Cortical electrical stimulation combined with rehabilitative training: Enhanced functional recovery and dendritic plasticity following focal cortical ischemia in rats

Abstract

This study assessed the behavioral and dendritic structural effects of combining subdural motor cortical electrical stimulation with motor skills training following unilateral sensorimotor cortex lesions in adult male rats. Rats were pre-operatively trained on a skilled forelimb reaching task, the Montoya staircase test, and then received endothelin-1 induced ischemic lesions of the sensorimotor cortex. Ten to 14 days later, electrodes were implanted over the peri-lesion cortical surface. Rats subsequently began 10 days of rehabilitative training on the reaching task in 1 of 3 conditions: 1. 50 Hz stimulation during training, 2. 250 Hz stimulation during training or 3. no stimulation. No significant difference in performance was found between the 250 Hz and no stimulation groups. The 50 Hz stimulation group had significantly greater rates of improvement with the impaired forelimb in comparison to 250 Hz and no stimulation groups combined. Fifty Hz stimulated animals also had a significant increase in the surface density of dendritic processes immunoreactive for the cytoskeletal protein, microtubule-associated protein 2, in the peri-lesion cortex compared to the other groups. These results support the efficacy of combining rehabilitative training with cortical electrical stimulation to improve functional outcome and cortical neuronal structural plasticity following sensorimotor cortical damage.     

Service learning in physiotherapy taken to a new level: experiences in South Africa

Abstract

Limited financial resources and social problems in the communities surrounding the University of the Free State (UFS) in South Africa prompted the need for community engagement as a core university activity. A facilitator in the form of a non-profit company called the Khula Xhariep Partnership (KXP) was created to ensure sustainable opportunities for members involved in community engagement. In 2005, the Physiotherapy Department of the UFS initiated a community outreach programme in the form of a service learning module with specific service learning pedagogic skills and outcomes to meet the mandatory requirements of all the relevant statutory bodies, and the mission statement of the KXP. From this service learning module, it became clear that effective civic engagement can only take place when integrated in all university activities, within a structured curriculum with definite teaching and learning outcomes, quality academic supervision, assessment and research.     

PROTECTIVE EFFECT OF TETRAMETHYLPYRAZINE ON LEARNING AND MEMORY FUNCTION IN D-GALACTOSE-LESIONED MICE

ALZHEIMER'Sdisease(AD)isaneurodegenerative disorderofcentralnervoussystemthatcausespro-gressivecognitiveandmemorydysfunctionintheelderlypeople.ADbrainsarecharacterizedbythepresenceofsenileplaques(SP)andneurofibrillarytangles (NFT),ac-companiedbythedecreaseofacetylcholine(ACh)levelandAofnumberofcholinergicneuronsandsynapses.1,2 Withtheincreaseoftheelderlypeople,theincidenceofADisincreas-ingandgivingrisetoaheavyloadonfamiliesandsociety.ThoughalotofresearcheshavebeenmadeonAD,thepath-oge…     

The Learning Curve Measured by Operating Times for Laparoscopic and Open Gastric Bypass: Roles of Surgeon's Experience,Institutional Experience,Body Mass Index and Fellowship Training

Background: Surgeons must overcome a substantial learning curve before mastering laparoscopic Rouxen-Y gastric bypass (LRYGBP). This learning curve can be defined in terms of mortality, morbidity or length of surgery. The aim of this study was to compare the learning curves in terms of surgical time for the first 3 surgeons performing LRYGBP in our hospital with the length of surgery for open gastric bypass (CONTROLS). Methods: We compared 494 primary LRYGBPs performed by 3 surgeons (393 by 1st SURGEON, 57 by 2nd SURGEON and 44 by 3rd SURGEON) to 159 open vertical banded gastroplasty-Roux-en-Y gastric bypasses (CONTROLS). Data for LRYGBP patients were prospectively recorded while those for CONTROLS were retrospectively obtained. Factors that significantly affected the length of surgery were identified by univariate and multivariate linear regression analysis. Results: LRYGBP and CONTROL patients were similar in age, height, weight and BMI, although more CONTROLS were male. Median time for the 1st SURGEON performing LRYGBP dropped for each subsequent 100 operations: 1st 100 – 190 min, 2nd 100 – 135 min, 3rd 100 – 110 min and 4th 100 – 100 min. Median time for the 2nd SURGEON performing LRYGBP was 120 min, 3rd SURGEON 173 min and CONTROLS 64 min. Length of surgery significantly correlated with surgical experience in terms of number of operations and BMI of patient. Times for 2nd SURGEON, a fellowship trained laparoscopic surgeon, started significantly faster than 1st SURGEON's, but did not significantly improve with experience. 3rd SURGEON's initial times were similar to 1st SURGEON's, but his times improved more rapidly with experience. Times for CONTROLS were significantly faster than all laparoscopic groups and did not correlate with operation number or patient BMI. Conclusions: The length of surgery for LRYGBPs continued to shorten beyond 400 operations for the first surgeon performing LRYGBP in our hospital. Previous fellowship training in LRYGBP shortened surgical times during initial clinical experience as an attending for the second surgeon. The learning curve for a subsequent experienced laparoscopic surgeon was truncated because of the already established LRYGBP program.     

Impact of Fellowship Training on the Learning Curve for Laparoscopic Gastric Bypass

Background: We have previously shown that the learning curve for laparoscopic Roux-en-Y gastric bypass (LRYGBP) is approximately 75 cases. Patients have worse outcomes during the learning curve. Our aim was to evaluate the impact of fellowship training on outcomes during a surgeon's early experience with LRYGBP. Methods: The study population consisted of the first 75 consecutive LRYGBP operations attempted by two laparoscopic surgeons, one with laparoscopic gastric bypass fellowship training (Group A) and one without laparoscopic bypass fellowship training (Group B). Outcome parameters included mortality, major perioperative complications, operative time, and conversion to an open operation. Results: Age, BMI, and gender distribution were similar in both groups. Operative time was significantly longer in Group B (189 min. vs 122 min., P <0.05). Conversion to an open procedure occurred uncommonly in both groups (3%). Major complications occurred more frequently in Group B (13% vs 8%, P =NS). In addition, the complications in Group B were more severe, resulting in 2 deaths. No deaths occurred in Group A. Conclusion: Laparoscopic gastric bypass fellowship training improves perioperative outcomes during a surgeon's early experience with LRYGBP.     

Assessment of the effects of a taped cognitive behavior message on postoperative complications (therapeutic suggestions under anesthesia)

Background: The authors studied whether playing a taped cognitive-behavior message during and immediately following bariatric surgery will improve performance of a postoperative regimen designed to enhance recovery. Methods:The double-blinded placebo-controlled study consisted of 27 morbidly obese bariatric surgical patients randomly assigned to listen to either a blank (Controls) or a positive therapeutic message audiotape (Tape). A Postoperative Regimen Checklist (PRC) quantified different parts of the postoperative recovery regimen. Results:The data showed that patients in the Tape group, compared to the Controls: 1) achieved better scores at most PRC assessment points (p<0.05), 2) required less encouragement to perform tasks (p<0.05), and 3) were discharged from the hospital a mean of 1.6 days earlier. Conclusions: A taped cognitive-behavioral message, played to patients repetitively during and immediately following bariatric surgery, is effective in enhancing postoperative compliance and reducing in-patient length of stay.     

Machine Learning Solutions for Osteoporosis—A Review

Osteoporosis and its clinical consequence, bone fracture, is a multifactorial disease that has been the object of extensive research. Recent advances in machine learning (ML) have enabled the field of artificial intelligence (AI) to make impressive breakthroughs in complex data environments where human capacity to identify high-dimensional relationships is limited. The field of osteoporosis is one such domain, notwithstanding technical and clinical concerns regarding the application of ML methods. This qualitative review is intended to outline some of these concerns and to inform stakeholders interested in applying AI for improved management of osteoporosis. A systemic search in PubMed and Web of Science resulted in 89 studies for inclusion in the review. These covered one or more of four main areas in osteoporosis management: bone properties assessment (n = 13), osteoporosis classification (n = 34), fracture detection (n = 32), and risk prediction (n = 14). Reporting and methodological quality was determined by means of a 12-point checklist. In general, the studies were of moderate quality with a wide range (mode score 6, range 2 to 11). Major limitations were identified in a significant number of studies. Incomplete reporting, especially over model selection, inadequate splitting of data, and the low proportion of studies with external validation were among the most frequent problems. However, the use of images for opportunistic osteoporosis diagnosis or fracture detection emerged as a promising approach and one of the main contributions that ML could bring to the osteoporosis field. Efforts to develop ML-based models for identifying novel fracture risk factors and improving fracture prediction are additional promising lines of research. Some studies also offered insights into the potential for model-based decision-making. Finally, to avoid some of the common pitfalls, the use of standardized checklists in developing and sharing the results of ML models should be encouraged. © 2021 American Society for Bone and Mineral Research (ASBMR).     

On the inter-relations between artificial and physiological neural networks

Abstract

This paper discusses the inter-relations between findings on the physiological neural network (PNN) and artificial neural networks (ANN). It discusses the interaction of progress in both PNN and ANN for the purpose of borrowing from ANN's mathematical understandings to establish pointers for further explorations to better understand the PNN, and also for the reciprocal transferring of knowledge from PNN findings to improve ANN schemes. Such improvements in ANN are essential for better handling the needs of the information technology (IT) explosion in dealing with huge data bases and where data often defy analysis and are incomplete and fuzzy. On the other hand, principles and elements of ANN designs that appear to be important and successful can serve as guides for identifying them in the PNN, to be subsequently confirmed by bioanalytical tests. Hence progress in PNN is obviously essential for progress in ANN, as is progress in ANN helpful in PNN modeling, though its laboratory confirmation is still a far lengthier process. We discuss certain specific ANN schemes with respect to the above inter-relations with PNN. We feel that the progress in both PNN and ANN research provides a major link between the thrust in information technology developments and the thrust in biological science research, which are most probably the two major focus areas of research at the dawn of the 21st century. [Neurol Res 2001; 23: 482-488]     

Discussion paper - Attending to pain: 'Mechanisms of musculoskeletal physiotherapy'

Abstract

Zusman (Zusman M. Mechanisms of musculoskeletal physiotherapy. Phys Ther Rev 2004;9:39–49) offers a welcome paper hypothesising potential neurophysiological mechanisms (habituation and extinction) underpinning musculoskeletal physiotherapy. The strong review of clinical and physiological evidence relating to cellular learning offers a potential theoretical base to practice, supplementing recent physiotherapy literature in this field. His paper raises several themes that relate to the ways in which physiotherapists interpret evidence and the discussion here will focus on these contextual themes.