Changes in oro-facial function and hand-grip strength during a 2-year observation period after stroke

Objectives

Recovery from stroke-related oro-facial impairment has rarely been investigated. In this longitudinal study chewing efficiency, maximum lip and bite force as well as masseter muscle thickness were evaluated and compared with hand-grip force.

Materials and methods

Thirty-one hospitalized stroke patients and 24 controls were recruited for this cohort study with 2-year follow-up. Chewing efficiency was evaluated with a color mixing ability test, lip forces with a traction dynamometer, bite force with a digital gauge, masseter muscle thickness using ultrasound measurements and grip strength with a hand dynamometer.

Results

During the 2-year observation period, patients were evaluated four times. A total of 21 patients dropped out of the study. Stroke patients showed significantly impaired chewing efficiency and lower lip forces than controls with no significant improvement over time. Bite forces were not different between ipsi- and contralesional sides, in contrast to contralesional hand-grip strength which was significantly impaired and did not improve during the observation period. On the first examination with a median of 40 days after stroke, masseter thickness was reduced contralesional, but did not continue to show significant side-differences during follow-up.

Conclusions

Stroke affects the upper limb and the masseter muscles differently on a functional and morphological level. Further research is needed to evaluate the predictive value of oro-facial parameters on functional outcome after stroke.

Clinical relevance

Impaired chewing efficiency and reduced lip force are quantifiable symptoms in stroke patients which seem not to improve in absence of oro-facial rehabilitation procedures.     

25 Jahre Notfall+Rettungsmedizin – reine Männersache?

Notfall + Rettungsmedizin -     

Aversive Learning in Adolescents: Modulation by Amygdala–Prefrontal and Amygdala–Hippocampal Connectivity and Neuroticism

Neuroticism involves a tendency for enhanced emotional and cognitive processing of negative affective stimuli and a propensity to worry and be anxious. It is known that this trait modulates fear learning and the activation of brain regions involved in it such as the amygdala, hippocampus, and prefrontal cortex and their connectivity. Thirty-nine (21 female) 14-year-old healthy adolescents participated in functional magnetic resonance imaging (fMRI) of aversive pavlovian differential delay conditioning. An unpleasant sound served as unconditioned stimulus (US) and pictures of neutral male faces as conditioned stimuli (CS+ followed by the US in 50% of the cases; CS− never followed by the US). During acquisition (CS+/− differentiation), higher levels of neuroticism were associated with a stronger interaction between the right amygdala and the right hippocampus as well as the right amygdala and prefrontal cortical regions, specifically ventromedial prefrontal cortex, dorsolateral prefrontal cortex, and anterior cingulate cortex. The association of stronger conditionability of fear and connectivity of brain regions related to consolidation of fear associations and neuroticism points to underlying mechanisms of the enhanced propensity for anxiety disorders in highly neurotic participants. This is especially important in adolescence, a vulnerable time for the onset of mental disorders such as anxiety disorders.     

Prevalence of Orthohantavirus-Reactive Antibodies in Humans and Peri-Domestic Rodents in Northern Ethiopia

In 2012, Tigray orthohantavirus was discovered in Ethiopia, but its seasonal infection in small mammals, and whether it poses a risk to humans was unknown. The occurrence of small mammals, rodents and shrews, in human inhabitations in northern Ethiopia is affected by season and presence of stone bunds. We sampled small mammals in two seasons from low- and high-density stone bund fields adjacent to houses and community-protected semi-natural habitats in Atsbi and Hagere Selam, where Tigray orthohantavirus was first discovered. We collected blood samples from both small mammals and residents using filter paper. The presence of orthohantavirus-reactive antibodies in blood was then analyzed using immunofluorescence assay (human samples) and enzyme linked immunosorbent assays (small mammal samples) with Puumala orthohantavirus as antigen. Viral RNA was detected by RT-PCR using small mammal blood samples. Total orthohantavirus prevalence (antibodies or virus RNA) in the small mammals was 3.37%. The positive animals were three Stenocephalemys albipes rats (prevalence in this species = 13.04%). The low prevalence made it impossible to determine whether season and stone bunds were associated with orthohantavirus prevalence in the small mammals. In humans, we report the first detection of orthohantavirus-reactive IgG antibodies in Ethiopia (seroprevalence = 5.26%). S. albipes lives in close proximity to humans, likely increasing the risk of zoonotic transmission.     

Biochemical mechanisms of hibernation and stunning in the human heart

BACKGROUND: Myocardial hibernation and stunning are characterized by depressed cardiac function in the presence of reduced or normal coronary blood flow. The underlying biochemical mechanisms are widely unknown and only limited data are available in human hearts. METHODS AND RESULTS: Left ventricular transmural myocardial biopsies were obtained from normal and dysfunctional segments of patients undergoing coronary bypass surgery. Segments were classified as hibernating (n=10) or stunned (n=9) using contrast ventriculography and echocardiography, single photon emission computed tomography (SPECT), and positron emission tomography (PET). In each patient, biopsies from normal myocardial segments were used as controls (n=19). Compared to control myocardium, levels of cAMP (3'-5'cyclic adenosine monophosphate, in fmol/mg wet weight, means+/-S.E.M.) were higher in hibernating (673+/-76 versus 518+/-47, P<0.05) but unchanged in stunned myocardium (513+/-73 versus 466+/-97, P>0.05). Protein expression of phospholamban, sarcoendoplasmic Ca(2+)-ATPase 2a, calsequestrin, the inhibitory subunit of troponin, as well as the activation of p38 MAP kinase were not different when compared to controls. However, heat shock protein 72 (Hsp72) was increased 55% in stunned (2.89+/-0.58 versus 1.86+/-0.32, P<0.05) but not in hibernating myocardium (1.68+/-0.34 versus 1.67+/-0.29, P>0.05). CONCLUSIONS: The data from the present study suggest different pathophysiological mechanisms for myocardial hibernation and stunning. Alterations in the homeostasis of cAMP might be a compensatory mechanism in myocardial hibernation, whereas expression of Hsp72 appears to be cardioprotective in human myocardial stunning. Future studies should further elucidate these mechanisms and their potential impact on future therapeutic interventions.     

Associations of delay discounting and drinking trajectories from ages 14 to 22

Background

While drinking alcohol, one must choose between the immediate rewarding effects and the delayed reward of a healthier lifestyle. Individuals differ in their devaluation of a delayed reward based on the time required to receive it, i.e., delay discounting (DD). Previous studies have shown that adolescents discount more steeply than adults and that steeper DD is associated with heavier alcohol use in both groups.

Methods

In a large-scale longitudinal study, we investigated whether higher rates of DD are an antecedent or a consequence of alcohol use during adolescent development. As part of the IMAGEN project, 2220 adolescents completed the Monetary Choice Questionnaire as a DD measure, the Alcohol Use Disorders Identification Test, and the Timeline Follow Back interview at ages 14, 16, 18, and 22. Bivariate latent growth curve models were applied to investigate the relationship between DD and drinking. To explore the consequences of drinking, we computed the cumulative alcohol consumption and correlated it with the development of discounting. A subsample of 221 participants completed an intertemporal choice task (iTeCh) during functional magnetic resonance imaging at ages 14, 16, and 18. Repeated-measures ANOVA was used to differentiate between high-risk and low-risk drinkers on the development of neural processing during intertemporal choices.

Results

Overall, high rates of DD at age 14 predicted a greater increase in drinking over 8 years. In contrast, on average, moderate alcohol use did not affect DD from ages 14 to 22. Of note, we found indicators for less brain activity in top-down control areas during intertemporal choices in the participants who drank more.

Conclusions

Steep DD was shown to be a predictor rather than a consequence of alcohol use in low-level drinking adolescents. Important considerations for future longitudinal studies are the sampling strategies to be used and the reliability of the assessments.

     

Sex differences in symptomatology of psychosis-risk patients and in prediction of psychosis

Archives of Women's Mental Health - Sex differences may be important for understanding underlying pathophysiological mechanisms and developing effective preventions and treatments of mental...     

Effects of probucol versus aspirin and versus brachytherapy on restenosis after femoropopliteal angioplasty: the PAB randomized multicenter trial.

PURPOSE: To evaluate the effect of probucol and/or of endovascular brachytherapy (EVBT) on restenosis after percutaneous transluminal angioplasty (PTA) of femoropopliteal arteries. METHODS: A total of 335 patients (206 men; mean age 72+/-9 years) with intermittent claudication were randomized according to a 2x2 factorial design to 1 of the 4 groups: probucol, placebo, EVBT, and EVBT+probucol. Probucol (1 g/d) or placebo were given in double-blinded fashion 1 month before and for 6 months after PTA. Gamma irradiation (192Iridium, 14 Gy, 5-mm reference depth) was randomly applied in an unblinded manner from a noncentered endoluminal catheter. All patients received aspirin (100 mg/d). Primary endpoint was restenosis (>50% diameter reduction) detected by duplex ultrasound 6 months after PTA. Secondary endpoints included clinical and hemodynamic assessment. RESULTS: Restenosis in patients undergoing EVBT was 17% (23/133) versus 35% (50/142) in patients without EVBT (p<0.001); in patients treated with probucol versus placebo, the rates were 23% (31/135) and 30% (43/140, p<0.001). Three quarters (77%, 102/133) of patients were free of claudication after EVBT therapy versus 61% (87/142) without EVBT (p<0.05). Need for target vessel revascularization was 6% (8/133) with EVBT versus 14% (20/142) without EVBT (p<0.01). Late thrombotic occlusions occurred in 4% (6/133), exclusively in patients treated with EVBT after stent implantation. CONCLUSIONS: Endovascular brachytherapy significantly reduces restenosis, improves symptoms, and reduces reinterventions after PTA of femoropopliteal arteries. Probucol reduces restenosis but has no additive effect when combined with brachytherapy.     

Neonatal facial movements in the first minutes of life--eye opening and tongue thrust: an observational study

Infants born by caesarean section (CS) near or at term were observed to display spontaneous facial movements in their first minutes. We hypothesized that those are reproducible. Up to now, nothing was known about the significance, frequency, and determinants of such facial activity. Repetitive eye opening (EO) and tongue thrust (TT) actions were documented during 1 to 5 minutes, 5 to 10 minutes, and 1 to 15 minutes in 102 infants. In addition, 32 infants were recorded on video from minute 2 to minute 10. Infant- and maternal- influencing factors were noted and videos analyzed using Interact (Version 7.1, Mangold International, Arnstorf, Germany). According to our results, 99 of 102 newborns (gestational age, 33 to 42 weeks) performed EO or TT during the first 15 minutes. Preterm and infants with lower Apgar scores and infants born under general anesthesia showed less EO. Infants of smoking mothers, newborns admitted to special care, and infants with lower umbilical artery pH had significantly fewer TT episodes. Within a "normal" population of newborns of > 37 weeks at delivery (n = 57), 97% showed EO and 95% showed TT. In the filmed 32 newborns, infants began EO at 2:40 and TT at 2:34 minutes of life on average. Crying had no influence, but suctioning/intervention reduced EO frequency. In conclusion, EO and TT are occurring regularly during neonatal adaptation. TT seems to be an inborn automatic behavior; numerous occurrences of EO argue for neurological well-being. Both facial actions may initiate maternal-infant attachment.     

Flexible use of post-saccadic visual feedback in oculomotor learning

Saccadic eye movements bring objects of interest onto our fovea. These gaze shifts are essential for visual perception of our environment and the interaction with the objects within it. They precede our actions and are thus modulated by current goals. It is assumed that saccadic adaptation, a recalibration process that restores saccade accuracy in case of error, is mainly based on an implicit comparison of expected and actual post-saccadic position of the target on the retina. However, there is increasing evidence that task demands modulate saccade adaptation and that errors in task performance may be sufficient to induce changes to saccade amplitude. We investigated if human participants are able to flexibly use different information sources within the post-saccadic visual feedback in task-dependent fashion. Using intra-saccadic manipulation of the visual input, participants were either presented with congruent post-saccadic information, indicating the saccade target unambiguously, or incongruent post-saccadic information, creating conflict between two possible target objects. Using different task instructions, we found that participants were able to modify their saccade behavior such that they achieved the goal of the task. They succeeded in decreasing saccade gain or maintaining it, depending on what was necessary for the task, irrespective of whether the post-saccadic feedback was congruent or incongruent. It appears that action intentions prime task-relevant feature dimensions and thereby facilitated the selection of the relevant information within the post-saccadic image. Thus, participants use post-saccadic feedback flexibly, depending on their intentions and pending actions.