsement by ACSM. In addition, the authors declare that there are no conflicts of interest. Although Motus is a for-profit company and the Director of Research at Motus, Brittany Dowling, is an author on the paper, the approach used in this paper is an objective, data-driven approach and is not only applicable to this data set. The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation Accepted for Publication: 31 January 2018 © 2018 American College of Sports Medicine

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The Rise and Fall of Transcranial Doppler Ultrasonography for the Diagnosis of Vasospasm in Aneurysmal Subarachnoid Hemorrhage

No abstract available

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Identification of a novel lethal form of autosomal recessive ichthyosis caused by UDP-glucose ceramide glucosyltransferase deficiency

UGCG:NM_003358:exon2:c.142dupA;p.(Ser48Lysfs*18).

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Capillary response to skeletal muscle contraction: evidence that redundancy between vasodilators is physiologically relevant during active hyperaemia

Abstract

We sought to determine if redundancy between vasodilators is physiologically relevant during active hyperaemia. As inhibitory interactions between vasodilators are indicative of redundancy, we tested whether vasodilators implicated in mediating active hyperaemia, (potassium (K⁺), adenosine (ADO) and nitric oxide (NO)), inhibit one anothers vasodilatory effects through direct drug application and during muscle contraction. Using the hamster cremaster muscle and intravital microscopy we locally stimulated capillaries with one vasodilator in the absence and the presence of a second vasodilator (10⁻⁷M SNAP, 10⁻⁷M ADO, 10 mm KCl) applied sequentially and simultaneously, and observed the response in the associated upstream 4A arteriole controlling the perfusion of the stimulated capillary. We found that KCl significantly attenuated SNAP and ADO-induced vasodilatations by ∼49.7% and ∼128.0% respectively and ADO significantly attenuated KCl and SNAP-induced vasodilatations by ∼94.7% and ∼59.6% respectively. NO significantly attenuated KCl vasodilatation by 93.8% Further, during muscle contraction we found that inhibition of NO production using L-NAME and inhibition of ADO receptors using XAC was effective at inhibiting contraction-induced vasodilatation but only in the presence of K⁺ release channel inhibition. Thus, only when the inhibiting vasodilator K⁺ was blocked was the second vasodilator, NO or ADO able to produce effective vasodilatation. Therefore, we show that there are inhibitory interactions between specific vasodilators at the level of the capillary. Further, these inhibitions can be observed during muscle contraction indicating that redundancies between vasodilators are physiologically relevant and influence vasodilatation during active hyperaemia.

This article is protected by copyright. All rights reserved

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Early development of the enteric nervous system visualized by using a new transgenic zebrafish line harboring a regulatory region for choline acetyltransferase a (chata) gene

Publication date: June 2018
Source:Gene Expression Patterns, Volume 28
Author(s): Masataka Nikaido, Saki Izumi, Honoka Ohnuki, Yuki Takigawa, Kyo Yamasu, Kohei Hatta
The enteric nervous system (ENS) is the largest part of the peripheral nervous system in vertebrates. Toward the visualization of the development of the vertebrate ENS, we report our creation of a new transgenic line, Tg(chata:GGFF2) which has a 1.5-kb upstream region of the zebrafish choline acetyltransferase a (chata) gene followed by modified green fluorescent protein (gfp). During development, GFP + cells were detected in the gut by 60 h post-fertilization (hpf). In the gut of 6- and 12-days post-fertilization (dpf) larvae, an average of 92% of the GFP + cells were positive for the neuronal marker HuC/D, suggesting that GFP marks enteric neurons in this transgenic line. We also observed that 66% of the GFP + cells were choline acetyltransferase (ChAT)-immunopositive at 1.5 months. Thus, GFP is expressed at the larval stages at which ChAT protein expression is not yet detected by immunostaining. We studied the spatiotemporal pattern of neural differentiation in the ENS by live-imaging of this transgenic line. We observed that GFP + or gfp + cells initially formed a pair of bilateral rows at 60 hpf or 53 hpf, respectively, in the migrating enteric neural crest cells. Most of the GFP + cells did not migrate, and most of the new GFP + cells were added to fill the space among the previously formed GFP + cells. GFP expression reached the anus by 72 hpf. New GFP + cells then also appeared in the dorsal and ventral sides of the initial GFP + rows, resulting in their distribution on the entire gut by 4 dpf. A small number of new GFP + cells were found to move among older GFP + cells just before the cells stopped migration, suggesting that the moving GFP + cells may represent neural precursor cells searching for a place for the final differentiation. Our data suggest that the Tg(chata:GGFF2) line could serve as a useful tool for studies of enteric neural differentiation and cell behavior.



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Oxygen-induced alterations in the expression of chromatin modifying enzymes and the transcriptional regulation of imprinted genes

Publication date: June 2018
Source:Gene Expression Patterns, Volume 28
Author(s): William M. Skiles, Avery Kester, Jane H. Pryor, Mark E. Westhusin, Michael C. Golding, Charles R. Long
Embryo culture and assisted reproductive technologies have been associated with a disproportionately high number of epigenetic abnormalities in the resulting offspring. However, the mechanisms by which these techniques influence the epigenome remain poorly defined. In this study, we evaluated the capacity of oxygen concentration to influence the transcriptional control of a selection of key enzymes regulating chromatin structure. In mouse embryonic stem cells, oxygen concentrations modulated the transcriptional regulation of the TET family of enzymes, as well as the de novo methyltransferase Dnmt3a. These transcriptional changes were associated with alterations in the control of multiple imprinted genes, including H19, Igf2, Igf2r, and Peg3. Similarly, exposure of in vitro produced bovine embryos to atmospheric oxygen concentrations was associated with disruptions in the transcriptional regulation of TET1, TET3, and DNMT3a, along with the DNA methyltransferase co-factor HELLS. In addition, exposure to high oxygen was associated with alterations in the abundance of transcripts encoding members of the Polycomb repressor complex (EED and EZH2), the histone methyltransferase SETDB1 and multiple histone demethylases (KDM1A, KDM4B, and KDM4C). These disruptions were accompanied by a reduction in embryo viability and suppression of the pluripotency genes NANOG and SOX2. These experiments demonstrate that oxygen has the capacity to modulate the transcriptional control of chromatin modifying genes involved in the establishment and maintenance of both pluripotency and genomic imprinting.



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Editorial Board

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Contents

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ResQPOD ITD Overview

The ResQPOD® impedance threshold device (ITD) is a simple, non-invasive device that delivers intrathoracic pressure regulation (IPR) therapy during basic or advanced life support CPR to improve perfusion. - See more from ZOLL.

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miR-155 Affects Osteosarcoma MG-63 Cell Autophagy Induced by Adriamycin Through Regulating PTEN-PI3K/AKT/mTOR Signaling Pathway

Cancer Biotherapy & Radiopharmaceuticals , Vol. 0, No. 0.


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Multisession anodal transcranial direct current stimulation induces motor cortex plasticity enhancement and motor learning generalization in an aging population

Publication date: February 2018
Source:Clinical Neurophysiology, Volume 129, Issue 2
Author(s): Gaëlle Dumel, Marie-Ève Bourassa, Camille Charlebois-Plante, Martine Desjardins, Julien Doyon, Dave Saint-Amour, Louis De Beaumont
ObjectivesThe present aging study investigated the impact of a multisession anodal-tDCS protocol applied over the primary motor cortex (M1) during motor sequence learning on generalization of motor learning and plasticity-dependent measures of cortical excitability.MethodsA total of 32 cognitively-intact aging participants performed five consecutive daily 20-min sessions of the serial-reaction time task (SRTT) concomitant with either anodal (n = 16) or sham (n = 16) tDCS over M1. Before and after the intervention, all participants performed the Purdue Pegboard Test (PPT) and Transcranial Magnetic Stimulation (TMS) measures of cortical excitability were collected.ResultsRelative to sham, participants assigned to the anodal-tDCS intervention revealed significantly greater performance gains on both the trained SRTT and the untrained PPT as well as a greater disinhibition of long-interval cortical inhibition (LICI). Generalization effects of anodal-tDCS significantly correlated with LICI disinhibition.ConclusionAnodal-tDCS facilitates motor learning generalisation in an aging population through intracortical disinhibition effects.SignificanceThe current findings demonstrate the potential clinical utility of a multisession anodal-tDCS over M1 protocol as an adjuvant to motor training in alleviating age-associated motor function decline. This study also reveals the pertinence of implementing brain stimulation techniques to modulate age-associated intracortical inhibition changes in order to facilitate motor function gains.



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Can clinical neurophysiology assist in patient selection for DBS in pediatric dystonia?

Publication date: February 2018
Source:Clinical Neurophysiology, Volume 129, Issue 2
Author(s): Stephen Tisch




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Observations on muscle activity in REM sleep behavior disorder assessed with a semi-automated scoring algorithm

Publication date: March 2018
Source:Clinical Neurophysiology, Volume 129, Issue 3
Author(s): Jesper Jeppesen, Marit Otto, Yoon Frederiksen, Allan K. Hansen, Tatyana D. Fedorova, Karoline Knudsen, Adjmal Nahimi, David J. Brooks, Per Borghammer, Michael Sommerauer
ObjectivesRapid eye movement (REM) sleep behavior disorder (RBD) is defined by dream enactment due to a failure of normal muscle atonia. Visual assessment of this muscle activity is time consuming and rater-dependent.MethodsAn EMG computer algorithm for scoring 'tonic', 'phasic' and 'any' submental muscle activity during REM sleep was evaluated compared with human visual ratings. Subsequently, 52 subjects were analyzed with the algorithm. Duration and maximal amplitude of muscle activity, and self-awareness of RBD symptoms were assessed.ResultsThe computer algorithm showed high congruency with human ratings and all subjects with RBD were correctly identified by excess of submental muscle activity, when artifacts were removed before analysis. Subjects with RBD exhibited prolonged bouts of 'phasic' muscle activity with high amplitude. Self-awareness of RBD symptoms correlated with amount of REM sleep without atonia.ConclusionsOur proposed algorithm was able to detect and rate REM sleep without atonia allowing identification of RBD. Increased duration and amplitude of muscle activity bouts were characteristics of RBD. Quantification of REM sleep without atonia represents a marker of RBD severity.SignificanceOur EMG computer algorithm can support a diagnosis of RBD while the quantification of altered muscle activity provides a measure of its severity.



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Differential changes in the spinal segmental locomotor output in Hereditary Spastic Paraplegia

Publication date: March 2018
Source:Clinical Neurophysiology, Volume 129, Issue 3
Author(s): G. Martino, Y. Ivanenko, M. Serrao, A. Ranavolo, F. Draicchio, M. Rinaldi, C. Casali, F. Lacquaniti
ObjectiveA comprehensive treatment of Hereditary Spastic Paraplegia (HSP) should consider the specific pathophysiological changes in the spinal cord. Here we reported a detailed characterization of the spinal motoneuronal output in HSP during locomotion.MethodsWe recorded kinematics and electromyographic (EMG) activity of 12 leg muscles in 29 patients with pure forms of HSP and compared them with 30 controls while walking at matched speeds. We assessed the spinal locomotor output by evaluating EMG patterns and by mapping them onto the rostrocaudal location of the spinal motoneuron pools.ResultsThe activity profiles of muscles innervated from the sacral segments were significantly wider in patients. Similarly, spinal maps revealed a tendency for spreading the main loci of activation, involving initially the sacral segments and, at more severe stages, the lumbar segments.ConclusionsThe degeneration of the corticospinal tract in HSP is associated with a widening of spinal locomotor output spreading from caudal to rostral segments.SignificanceThe findings highlight pathophysiologically relevant differential changes in the spinal locomotor output in HSP related to the specific innervation of muscles in the spinal cord, and might be helpful for developing future therapeutic strategies and identifying physiological markers of the disease.



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Detection radius of EMG for fasciculations: Empiric study combining ultrasonography and electromyography

Publication date: February 2018
Source:Clinical Neurophysiology, Volume 129, Issue 2
Author(s): Martin Regensburger, Felix Tenner, Cornelia Möbius, Axel Schramm
ObjectiveThe aims of this study were to investigate the detection radius and sensitivity of EMG for fasciculations.MethodsMuscle ultrasonography was performed simultaneously to EMG recordings in patients with fasciculations in the context of amyotrophic lateral sclerosis. Ultrasonography and EMG parameters were analyzed for selected fasciculations.ResultsA total of 381 fasciculations were detected by ultrasonography in 18 muscles of 10 patients. Out of these, 125 (33%) were EMG-negative. In contrast, none of the fasciculations detected by EMG were ultrasonography-negative. EMG detection probability decreased significantly with increasing distance from the center of the fasciculation. EMG detection rate was 98% when the EMG needle was located within the fasciculation and 50% at 7.75 mm distance from the fasciculation center. In addition, EMG detection depended significantly on cross-sectional area of the fasciculation and presence of neurogenic changes.ConclusionsFor detecting the same fasciculations, EMG is less sensitive than ultrasonography. EMG detection probability decreases sharply at a distance comparable to motor unit size.SignificanceThese results extend previous knowledge about superior sensitivity of ultrasonography for fasciculations. Moreover, our novel bimodal detection method provides first in vivo data about the EMG detection radius for fasciculations in a clinical setting.



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Evaluation of afferent pain pathways in adrenomyeloneuropathic patients

Publication date: March 2018
Source:Clinical Neurophysiology, Volume 129, Issue 3
Author(s): Sara Yagüe, Misericordia Veciana, Carlos Casasnovas, Montserrat Ruiz, Jordi Pedro, Josep Valls-Solé, Aurora Pujol
ObjectivePatients with adrenomyeloneuropathy may have dysfunctions of visual, auditory, motor and somatosensory pathways. We thought on examining the nociceptive pathways by means of laser evoked potentials (LEPs), to obtain additional information on the pathophysiology of this condition.MethodsIn 13 adrenomyeloneuropathic patients we examined LEPs to leg, arm and face stimulation. Normative data were obtained from 10 healthy subjects examined in the same experimental conditions. We also examined brainstem auditory evoked potentials (BAEPs), pattern reversal full-field visual evoked potentials (VEPs), motor evoked potentials (MEPs) and somatosensory evoked potentials (SEPs).ResultsUpper and lower limb MEPs and SEPs, as well as BAEPs, were abnormal in all patients, while VEPs were abnormal in 3 of them (23.1%). LEPs revealed abnormalities to stimulation of the face in 4 patients (30.7%), the forearm in 4 patients (30.7%) and the leg in 10 patients (76.9%).ConclusionsThe pathologic process of adrenomyeloneuropathy is characterized by a preferential involvement of auditory, motor and somatosensory tracts and less severely of the visual and nociceptive pathways. This non-inflammatory distal axonopathy preferably damages large myelinated spinal tracts but there is also partial involvement of small myelinated fibres.SignificanceLEPs studies can provide relevant information about afferent pain pathways involvement in adrenomyeloneuropathic patients.



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Postoperative rehabilitation after deep brain stimulation surgery for movement disorders

Publication date: March 2018
Source:Clinical Neurophysiology, Volume 129, Issue 3
Author(s): Niels Allert, Binith Cheeran, Günther Deuschl, Michael T. Barbe, Ilona Csoti, Markus Ebke, Martin Glaser, Jun-Suk Kang, Stefan Kelm, Paul Krack, Julia Kroth, Ulrich Jobst, Markus Leisse, Antonio Oliviero, Peter Nikolaus Nolte, Johanna Quick-Weller, Martin Strothjohann, Gertrúd Tamás, Michael Werner, Muthuraman Muthuraman, Jens Volkmann, Alfonso Fasano, Sergiu Groppa
Deep brain stimulation (DBS) is a highly efficient, evidence-based therapy for a set of neurological and psychiatric conditions and especially movement disorders such as Parkinson's disease, essential tremor and dystonia. Recent developments have improved the DBS technology. However, no unequivocal algorithms for an optimized postoperative care exist so far. The aim of this review is to provide a synopsis of the current clinical practice and to propose guidelines for postoperative and rehabilitative care of patients who undergo DBS. A standardized work-up in the DBS centers adapted to each patient's clinical state and needs is important, including a meticulous evaluation of clinical improvement and residual symptoms with a definition of goals for neurorehabilitation. Efficient and complete information transfer to subsequent caregivers is essential. A coordinated therapy within a multidisciplinary team (trained in movement disorders and DBS) is needed to achieve the long-range maximal efficiency. An optimized postoperative framework might ultimately lead to more effective results of DBS.



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The utility of motor unit number estimation methods versus quantitative motor unit potential analysis in diagnosis of ALS

Publication date: March 2018
Source:Clinical Neurophysiology, Volume 129, Issue 3
Author(s): A.B. Jacobsen, R.S. Kristensen, A. Witt, A.G. Kristensen, L. Duez, S. Beniczky, A. Fuglsang-Frederiksen, H. Tankisi
ObjectiveTo compare the diagnostic utility of motor unit number estimation (MUNE) methods to motor unit potential (MUP) analysis in amyotrophic lateral sclerosis (ALS).MethodsTwenty-five patients (1 definite, 11 probable, 9 possible ALS and 4 progressive muscular atrophy) and 22 healthy controls were prospectively included. Quantitative MUP analysis and three MUNE methods; Multiple Point Stimulation MUNE (MPS), Motor Unit Number Index (MUNIX) and MScanFit MUNE (MScan) were done in abductor pollicis brevis muscle. The sensitivities were compared by McNemar chi-square test. MUNE, MUP and revised ALS Functional Rating Scale (ALSFRS-R) parameters were correlated by regression analysis.ResultsThe sensitivities of MPS (76%) and MScan (68%) were higher than MUP duration (36%) and amplitude (40%) in detecting motor unit loss (p < 0.05). MUNE methods increased the categorical probability from possible to probable ALS in 4 patients (16%). There was only significant correlation between ALSFRS-R and MScan (r = 0.443, p = 0.027) among the electrophysiological tests. MUNE methods did not correlate to MUP parameters.ConclusionsMUNE methods are more sensitive in showing abnormality than MUP analysis.SignificanceMUNE methods, in particular MScan, may have the potential to be implemented in the clinical practice for diagnosis and follow-up of neuromuscular disorders particularly ALS.



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Better diagnostic accuracy of neuropathy in obesity: A new challenge for neurologists

Publication date: March 2018
Source:Clinical Neurophysiology, Volume 129, Issue 3
Author(s): Brian C. Callaghan, Rong Xia, Evan Reynolds, Mousumi Banerjee, Charles Burant, Amy Rothberg, Rodica Pop-Busui, Emily Villegas-Umana, Eva L. Feldman
ObjectiveTo determine the comparative diagnostic characteristics of neuropathy measures in an obese population.MethodsWe recruited obese participants from the University of Michigan's Weight Management Program. Receiver operative characteristic analysis determined the area under the curve (AUC) of neuropathy measures for distal symmetric polyneuropathy (DSP), small fiber neuropathy (SFN), and cardiovascular autonomic neuropathy (CAN). The best test combinations were determined using stepwise and Score subset selection models.ResultsWe enrolled 120 obese participants. For DSP, seven of 42 neuropathy measures (Utah Early Neuropathy Score (UENS, N = 62), Michigan Neuropathy Screening Instrument (MNSI) reduced combined index, MNSI examination, nerve fiber density (NFD) leg, tibial F response, MNSI questionnaire, peroneal distal motor latency) had AUCs ≥ 0.75. Three of 19 small fiber nerve measures for SFN (UENS, NFD leg, Sudoscan feet (N = 70)) and zero of 16 CAN measures had AUCs ≥ 0.75. Combinations of tests performed better than individual tests with AUCs of 0.82 for DSP (two parameters) and 0.84 for SFN (three parameters).ConclusionsMany neuropathy measures demonstrate good test performance for DSP in obese participants. Select few small fiber nerve measures performed well for SFN, and none for CAN.SignificanceSpecific combinations of tests should be used for research studies to maximize diagnostic performance in obese cohorts.



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Somatosensory Evoked Potentials and Central Motor Conduction Times in children with dystonia and their correlation with outcomes from Deep Brain Stimulation of the Globus pallidus internus

Publication date: February 2018
Source:Clinical Neurophysiology, Volume 129, Issue 2
Author(s): Verity M. McClelland, Doreen Fialho, Denise Flexney-Briscoe, Graham E. Holder, Markus C. Elze, Hortensia Gimeno, Ata Siddiqui, Kerry Mills, Richard Selway, Jean-Pierre Lin
ObjectivesTo report Somatosensory Evoked Potentials (SEPs) and Central Motor Conduction Times (CMCT) in children with dystonia and to test the hypothesis that these parameters predict outcome from Deep Brain Stimulation (DBS).Methods180 children with dystonia underwent assessment for Globus pallidus internus (GPi) DBS, mean age 10 years (range 2.5–19). CMCT to each limb was calculated using Transcranial Magnetic Stimulation. Median and posterior tibial nerve SEPs were recorded over contralateral and midline centro-parietal scalp. Structural abnormalities were assessed with cranial MRI. One-year outcome from DBS was assessed as percentage improvement in Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS-m).ResultsAbnormal CMCTs and SEPs were found in 19% and 47% of children respectively and were observed more frequently in secondary than primary dystonia. Of children proceeding to DBS, better outcome was seen in those with normal (n = 78/89) versus abnormal CMCT (n = 11/89) (p = 0.002) and those with normal (n = 35/51) versus abnormal SEPs (n = 16/51) (p = 0.001). These relationships were independent of dystonia aetiology and cranial MRI findings.ConclusionsCMCTs and SEPs provide objective evidence of motor and sensory pathway dysfunction in children with dystonia and relate to DBS outcome.SignificanceCMCTs and SEPs can contribute to patient selection and counselling of families about potential benefit from neuromodulation for dystonia.



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EEG synchronization measures predict epilepsy-related BOLD-fMRI fluctuations better than commonly used univariate metrics

Publication date: March 2018
Source:Clinical Neurophysiology, Volume 129, Issue 3
Author(s): Rodolfo Abreu, Alberto Leal, Fernando Lopes da Silva, Patrícia Figueiredo
ObjectiveWe hypothesize that the hypersynchronization associated with epileptic activity is best described by EEG synchronization measures, and propose to use these as predictors of epilepsy-related BOLD fluctuations.MethodsWe computed the phase synchronization index (PSI) and global field synchronization (GFS), within two frequency bands, a broadband (1–45 Hz) and a narrower band focused on the presence of epileptic activity (3–10 Hz). The associated epileptic networks were compared with those obtained using conventional unitary regressors and two power-weighted metrics (total power and root mean square frequency), on nine simultaneous EEG-fMRI datasets from four epilepsy patients, exhibiting inter-ictal epileptiform discharges (IEDs).ResultsThe average PSI within 3–10 Hz achieved the best performance across several measures reflecting reliability in all datasets. The results were cross-validated through electrical source imaging of the IEDs. The applicability of PSI when no IEDs are recorded on the EEG was evaluated on three additional patients, yielding partially plausible networks in all cases.ConclusionsEpileptic networks can be mapped based on the EEG PSI metric within an IED-specific frequency band, performing better than commonly used EEG metrics.SignificanceThis is the first study to investigate EEG synchronization measures as potential predictors of epilepsy-related BOLD fluctuations.



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Epileptiform and periodic EEG activities induced by rapid sevoflurane anaesthesia induction

Publication date: March 2018
Source:Clinical Neurophysiology, Volume 129, Issue 3
Author(s): Eila Sonkajärvi, Seppo Rytky, Seppo Alahuhta, Kalervo Suominen, Timo Kumpulainen, Pasi Ohtonen, Elina Karvonen, Ville Jäntti
ObjectivesThe aim of the study was to compare the EEG findings and haemodynamic parameters of adult male patients while undergoing mask induction with sevoflurane anaesthesia with either controlled hyperventilation (CH) or spontaneous breathing (SB).MethodsTwenty male patients, aged 23–52 (mean 42) years were anaesthetized randomly with either spontaneous breathing or mild controlled hyperventilation via mask. EEG was recorded using a full 10–20 electrode set.ResultsAnaesthesia induction with high inhaled concentrations of sevoflurane produced several epileptiform and periodic EEG patterns. CH doubled the amount of these EEG patterns compared to SB. Higher heart rate was recorded in the CH group.ConclusionsWe describe a high incidence of paroxysmal EEG activity: epileptiform and generalized periodic discharges (GPDs) during rapid sevoflurane in nitrous oxide-oxygen mask induction in hyperventilated male patients. However these activities have no effect to the heart rate or the mean arterial pressure.SignificanceThe monitoring of GPDs and burst suppression patterns during rapid anaesthesia induction with sevoflurane provides possibility to study the effects of volatile anaesthetics in the healthy brain. In order to analyse the different sources of EEG patterns a wide-band multichannel EEG recording is necessary.



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Automatic bad channel detection in intracranial electroencephalographic recordings using ensemble machine learning

Publication date: March 2018
Source:Clinical Neurophysiology, Volume 129, Issue 3
Author(s): Viateur Tuyisenge, Lena Trebaul, Manik Bhattacharjee, Blandine Chanteloup-Forêt, Carole Saubat-Guigui, Ioana Mîndruţă, Sylvain Rheims, Louis Maillard, Philippe Kahane, Delphine Taussig, Olivier David
ObjectiveIntracranial electroencephalographic (iEEG) recordings contain "bad channels", which show non-neuronal signals. Here, we developed a new method that automatically detects iEEG bad channels using machine learning of seven signal features.MethodsThe features quantified signals' variance, spatial–temporal correlation and nonlinear properties. Because the number of bad channels is usually much lower than the number of good channels, we implemented an ensemble bagging classifier known to be optimal in terms of stability and predictive accuracy for datasets with imbalanced class distributions. This method was applied on stereo-electroencephalographic (SEEG) signals recording during low frequency stimulations performed in 206 patients from 5 clinical centers.ResultsWe found that the classification accuracy was extremely good: It increased with the number of subjects used to train the classifier and reached a plateau at 99.77% for 110 subjects. The classification performance was thus not impacted by the multicentric nature of data.ConclusionsThe proposed method to automatically detect bad channels demonstrated convincing results and can be envisaged to be used on larger datasets for automatic quality control of iEEG data.SignificanceThis is the first method proposed to classify bad channels in iEEG and should allow to improve the data selection when reviewing iEEG signals.



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Development, validation and utility of a simulation model of the nociceptive flexion reflex threshold

Publication date: March 2018
Source:Clinical Neurophysiology, Volume 129, Issue 3
Author(s): Carlo Jurth, Teresa M. Dörig, Gregor Lichtner, Anna Golebiewski, Axel Jakuscheit, Falk von Dincklage
ObjectiveA variety of algorithms is used for nociceptive flexion reflex threshold (NFRT) estimation, but their estimation accuracy is unknown. We developed a computer based simulation model of the NFRT to quantify and compare the accuracy of available estimation algorithms.MethodsThis simulation model is based on basic characteristics of the NFRT and specified by data collected from 60 healthy volunteers. We validated the model by comparing simulated data with data obtained independently in another volunteer population. The model was used to quantify the accuracy of previously published NFRT estimation algorithm for three NFRT variabilities representing sensory deprivation, distraction and general anaesthesia.ResultsThe dynamic staircase algorithm obtained most accurate NFRT estimates during all NFRT variabilities. The number of stimuli applied can be chosen higher to increase estimate precision or lower to reduce measurement time.ConclusionsOur simulation model is a valid tool to measure the accuracy of NFRT estimation algorithms. It can be applied to analyse and develop algorithms. The dynamic staircase algorithm shows the highest precision in NFRT estimation and is recommended for NFRT studies.SignificanceUsing optimized NFRT estimation algorithms increases precision in clinical and experimental NFRT studies and might therefore reduce the measurement effort necessary.



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Fasciculation: Does distance really matter?

Publication date: February 2018
Source:Clinical Neurophysiology, Volume 129, Issue 2
Author(s): Mamede de Carvalho




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Epidural motor cortex stimulation for intractable leg pain

Publication date: March 2018
Source:Clinical Neurophysiology, Volume 129, Issue 3
Author(s): Hiroshi Fujioka, Eiichirou Urasaki, Akifumi Izumihara, Katsuhiro Yamashita




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Diagnostic yield of standard-wake and sleep EEG recordings

Publication date: Available online 3 February 2018
Source:Clinical Neurophysiology
Author(s): Pirgit Meritam, Elena Gardella, Jørgen Alving, Daniella Terney, Melita Cacic Hribljan, Sándor Beniczky
ObjectiveTo investigate whether Posterior Dominant Rhythm (PDR) can be reliably assessed in sleep-EEG recordings and to investigate the diagnostic yield of standard-wake and sleep-recordings.MethodsEEG recordings of 303 consecutive patients aged 18-88 years were analyzed. All patients had both standard-wake and sleep-recordings, including patients who had abnormal standard recordings. Melatonin was used in 6% of sleep EEGs, and sleep deprivation in 94%. The mean duration of sleep was 41 minutes. We measured the PDR frequency in standard and sleep-recordings, both before and after sleep. We compared the diagnostic yield of standard-wake and sleep EEG recordings.ResultsCompared to standard EEG, sleep-recordings showed a significantly lower PDR frequency, both when measured before and after sleep (p<0.001). One-hundred-fifty-six patients (51%) had normal standard recordings, and 35 of them (22%) had abnormal findings in the sleep-recording. One-hundred-forty-seven patients had abnormal standard recordings and in 16 of them (11%) these abnormalities were not present in sleep-recording.ConclusionsPDR is significantly slower in the wake periods of sleep-recordings, compared to standard wake recordings.SignificanceSleep and standard wake recordings are complementary.



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Cortical inhibitory function in cervical dystonia

Publication date: February 2018
Source:Clinical Neurophysiology, Volume 129, Issue 2
Author(s): Christos Ganos, Elisa R. Ferrè, Angela Marotta, Panagiotis Kassavetis, John Rothwell, Kailash P. Bhatia, Patrick Haggard
ObjectiveTo assess the specificity of cortical inhibitory deficits in cervical dystonia patients.MethodsA systematic test battery was developed to assess spatial and temporal aspects of cortical inhibition, in motor and somatosensory systems of the hand. We tested 17 cervical dystonia (CD) patients and 19 controls assessing somatosensory spatial inhibition (grating orientation test, interdigital feedforward subliminal inhibition), somatosensory temporal inhibition (temporal discrimination threshold, feedforward subliminal inhibition), motor spatial inhibition (surround inhibition), and motor temporal inhibition (short interval intracortical inhibition).ResultsA significant deficit in CD was observed in both measures of somatosensory spatial inhibition, with a trend in the same direction in our measure of motor spatial inhibition. We found no significant group differences in temporal inhibition measures. Importantly, statistical comparison of effect sizes across the different measures showed that deficits in tests of spatial inhibition were greater than those in tests of temporal inhibition.ConclusionOur results suggest that CD is associated with abnormal function of local inhibitory cortical circuits subserving spatial sensory processing. Importantly, this abnormality relates to the somatotopic representation of an unaffected body part.SignificanceThese results clarify the nature of deficits in cortical inhibitory function in dystonia.



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The Clinical Utility of Qualitative Electroencephalography during Tilt Table Testing – a Retrospective Study

Publication date: Available online 3 February 2018
Source:Clinical Neurophysiology
Author(s): Srikanth Muppidi, Babak Razavi, Mitchell G. Miglis, Safwan Jaradeh
ObjectiveTo assess electroencephalography (EEG) changes during tilt table testing in syncope and other orthostatic syndromes.MethodsWe retrospectively reviewed consecutive tilt table studies with simultaneous EEG from April 2014 to May 2016 at our center. All patients had video EEG during tilt table. All patients had at least 10 minutes of head up tilt unless they had syncope or did not tolerate the study. Video EEG was interpreted by epileptologists.ResultsEighty-seven patients met the inclusion criteria. Mean age was 45 years, and 55 were women. Seven patients (∼8%) had syncope during tilt table, 11 patients (∼12%) had significant neurogenic orthostatic hypotension and a separate group of 11 patients (∼12%) had significant orthostatic tachycardia. Valsalva responses were abnormal in 7 of the 11 patients with orthostatic hypotension, suggesting an underlying neurogenic orthostatic hypotension. Visually discernable EEG changes were seen in only 3 patients (∼43%) who had syncope and in 1 patient (∼9%) with orthostatic tachycardia.ConclusionsQualitative EEG analysis based on visual inspection during tilt table study revealed abnormalities in less than half the patients with syncope and a very small fraction with orthostatic tachycardia.SignificanceRoutine qualitative EEG recording might not be clinically useful during tilt table studies.



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Finger Strength, Individuation, and their Interaction: Relationship to Hand Function and Corticospinal Tract Injury after Stroke

Publication date: Available online 3 February 2018
Source:Clinical Neurophysiology
Author(s): Eric T. Wolbrecht, Justin B. Rowe, Vicky Chan, Morgan L. Ingemanson, Steven C. Cramer, David J. Reinkensmeyer
ObjectiveThe goal of this study was to determine the relative contributions of finger weakness and reduced finger individuation to reduced hand function after stroke, and their association with corticospinal tract (CST) injury.MethodsWe measured individuated and synergistic maximum voluntary contractions (MVCs) of the index and middle fingers, in both flexion and extension, of 26 individuals with a chronic stroke using a robotic exoskeleton. We quantified finger strength and individuation, and defined a novel metric that combines them – "multifinger capacity". We used stepwise linear regression to identify which measure best predicted hand function (Box and Blocks Test, Nine Hole Peg Test) and arm impairment (the Upper Extremity Fugl-Meyer Test).ResultsCompared to metrics of strength or individuation, capacity survived the stepwise regression as the strongest predictor of hand function and arm impairment. Capacity was also most strongly related to presence or absence of lesion overlap with the CST.ConclusionsReduced strength and individuation combine to shrink the space of achievable finger torques, and it is the resulting size of this space – the multifinger capacity – that is of elevated importance for predicting loss of hand function.SignificanceMulti-finger capacity may be an important target for rehabilitative hand training.



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Mental Health of Mothers of Infants with Neonatal Abstinence Syndrome and Prenatal Opioid Exposure

Abstract

Background

The prevalence of opioid use during pregnancy is increasing. Two downstream effects are neonatal abstinence syndrome (NAS), a postnatal withdrawal syndrome, and long-term prenatal opioid exposure (LTPOE) without documented withdrawal symptoms in the infant. Mental health characteristics of mothers of infants with NAS and LTPOE have not been described.

Methods

Using linked maternal and infant Medicaid claims and birth certificate data, we analyzed 15,571 infants born to Medicaid-insured women 15–24 years old in a mid-Atlantic city from 2007 to 2010. Pairwise comparisons with multinomial logistic regression, adjusting for maternal and infant covariates, were performed. We compared four mental health conditions among mothers of infants with NAS, infants with LTPOE without NAS, and controls: depression, anxiety, bipolar disorder, and schizophrenia.

Results

The prevalence of depression among mothers of infants with NAS, infants with LTPOE, and controls was 26, 21.1, and 5.5% respectively. Similar results were found for anxiety. In multivariable analysis, mothers of infants with NAS and LTPOE had approximately twice the depression risk as controls, while mothers of infants with LTPOE had 2.2 times the bipolar disorder risk and 4.6 times the schizophrenia risk as controls. The overall risk of mental health conditions in mothers of infants with NAS and LTPOE was similar.

Discussion

Mothers of infants with LTPOE who did not develop NAS are at similarly high risk for mental health conditions as mothers of infants with NAS, and both are at higher risk than controls. Therefore, those mothers of infants who did not develop symptoms of NAS despite LTPOE may be a vulnerable population that needs additional mental health support in the post-partum period.

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Muscular strength as a predictor of all-cause mortality in apparently healthy population: a systematic review and meta-analysis of data from approximately 2 million men and women

Publication date: Available online 7 February 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Antonio García-Hermoso, Iván Cavero-Redondo, Robinson Ramírez-Vélez, Jonatan Ruiz, Francisco B. Ortega, Duck-Chul Lee, Vicente Martínez-Vizcaíno
ObjectiveThe aim of the present systematic review and meta-analysis was to determine the relationship between muscular strength and all-cause mortality risk and to examine the sex-specific impact of muscular strength on all-cause mortality in apparently healthy population.Data SourcesTwo authors systematically searched MEDLINE, EMBASE and SPORTDiscus databases and conducted manual searching of reference lists of selected articles.Study SelectionEligible cohort studies were those that examined the association of muscular strength with all-cause mortality in apparently healthy population. The hazard ratio (HR) estimates with 95% confidence interval (CI) were pooled by using random effects meta-analysis models after assessing heterogeneity across studies.Data extractionTwo authors independently extracted data.Data SynthesisThirty-eight studies with 1,907,580 participants were included in the meta-analysis. The included studies had a total of 63,087 deaths. Higher levels of handgrip strength were associated with a reduced risk of all-cause mortality (HR= 0.69; 95% CI, 0.64–0.74) compared to lower muscular strength, with a slightly stronger association in women (HR= 0.60; 95% CI, 0.51–0.69) than men (HR= 0.69; 95% CI, 0.62–0.77) (all p<0.001). Also, adults with higher levels of muscular strength, as assessed by knee extension strength test, had a 14% lower risk of death (HR= 0.86: 95% CI, 0.80–0.93; p < 0.001) compared to adults with lower muscular strength.ConclusionsHigher levels of upper- and lower-body muscular strength are associated with a lower risk of mortality in adult population, regardless of the age and follow-up period. Muscular strength tests can be easily performed to identify people with a lower muscular strength and, consequently, with an increased risk of mortality.



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Assessment of sleep quantity and sleep disturbances during recovery from sports-related concussion in youth athletes

Publication date: Available online 7 February 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Donna L. Murdaugh, Kim E. Ono, Andrew Reisner, Thomas G. Burns
ObjectiveTo determine the relationship between sleep quantity and sleep disturbances on symptoms and neurocognitive ability at the acute phase (<7 days) and post-sports-related concussion (SRC; >21 days).DesignProspective inception cohort studySettingGeneral community setting of regional middle and high schools.ParticipantsSample included 528 youth athletes with SRC and 443 controls ages 10-18.Main Outcome MeasuresAthletes completed the Immediate Post-Concussive Assessment and Cognitive Testing (ImPACT) battery. Partial correlation analyses and independent t-tests were conducted to assess sleep quantity the night before testing. Multivariate analysis of covariance was used to assess sleep disturbances and its interaction with age.ResultsLess sleep quantity was correlated with greater report of cognitive (p = 0.001) and neuropsychological (p = 0.024) symptoms specific for prolonged recovery from SRC. Sleep disturbances significantly impacting each migraine, cognitive, and neuropsychological symptoms (p < 0.001). A significant interaction was found between sleep disturbances and age (p = 0.04) at >21 days post-SRC.ConclusionsFindings emphasize that continued presence of low sleep quantity and sleep disturbances in youth athletes with SRC should be a specific indicator to health professionals that these athletes are at an increased risk for protracted recovery. Further research should identify additional factors that may interact with sleep to increase risk of protracted recovery.



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Evaluating the Use of Medicare Part D in the Spinal Cord Injury/Disorder Veteran Population

Publication date: Available online 6 February 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Maya N. Hatch, Jason Raad, Katie Suda, Kevin T. Stroupe, Alice J. Hon, Bridget M. Smith
ObjectiveTo examine the different sources of medications, the most common drugs classes filled, and the characteristics associated with Medicare Part D pharmacy use in Veterans with spinal cord injuries/disorders (SCI/D).DesignThis was a retrospective, cross-sectional observation study.SettingDepartment of Veterans Affairs (VA)ParticipantsVeterans with SCI/D using Medicare or Veteran Affairs Pharmacy benefits.InterventionsNoneMain Outcome Measure(s)Characteristics and top 10 most common drug classes were examined in Veterans who (1) used VA pharmacies only, (2) dually used VA and Part D pharmacies, or (3) Part D pharmacies only. Chi-squared tests and multinomial logistic regression analyses were used to determine associations of patient variables. Patient level frequencies were used to determine the most common drug classes.Results13,442 Veterans with SCI/D were analyzed in this study: 11,788 (87.7%) were VA Only users, 1,281 (9.5%) used both VA and Part D, and 373 (2.8%) used Part D Only. Veterans over the age of 50 were more likely to use Part D, whereas those with a traumatic injury, or secondary conditions, were less associated with Part D use. Opioids were the most frequently filled drug class across all groups. Other frequently used drug classes included skeletal muscle relaxants, gastric medications, anti-depressants (other), anticonvulsants, and antilipemics.ConclusionApproximately 12% of Veterans with a SCI/D are receiving medication outside of the VA system. Polypharmacy in this population of Veterans is relatively high, emphasizing the importance of health information exchange between systems for improved care for this medically complex population.



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Descriptive Findings of the VA Polytrauma Rehabilitation Centers TBI Model Systems National Database

Publication date: Available online 7 February 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Susan Ropacki, Risa Nakase-Richardson, Leah Farrell-Carnahan, Greg J. Lamberty, Xinyu Tang
ObjectivePresent initial descriptive findings from the Veterans Affairs (VA) Polytrauma Rehabilitation Centers (PRC) Traumatic Brain Injury (TBI) Model Systems (MS) National Database.DesignProspective cohort study.SettingVA PRC TBIMS National Database.Participants712 service members and veterans with TBI who consented to participate between January 2010 and June 2015.InterventionsNot applicable.Main outcomesDemographics, pre-injury characteristics, injury characteristics, rehabilitation course, functional outcomes and discharge disposition by TBI severity level.ResultsCohort was predominantly male with moderate to severe TBI secondary to vehicular accident or blast injury. Sixty-five percent were active duty service members; one-third injured during deployment. One-third reported mental health treatment and/or alcohol use problems in the year predating the index TBI. Median number of days between injury and PRC admission was 42.5. Nearly 25% reported clinical levels of Post-Traumatic Stress Disorder (PTSD); 75% reported mild to moderate neurobehavioral symptomatology. Median length of stay in the PRC was 36 days; those with severe TBI had the longest lengths of stay. Functional independence ratings improved from admission to discharge across all TBI severity levels. A majority were discharged to urban areas to reside with spouses or other residents in private residences or adult homes, with some variability by injury severityConclusionsThe VA PRC TBIMS national database is a rich source of information on a unique group of individuals with TBI and promises to complement existing knowledge on TBI in the civilian population.



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Cardiovascular stress-response adaptation: Conceptual basis, empirical findings, and implications for disease processes

Publication date: Available online 6 February 2018
Source:International Journal of Psychophysiology
Author(s): Brian M. Hughes, Wei Lü, Siobhán Howard
Cardiovascular reactivity to stress is an established marker of lifetime disease risk, with both elevated and blunted reactions empirically identified as being predictive of ill-health. However, in the relevant studies, traditional laboratory protocols do not account for patterns of response adaptation across time, patterns that may be particularly important in the prediction of future health outcomes. We outline the evidence suggesting that habituation to repeated or prolonged stress represents an informative and health-relevant aspect of the cardiovascular stress response. In this position paper, we outline what studies of cardiovascular adaptation have elucidated to date. Cardiovascular response habituation occurs for various types of stressor, is most pronounced after initial stress responses have subsided (making initial stress responses potentially misleading if scrutinized in isolation), emerges in both women and men, and is subject to individual differences. Such moderating factors fit within the biopsychosocial model, suggesting that CVR adaptation is etiologically relevant and potentially modifiable through intervention. However, as yet, there is no prospective evidence to confirm that patterns of adaptation predict adverse health, despite there being strong reasonable and logical grounds to suspect so. We suggest how existing studies may offer a means to fill this gap in prospective evidence, and outline four potential typologies in cardiovascular reactivity patterns that fit within and extend the classic reactivity hypothesis.



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Localised cutaneous microvascular adaptation to exercise training in humans

Abstract

Purpose

Exercise training induces adaptation in conduit and resistance arteries in humans, partly as a consequence of repeated elevation in blood flow and shear stress. The stimuli associated with intrinsic cutaneous microvascular adaptation to exercise training have been less comprehensively studied.

Methods

We studied 14 subjects who completed 8-weeks cycle ergometer training, with partial cuff inflation on one forearm to unilaterally attenuate cutaneous blood flow responses during each exercise-training bout. Before and after training, bilateral forearm skin microvascular dilation was determined using cutaneous vascular conductance (CVC: skin flux/blood pressure) responses to gradual localised heater disk stimulation performed at rest (33, 40, 42 and 44 °C).

Results

Cycle exercise induced significant increases in forearm cutaneous flux and temperature, which were attenuated in the cuffed arm (2-way ANOVA interaction-effect; P < 0.01). We found that forearm CVC at 42 and 44 °C was significantly lower in the uncuffed arm following 8-weeks of cycle training (P < 0.01), whereas no changes were apparent in the contralateral cuffed arm (P = 0.77, interaction-effect P = 0.01).

Conclusions

Lower limb exercise training in healthy young men leads to lower CVC-responses to a local heating stimulus, an adaptation mediated, at least partly, by a mechanism related to episodic increases in skin blood flow and/or skin temperature.

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Letter to the editor

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Chlamydia trachomatis and Adverse Pregnancy Outcomes: Meta-analysis of Patients With and Without Infection

Abstract

Objectives

We conducted a meta-analysis to determine the association between Chlamydia trachomatis and adverse perinatal outcomes.

Methods

Electronic databases were searched between 1970 and 2013. Included studies reported perinatal outcomes in women with and without chlamydia. Summary odds ratios were calculated using fixed- and random-effects models. Study bias was assessed using a Funnel Plot and Begg's test.

Results

Of 129 articles identified, 56 studies met the inclusion criteria encompassing 614,892 subjects. Chlamydia infection in pregnancy was associated with preterm birth (OR = 1.27, 95% CI 1.05, 1.54) with a large quantity of heterogeneity (I² = 61%). This association lost significance when limiting the analysis to high-quality studies based on the Newcastle–Ottawa Scale. Chlamydia infection in pregnancy was also associated with preterm premature rupture of membranes (OR = 1.81, 95% CI 1.0, 3.29), endometritis (OR 1.69, 95% CI 1.20, 2.38), low birthweight (OR 1.34, 95% CI 1.21, 1.48), small for gestational age (OR 1.14, 95% CI 1.05, 1.25) and intrauterine fetal demise (OR 1.44, 95% CI 1.06, 1.94).

Conclusions

This review provides evidence that chlamydia in pregnancy is associated with a small increase in the odds of multiple adverse pregnancy outcomes. The literature is complicated by heterogeneity and the fact that the association may not hold in higher quality and prospective studies or those that use more contemporary nucleic acid testing.

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Pilot Study of a Novel Partnership for Installing Smoke Alarms

Abstract

Objectives To demonstrate the feasibility of partnering fire department personnel and home visiting nurses to increase the number of low-income homes protected by smoke alarms. Methods During a regularly scheduled home visit, nurses at the Nurse-Family Partnership of Maricopa County (NFP) informed their clients about an opportunity to have smoke alarms installed in their homes for free. For interested families, nurses sent a referral to the Phoenix Fire Department (PFD), scheduled an appointment, and accompanied the PFD volunteers during the installation. During the appointment, PFD personnel installed alarms and provided safety education. Clients completed a follow-up survey 1–3 months after the installation visit. In-depth interviews were completed with key informants from NFP and PFD to solicit feedback on the program. Results Fifty-two smoke alarm installation visits were completed. Before the fire department arrived, 55% of homes had no working smoke alarm. Almost all (94%) homes received at least one new smoke alarm, and every home had at least one working smoke alarm at the end of the fire department visit. At follow-up, all homes maintained at least one working smoke alarm. Members from both organizations were enthusiastic about, and supportive of the project. NFP nurses appreciated the skill and knowledge of the firefighters; PFD representatives noted that the nurses' relationships with clients made it easier for them to gain access to families who are often described as "hard-to-reach". Conclusions Partnering home visiting nurses and fire departments can be successful to increase the number of vulnerable homes with smoke alarms.

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Vasoconstrictor stimulus determines the functional contribution of myoendothelial feedback to mesenteric arterial tone

Abstract

Constriction of isolated resistance arteries in response to α₁-adrenoceptor agonists is limited by reciprocal engagement of inhibitory endothelial mechanisms via myoendothelial feedback. In the current model of feedback, agonist stimulation of smooth muscle cells results in localized InsP₃­dependent Ca²⁺ transients that activate endothelial IK_Ca channels. The subsequent hyperpolarization of the endothelial membrane potential then feeds back to the smooth muscle to limit further reductions in vessel diameter. We hypothesized that the functional contribution of InsP₃/IK_Ca channel-mediated myoendothelial feedback to limiting arterial diameter may be influenced by the nature of the vasoconstrictor stimulus. To test this hypothesis, we investigated the functional role of myoendothelial feedback in modulating responses of rat mesenteric resistance arteries to the adrenoceptor agonist noradrenaline, the thromboxane A₂ mimetic U46619, increases in intravascular pressure and stimulation of perivascular sympathetic nerves. In isolated arteries, responses to noradrenaline and stimulation of sympathetic nerves, but not to U46619 and increases in intravascular pressure, were modulated by IK_Ca channel-dependent myoendothelial feedback. In the intact mesenteric bed perfused under conditions of constant flow, responses to exogenous noradrenaline were modulated by myoendothelial feedback but, shear stress-induced release of NO and activation of endothelial SK_Ca channels appeared to be the primary mediators of endothelial modulation of vasoconstriction to agonists and nerve stimulation. Thus, we propose that myoendothelial feedback may contribute to local control of diameter within arterial segments, but at the level of the intact vascular bed, increases in shear stress may be the major stimulus for engagement of the endothelium during vasoconstriction.

This article is protected by copyright. All rights reserved

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Maternal Care Providers’ Barriers Regarding Influenza and Pertussis Vaccination During Pregnancy in Catalonia, Spain

Abstract

Objective Maternal care providers (MCPs), obstetrician-gynaecologists and midwives are uniquely placed to increase maternal vaccination acceptance. We aimed to assess their knowledge, attitudes and practices regarding influenza and pertussis vaccination during pregnancy. Methods We conducted an online survey among MCPs working at "Attention to Sexual and Reproductive Health" (ASSIR) Units in Catalonia region. The survey included questions about current recommendations of influenza and pertussis immunization during pregnancy, reasons for not routinely recommending vaccination and several strategies to increase vaccination uptake. Results A total of 194 MCPs completed the survey, 178 (91.8%) were female and 145 (70%) were midwives. Only 61 (31.4%) stated they vaccinated themselves annually against influenza with a significant lower uptake among midwives (26.9%) than obstetrician-gynaecologists (44.9%) (p = 0.03). Overall, 53.6% of MCPs knew influenza vaccine was indicated during first trimester but only 43.3% stated they prescribed it. Almost all MCPs (98.5%) knew pertussis vaccine was recommended and 97.4% stated they prescribed it. The most important vaccination barrier found was the concern related to vaccine adverse events (25.9%) and more midwives than obstetrician-gynaecologists expressed this concern (30.8 vs. 10%) (p = 0.02). The most popular strategies were: including vaccine recommendations in the pregnancy booklet (93.8%) and receiving vaccination training (92.3%). In the adjusted analysis, the only factor significantly associated with MCPs' prescription of influenza vaccine during second/third trimester was having been vaccinated themselves (odds ratio 3.70, 95% confidence interval 1.3–13.2). Conclusions for Practice Implementation of practical tools, continuous training and clear definition of responsibilities regarding vaccination among MCPs may have a significant impact on maternal vaccination coverage.

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Motivating Smoking Cessation Text Messages: Perspectives from Pregnant Smokers

Abstract

Objectives

The purpose of this research is to analyze cessation text-messages written by pregnant smokers to elucidate the target population's preferred content and message attributes. To achieve this goal, the objectives of this study are three-fold; to qualitatively code messages written by pregnant smokers for frame, type of appeal, and intended target.

Methods

Study participants were recruited as part of a larger trial of pregnant smokers who were enrolled in a text-messaging program or control group and surveyed 1 month post-enrollment. Each participant was asked to write a brief message to another pregnant smoker and two independent coders qualitatively analyzed responses.

Results

User generated messages (N = 51) were equally loss and gain framed, and the most common appeals were: fear, guilt, cognitive, hope and empathy, in order of most to least frequent. The target of the majority of the messages was the baby.

Conclusions for Practice

Allowing pregnant smokers to write cessation text-messages for other pregnant women can provide relevant insight into intervention content. Specifically, pregnant smokers appear to equally promote gain and loss frames, but may prefer messages that include components of fear and guilt related to the impact of smoking on their baby. Additional research is needed to systematically uncover perspectives of pregnant smokers to ensure interventions are optimally effective.

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Implementation of Steps 1–9 to Successful Breastfeeding Reduces the Frequency of Mild and Severe Episodes of Diarrhea and Respiratory Tract Infection Among 0–6 Month Infants in Democratic Republic of Congo

Abstract

Introduction

Global initiatives to improve breastfeeding practices have focused on the Ten Steps to Successful Breastfeeding. The aim of this study was to assess the effect of implementing Baby-Friendly Hospital Initiative (BFHI) steps 1–9 and BFHI steps 1–10 on incidence of diarrhea and respiratory illnesses in the first 6 months of life.

Methods

We reanalyzed a cluster randomized trial in which health-care clinics in Kinshasa, Democratic Republic of Congo, were randomly assigned to standard care (control group), BFHI steps 1–9, or BFHI steps 1–10. Outcomes included episodes of diarrhea and respiratory illness. Piecewise Poisson regression with generalized estimation equations to account for clustering by clinic was used to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI).

Results

Steps 1–9 was associated with a decreased incidence of reported diarrhea (IRR 0.72, 95% CI 0.53, 0.99) and respiratory illness (IRR 0.48, 95% CI 0.37, 0.63), health facility visits due to diarrhea (IRR 0.60, 95% CI 0.42, 0.85) and respiratory illness (IRR 0.47, 95% CI 0.36, 0.63), and hospitalizations due to diarrhea (IRR 0.42, 95% CI 0.17, 1.06) and respiratory illness (IRR 0.33, 95% CI 0.11, 0.98). Addition of Step 10 attenuated this effect: episodes of reported diarrhea (IRR 1.24, 95% CI 0.93, 1.68) and respiratory illness (IRR 0.77, 95% CI 0.60, 0.99), health facility visits due to diarrhea (IRR 0.76, 95% CI 0.54, 1.08) and respiratory illness (IRR 0.75 95% CI 0.57, 0.97), and hospitalizations due to respiratory illness (IRR 0.48 95% CI 0.16, 1.40); but strengthened the effect against hospitalizations due to diarrhea (IRR 0.14, 95% CI 0.03, 0.60).

Conclusions

Implementation of steps 1–9 significantly reduced incidence of mild and severe episodes of diarrhea and respiratory infection in the first 6 months of life, addition of step 10 appeared to lessen this effect.

Trial Registration

NCT01428232.

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Integrating Obstetrical Care and WIC Nutritional Services to Address Maternal Obesity and Postpartum Weight Retention

Abstract

Objective

This pilot study evaluated a cost neutral, integrated Special Supplemental Nutrition Program for Women Infants and Children (WIC) and obstetrical service model designed to prevent postpartum weight retention in obese women.

Methods

A sample of women who received benefits from the Johns Hopkins (JH) WIC program and prenatal care from the JH Nutrition in Pregnancy Clinic, which provides obstetrical care for women with a BMI ≥ 30 kg/m², participated in the WICNIP randomized clinical trial. Intervention participants received enhanced nutrition services and education at five visits and during one phone call between delivery and 6 months postpartum. Control participants received standard WIC services. Weight data was collected for all participants at multiple time points: pre-pregnancy, delivery, and postpartum at 4, 6 weeks, 4, and 6 months. Maternal socio-demographic factors, obesity class and the number of education contacts received were also recorded.

Results

Fifty-three African-American women were randomized into the intervention and control groups. Intervention participants retained significantly less gestational weight gain than control participants (3.0 ± 11.8 vs. 12.6 ± 20.4, p < 0.05). In both groups, participants with Class III obesity retained significantly less weight than participants in Classes I and II (p = 0.02).

Conclusions for Practice

An integrated WIC and obstetrical service model is feasible and can limit postpartum weight retention in obese women. Weight retention at 6 months postpartum between intervention and control participants was statistically significant. Further research should explore targeted interventions by obesity class to address weight retention for low-income, African American women who participate in WIC.

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Evaluation of Hepatitis B Virus Screening, Vaccination, and Linkage to Care Among Newly Arrived Refugees in Four States, 2009–2011

Abstract

Many U.S.-bound refugees originate from countries with intermediate or high hepatitis B virus (HBV) infection prevalence and have risk for severe liver disease. We evaluated HBV screening and vaccination of newly arrived refugees in four states to identify program improvement opportunities. Data on HBV testing at domestic health assessments (1/1/2009–12/31/2011) were abstracted from state refugee health surveillance systems. Logistic regression identified correlates of infection. Over 95% of adults aged ≥19 years (N = 24,647) and 50% of children (N = 12,249) were tested. Among 32,107 refugees with valid results, the overall infection prevalence was 2.9% (0.76–9.25%); HBV prevalence reflected the burden in birth countries. Birth in the Western Pacific region carried the greatest infection risk (adjusted prevalence ratio = 4.8, CI 2.9, 7.9). Care linkage for infection was unconfirmed. Of 7409 susceptible persons, 38% received 3 doses of hepatitis B vaccine. Testing children, documenting care linkage, and completing 3-dose vaccine series were opportunities for improvement.

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Safety and efficacy of peri-operative administration of hydroxyethyl starch in children undergoing surgery: A systematic review and meta-analysis

BACKGROUND Hydroxyethyl starch (HES) solutions have shown their efficiency for intravascular volume expansion. However, a safety recommendation limiting their use in adult patients has recently been made. The aim of this meta-analysis was to assess the efficacy and adverse effects of HES when administered intra-operatively to paediatric patients. METHODS A search was performed for randomised controlled trials (RCTs) published before December 2016 involving paediatric patients who received 6% low molecular weight HES. Reviewers extracted valid data, including peri-operative total fluid intakes, mortality, renal function, coagulation tests, blood loss and length of hospital and ICU stay. All data were analysed using classical mean differences [and their 95% confidence intervals (CIs)] and trial sequential analysis. A Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification was performed for all outcomes. RESULTS Nine RCTs involving 530 peri-operative paediatric patients were analysed. Compared with other fluids, HES did not significantly modify the amount of peri-operative fluid administered [mean difference 0.04; 95% CI (−1.76 to 1.84) ml kg−1], urine output [mean difference −33; 95% CI (−104 to 38) ml kg−1] or blood loss [mean difference −0.09; (−0.32 to 0.15) ml kg−1]. Trial sequential analysis determined that the outcomes for peri-operative fluid and urine output were underpowered. Finally, all results were graded as very low quality of evidence. CONCLUSION Intravascular volume expansion with low molecular weight 6% HES did not appear to modify renal function, blood loss or transfusion when administered to children during the peri-operative period. However, given the lack of statistical power and the very low GRADE quality of evidence, more high-quality RCTs are needed to explore these outcomes. Correspondence to Prof. Gilles Orliaguet, MD, PhD, Service d'Anesthésie Réanimation, Hôpital Universitaire Necker-Enfants Malades, 149 rue de Sèvres, Paris 75743, France Tel: +33 144494458; fax: +33 144494170; e-mail: gilles.orliaguet@aphp.fr Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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Patient factors and outcomes associated with the withdrawal or withholding of life-sustaining therapies in mechanically ventilated brain-injured patients: An observational multicentre study

BACKGROUND Knowledge of the factors associated with the decision to withdraw or withhold life support (WWLS) in brain-injured patients is limited. However, most deaths in these patients may involve such a decision. OBJECTIVES To identify factors associated with the decision to WWLS in brain-injured patients requiring mechanical ventilation who survive the first 24 h in the ICU, and to analyse the outcomes and time to death. DESIGN A retrospective observational multicentre study. SETTINGS Twenty French ICUs in 18 university hospitals. PATIENTS A total of 793 mechanically ventilated brain-injured adult patients. INTERVENTIONS None. MAIN OUTCOME MEASURES Decision to WWLS within 3 months of ICU admission, and death or Glasgow Outcome Scale (GOS) score at day 90. RESULTS A decision to WWLS was made in 171 patients (22%), of whom 89% were dead at day 90. Out of the 247 deaths recorded at day 90, 153 (62%) were observed after a decision to WWLS. The median time between admission and death when a decision to WWLS was made was 10 (5 to 20) days vs. 10 (5 to 26) days when no end-of-life decision was made (P 

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Robust identification of mosaic variants in congenital heart disease

Abstract

Mosaicism due to somatic mutations can cause multiple diseases including cancer, developmental and overgrowth syndromes, neurodevelopmental disorders, autoinflammatory diseases, and atrial fibrillation. With the increased use of next generation sequencing technology, multiple tools have been developed to identify low-frequency variants, specifically from matched tumor-normal tissues in cancer studies. To investigate whether mosaic variants are implicated in congenital heart disease (CHD), we developed a pipeline using the cancer somatic variant caller MuTect to identify mosaic variants in whole-exome sequencing (WES) data from a cohort of parent/affected child trios (n = 715) and a cohort of healthy individuals (n = 416). This is a novel application of the somatic variant caller designed for cancer to WES trio data. We identified two cases with mosaic KMT2D mutations that are likely pathogenic for CHD, but conclude that, overall, mosaicism detectable in peripheral blood or saliva does not account for a significant portion of CHD etiology.

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