Publication date: Available online 10 March 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Kimberly J. Waddell, Catherine E. Lang
ObjectiveTo compare self-reported with sensor-measured upper limb (UL) performance in daily life for individuals with chronic (≥6mo) UL paresis poststroke.DesignSecondary analysis of participants enrolled in a phase II randomized, parallel, dose-response UL movement trial. This analysis compared the accuracy and consistency between self-reported UL performance and sensor-measured UL performance at baseline and immediately post an 8-week intensive UL task-specific intervention.SettingOutpatient rehabilitation.ParticipantsCommunity-dwelling individuals with chronic (≥6mo) UL paresis poststroke (N=64).InterventionsNot applicable.Main Outcome MeasuresMotor Activity Log amount of use scale and the sensor-derived use ratio from wrist-worn accelerometers.ResultsThere was a high degree of variability between self-reported UL performance and the sensor-derived use ratio. Using sensor-based values as a reference, 3 distinct categories were identified: accurate reporters (reporting difference ±0.1), overreporters (difference >0.1), and underreporters (difference <−0.1). Five of 64 participants accurately self-reported UL performance at baseline and postintervention. Over half of participants (52%) switched categories from pre-to postintervention (eg, moved from underreporting preintervention to overreporting postintervention). For the consistent reporters, no participant characteristics were found to influence whether someone over- or underreported performance compared with sensor-based assessment.ConclusionsParticipants did not consistently or accurately self-report UL performance when compared with the sensor-derived use ratio. Although self-report and sensor-based assessments are moderately associated and appear similar conceptually, these results suggest self-reported UL performance is often not consistent with sensor-measured performance and the measures cannot be used interchangeably.
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Σάββατο 10 Μαρτίου 2018
Comparison of Self-Report Versus Sensor-Based Methods for Measuring the Amount of Upper Limb Activity Outside the Clinic
Extreme delta - with or without brushes: a potential surrogate marker of disease activity in anti-NMDA-receptor encephalitis
NMDARE is a treatable antibody-mediated neurological syndrome resulting in neuropsychiatric disturbances and seizures, which may evolve to severe encephalopathy, autonomic disturbance and orofacial dyskinesias (Dalmau et al. 2011). Clinical seizures are seen in 80% of cases (Dalmau et al. 2011) and EEG abnormalities in 90% (Titulaer et al. 2013), of which the potentially specific EEG pattern of "extreme delta brush" may carry worse prognosis (Schmitt et al. 2012) and may be associated with electrographic seizures (Veciana et al.
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Long Term Electroencephalography in Preterm Neonates: Safety and Quality of Electrode Types
Seizures in preterm neonates have been reported with an incidence ranging between 3.9%-48% (Hellstrom-Westas et al., 1985; Scher et al., 1993; Vesoulis et al., 2014; Lloyd et al., 2017). Seizure incidence varies with the EEG modality utilized- amplitude-integrated EEG (aEEG) versus conventional EEG. Early life seizures in sick premature neonates portend both poor short and long term outcomes. Seizures in extremely low birth weight neonates were associated with short term morbidities such as severe intraventricular hemorrhage, sepsis, meningitis and cystic periventricular leukomalacia (Davis et al., 2010).
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Identification of novel mutations in FFPE lung adenocarcinomas using DEPArray sorting technology and next-generation sequencing
Abstract
Formalin-fixed paraffin-embedded (FFPE) tissues are utilized as the standard diagnostic method in pathology laboratories. However, admixture of unwanted tissues and shortage of normal samples, which can be used to detect somatic mutation, are considered critical factors to accurately diagnose cancer. To explore these challenges, we sorted the pure tumor cells from 22 FFPE lung adenocarcinoma tissues via Di-Electro-Phoretic Array (DEPArray) technology, a new cell sorting technology, and analyzed the variants with next-generation sequencing (NGS) for the most accurate analysis. The allele frequencies of the all gene mutations were improved by 1.2 times in cells sorted via DEPArray (tumor suppressor genes, 1.3–10.1 times; oncogenes, 1.3–2.6 times). We identified 16 novel mutations using the sequencing from sorted cells via DEPArray technology, compared to detecting 4 novel mutation by the sequencing from unsorted cells. Using this analysis, we also revealed that five genes (TP53, EGFR, PTEN, RB1, KRAS, and CTNNB1) were somatically mutated in multiple homogeneous lung adenocarcinomas. Together, we sorted pure tumor cells from 22 FFPE lung adenocarcinomas by DEPArray technology and identified 16 novel somatic mutations. We also established the precise genomic landscape for more accurate diagnosis in 22 lung adenocarcinomas with mutations detected in pure tumor cells. The results obtained in this study could offer new avenues for the treatment and the diagnosis of squamous cell lung cancers.
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Single-center ventral hernia repair with porcine dermis collagen implant
Abstract
Introduction
This study aims to evaluate the outcomes and utilization of porcine acellular dermal collagen implant (PADCI) during VHR at a large tertiary referral center.
Methods
Records of 5485 patients who underwent VIHR from June 1995 to August 2014 were retrospectively reviewed to identify patients >18 years of age who had VIHR with PADCI reinforcement. Use of multiple mesh reinforcement products, inguinal hernias, and hiatal hernias were exclusion criteria. The primary outcome was hernia recurrence, and secondary outcomes were early complications and surgical site occurrences (SSOs). Uni- and multivariate analyses assessed risk factors for recurrence after PADCI reinforced VIHR.
Results
There were 361 patients identified (54.5% female, mean age of 56.7 ± 12.5 years, and mean body mass index (BMI) of 33.0 ± 9.9 kg/m2). Hypertension (49.5%), diabetes (24.3%), and coronary artery disease (14.4%) were the most common comorbidities, as was active smoking (20.7%). Most were classified as American Association of Anesthesiologists (ASA) Class 3 (61.7%). Hernias were distributed across all grades of the ventral hernia working group (VHWG) grading system: grade I 93 (25.7%), grade II 51 (14.1%), grade III 113 (31.3%), and grade IV 6 (1.6%). Most VIHR were performed from an open approach (96.1%), and were frequently combined with concomitant surgical procedures (47.9%). Early postoperative complications (first 30 days) were reported in 39.0%, with 71 being SSO. Of the 19.7% of patients with SSO, there were 31 who required procedural intervention. After a mean follow-up of 71.5 ± 20.5 months, hernia recurrence was documented in 34.9% of patients. Age and male gender were predictors of recurrence on multivariate analysis.
Conclusion
To the best of our knowledge, this is the largest retrospective single institutional study evaluating PADCI to date. Hernias repaired with PADCI were frequently in patients undergoing concomitant operations. Reinforcement with PADCI may be considered a temporary closure, with a relatively high recurrence rate, especially among patients who are older, male, and undergo multiple explorations in a short perioperative period.
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En bloc endoscopic mucosal resection is equally effective for sessile serrated polyps and conventional adenomas
Abstract
Background
Sessile serrated polyps (SSPs) are associated with higher rates of incomplete resection compared to conventional adenomas after traditional snare polypectomy. Outcomes after endoscopic mucosal resection (EMR) are less established. The aim of this study was to evaluate the rate of residual neoplasia at surveillance colonoscopy for SSPs compared to conventional adenomas ≥ 10 mm after en bloc EMR.
Methods
Retrospective cohort study of consecutive patients referred for EMR of a colonic lesion ≥ 10 mm from 2005 to 2013. Data on procedures, histopathology, and surveillance colonoscopies were recorded. The primary outcome was rate of macroscopically evident residual neoplasia at surveillance colonoscopy for SSPs compared to adenomas. Secondary outcomes included rate of neoplasia at the resection margin.
Results
283 consecutive patients with 293 polyps underwent en bloc EMR including 101 SSPs and 192 adenomas. Pathology commented on the lateral resection margins of the specimen in 235 cases (80%). Of these, neoplasia was noted at the resection margin in 29/64 SSPs (45.3%) compared to 65/171 adenomas (38.0%; P = .37). Surveillance data were available for 153 index lesions with a median interval of 13 months (interquartile range, 10.75–23.25 months). Ten resection sites (6.5%) were found to have residual neoplasia, including 2/52 SSPs (3.8%) and 8/101 adenomas (7.9%; P = .50). Of the cases with surveillance data 128/153 (84%) commented on the lateral margin of the resection specimen. Residual neoplasia was noted in 3/68 lesions (4.4%) with negative margins compared to 5/60 lesions (8.3%) with positive margins (P = .47).
Conclusions
En bloc EMR for colonic lesions ≥ 10 mm is associated with a 6.5% rate of macroscopic residual neoplasia. Although 45% of SSPs had neoplasia extending to the resection margin, rates of residual neoplasia at surveillance colonoscopy were low. These results suggest that when feasible en bloc EMR is a reasonable option to resect SSPs ≥ 10 mm.
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Effect of language experience on selective auditory attention: An event-related potential study
Publication date: Available online 9 March 2018
Source:International Journal of Psychophysiology
Author(s): Pia Rämä, Alina Leminen, Satu Koskenoja-Vainikka, Miika Leminen, Kimmo Alho, Teija Kujala
Dual language experience has typically been shown to improve various executive control functions. We investigated with event-related brain potentials (ERPs) recorded from early (natively) bilingual speakers and control participants whether it also affects auditory selective attention. We delivered to our participants two tone streams, one to the left and one to the right ear. Both streams consisted of standard tones and two types of infrequent deviant tones which had either an enhanced duration or intensity. The participants were instructed to attend either to the right or left stream and to detect longer-duration deviants in the attended stream. The results showed that the early bilinguals did not outperform the controls in target detection accuracy or speed. However, the late portion of the attention-related ERP modulation (the negative difference, Nd) was larger over the left hemisphere in the early bilinguals than in the controls, suggesting that the maintenance of selective attention or further processing of selectively attended sounds is enhanced in the bilinguals. Moreover, the late reorienting negativity (RON) in response to intensity-deviant tones was larger in the bilinguals, suggesting more efficient disengagement of attention from distracting auditory events. Hence, our results demonstrate that brain responses associated with certain aspects of auditory attention are enhanced in the bilingual adults, indicating that early dual language exposure modulates the neuronal responsiveness of auditory modality.
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Integrin αVβ3 can substitute for collagen-binding β1-integrins in vivo to maintain a homeostatic interstitial fluid pressure
New Findings
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What is the central question of this study?
Collagen-binding β1-integrins function physiologically in cellular control of dermal interstitial fluid pressure (PIF) in vivo and thereby participate in control of extravascular fluid volume. During anaphylaxis, simulated by injection of Compound 48/80 integrin αVβ3 takes over this physiological function. Here we addressed the question whether integrin αVβ3 can replace collagen-binding β1-integrin to maintain a long-term homeostatic PIF.
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What is the main finding and its importance?
Mice lacking the collagen-binding integrin α11β1 show a complex dermal phenotype with regard to the interstitial physiology apparent in the control of PIF. Notably dermal PIF is not lowered with Compound 48/80 in these animals. Our present data infer the integrin αVβ3 to be the likely candidate that has taken over the role of collagen-binding β1-integrins for maintaining a steady-state homeostatic PIF. A better understanding of molecular processes involved in control of PIF is instrumental for establishing novel treatment regimens for control of edema formation in anaphylaxis and septic shock.
Abstract
Accumulated data indicate that cell-mediated contraction of reconstituted collagenous gels in vitro can serve as a model for cell-mediated control of interstitial fluid pressure (PIF) in vivo. A central role for collagen-binding β1-integrins in both processes has been established. Furthermore, integrin αVβ3 takes over the role of collagen-binding β1-integrins in mediating contraction after perturbations of collagen-binding β1-integrins in vitro. Integrin αVβ3 is also instrumental for normalization of dermal PIF that has been lowered due to mast cell degranulation with Compound 48/80 (C48/80) in vivo. Here we demonstrate a role of integrin αVβ3 in maintaining a long term homeostatic dermal PIF in mice lacking the collagen-binding integrin α11β1 (α11−/- mice). Measurements of PIF were performed after circulatory arrest. Furthermore, cell-mediated integrin αVβ3-directed contraction of collagenous gels in vitro depends on free access of a collagen-site known to bind several ECM proteins that form substrates for αVβ3-directed cell attachment, such as fibronectin and fibrin. A streptococcal collagen-binding protein, CNE, specifically binds to and block this site on the collagen triple helix. Here we show that whereas CNE perturbed αVβ3-directed and PDGF-BB induced normalization of dermal PIF after C48/80 it did not affect αVβ3-dependent maintenance of a homeostatic dermal PIF. These data imply that dynamic modifications of the ECM structure is needed during acute patho-physiologic modulations of PIF but not for long-term maintenance of a homeostatic PIF. Our data thus show that collagen-binding β1-integrins, integrin αVβ3 and ECM-structure are potential targets for novel therapy aimed to modulate edema formation and hypovolemic shock during anaphylaxis.
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Anaphylactic hypotension causes renal and adrenal sympathoexcitaion and induces c-fos in the hypothalamus and medulla oblongata
New Findings
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What is the central question of this study?
Whether anaphylaxis affects sympathetic outflows to the brown adipose tissue (BAT) and adrenal grand is not known. Moreover, it is unknown whether anaphylaxis affects some brain areas in association with sympathetic regulation.
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What is the main finding and its importance?
We showed that sympathoexcitatory responses to anaphylaxis regionally occurred in the kidney and adrenal grand, but not in the thermogenesis-related BAT. Further, anaphylactic hypotension also caused increase in c-fos immunoreactivity in the hypothalamic and medullary areas. Moreover, catecholaminergic neurons of the brain stem causes adrenal sympathoexcitation in a baroreceptor-independent manner.
Abstract
We previously reported that sympathetic nerve activity (SNA) to the kidney and the hind limb increases during anaphylactic hypotension in anesthetized rats. Based on this evidence, we examined effects of anaphylactic hypotension on SNA to the brown adipose tissue (BAT), and the adrenal gland and kidney in anesthetized rats. We demonstrated that adrenal and renal SNA, but not BAT-SNA, were stimulated. In addition, the effects of anaphylaxis on neural activities of the hypothalamic and medullary nuclei, which are candidates for relaying efferent SNA to the peripheral organs, were investigated via immunohistochemical staining of c-fos. Anaphylaxis increased c-fos expression in the neurons of the paraventricular nucleus (PVN) of the hypothalamus and in those of the nucleus tractus solitarius (NTS) and rostral ventrolateral medulla (RVLM) of the medulla oblongata; c-fos was expressed in gamma-aminobutyric acid (GABA)-ergic neurons of the NTS and in the catecholaminergic neurons of the RVLM. In addition, c-fos expression in the rostral NTS and mid NTS during anaphylaxis were reduced by sinoaortic baroreceptor denervation, however increased c-fos expression in the caudal NTS and RVLM or adrenal sympathoexcitation were not affected by sinoaortic baroreceptor denervation. These results indicated that anaphylactic hypotension activates the hypothalamic PVN, and the medullary NTS and RVLM, independently of the baroreflex pathway. Further, it stimulated efferent SNA to the adrenal grand and kidney to restore blood pressure.
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Electroencephalographic correlates of low-frequency vagus nerve stimulation therapy for Crohn’s disease
Source:Clinical Neurophysiology
Author(s): Astrid Kibleur, Sonia Pellissier, Valérie Sinniger, Jade Robert, Eloise Gronlier, Didier Clarençon, Laurent Vercueil, Dominique Hoffmann, Bruno Bonaz, Olivier David
ObjectivesIn the context of the first clinical trial of vagus nerve stimulation (VNS) in Crohn's disease (CD), our main objective was to quantify the acute and chronic effects of VNS on brain activity in CD patients.MethodsWe measured the electroencephalogram (EEG) in 9 CD patients under VNS at 10 Hz just before VNS initiation, after 6 weeks and after 12 months of chronic VNS.ResultsAcute VNS induced increased spectral power in delta and theta bands on frontal, temporal and occipital electrodes. The main significant modulation was the 12 months' chronic effect of VNS which consisted mainly in a decreased power in the alpha frequency band which was correlated with the normalization of bowel mucosal inflammation, anxiety state and vagal tone.ConclusionsIn addition to the activation of vagal efferent fibers that regulate the autonomic nervous system, our data suggest that chronic VNS has a regulatory action via afferent vagal fibers on anxio-depressive symptomatology associated to CD, which could be directly highlighted by the modulation of EEG alpha power known to be associated to depressed states.SignificanceThis is the first report of the central effects of VNS in CD patients.
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Systemic effects of deep brain stimulation on synergic control in Parkinson’s disease
Source:Clinical Neurophysiology
Author(s): Ali Falaki, Hang Jin Jo, Mechelle M. Lewis, Barbara O'Connell, Sol De Jesus, James McInerney, Xuemei Huang, Mark L. Latash
ObjectiveWe explored effects of deep brain stimulation (DBS) in patients with Parkinson's disease (PD) on the synergic control of fingers in a multi-finger force production task and of muscles in a task involving vertical posture.MethodsThe finger task involved the four fingers of a hand producing accurate total force followed by a targeted quick force pulse. The postural task involved releasing a load from extended arms. The analysis of synergies was performed within the framework of the uncontrolled manifold hypothesis.ResultsDBS led to no significant changes in indices of stability during steady-state phases. In contrast, DBS improved indices of agility, quantified as anticipatory synergy adjustments that reduced stability of salient performance variables in preparation to their quick change. There were moderate-to-strong correlations between indices of both stability and agility measured in the multi-finger force production and multi-muscle whole-body action.ConclusionsOur results point at systemic changes in synergic control in PD. They show that DBS is effective in improving only one components of synergic control related to agility in performance being relatively ineffective for the stability component.SignificanceThe results show systemic brain mechanisms of synergies and suggest differential effects of DBS on indices of stability and agility.
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Emotion identification and aging: Behavioral and neural age-related changes
Source:Clinical Neurophysiology
Author(s): Ana R. Gonçalves, Carina Fernandes, Rita Pasion, Fernando Ferreira-Santos, Fernando Barbosa, João Marques-Teixeira
ObjectiveAging is known to alter the processing of facial expressions of emotion (FEE), however the impact of this alteration is less clear. Additionally, there is little information about the temporal dynamics of the neural processing of facial affect.MethodsWe examined behavioral and neural age-related changes in the identification of FEE using event-related potentials. Furthermore, we analyze the relationship between behavioral/neural responses and neuropsychological functioning. To this purpose, 30 younger adults, 29 middle-aged adults and 26 older adults identified FEE.ResultsThe behavioral results showed a similar performance between groups. The neural results showed no significant differences between groups for the P100 component and an increased N170 amplitude in the older group. Furthermore, a pattern of asymmetric activation was evident in the N170 component. Results also suggest deficits in facial feature decoding abilities, reflected by a reduced N250 amplitude in older adults. Neuropsychological functioning predicts P100 modulation, but does not seem to influence emotion identification ability.ConclusionsThe findings suggest the existence of a compensatory function that would explain the age-equivalent performance in emotion identification.SignificanceThe study may help future research addressing behavioral and neural processes involved on processing of FEE in neurodegenerative conditions.
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Moving functional classification of dorsal horn neurons from art to science
Abstract
In this issue of the Journal of Physiology, Balachandar and Prescott (2018) model the action potential discharge patterns (ie, spiking types) that have long been used to classify superficial dorsal horn (SDH: lamina I-II) neurons by varying the expression levels of two potassium conductances.
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Transformation of a Pediatric Primary Care Waiting Room: Creating a Bridge to Community Resources
Abstract
Introduction Children and families living in poverty frequently encounter social risks that significantly affect their health and well-being. Physicians' near universal access to at-risk children and their parents presents opportunities to address social risks, but time constraints frequently interfere. We sought to redesign our waiting room to create a clinic-to-community bridge and evaluate the impact of that redesign on family-centered outcomes. Methods We conducted a pre-post study of a waiting room redesign at a large, academic pediatric primary care center. Design experts sought input about an optimal waiting room from families, community partners and medical providers. Family caregivers were surveyed before and after redesign regarding perceived availability of help with social needs and access to community resources, and hospitality and feelings of stress. Pre-post differences were assessed using the Chi square or Wilcoxon rank sum test. Results The key redesign concepts that emerged included linkages to community organizations, a welcoming environment, and positive distractions for children. A total of 313 caregiver surveys were completed (pre-160; post-153). Compared to pre-redesign, caregivers surveyed post-redesign were significantly more likely to perceive the waiting room as a place to obtain help connecting to community resources and find information about clinical and educational resources (both p < 0.05). Families were also significantly more likely to report the waiting room as more welcoming and relaxing, with sufficient privacy and space (all p < 0.05). Discussion Waiting rooms, typically a place of wasted time and space, can be redesigned to enhance families' engagement and connection to community resources.
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Perceived Need for Treatment and Engagement in Mental Health Services Among Community-Referred Racial/Ethnic Minority Adolescents
Abstract
This study examines clinical and family predictors of perceived need for treatment and engagement in mental health treatment services among community-referred racial/ethnic minority adolescents and their primary caregivers. Findings indicated that the majority of families perceived a need for treatment, but that perceived need was not associated with treatment engagement. Family factors (i.e., low cohesion and high conflict within the family) predicted perceived need for treatment among adolescents, whereas clinical factors (i.e., adolescent internalizing and externalizing symptomatology) predicted caregiver perceived need for adolescent treatment. Neither clinical nor family factors predicted treatment engagement.
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