Impact of EMG-triggered neuromuscular stimulation of the wrist and finger extensors of the paretic hand after stroke: a systematic review of the literature

OBJECTIVE: To assess whether EMG-triggered neuromuscular electrical stimulation (EMG-NMES) applied to the extensor muscles of the forearm improves hand function after stroke. DESIGN: Systematic review of randomized controlled trials. METHODS: A computer-aided literature search up to June 2006 identified articles comparing EMG-NMES of the upper extremity with usual care. Methodological quality was rated on the Physiotherapy Evidence Database scale (PEDro), and the Hedges' g model was used to calculate the summary effect sizes (SES) using fixed or random models depending on heterogeneity. RESULTS: Eight studies, selected out of 192 hits and presenting 157 patients, were included in quantitative and qualitative analyses. The methodological quality ranged from 2 to 6 points. The meta-analysis revealed non-significant effect sizes in favour of EMG-NMES for reaction time, sustained contraction, dexterity measured with the Box and Block manipulation test, synergism measured with the Fugl-Meyer Motor Assessment Scale and manual dexterity measured with the Action Research Arm test. CONCLUSION: No statistically significant differences in effects were found between EMG-NMES and usual care. Most studies had poor methodological quality, low statistical power and insufficient treatment contrast between experimental and control groups. In addition, all studies except two investigated the effects of EMG-NMES in the chronic phase after stroke, whereas the literature suggests that an early start, within the time window in which functional outcome of the upper limb is not fully defined, is more appropriate.     

Effects of self-discrepancies on activity-related behaviour: explaining disability and quality of life in patients with chronic low back pain

In chronic low back pain (CLBP) research, the self-discrepancy model has been applied to explain dysfunctional avoidance and persistence behaviour. The main aim of this study was to evaluate whether specific self-discrepancies in patients with CLBP are associated with the abovementioned types of activity-related behaviour and whether changes in self-discrepancies over time are associated with changes in activity-related behaviour. Furthermore, the aim was to evaluate whether avoidance and persistence behaviour are associated with a higher level of disability and a diminished quality of life and whether changes over time in avoidance and persistence behaviour result in changes in disability and quality of life. A longitudinal cohort study in a sample of patients with CLBP (N = 116), in which self-discrepancies, disability, quality of life, and objectively registered characteristics of activity-related behaviour were measured, was performed to evaluate the pathways in the aforementioned self-discrepancy model. Results indicate that patients with CLBP who feel closer to their ideal-other show more characteristics of persistence behaviour. Patients who move further away from their ideal-own also show more characteristics of persistence behaviour. Furthermore, in patients characterized as avoider, a decrease in a patient’s daily uptime was associated with a decrease of mental health-related quality of life.     

Myelofibrosis and idiopathic thrombocytopenic purpura

 A case of idiopathic myelofibrosis (IMF) with concomitant autoimmune thrombocytopenic purpura (AITP) is reported. The literature on platelet antibodies in IMF is reviewed. Received: 25 March 1997 / Accepted: 11 July 1997     

Optical Imaging of Cat Auditory Cortex Cochleotopic Selectivity Evoked by Acute Electrical Stimulation of a Multi-channel Cochlear Implant

We measured reflectance changes by means of optical imaging of intrinsic signals to study the effects of acute electrical cochlear stimulation on the topography of the cat auditory cortex. After single-pulse electrical stimulation at selected sites of a multichannel implant device, we found topographically restricted response areas representing mainly the high-frequency range in Al. Systematic variation of the stimulation pairs and thus of the cochlear frequency sites revealed a systematic and corresponding shift of the response areas that matched the underlying frequency organization. Intensity functions were usually very steep. Increasingly higher stimulation currents evoked increasingly larger response areas, resulting in decreasing spatial, i.e. cochleotopic, selectivity; however, we observed only slight positional shifts of the focal zones of activity. Electrophysiological recordings of local field potential maps in the same individual animals revealed close correspondence of the locations of the cortical response areas. The results suggest that the method of optical imaging can be used to map response areas evoked by electrical cochlear stimulation, thereby maintaining a profound cochleotopic selectivity. Further experiments in chronically stimulated animals will shed more light on the degree of functional and reorganizational capacities of the primary auditory cortex and could be beneficial for our understanding of the treatment of profound deafness.     

Fear of injury and physical deconditioning in patients with chronic low back pain

OBJECTIVES: To test the assumption that fear of injury leads to disability and physical deconditioning in patients with chronic low back pain (CLBP) and to evaluate the relation between disability and physical deconditioning. DESIGN: Survey in a cross-sectional design. SETTING: A rehabilitation center in the Netherlands. PARTICIPANTS: Forty patients with nonspecific CLBP. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Fear of injury was measured with the Tampa Scale of Kinesiophobia. Physical fitness was expressed in aerobic fitness measured as predicted maximum oxygen consumption derived in a submaximal exercise test according the protocol of Siconolfi. Disability was measured with the Roland Disability Questionnaire. The association between fear of injury and physical fitness or disability was examined with correlational and multiple linear regression analyses. RESULTS: Fear of injury correlated significantly with disability (r=.44), but did not correlate significantly with aerobic fitness. There was no statistically significant association between disability and aerobic fitness. Multiple regression analysis revealed that aerobic fitness was predicted by gender only. CONCLUSIONS: Fear of injury appears to be more strongly associated with perceived disability than with aerobic fitness. The assumption that fear of injury leads to physical deconditioning was not confirmed in this sample of patients with CLBP.     

Anti-C1q autoantibodies in murine lupus nephritis

Autoantibodies against C1q can be found in the circulation of patients with several autoimmune diseases including systemic lupus erythematosus (SLE). In SLE there is an association between the occurrence of these antibodies and renal involvement. How anti-C1q autoantibodies contribute to renal disease is currently unknown. Cohorts of MRL-lpr mice, which are known to develop age-dependent SLE-like disease, were used to study the relationship between levels of anti-C1q autoantibodies and renal disease. We collected serum, urine and renal tissue and analysed autoantibodies, complement levels and renal deposition as well as renal function. At 2 months of age all mice already had elevated levels of anti-C1q autoantibodies, and elution of kidneys revealed the presence of these antibodies in renal immune deposits in MRL-lpr mice and not in control MRL^+/+ mice. In conclusion, anti-C1q antibodies are already present in serum and immune deposits of the kidney early in life and therefore can play a role in nephritis during experimental SLE-like disease in mice.     

Splenic abscess caused by Peptostreptococcus species, diagnosed with the aid of abdominal computerized tomography and treated with percutaneous drainage and antibiotics: a case report.

We describe herein a 63-year-old patient with a splenic abscess due to Peptostreptococcus spp., diagnosed with the aid of abdominal computerised tomography and treated with ultra-sound guided percutaneous drainage and antibiotics. The bacteriological characteristics of splenic abscesses are discussed.     

Novel insights in localization and expression levels of C5aR and C5L2 under native and post-transplant conditions in the kidney

AIMS: The complement system, and especially C5a, plays an important role in the pathophysiology of renal diseases and post-transplant renal injury. The two receptors for C5a are C5a receptor (C5aR) and C5a-like-receptor-2 (C5L2). Only renal C5aR expression has been reported, although exact localization and alterations in expression after transplantation are unknown. MATERIALS AND RESULTS: Renal C5aR and C5L2 expression and localization were analyzed immunohistochemically. C5aR and C5L2 expression was analyzed in human kidney biopsies obtained from living donors and patients suffering from acute tubular necrosis, acute cellular and vascular rejection or IF/TA. C5aR was expressed in the thick ascending limb of Henle's loop and first part of the distal convoluted tubule (DCT). Under inflammatory conditions, C5aR was de novo expressed in proximal tubuli. C5L2 was expressed in the kidney and localized to DCT1, DCT2 and connecting tubule. Persistent distal tubular expression of both receptors was demonstrated after renal transplantation. CONCLUSIONS: This study shows distinct renal expression patterns for C5aR and C5L2. Our findings suggest a functional role for renal C5L2 rather than being a C5a decoy receptor. Future studies focusing on renal C5a-C5aR interaction should take differential C5aR and C5L2 expression into account, alongside abundant C5aR expression on infiltrating cells.