New advances in the rehabilitation of CNS diseases applying rTMS

Transcranial magnetic stimulation (TMS) can directly stimulate the CNS, modifying the brain's plasticity to enhance the behavior of the paretic extremities. Studies with low-frequency repetitive TMS (rTMS) on the intact hemisphere and those with high frequencies on the affected hemisphere could increase the speed of movement in the hand affected by CNS injury. Stimulation of the motor pathway may contribute to faster improvement in patients with spinal cord injury. Symptoms of Parkinson's disease (such as cognition and working memory, neglect syndrome and global aphasia) can be influenced by rTMS. However, the site of stimulation and the parameters of rTMS are different. Processes that contribute to the behavior of rTMS include the modification of brain plasticity, induction of neurogenesis, growth of new fibers in the spinal cord or all of these together. According to previous research, rTMS may be suitable as an add-on therapy to rehabilitation in CNS diseases.     

Influence of speed and step frequency during walking and running on motion sensor output

PURPOSE: Studies have reported strong linear relationships between accelerometer output and walking/running speeds up to 10 km x h(-1). However, ActiGraph uniaxial accelerometer counts plateau at higher speeds. The aim of this study was to determine the relationships of triaxial accelerometry, uniaxial accelerometry, and pedometry with speed and step frequency (SF) across a range of walking and running speeds. METHODS: Nine male runners wore two ActiGraph uniaxial accelerometers, two RT3 triaxial accelerometers (all set at a 1-s epoch), and two Yamax pedometers. Each participant walked for 60 s at 4 and 6 km x h(-1), ran for 60 s at 10, 12, 14, 16, and 18 km x h(-1), and ran for 30 s at 20, 22, 24, and 26 km x h(-1). Step frequency was recorded by a visual count. RESULTS: ActiGraph counts peaked at 10 km x h(-10 (2.5-3.0 Hz SF) and declined thereafter (r=0.02, P>0.05). After correction for frequency-dependent filtering, output plateaued at 10 km x h(-1) but did not decline (r=0.77, P<0.05). Similarly, RT3 vertical counts plateaued at speeds > 10 km x h(-1) (r=0.86, P<0.01). RT3 vector magnitude and anteroposterior and mediolateral counts maintained a linear relationship with speed (r>0.96, P<0.001). Step frequency assessed by pedometry compared well with actual step frequency up to 20 km x h(-1) (approximately 3.5 Hz) but then underestimated actual steps (Yamax r=0.97; ActiGraph pedometer r=0.88, both P<0.001). CONCLUSION: Increasing underestimation of activity by the ActiGraph as speed increases is related to frequency-dependent filtering and assessment of acceleration in the vertical plane only. RT3 vector magnitude was strongly related to speed, reflecting the predominance of horizontal acceleration at higher speeds. These results indicate that high-intensity activity is underestimated by the ActiGraph, even after correction for frequency-dependent filtering, but not by the RT3. Pedometer output is highly correlated with step frequency.     

Diagnosis and treatment of a perforated duodenal diverticulum

Perforation is an exceptionally rare complication of duodenal diverticula and often presents with nonspecific symptoms and signs. We present a case of a perforated duodenal diverticulum diagnosed on computed tomography and successfully repaired with a diverticulectomy.     

Is seminal vesicle implantation with permanent sources possible? A dose–volume histogram analysis in patients undergoing combined 103Pd implantation and external beam radiation for T3c prostate cancer

PURPOSE: Combined brachytherapy and external beam radiation therapy (EBRT) of the prostate and seminal vesicles (SVs) is evolving as a successful treatment option for high-risk prostate cancer. Dose-volume histogram (DVH) analysis of the SV was performed in patients with biopsy-positive SV who received implantation of the SV and prostate. METHODS AND MATERIALS: Fifteen consecutive patients with high-risk features (prostate-specific antigen [PSA] > or =10 ng/mL, Gleason score > or = 7, or clinical stage > or = T2b) and a positive SV biopsy were treated with a 103Pd implant of the prostate and SV followed by 45Gy of EBRT. DVHs were generated for the prostate and total SV volume (SVT). In addition, the SV was divided into 3-mm-thick volumes identified as SV1, SV2, SV3, SV4, SV5, and SV6 starting from the junction of the prostate and SV and extending distally. Delivered dose was defined as the D90 (dose delivered to 90% of the organ on DVH). RESULTS: The median number of seeds implanted into the prostate and the SVT was 59 (41-94) and 9 (4-21), respectively. The median D90 values for the prostate, SVT, SV1, SV2, SV3, SV4, SV5, and SV6 were 103.2 (87.4-137.1), 46.2 (4.0-69.4), 76.0 (31.2-147), 63.4 (25.1-145.9), 49.7 (15.3-118), 27.4 (9.3-135.1), 14.2 (2.3-100.3), and 3.9 (0-61.5) Gy, respectively. CONCLUSIONS: Implantation of the SV using a real-time intraoperative approach is technically feasible and results in higher doses to the SV than has been reported with implantation of the prostate alone. Although dose distribution in the SV can be variable and unpredictable, these doses, in combination with 45 Gy of EBRT, may be adequate to control disease spread in these organs.     

Assessment of postbrachytherapy sexual function: a comparison of the IIEF-5 and the MSEFS

PURPOSE: This study is to compare the Mount Sinai Erectile Function Score (MSEFS), our brachytherapy program's physician-assigned scale, with patients' independently completed International Index of Erectile Function-5 (IIEF-5). METHODS AND MATERIALS: A total of 1202 patients with T1-T3 prostate cancer were treated with ultrasound-guided radioactive seed implantation +/- EBRT with at least one visit where both MSEFS and IIEF-5 were completed. Spearman rho correlations were performed. RESULTS: The MSEFS significantly correlated with the total IIEF-5 scores on all comparisons. The coefficient was 0.65 for comparisons at initial consultation and 0.76 for all visits. The correlations remained strong, averaging to 0.76 for visits 1 through 10. CONCLUSIONS: In assessing erectile dysfunction after radiation, the MSEFS correlates well with, but cannot be replaced by, the IIEF-5, which is weighted toward one's degree of sexual desire. More insight into patients' erectile function after brachytherapy may be gotten if the IIEF-15 is used instead of the IIEF-5 with our MSEFS.     

Hind limb ischemia-reperfusion in the leptin receptor deficient (db/db) mouse

BACKGROUND: Diabetic patients have high incidence of peripheral vascular disease and limb loss after acute extremity injury. Experiments were designed to test the hypothesis that acute tissue injury in leptin receptor deficient (Db) diabetic (type2) mice would be more severe than in non-diabetic mice. METHODS: Db and wild type (Wt) mice were subjected to 3 h of ischemia followed by either 4 or 24 h of reperfusion (3/4 IR, 3/24 IR). Muscle analyzed for tissue viability (mitochondrial activity), cytokines (KC-murine equivalent of human IL-8, TNFalpha, IL-6), growth factor, and histological evaluation (neutrophils/uninjured muscle fibers). Tissue perfusion was detected during basal and reperfusion conditions using laser Doppler imaging. RESULTS: Mitochondrial activity and histological evaluation for tissue injury did not differ in the Db versus Wt mice at the time intervals studied. When compared with their respective sham animals, both Db and Wt mice had similarly increased levels of KC, IL-6, and VEGF after 3/24 IR. TNFalpha levels increased in Db but not Wt mice after IR. Although absolute increases in TNFalpha and KC were higher in Db mice, VEGF levels were actually lower in the Db mice. CONCLUSION: The patterns of tissue perfusion, cytokines, and growth factors were different in Db versus Wt mice. At the acute time intervals studied, these differences did not correlate with an expected greater degree of acute muscle injury in Db mice.