The diagnostic validity of the Athens Insomnia Scale

OBJECTIVE: To provide documentation for the diagnostic validity of the Athens Insomnia Scale (AIS), a self-assessment psychometric tool which has previously shown high consistency, reliability and external validity for the evaluation of the intensity of sleep difficulty. METHODS: The AIS was administered to a total of 299 subjects (105 primary insomniacs, 100 psychiatric outpatients, 44 psychiatric inpatients and 50 nonpatient controls) who were also assessed for the ICD-10 diagnosis of "nonorganic insomnia" blindly in terms of the AIS scores. RESULTS: 176 subjects were identified as insomniacs and 123 as noninsomniacs. Logistic regression of AIS total score against the ICD-10 diagnosis of insomnia demonstrated that a score of 6 is the optimum cutoff based on the balance between sensitivity and specificity. When diagnosing individuals with a score of 6 or higher as insomniacs, the scale presents with 93% sensitivity and 85% specificity (90% overall correct case identification). For this cutoff score, in the general population, the scale has a positive predictive value (PPV) of 41% and a negative predictive value (NPV) of 99%. For the same cutoff score, among unselected psychiatric patients, the PPV was found to be 86% and the NPV 92%. Other cutoff scores can be also considered, however, depending on the importance of avoiding false positive or false negative results; for example, for a cutoff score of 10, the PPV in the general population reaches about 90% without the NPV becoming lower than 94%. CONCLUSION: The AIS can be utilized in clinical practice and research, not only as an instrument to measure the intensity of sleep-related problems, but also as a screening tool in reliably establishing the diagnosis of insomnia.     

Evaluating the “cushion effect” among children in frontal motor vehicle crashes

Background

The “Cushion Effect,” the phenomenon in which obesity protects against abdominal injury in adults in motor vehicle accidents, has not been evaluated among pediatric patients. This work evaluates the association between subcutaneous fat cross-sectional area, quantified using analytic morphomic techniques and abdominal injury.

Beyond faithful conduction: short-term dynamics, neuromodulation, and long-term regulation of spike propagation in the axon

Most spiking neurons are divided into functional compartments: a dendritic input region, a soma, a site of action potential initiation, an axon trunk and its collaterals for propagation of action potentials, and distal arborizations and terminals carrying the output synapses. The axon trunk and lower order branches are probably the most neglected and are often assumed to do nothing more than faithfully conducting action potentials. Nevertheless, there are numerous reports of complex membrane properties in non-synaptic axonal regions, owing to the presence of a multitude of different ion channels. Many different types of sodium and potassium channels have been described in axons, as well as calcium transients and hyperpolarization-activated inward currents. The complex time- and voltage-dependence resulting from the properties of ion channels can lead to activity-dependent changes in spike shape and resting potential, affecting the temporal fidelity of spike conduction. Neural coding can be altered by activity-dependent changes in conduction velocity, spike failures, and ectopic spike initiation. This is true under normal physiological conditions, and relevant for a number of neuropathies that lead to abnormal excitability. In addition, a growing number of studies show that the axon trunk can express receptors to glutamate, GABA, acetylcholine or biogenic amines, changing the relative contribution of some channels to axonal excitability and therefore rendering the contribution of this compartment to neural coding conditional on the presence of neuromodulators. Long-term regulatory processes, both during development and in the context of activity-dependent plasticity may also affect axonal properties to an underappreciated extent.     

依达拉奉右莰醇对急性缺血性脑卒中患者神经功能及血清炎性因子的影响

目的：本研究探讨依达拉奉右莰醇对急性缺血性脑卒中（AIS）患者的神经功能及血清炎性因子的影响。方法：回顾性分析自2020年9月至2021年4月本院收治的197例AIS患者的临床资料。根据治疗方式,分为依达拉奉右莰醇组、常规治疗组、依达拉奉右莰醇联合阿替普酶组和阿替普酶组;疗程为10天。比较依达拉奉右莰醇组与常规治疗组,阿替普酶组与依达拉奉右莰醇联合阿替普酶组治疗前后NIHSS评分及炎性因子的变化。结果：4组患者治疗前的NIHSS评分及炎性因子水平无显著性差异。基线校正前,依达拉奉右莰醇联合阿替普酶组NIHSS评分,hs-CRP、TNF-α和IL-6下降数值最多;常规治疗组神经功能和各项炎性因子的前后下降程度都弱于其他组。两因素析因分析表明,相较于未使用依达拉奉右莰醇的治疗组（常规治疗组以及阿替普酶组）,无论是否连用阿替普酶的情况下,使用依达拉奉右莰醇均能显著改善NIHSS评分,以及hs-CRP、TNF-α、IL-6炎性因子水平（P = 0.001）。基线校正后,结论依然成立。两两比较结果表明,依达拉奉右莰醇组联合阿替普酶组的NIHSS评分,hs-CRP、TNF-α、IL-6的下降数值均＞阿替普酶组,且均具有统计学意义（P < 0.05）;依达拉奉右莰醇组的NIHSS评分和各炎性因子的下降数值＞常规治疗组,且差异具有统计学意义（P < 0.05）; 依达拉奉右莰醇组与阿替普酶组之间的NIHSS评分的下降数值无统计学差异（P > 0.05）。结论：依达拉奉右莰醇能明显降低AIS患者的炎性因子水平,改善AIS患者的神经功能;依达拉奉右莰醇联合阿替普酶较阿替普酶单独治疗能显著改善AIS患者的神经功能。相较于未使用依达拉奉右莰醇的治疗,使用依达拉奉右莰醇治疗（无论是否联用阿替普酶）均能显著改善AIS患者的神经功能及炎性因子水平。     

Enabling Task-Specific Volitional Motor Functions via Spinal Cord Neuromodulation in a Human With Paraplegia

We report a case of chronic traumatic paraplegia in which epidural electrical stimulation (EES) of the lumbosacral spinal cord enabled (1) volitional control of task-specific muscle activity, (2) volitional control of rhythmic muscle activity to produce steplike movements while side-lying, (3) independent standing, and (4) while in a vertical position with body weight partially supported, voluntary control of steplike movements and rhythmic muscle activity. This is the first time that the application of EES enabled all of these tasks in the same patient within the first 2 weeks (8 stimulation sessions total) of EES therapy.     

Pedicle screw instrumentation in adolescent idiopathic scoliosis (AIS)

Introduction  

Pedicle screw instrumentation in AIS has advantages of rigid fixation, improved deformity correction and a shorter fusion, but needs an exacting technique.     

Activity-Based Therapy for Recovery of Walking in Individuals With Chronic Spinal Cord Injury: Results From a Randomized Clinical Trial

ObjectiveTo examine the effects of activity-based therapy (ABT) on neurologic function, walking ability, functional independence, metabolic health, and community participation.DesignRandomized controlled trial with delayed treatment design.SettingOutpatient program in a private, nonprofit rehabilitation hospital.ParticipantsVolunteer sample of adults (N=48; 37 men and 11 women; age, 18–66y) with chronic (≥12mo postinjury), motor-incomplete (ASIA Impairment Scale grade C or D) spinal cord injury (SCI).InterventionsA total of 9h/wk of ABT for 24 weeks including developmental sequencing; resistance training; repetitive, patterned motor activity; and task-specific locomotor training. Algorithms were used to guide group allocation, functional electrical stimulation utilization, and locomotor training progression.Main Outcome MeasuresNeurologic function (International Standards for Neurological Classification of Spinal Cord Injury); walking speed and endurance (10-meter walk test, 6-minute walk test, and Timed Up and Go test); community participation (Spinal Cord Independence Measure, version III, and Reintegration to Normal Living Index); and metabolic function (weight, body mass index, and Quantitative Insulin Sensitivity Check).ResultsSignificant improvements in neurologic function were noted for experimental versus control groups (International Standards for Neurological Classification of Spinal Cord Injury total motor score [5.1±6.3 vs 0.9±5.0; P=.024] and lower extremity motor score [4.2±5.2 vs −0.6±4.2; P=.004]). Significant differences between experimental and control groups were observed for 10-meter walk test speed (0.096±0.14m/s vs 0.027±0.10m/s; P=.036) and 6-minute walk test total distance (35.97±48.2m vs 3.0±25.5m; P=.002).ConclusionsABT has the potential to promote neurologic recovery and enhance walking ability in individuals with chronic, motor-incomplete SCI. However, further analysis is needed to determine for whom ABT is going to lead to meaningful clinical benefits.     

Prospective randomized comparison of radiation exposure from full spine radiographs obtained in three different techniques

Problem: The purpose of the investigation was a comparison of two different digital X-ray techniques with conventional standing full spine films. Evaluation of dose area product, image quality and inter-observer error of Cobb-angle measurement in patients with scoliosis and kyphoscoliosis were studied.Methods: A consecutive series of 150 patients were prospectively randomized into three groups. Patients in group 1 (n=53) received a conventional standing postero-anterior full spine radiograph. All films were evaluated on the light box. Patients in group 2 (n=48) received a X-ray using the digital storage phosphor plate system (CR). For group 3 (n=49) digital pulsed fluoroscopy was used. In groups 2 and 3 images were exported to a picture archiving and communicating system (PACS) workstation and viewed on a monitor (Siemens SMM 21140P, Germany). Dose area product measurements were performed in all three groups (Diamentor-M, PTW, Freiburg). Three experienced investigators independently reviewed all pictures. Pedicles and endplates were counted. Cobb-angles of the main curves were measured.Results: The mean dose area product was 97.0 cGy cm⊃ (37.0–380.0 cGy cm⊃) for conventional films, 31.5 cGy cm⊃ (6.0–66.0 cGy cm⊃) for CR imaging and 5.0 cGy cm⊃ (1.0–29.0 cGy cm⊃) for digital fluoroscopy. The differences of Cobb-angle measurements were not significantly different for the three methods. Differences in the count of pedicles and endplates between the investigators were significantly lower for the conventional film as an indicator for the best detail presentation.Conclusion: A significant reduction in dose area product is possible with modern digital X-ray methods. The inter-observer error of Cobb-angle measurement is not significantly altered. The detail information is decreased in comparison to conventional films.