Delayed high-frequency suppression after automated single-pulse electrical stimulation identifies the seizure onset zone in patients with refractory epilepsy

Publication date: Available online 4 July 2018
Source:Clinical Neurophysiology
Author(s): Tyler S. Davis, John D. Rolston, Robert J. Bollo, Paul A. House
ObjectiveSingle-pulse electrical stimulation (SPES) of intracranial electrodes evokes responses that may help identify the seizure onset zone (SOZ); however, lack of automation and response variability has limited clinical adoption of this technique. We evaluated whether automated delivery of low-current SPES could evoke delayed high-frequency suppression (DHFS) of ongoing electrocorticography (ECoG) signals that, when combined with objective analytic techniques, may provide a reliable marker of this zone.MethodsLow-current SPES (1-ms, 3.5-mA biphasic pulses) was delivered to 652 electrodes across 10 patients undergoing ECoG for seizure focus localization. DHFS was measured by calculating the normalized trial-averaged time-frequency power (70-250 Hz) 0.4-1 sec post-stimulation. Electrodes that evoked suppression when stimulated or recorded suppression when stimulation was nearby were used to estimate the SOZ.ResultsThe estimated SOZ significantly identified the clinical SOZ in 6 of 10 patients (5 of 7 temporal foci) with a false-positive rate of 0-0.06. Stimulation required <2 hours, was undetectable by patients, and did not induce seizures or after-discharges.ConclusionsWe show that DHFS provides accurate estimates of the clinical SOZ in patients with refractory epilepsy.SignificanceThis approach may increase the safety, speed, and reproducibility of SOZ identification while reducing cost, subjectivity, and patient discomfort.



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Behavioral and electrophysiological evidence for GABAergic modulation through transcutaneous vagus nerve stimulation

Publication date: September 2018
Source:Clinical Neurophysiology, Volume 129, Issue 9
Author(s): Marius Keute, Philipp Ruhnau, Hans-Jochen Heinze, Tino Zaehle
ObjectiveTranscutaneous vagus nerve stimulation (tVNS) has been hypothesized to modulate γ-aminobutyric (GABA) transmission in the human brain. GABA in the motor cortex is highly correlated to measures of automatic motor inhibition that can be obtained in simple response priming paradigms. To test the effects of tVNS on GABA transmission, we measured tVNS-induced alterations in behavioral and electrophysiology during automatic motor inhibition.MethodsParticipants were 16 young, healthy adults (8 female). We combined a subliminal response priming paradigm with tVNS and EEG measurement. In this paradigm, automatic motor inhibition leads to a reversal of the priming effect, a phenomenon referred to as the negative compatibility effect (NCE). We compute the NCE separated by response hands, hypothesizing a modulation of the left-hand NCE. Using EEG we measured readiness potentials, an established electrophysiological index of cortical motor preparation.ResultsAs hypothesized, for the ipsilateral hand/contralateral hemisphere, compared to sham stimulation, tVNS increased the NCE and modulated the electrophysiological readiness potentials.ConclusionOur results indicate that tVNS is selectively affecting the GABAergic system in the motor system contralateral to the stimulated ear as reflected in a behavioral and electrophysiological modulation.SignificanceWe provide first combined behavioral and electrophysiological evidence for direct GABAergic neuromodulation through tVNS.



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Doing it the other way round – mapping motor function by intrinsic activity

Publication date: Available online 5 July 2018
Source:Clinical Neurophysiology
Author(s): Johannes Sarnthein, Richard Wennberg




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Electrophysiological Evidence of an Attentional Bias towards Appetitive and Aversive Words in Adults with Attention-Deficit/Hyperactivity Disorder

Publication date: Available online 4 July 2018
Source:Clinical Neurophysiology
Author(s): Shushakova A., Wiesner C. D., Ohrmann P., Pedersen A.
ObjectiveEmotional dysregulation has emerged as a core symptom domain in adults with Attention-Deficit/Hyperactivity Disorder (ADHD). However, the pathophysiological underpinnings remain poorly understood. This study investigated attentional biases to positive and negative emotional words as possible contributing mechanisms.MethodsEvent-related potentials (ERPSs) and behavioral attention bias indices were recorded from 39 adult patients with ADHD and 41 healthy controls during a verbal dot-probe task with positive-neutral, negative-neutral, and neutral-neutral word pairs.ResultsCue-locked N2pc amplitudes indicated a significant attentional bias towards emotional words in patients with ADHD and healthy controls. In healthy controls, the bias was only significant in positive trials. In patients, the bias was associated with ADHD severity and self-reported poor emotion regulation skills. ADHD patients also exhibited reduced target-locked P1 amplitudes and inferior behavioral performance compared with healthy controls.ConclusionsOur findings provide evidence of an attention bias to positive and negative emotional stimuli in adult patients with ADHD and adverse effects of emotional stimuli on task performance.SignificanceAn attentional bias to emotional stimuli might contribute to emotional reactivity and dysregulation in adult patients with ADHD.



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Diagnostic accuracy of quantitative EEG to detect delayed cerebral ischemia after subarachnoid hemorrhage: A preliminary study

Publication date: Available online 5 July 2018
Source:Clinical Neurophysiology
Author(s): B. Balança, F. Dailler, S. Boulogne, T. Ritzenthaler, F. Gobert, S. Rheims, N. Andre-Obadia
ObjectiveDelayed cerebral ischemia (DCI) is the most important and preventable morbidity cause after subarachnoid hemorrhage (SAH). Therefore, DCI early detection is a major challenge. Yet, neurological examination can be unreliable in poor grade SAH patients. EEG provides information from most superficial cortical area, with ischemia-related changes. This study aims at defining an alpha-theta/delta (AT/D) ratio decrease thresholds to detect DCI.MethodsWe used EEG with a montage matching vascular territories (right and left anterior central and posterior) and compared them to follow-up brain imaging.Results15 SAH patients (Fischer≥3, World Federation of Neurological Surgeons scale ≥4, 9 DCI) were monitored during 6.4 [4-8] days (min=2d, max=13d). AT/D changes could follow three different patterns: (1) prolonged or (2) transient decrease and (3) no decrease or progressive increase. A regional 30% decrease outlasting 3.7h reached 100% sensitivity and 88.9% specificity to detect DCI. Only 22.6% were in a zone of uncertain diagnosis (3.7-8.04h). These prolonged decreases, with a loss of transient changes, started in cortical areas evolving toward DCI, and preceded intracranial changes when available.ConclusionAlthough this study has a small sample size, prolonged AT/D decrease seems to be a reliable biomarker of DCI.SignificancecEEG changes are likely to precede cerebral infarction and could be useful at the bedside to detect DCI before irreversible damage.



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Cervical dystonia: Normal auditory mismatch negativity and abnormal somatosensory mismatch negativity

Publication date: Available online 4 July 2018
Source:Clinical Neurophysiology
Author(s): Jui-Cheng Chen, Antonella Macerollo, Anna Sadnicka, Min-Kuei Lu, Chon-Haw Tsai, Prasad Korlipara, Kailash Bhatia, John C. Rothwell, Mark J. Edwards
ObjectivePrevious electrophysiological and psychophysical tests have suggested that somatosensory integration is abnormal in dystonia. Here, we hypothesised that this abnormality could relate to a more general deficit in pre-attentive error/deviant detection in patients with dystonia. We therefore tested patients with dystonia and healthy subjects using a mismatch negativity paradigm (MMN), where evoked potentials generated in response to a standard repeated stimulus are subtracted from the responses to a rare "odd ball" stimulus.MethodsWe assessed MMN for somatosensory and auditory stimuli in patients with cervical dystonia and healthy age matched controls.ResultsWe found a significant group∗oddball type interaction effect (F (1, 34) = 4.5, p = 0.04, ρI = 0.63). A follow up independent t-test for sMMN data, showed a smaller sMMN amplitude in dystonic patients compared to controls (mean difference control-dystonia: -1.0 µV ± 0.3, p < 0.00, t = -3.1). However the amplitude of aMMN did not differ between groups (mean difference control-dystonia: -0.2 µV ± 0.2, p = 0.24, t = -1.2). We found a positive correlation between somatosensory MMN and somatosensory temporal discrimination threshold.ConclusionThese results suggest that pre-attentive error/deviant detection, specifically in the somatosensory domain, is abnormal in dystonia. This could underlie some previously reported electrophysiological and psychophysical abnormalities of somatosensory integration in dystonia.SignificanceOne could hypothesize a deficit in pre-conscious orientation towards potentially salient signals might lead to a more conservative threshold for decision-making in dystonia.



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Forceps de-inversion converting a polyp into a diverticulum

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Endoscopic purse-string suturing with multiple over-the-scope clips for closure of a large mucosal defect after duodenal endoscopic submucosal dissection

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Electrophysiological Evidence of an Attentional Bias towards Appetitive and Aversive Words in Adults with Attention-Deficit/Hyperactivity Disorder

The emotional symptom domain of Attention-Deficit/Hyperactivity Disorder (ADHD) has received increasing attention in the past decade (see Shaw et al., 2014; Retz et al., 2012 for reviews). Moving beyond the traditionally studied symptom domains of hyperactivity, impulsivity, and inattention is particularly important, considering the findings of significant and independent impairments associated with emotion dysregulation (ED) in patients with ADHD (Barkley and Murphy, 2010; Bunford et al., 2014).

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Doing it the other way round – mapping motor function by intrinsic activity

The first neurosurgeons were already known for their aim to localize areas indispensable for motor function. Among them, Krause injected small currents in what became known as primary motor cortex (M1) and noted movements in specific parts of the body (Krause, 1908). Another great leap forward came as Penfield and Jasper laid the foundations for the sensorimotor homunculi, by which time technology had evolved with the advent of EEG so that cortical stimulation could be complemented by electrocorticography (ECoG) recordings of intrinsic brain activity.

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Diagnostic accuracy of quantitative EEG to detect delayed cerebral ischemia after subarachnoid hemorrhage: A preliminary study

Case fatality and morbidity of aneurysmal subarachnoid hemorrhage (SAH) decreased during the past decades (Nieuwkamp et al., 2009). Despite improvement of both its prevention (Pickard et al., 1989) and management strategies (Nieuwkamp et al., 2009; Connolly et al., 2012), delayed cerebral ischemia (DCI), which occurs between three to 21 days after bleeding (Charpentier et al., 1999), is the most important and preventable cause of SAH morbidity (Francoeur and Mayer, 2016). DCI pathophysiology is still debated and encompass proximal vasospasm, capillary vasospasm, and spreading depolarizations (Dreier, 2011; Francoeur and Mayer, 2016).

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Delayed high-frequency suppression after automated single-pulse electrical stimulation identifies the seizure onset zone in patients with refractory epilepsy

Twenty to thirty percent of patients with epilepsy are pharmacoresistent (Tonini et al. , 2004). Epilepsy surgery, in which the seizure focus is removed, is an option for some patients and leads to seizure freedom in ∼55-70% of temporal resections and 30-50% of neocortical resections (Tonini et al. , 2004). Many patients require surgical implantation of intracranial electrocorticography (ECoG) electrodes for seizure monitoring to estimate the seizure onset zone (SOZ). Because ECoG is invasive and involves prolonged hospitalization, some patients are hesitant to undergo the procedure, and some neurologists are reluctant to refer patients despite the possibility of seizure freedom.

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Cervical dystonia: Normal auditory mismatch negativity and abnormal somatosensory mismatch negativity

Dystonia is characterized by abnormal postures of the affected body part (Marsden, 1976). This motor dysfunction is the visible part of dystonia, but there is a significant body of evidence suggesting that failures in sensorimotor integration and pure sensory abnormalities

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The effects of error-augmentation versus error-reduction paradigms in robotic therapy to enhance upper extremity performance and recovery post-stroke: a systematic review

Despite upper extremity function playing a crucial role in maintaining one's independence in activities of daily living, upper extremity impairments remain one of the most prevalent post-stroke deficits. To en...

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Energetic Cost of Walking and its Physiological Correlates in Persons with Multiple Sclerosis who have Moderate Mobility Disability

Publication date: Available online 4 July 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Brenda Jeng, Brian M. Sandroff, Robert W. Motl
ObjectiveThis study examined aerobic capacity, upper leg muscular strength, and static postural control as correlates of the energetic cost of walking (Cw) in moderate MS mobility disability.DesignCross-sectional studySettingUniversity-based laboratoryParticipants44 persons with MS (aged 48.43±8.64 years) who have reached a benchmark of moderate mobility disability (i.e., Expanded Disability Status Scale scores between 4.0-6.0) participated in the study.Main Outcome MeasuresCw was based on (a) net oxygen consumption collected using a portable metabolic unit and (b) walking speed during the 6-Minute Walk (6MW). Participants underwent standard assessments of peak aerobic capacity, upper leg muscular strength, and static postural control.ResultsThe data were analyzed using bivariate correlation and linear regression analyses. Cw was inversely correlated with peak oxygen consumption (r=‒.308, p<0.05), peak power output (r=‒.548, p<0.00), and peak torque at 75° knee flexion (r=‒.340, p<0.05), whereas Cw was positively correlated COP area sway (r=0.319, p<0.05), and mediolateral sway velocity (r=.411, p<0.05). 40.3% of variance in Cw was explained by peak power output (β=‒.526, p<0.01) and mediolateral sway velocity (β=.339, p<0.05).ConclusionOur findings demonstrate that aerobic power and postural sway may be important correlates of Cw in moderate MS mobility disability. Peak power output reflects a person's physiological functional reserve that is directly relevant for understanding the penalty of walking impairment on the energetic demands of walking. The association between mediolateral postural sway and Cw suggests that mechanical inefficiency controlling the trajectory of the body's center of pressure during ambulation may contribute to the elevated Cw.



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Functional measures upon admission to acute inpatient rehabilitation predicts quality of life after ischemic stroke

Publication date: Available online 4 July 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Chen Lin, Mansi Katkar, Jungwha Lee, Elliot Roth, Richard L. Harvey, Shyam Prabhakaran
ObjectiveTo evaluate the association between functional measures at admission to acute inpatient rehabilitation (AIR) and HRQOL scores at 3 months after ischemic stroke.DesignConsecutive patients with ischemic stroke admitted to AIR were consented to a prospective registry.SettingLarge academic referral inpatient rehabilitation hospitalParticipantsOne-hundred thirteen patients with ischemic strokeInterventionsNAMain Outcome MeasuresAdmission Functional Independence Measure (FIM) and Berg Balance Scores (BBS) were abstracted when available. The Neuro-QOL questionnaire was used to assess 3-month HRQOL in 4 domains: upper extremity (UE), lower extremity (LE), executive functions (EF), and general concerns (GC). Associations of FIM and BBS scores with impaired HRQOL at 3 months were evaluated.ResultsOne-hundred thirteen patients (mean age 70.6 ± 14.5 years; 54.0% male; 56.6% Caucasian) were included in the analysis. The median time from stroke onset to admission FIM and BBS was 6.4 (IQR 4.2-11.3) and 8.9 (IQR 5.8-14.4) days, respectively. A 5-point increase in admission FIM score decreased the likelihood of impairment in HRQOL at 3 months by 25% for GC (OR 0.75, 95% CI 0.61-0.93, p=0.01), 31% for EF (OR 0.69, 95% CI 0.56-0.85, p=0.001), 16% for UE function (OR 0.84, 95% CI 0.73-0.96, p=0.01), and 21% for LE function (OR 0.79, 95% CI 0.67-0.93 p=0.004). A 5-point increase in admission BBS decreased the likelihood of impairment in HRQOL domains at 3 months by 15% for UE function (OR 0.85, 95% CI 0.75-0.98, p=0.02) and 25% for LE function (OR 0.75, 95% CI 0.64-0.89, p=0.001).ConclusionsAdmission FIM and BBS were strongly associated with 3-month HRQOL associated across multiple domains following stroke. These findings indicate that HRQOL can be predicted earlier in a patient's course during AIR.



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A Systematic Review and Meta-Analysis of Rehabilitative Interventions for Unilateral Spatial Neglect and Hemianopia from 2006 through 2016

Publication date: Available online 4 July 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Karen P.Y. Liu, Jessica Hanly, Paul Fahey, Shirley S.M. Fong, Rosalind Bye
ObjectiveTo evaluate the effectiveness of activity-based, non-activity-based, and combined activity- and non-activity-based, rehabilitative interventions for individuals presenting with unilateral spatial neglect (USN) and hemianopia.Data SourcesWe searched CINAHL, Cochrane Library, EMBASE, MEDLINE and PubMed from 2006 to 2016.Study SelectionRandomized controlled trials (RCTs), with a score of 6 or above in the PEDro Scale, that examined the effects of activity-based and non-activity-based rehabilitation interventions for people with USN or hemianopia. Two reviewers selected studies independently.Data ExtractionExtracted data from the published RCTs. Mean differences (MD) or Standardized mean differences (SMD), and 95% confidence intervals (CIs), were calculated. Heterogeneity was assessed using the I² statistic.aData SynthesisTwenty RCTs for USN and five for hemianopia, involving 594 and 206 stroke participants respectively, were identified. Encouraging results were found in relation to activity-based interventions for visual scanning training and compensatory training for hemianopia (MD=5.11; CI=0.83 to 9.4; P=0.019; I²=25.16% on visual outcomes), and optokinetic stimulation and smooth pursuit training for USN (SMD=0.49, CI=0.01 to 0.97, P=0.045, I²=49.35% on functional performance in activities of daily living; SMD=0.96; CI=0.09 to 1.82; P=0.031; I²=89.57% on neglect).ConclusionsActivity-based interventions are effective and commonly used in the treatment of USN and hemianopia. Non-activity-based and combined approaches, for both impairments, have not been refuted, as more studies are required for substantiated conclusions to be drawn.



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Inadequate Postoperative Energy Intake Relative to Total Energy Requirements Diminishes Acute Phase Functional Recovery from Hip Fracture

Publication date: Available online 4 July 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Tatsuro Inoue, Shogo Misu, Toshiaki Tanaka, Hiroki Sakamoto, Kentaro Iwata, Yuki Chuman, Rei Ono
ObjectiveTo investigate whether postoperative voluntary energy intake (EI) affects functional recovery with hip fracture during the acute phase.DesignProspective cohort study.SettingThree acute care hospitals.ParticipantsHip fracture patients (N = 200) who were consecutively admitted to 3 acute hospitals because of falling.InterventionsNot applicable.Main Outcome MeasurePatients were stratified into three groups based on the ratio of measured EI to estimated total energy expenditure (TEE) as inadequate (EI/TEE < 0.7), intermediate (0.7 ≤ EI/TEE < 1), and adequate (EI/TEE ≥ 1) groups. The functional status was evaluated using the motor domain of a functional independence measure (FIM). We calculated efficiency based on the motor FIM scores (change in postoperative motor FIM scores/length of the rehabilitation period) to assess the beneficial effect of rehabilitation.ResultsThe median hospital stay was 24 days. The inadequate group comprised 73 (36.5%) patients (median EI/TEE: 0.54; interquartile range: 0.42–0.64); intermediate group comprised 92 (46.0%) patients (median EI/TEE: 0.87; interquartile range: 0.78–0.94), and adequate group comprised 35 (17.5%) patients (median EI/TEE: 1.10; interquartile range: 1.04–1.15). Absolute functional gain (AFG) and efficiency of motor FIM gain (EFG) scores were higher in the adequate group than in the others (P < 0.01). After adjustment for potential confounders, a significant association between postoperative EI/TEE group and logarithm of EFG scores was observed to persist (inadequate group, standardized β = −0.14; reference: adequate group; P = 0.03; R² for the entire model = 0.25).ConclusionsPostoperative EI less than 70% of TEE diminishes functional recovery with hip fracture.



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Sense of Coherence, disability, and health-related quality of life: a cross-sectional study of rehabilitation patients in Norway

Publication date: Available online 4 July 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Vegard Pihl Moen, Geir Egil Eide, Jorunn Drageset, Sturla Gjesdal
ObjectiveTo study relationships between Sense of Coherence (SOC), disability and mental and physical components of health-related quality of life (HRQoL) among rehabilitation patients.DesignSurvey.SettingRehabilitation centers in secondary care.ParticipantsA total of 975 from the Western Norway Health Region consented to participate and had valid data of the main outcome measures.InterventionsNot applicableMain outcome measuresSOC was measured with the Sense of Coherence questionnaire (SOC-13), disability with the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), and HRQoL with the Short Form health survey (SF-36).ResultsMean scores (standard deviation) were 62.9 (12.3) for SOC-13, 30.8 (16.2) for WHODAS 2.0, 32.8 (9.6) for SF-36 physical component score and 43.6 (11.8) for SF-36 mental component score. Linear regression analysis showed that increased SOC score was associated with reduced disability scores in the following domains with estimated regression coefficients (95% confidence interval; CI) Cognition –0.20 (–0.32 to –0.08), Getting along –0.36 (–0.52 to –0.25), and Participation –0.23 (–0.36 to –0.11). The fit of two structural models with the association from SOC to HRQoL and disability or with disability as a mediator was better for the mental versus the physical component of HRQoL. High SOC increased the mental component of HRQoL, consistent for all diagnostic groups. For both models, good fit was reported for circulatory and less good fit for musculoskeletal diseases.ConclusionsThe results indicate that higher SOC decreases disability in mental domains. The effect of SOC on disability and HRQoL might vary between diagnostic groups. SOC could be a target in rehabilitation, especially among patients with circulatory diseases, but prospective studies are needed.



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Does home-based progressive resistance or high intensity circuit training improve strength, function, activity or participation in children with cerebral palsy?

Publication date: Available online 4 July 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Christian Schranz, Annika Kruse, Teresa Belohlavek, Gerhardt Steinwender, Markus Tilp, Thomas Pieber, Martin Svehlik
ObjectiveDoes home-based progressive resistance or high intensity circuit training improve strength, function, activity or participation in children with cerebral palsy?DesignThis was the first study on high intensity circuit training for children with cerebral palsy. This study was conducted as a randomized prospective controlled pilot-study.SettingEvaluation took place at the gait laboratory of the university hospital, training sessions were performed at home.Participants22 children with CP (average age:12 years, 10 months, 19 GMFCS I, 3 GMFCS II) were randomly assigned either to PRT or HICT.InterventionsThe PRT-group trained with progressive overload while the HICT-group performed as many repetitions as possible within 30s-intervals (8-weeks, 3 times weekly in both groups).Outcome measuresOutcome measures stretched over all domains of the International Classification of Functioning, Disability and Health and included muscle strength, Muscle power sprint test, Timed-stairs-test, 6-minute walking test, Gait Profile Score, Timed-up-and-go test and participation questionnaires.ResultsOnly the HICT-group was able to improve strength. Furthermore, HICT-group scored better in the Muscle power sprint test while PRT-participants improved in the timed-stairs-test and Timed-up-and-go test. There was no change of any other measures of mobility or participation for both groups.ConclusionBoth programs improved function specific to intervention. However, only HICT-group showed significant strength improvements. Compliance was decent in both groups, but the average training unit was shorter in the HICT-group. Both exercise programs showed functional benefits but HICT might be the preferable option for strengthening in highly functional children with CP.



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Extracorporeal Shock Waves versus Botulinum Toxin Type A in the Treatment of Post-Stroke Upper Limb Spasticity – A Randomized, Noninferiority Trial

Publication date: Available online 4 July 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Yah-Ting Wu, Hui-Kung Yu, Li-Ru Chen, Chih-Ning Chang, Yi-Min Chen, Gwo-Chi Hu
ObjectiveTo investigate whether extracorporeal shock wave therapy (ESWT) is noninferior to botulinum toxin type A (BoNT-A) for the treatment of post-stroke upper limb spasticity.DesignRandomized noninferiority trial.SettingReferral medical center.ParticipantsForty-two patients with chronic stroke (28 men; mean age, 61.0 ± 10.6 years).InterventionsPatients received either ESWT or BoNT-A. During the study period, all patients continued their regular rehabilitation.Main Outcome MeasuresAssessments were performed at baseline and at 1, 4, and 8 weeks after the intervention. The primary outcome was the change from baseline of the modified Ashworth scale (MAS) score of the wrist flexors at week 4. Secondary outcomes included the change of the MAS scores, Tardieu angles of the wrist and elbow flexors, wrist and elbow passive range of motion (PROM), and upper extremity Fugl-Meyer assessment (UE-FMA) score during the study period, as well as the treatment response rate.ResultsThe primary outcome result in the ESWT group (-0.80 ± 0.41) was similar to that in the BoNT-A group (-0.90 ± 0.44), with a higher confidence limit (0.4) for the difference between groups within the prespecified margin of 0.5, indicating the noninferiority of ESWT to BoNT-A. The response rate was not significantly different between the 2 groups. Both groups showed significant improvement in secondary outcomes relative to baseline; however, the ESWT group yielded greater improvement in wrist and elbow PROM and UE-FMA score.ConclusionOur results suggest that ESWT is a noninferior treatment alternative to BoNT-A for post-stroke upper limb spasticity. ESWT and BoNT-A caused similar reduction in spasticity of the wrist and elbow flexors; however, ESWT yielded greater improvement in wrist and elbow PROM and UE-FMA score.



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The Effects of Neck-Specific Training versus Prescribed Physical Activity on Pain and Disability in Patients with Cervical Radiculopathy: A Randomized Clinical Trial

Publication date: Available online 4 July 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Åsa Dedering, Anneli Peolsson, Joshua A. Cleland, Marie Halvorsen, Mikael Svensson, Marie Kierkegaard
ObjectiveTo compare the effects of a neck-specific training program to prescribed physical activity with both groups receiving a cognitive behavioral approach, on pain and disability in patients with cervical radiculopathy (CR).DesignParallel-group randomized clinical trial with follow-up at 3, 6, 12 and 24 months.SettingRecruitment and assessments of participants were performed at a university hospital. Interventions were performed in primary care setting at outpatient physiotherapy clinics.ParticipantsA total of 144 patients with CR were recruited to participate in this clinical trial.InterventionsPatients were randomly assigned to 3 months of either of a neck-specific training program or prescribed physical activity.Main Outcome measuresPrimary outcomes included self-rated neck and arm pain as collected by the Visual Analogue Scale (VAS). Secondary outcomes were self-rated headache measured with the VAS, the Neck Disability Index, the EuroQol 5D, the Fear Avoidance Beliefs Questionnaire and the Hospital Anxiety and Depression Scale. Assessments were performed at baseline and at 3, 6, 12 and 24 months follow-up periods.ResultsIntention-to-treat and per-protocol analyses showed no significant interaction (group*time) or group effects. There were, however, significant time effects indicating improvement over time for both groups for all outcomes except for levels of depression.ConclusionThe study revealed that neck-specific training as well as prescribed physical activity both including additional cognitive behavioural approach decreased the pain in patients with CR i.e. participants improved regardless of the intervention received. There is a lack of consensus of how to best manage individuals with CR. However, our findings suggest that CR has a natural favorable long-term outcome when patients are prescribed neck specific training and exercise in combination with a behavioral approach.



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Development of Composite Scores for the Traumatic Brain Injury Quality of Life Measurement System (TBI-QOL)

Publication date: Available online 3 July 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Callie E. Tyner, Aaron J. Boulton, Mark Sherer, Pam A. Kisala, Joseph J. Glutting, David S. Tulsky
ObjectiveTo develop a set of composite scores that can be used for interpreting quality of life (QOL) after traumatic brain injury (TBI) using nine of the patient reported outcomes measures from the TBI-QOL Measurement System.DesignParticipants completed 20 item banks from the TBI-QOL as part of a larger assessment. Composite index scores were created with normalized transformation with nonlinear area conversion using scores from nine of the banks, and are expressed in index score units, with higher composite scores indicating better functioning. For descriptive purposes, associations among composites and individual banks were evaluated using regression, along with patterns of composite scores by injury severity groups using ANOVA.SettingThree medical centers in the United States.ParticipantsFive hundred and four community-dwelling adults with a history of TBI.Interventionsn/aMain Outcomes Measure(s)TBI-QOLResultsFive composite indices were generated: Global QOL, Physical Health, Emotional Health, Cognitive Health, and Social Health. Lookup tables are provided herein. Composite scores were highly intercorrelated (all r > .60, p < .0001), and individual TBI-QOL banks all correlate strongly with the Global QOL Composite in the expected direction (all r > .50, p <.0001).ConclusionResearchers and clinicians can use the TBI-QOL Global QOL, Physical Health, Emotional Health, Cognitive Health, and Social Health composite scores to aggregate results from multiple TBI-QOL banks, which is anticipated to ease interpretation and reliability. This work additionally highlights the importance of considering non-physical symptoms as outcomes variables for TBI research, as cognitive, social, and emotional domains were some of the most strongly correlated banks with the Global QOL composite.



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Population genomics of bacterial host adaptation

Population genomics of bacterial host adaptation

Population genomics of bacterial host adaptation, Published online: 04 July 2018; doi:10.1038/s41576-018-0032-z

High-throughput sequencing technologies have enabled comparative analysis of large numbers of diverse bacterial genomes. Such studies are providing insights into the genomic changes that accompany changes in host specificity, with possible implications for controlling transmission of pathogenic bacteria.

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A study of temporal variations of 7Be and 210Pb concentrations and their correlations with rainfall and other parameters in the South West Coast of India

Publication date: December 2018
Source:Journal of Environmental Radioactivity, Volume 192
Author(s): M.P. Mohan, Renita Shiny D'Souza, S. Rashmi Nayak, Srinivas S. Kamath, Trilochana Shetty, K. Sudeep Kumara, I. Yashodhara, Y.S. Mayya, N. Karunakara
As a part of establishing a regional database on natural radioactivity, the atmospheric concentrations of ²¹⁰Pb and ⁷Be were measured over a three and half year period (2014–2017) in Mangalore and Kaiga in the South West Coast of India. A total of 99 air samples, collected in the different months of the year, were analysed in this study. The mean activity concentrations of ⁷Be and ²¹⁰Pb were found to be 5.5 ± 3.1 mBq m⁻³ and 1.1 ± 0.73 mBq m⁻³, respectively. Both the radionuclides exhibited strong seasonal variations, with maximum concentration of ⁷Be occurring in the summer and that of ²¹⁰Pb in the winter season. The concentration of both the radionuclides was minimum in the rainy season. Higher ²¹⁰Pb concentration during winter was attributed to the ingression of continental air masses due to the wind regime from the North East. The sunspot number index of the solar activity also plays an important role in the increase and decrease of ⁷Be concentration in the air. A clear trend of increased and lowered concentration of ⁷Be with lower and higher solar activity (low and high sunspot number), respectively, in accordance with the 11-year solar cycle, was observed in this study. The temporal variation of PM10 concentration was also studied and it showed maximum value in the winter and minimum in the rainy season with an average of 56.9 μg m⁻³. Statistically significant positive correlation was observed between the PM10 and ²¹⁰Pb activity concentration, whereas a weak correlation was observed between PM10 and ⁷Be. This is due to the fact that ⁷Be is largely associated with sub-micrometer size particles, whereas PM10 is contributed by larger sizes. The dependence of the activity concentrations of ⁷Be and ²¹⁰Pb with meteorological parameters such as rainfall, temperature, and humidity was studied through linear regression analysis. A significant correlation was observed between ⁷Be and ²¹⁰Pb concentrations with rainfall intensity (with identical correlation coefficients), which suggested that the removal mechanisms of these two radionuclides were similar. ⁷Be showed a strong correlation with temperature, whereas ²¹⁰Pb with humidity. A comparison of the data obtained in the present study for the South West Coast of India with the global literature values of ⁷Be and ²¹⁰Pb in aerosols showed that the values did not reflect the well-known latitudinal dependence of the ⁷Be tropospheric fluxes. Overall, the study provides an improved understanding of the correlation and variability of ²¹⁰Pb and ⁷Be concentrations in the atmosphere in the South West Coast of India.



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Expanding the phenotype of the X-linked BCOR microphthalmia syndromes

Abstract

Two distinct syndromes arise from pathogenic variants in the X-linked gene BCOR (BCL-6 corepressor): oculofaciocardiodental (OFCD) syndrome, which affects females, and a severe microphthalmia ('Lenz'-type) syndrome affecting males. OFCD is an X-linked dominant syndrome caused by a variety of BCOR null mutations. As it manifests only in females, it is presumed to be lethal in males. The severe male X-linked recessive microphthalmia syndrome ('Lenz') usually includes developmental delay in addition to the eye findings and is caused by hypomorphic BCOR variants, mainly by a specific missense variant c.254C > T, p.(Pro85Leu). Here, we detail 16 new cases (11 females with 4 additional, genetically confirmed, affected female relatives; 5 male cases each with unaffected carrier mothers). We describe new variants and broaden the phenotypic description for OFCD to include neuropathy, muscle hypotonia, pituitary underdevelopment, brain atrophy, lipoma and the first description of childhood lymphoma in an OFCD case. Our male X-linked recessive cases show significant new phenotypes: developmental delay (without eye anomalies) in two affected half-brothers with a novel BCOR variant, and one male with high myopia, megalophthalmos, posterior embryotoxon, developmental delay, and heart and bony anomalies with a previously undescribed BCOR splice site variant. Our female OFCD cases and their affected female relatives showed variable features, but consistently had early onset cataracts. We show that a mosaic carrier mother manifested early cataract and dental anomalies. All female carriers of the male X-linked recessive cases for whom genetic confirmation was available showed skewed X-inactivation and were unaffected. In view of the extended phenotype, we suggest a new term of X-linked BCOR-related syndrome.

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Population genomics of bacterial host adaptation

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Acute Pain Is Associated With Chronic Opioid Use After Total Knee Arthroplasty

Background and Objectives Pain scores are routinely reported in clinical practice, and we wanted to examine whether this routinely measured, patient-reported variable provides prognostic information, especially with regard to chronic opioid use, after taking preoperative and perioperative variables into account in a preoperative opioid user population. Methods In 32,874 preoperative opioid users undergoing primary total knee arthroplasty at Veterans Affairs hospitals between 2010 and 2015, we compared preoperative and perioperative characteristics in patients reporting lower versus higher acute pain (scores ≤4/10 vs >4/10 averaged over days 1–3). We calculated the propensity for lower acute pain based on all available data. After 1:1 propensity score matching, to identify similar patients differing only in acute pain, we contrasted rates of chronic significant opioid use (mean >30 mg/d in morphine equivalents) beyond postoperative month 3, discharge prescriptions, and changes in postoperative versus preoperative dose categories. Sensitivity analysis examined associations with dose escalation. Results Rates of chronic significant opioid use (21% overall) differed in patients with lower versus higher acute pain (36% vs 64% of the overall cohort). After propensity matching (total n = 20,926 patients) and adjusting for all significant factors, lower acute pain was associated with less chronic significant opioid use (rates 12% vs 16%), smaller discharge prescriptions (ie, supply

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Lateral undulation of the flexible spine of sprawling posture vertebrates

Abstract

Sprawling posture vertebrates have a flexible spine that bends the trunk primarily in the horizontal plane during locomotion. By coordinating cyclical lateral trunk flexion and limb movements, these animals are very mobile and show extraordinary maneuverability. The dynamic and static stability displayed in complex and changing environments are highly correlated with such lateral bending patterns. The axial dynamics of their compliant body can also be critical for achieving energy-efficient locomotion at high velocities. In this paper, lateral undulation is used to characterize the bending pattern. The production of ground reaction forces (GRFs) and the related center of mass (COM) dynamics during locomotion are the fundamental mechanisms to be considered. Mainly based on research on geckos, which show unrestricted movement in three-dimensional space, we review current knowledge on the trunk flexibility and waveforms of lateral trunk movement. We investigate locomotion dynamics and mechanisms underlying the lateral undulation pattern. This paper also provides insights into the roles of this pattern in obtaining flexible and efficient walking, running, and climbing. Finally, we discuss the potential application of lateral undulation patterns to bio-inspired robotics.

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