Effects of transcranial direct current stimulation on risky decision making are mediated by ‘hot’ and ‘cold’ decisions,personality, and hemisphere

Previous results point towards a lateralization of dorsolateral prefrontal cortex (DLPFC) function in risky decision making. While the right hemisphere seems involved in inhibitory cognitive control of affective impulses, the left DLPFC is crucial in the deliberative processing of information relevant for the decision. However, a lack of empirical evidence precludes definitive conclusions. The aim of our study was to determine whether anodal transcranial direct current stimulation (tDCS) over the right DLPFC with cathodal tDCS over the lDLPFC (anodal right/cathodal left) or vice versa (anodal left/cathodal right) differentially modulates risk‐taking in a task [the Columbia Card Task (CCT)] specifically engaging affect‐charged (Hot CCT) vs. deliberative (Cold CCT) decision making. The facilitating effect of the anodal stimulation on neuronal activity was emphasized by the use of a small anode and a big cathode. To investigate the role of individual differences in risk‐taking, participants were either smokers or non‐smokers. Anodal left/cathodal right stimulation decreased risk‐taking in the ‘cold’ cognition version of the task, in both groups, probably by modulating deliberative processing. In the ‘hot’ version, anodal right/cathodal left stimulation led to opposite effects in smokers and non‐smokers, which might be explained by the engagement of the same inhibitory control mechanism: in smokers, improved controllability of risk‐seeking impulsivity led to more conservative decisions, while inhibition of risk‐aversion in non‐smokers resulted in riskier choices. These results provide evidence for a hemispheric asymmetry and personality‐dependent tDCS effects in risky decision making, and may be important for clinical research on addiction and depression.     

Subject‐specific modeling of muscle force and knee contact in total knee arthroplasty

Understanding the mechanical loading environment and resulting joint mechanics for activities of daily living in total knee arthroplasty is essential to continuous improvement in implant design. Although survivorship of these devices is good, a substantial number of patients report dissatisfaction with the outcome of their procedure. Knowledge of in vivo kinematics and joint loading will enable improvement in preclinical assessment and refinement of implant geometry. The purpose of this investigation was to describe the mechanics of total knee arthroplasty during a variety of activities of daily living (gait, walking down stairs, and chair rise/sit). Estimates of muscle forces, tibial contact load, location, and pressure distribution was performed through a combination of mobile fluoroscopy data collection, musculoskeletal modeling, and finite element simulation. For the activities evaluated, joint compressive load was greatest during walking down stairs; however, the highest contact pressure occurred during chair rise/sit. The joint contact moment in the frontal plane was mainly varus for gait and walking down stairs, while it was valgus during chair rise/sit. Excursion of the center of pressure on the tibial component was similar during each activity and between the medial and lateral sides. The main determinants of center of pressure location were internal–external rotation, joint load, and tibial insert conformity. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1576–1587, 2016.     

Intrarenal abscesses due to Ureaplasma urealyticum in a transplanted kidney

A young woman developed multiple abscesses in her transplanted kidney. Amplification of the 16S rRNA gene with subsequent sequencing revealed Ureaplasma urealyticum as the infectious agent. Microbiological diagnosis and sensitivity testing led to therapy with levofloxacin, resulting in rapid recovery of the patient.     

AktivMobil – ein betriebliches Gesundheitsprogramm

Background

Workplace health promotion programs (WHPP) are becoming increasingly important. AktivMobil is a behavioral preventive WHPP that was developed for an occupational group with increased work-related strain. This study aimed to elucidate the impact of the program, consisting of a check-up session and a subsequent 20-week virtual and 6?hour personal coaching, on health-related quality of life and physical activity.

Methods

Health-related quality of life and physical activity were quantified by the Short-Form Health Survey (SF-36) and the International Physical Activity Questionnaire (IPAQ) in a quasi-experimental, controlled trial. In all, 28 employees took part in the intervention and were compared to 20 employees without intervention.

Results

The physical component summary score, physical functioning, physical role functioning, pain, general health, vitality, social functioning, mental health and health transition improved significantly in the treatment group after 20 weeks. However, no significant effects were observed for total physical activity and leisure time physical activity. In addition, there was no significant difference between treatment and control subjects at the second evaluation point.

Conclusions

The findings speak for the effectiveness of AktivMobil on promoting health-related quality of life, which is also an indicator of absenteeism. However, the combination with work-related strategies should not be ignored.

     

MicroRNA Profiling Reveals Distinct Signatures in Degenerative Rotator Cuff Pathologies

MicroRNAs (miRNAs) have emerged as key regulators orchestrating a wide range of inflammatory and fibrotic diseases. However, the role of miRNAs in degenerative shoulder joint disorders is poorly understood. The aim of this explorative case-control study was to identify pathology-related, circulating miRNAs in patients with chronic rotator cuff tendinopathy and degenerative rotator cuff tears (RCT). In 2017, 15 patients were prospectively enrolled and assigned to three groups based on the diagnosed pathology: (i) no shoulder pathology, (ii) chronic rotator cuff tendinopathy, and (iii) degenerative RCTs. In total, 14 patients were included. Venous blood samples (“liquid biopsies”) were collected from each patient and serum levels of 187 miRNAs were determined. Subsequently, the change in expression of nine candidate miRNAs was verified in tendon biopsy samples, collected from patients who underwent arthroscopic shoulder surgery between 2015 and 2018. Overall, we identified several miRNAs to be progressively deregulated in sera from patients with either chronic rotator cuff tendinopathy or degenerative RCTs. Importantly, for the several of these miRNAs candidates repression was also evident in tendon biopsies harvested from patients who were treated for a supraspinatus tendon tear. As similar expression profiles were determined for tendon samples, the newly identified systemic miRNA signature has potential as novel diagnostic or prognostic biomarkers for degenerative rotator cuff pathologies. © 2019 The Authors. Journal of Orthopaedic Research^® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. Inc. J Orthop Res 38:202–211, 2020     

Application of the Pareto principle to identify and address drug-therapy safety issues

Purpose

Adverse drug events (ADE) and medication errors (ME) are common causes of morbidity in patients presenting at emergency departments (ED). Recognition of ADE as being drug related and prevention of ME are key to enhancing pharmacotherapy safety in ED. We assessed the applicability of the Pareto principle (～80 % of effects result from 20 % of causes) to address locally relevant problems of drug therapy.

Methods

In 752 cases consecutively admitted to the nontraumatic ED of a major regional hospital, ADE, ME, contributing drugs, preventability, and detection rates of ADE by ED staff were investigated. Symptoms, errors, and drugs were sorted by frequency in order to apply the Pareto principle.

Results

In total, 242 ADE were observed, and 148 (61.2 %) were assessed as preventable. ADE contributed to 110 inpatient hospitalizations. The ten most frequent symptoms were causally involved in 88 (80.0 %) inpatient hospitalizations. Only 45 (18.6 %) ADE were recognized as drug-related problems until discharge from the ED. A limited set of 33 drugs accounted for 184 (76.0 %) ADE; ME contributed to 57 ADE. Frequency-based listing of ADE, ME, and drugs involved allowed identification of the most relevant problems and development of easily to implement safety measures, such as wall and pocket charts.

Conclusions

The Pareto principle provides a method for identifying the locally most relevant ADE, ME, and involved drugs. This permits subsequent development of interventions to increase patient safety in the ED admission process that best suit local needs.