The Utility of the Total Neuropathy Score as an Instrument to Assess Neuropathy Severity in Chronic Kidney Disease: A Validation Study

Publication date: Available online 6 March 2018
Source:Clinical Neurophysiology
Author(s): Tushar Issar, Ria Arnold, Natalie C.G. Kwai, Bruce A. Pussell, Zoltan H. Endre, Ann M. Poynten, Matthew C. Kiernan, Arun V. Krishnan
ObjectiveTo demonstrate construct validity of the Total Neuropathy Score (TNS) in assessing peripheral neuropathy in subjects with chronic kidney disease (CKD).Methods113 subjects with CKD and 40 matched controls were assessed for peripheral neuropathy using the TNS. An exploratory factor analysis was conducted and internal consistency of the scale was evaluated using Cronbach's alpha. Construct validity of the TNS was tested by comparing scores between case and control groups.ResultsFactor analysis revealed valid item correlations and internal consistency of the TNS was good with a Cronbach's alpha of 0.897. Subjects with CKD scored significantly higher on the TNS (CKD: median, 6, interquartile range, 1-13; controls: median, 0, interquartile range, 0-1; p<0.001). Subgroup analysis revealed construct validity was maintained for subjects with stages 3-5 CKD with and without diabetes.ConclusionsThe TNS is a valid measure of peripheral neuropathy in patients with CKD.SignificanceThe TNS is the first neuropathy scale to be formally validated in patients with CKD.



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Precision of perceived direction of gravity in partial bilateral vestibulopathy correlates with residual utricular function

Publication date: Available online 5 March 2018
Source:Clinical Neurophysiology
Author(s): A. Bürgin, C.J. Bockisch, A.A. Tarnutzer
ObjectiveGait imbalance in patients with bilateral-vestibular-deficiency (BVD) was linked to increased variability in perceived direction of gravity while upright. We hypothesized this to be true also when roll-tilted. Moreover, as utricular input is essential for spatial orientation, we predicted the variability of perceived vertical to correlate inversely with utricular function.MethodsSubjective visual vertical (SVV) and haptic vertical (SHV) were measured in various roll-orientations (0°/±45°/±90°) and postural adjustments along earth-vertical/earth-horizontal were collected in patients with partial BVD (n=10) and healthy controls (n=11). Patients with bilaterally-absent bone-conducted ocular vestibular-evoked myogenic-potentials (oVEMPs) were compared to those with (partially) preserved oVEMPs.ResultsFor the SVV (p<0.001) and SHV (p=0.004) variability was larger in patients than controls. Compared to those with (partially) preserved oVEMPs, patients with bilaterally-absent oVEMPs had higher SVV (p=0.024) and SHV (p=0.006) variability. Self-positioning along earth-horizontal was more variable in BVD-patients compared to controls (p<0.001). Again, variability was higher in those with bilaterally-absent oVEMPs (p=0.032). SVV/SHV-variability was correlated (R²=0.61, slope=1.06 [95%-CI=0.80-1.54]) in BVD-patients.ConclusionWith variability correlating amongst the different paradigms and with oVEMP-responses, this emphasizes the role of bilaterally intact utricular input for precise perception of gravity.SignificanceIn BVD-patients with bilaterally-absent oVEMPs intensified vestibular rehabilitation should be considered.



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Reproductive Life Planning: Raising the Questions

Abstract

Introduction Unintended pregnancy has been a concerning public health problem for decades. As we begin to understand the complexities of pregnancy intention and how women experience these pregnancies, reproductive life planning offers a paradigm shift. Methods Reproductive life planning is a patient-centered approach that places a patient's reproductive preferences—whether concrete or ambivalent—at the forefront of her clinical care. Results This process grants women and men the opportunity to consider how reproduction fits within the context of their broader lives. Within a clinical encounter, reproductive life planning allows counseling and care to be tailored to patient preferences. Discussion Although there is great potential for positive public health impacts in unintended pregnancy, contraceptive use and improved preconception health, the true benefit lies within reinforcing reproductive empowerment. Despite recommendations for universal adoption, many questions remain regarding implementation, equity and outcomes.

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EFNB2 haploinsufficiency causes a syndromic neurodevelopmental disorder

Ephrin B2, one of the ligand of the EphB receptors, is involved in a complex signaling pathway regulating the development of the nervous system, neuronal migration, erythropoiesis and vasculogenesis. We report a patient with a de novo variant in EFNB2 and a family in which segregates a 610-kb deletion at chromosome 13q33 encompassing only ARGLU1 and EFNB2 genes. The de novo variant was observed in a patient with anal stenosis, hypoplastic left ventricle and mild developmental delay. The deletion was identified in 2 sibs with congenital heart defect and mild developmental delay. One of the affected sibs further had myoclonic epilepsy and bilateral sensorineural hearing loss. The carrier mother was apparently asymptomatic. Because EFNB2 is located in the subtelomeric region of 13q chromosome, we reviewed the previous reports of terminal 13q deletion. We suggest that haploinsufficiency of the EFNB2 could be at the origin of several clinical features reported in 13qter deletions, including intellectual disability, seizures, congenital heart defects, anorectal malformation and hearing loss.

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The acute effect of Quercetin on muscle performance following a single resistance training session

Abstract

Purpose

To examine the effect of acute quercetin (Q) ingestion on neuromuscular function, biomarkers of muscle damage, and rate of perceived exertion (RPE) in response to an acute bout of resistance training.

Methods

10 young men (22.1 ± 1.8 years, 24.1 ± 3.1 BMI) participated in a randomized, double-blind, crossover study. Subjects consumed Q (1 g/day) or placebo (PLA) 3 h prior to a resistance training session which consisted of 3 sets of 8 repetitions at 80% of the one repetition maximum (1RM) completed bilaterally for eight different resistance exercises. Electromyographic (EMG) signals were recorded from the knee extensor muscles during maximal isometric (MVIC) and isokinetic voluntary contractions, and during an isometric fatiguing test. Mechanical and EMG signals, biomarkers of cell damage, and RPE score were measured PRE, immediately POST, and 24 h (blood indices only) following the resistance exercise.

Results

After a single dose of Q, the torque–velocity curve of knee extensors was enhanced and after the resistance exercise, subjects showed a lower MVIC reduction (Q: 0.91 ± 6.10%, PLA: 8.66 ± 5.08%) with a greater rate of torque development (+ 10.6%, p < 0.005) and neuromuscular efficiency ratio (+ 28.2%, p < 0.005). Total volume of the resistance exercises was significantly greater in Q (1691.10 ± 376.71 kg rep) compared to PLA (1663.65 ± 378.85 kg rep) (p < 0.05) with a comparable RPE score. No significant differences were found in blood marker between treatments.

Conclusions

The acute ingestion of Q may enhance the neuromuscular performance during and after a resistance training session.

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Implementation and Evaluation of a Recurring Interdisciplinary Community Health Fair in a Remote U.S.–Mexico Border Community

Abstract

The purpose of this project was to design, implement, and assess a recurring interdisciplinary community health fair in an underserved border town. University of California San Diego (UCSD) medical and pharmacy students, under faculty supervision, worked alongside community partners in Calexico, California to implement a health fair two miles from the U.S.–Mexico border. Demographic and screening data were described from 293 participants from 2014 to 2016. Over 90% (269/293) listed Mexico as their country of birth, 82.9% (243/293) were monolingual Spanish speakers, 75.4% (221/293) had an annual household income of ≤ $20,000, and 58.7% (172/293) described their health as fair or poor. Screening revealed 91.1% (265/291) were overweight or obese, 37.8% (109/288) had hypertension, 9.3% (27/289) had elevated blood sugar, and 11.4% (33/289) had elevated total cholesterol levels. This model could be replicated in other training settings to increase exposure to border health issues and connect patients to local health services.

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Cardiorespiratory and perceptual responses to self-regulated and imposed submaximal arm–leg ergometry

Abstract

Purpose

This study compared cardiorespiratory and perceptual responses to exercise using self-regulated and imposed power outputs distributed between the arms and legs.

Methods

Ten males (age 21.7 ± 3.4 years) initially undertook incremental arm-crank ergometry (ACE) and cycle ergometry (CYC) tests to volitional exhaustion to determine peak power output (W_peak). Two subsequent tests involved 20-min combined arm–leg ergometry (ALE) trials, using imposed and self-regulated protocols, both of which aimed to elicit an exercising heart rate of 160 beats min⁻¹. During the imposed trial, arm and leg intensity were set at 40% of each ergometer-specific W_peak. During the self-regulated trial, participants were asked to self-regulate cadence and resistance to achieve the target heart rate. Heart rate (HR), oxygen uptake ( \(\dot {V}_{\text{2}}}\) ), pulmonary ventilation ( \({\dot {V}_{\text{E}}}\) ), and ratings of perceived exertion (RPE) were recorded continuously.

Results

As expected, there were no differences between imposed and self-regulated trials for HR, \(\dot {V}_{\text{2}}}\) _, and \({\dot {V}_{\text{E}}}\) (all P ≥ 0.05). However, central RPE and local RPE for the arms were lower during self-regulated compared imposed trials (P ≤ 0.05). Lower RPE during the self-regulated trial was related to preferential adjustments in how the arms (33 ± 5% W_peak) and legs (46 ± 5% W_peak) contributed to the exercise intensity.

Conclusions

This study demonstrates that despite similar metabolic and cardiovascular strain elicited by imposed and self-regulated ALE, the latter was perceived to be less strenuous, which is related to participants doing more work with the legs and less work with the arms to achieve the target intensity.

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