Primary motor cortex long‐term plasticity in multiple system atrophy

In humans, intermittent and continuous theta‐burst stimulation (iTBS and cTBS) elicit long‐term changes in motor‐evoked potentials (MEPs) reflecting long‐term potentiation (LTP)‐ and depression (LTD)‐like plasticity in the primary motor cortex (M1). In this study, we used TBS to investigate M1 plasticity in patients with MSA. We also assessed whether responses to TBS reflect M1 excitability as tested by short‐interval intracortical inhibition (SICI), intracortical facilitation (ICF), short‐interval intracortical facilitation (SICF), and the input/output curves. We studied 20 patients with MSA and 20 healthy subjects (HS). Patients were clinically evaluated with the Unified Multiple System Atrophy Rating Scale. The left M1 was conditioned with TBS. Twenty MEPs were recorded from the right first dorsal interosseous muscle before TBS and 5, 15, and 30 minutes thereafter. In a subgroup of 10 patients, we also tested MEPs elicited by SICI, ICF, SICF, and input/output curves, before TBS. Between‐group analysis of variance showed that at all time points after iTBS MEPs increased, whereas after cTBS they decreased only in HS. In both subgroups tested, patients with predominant parkinsonian and cerebellar features, iTBS and cTBS left MEPs unchanged. MSA patients had reduced SICI, but normal ICF, SICF, and input/output curves. No correlation was found between patients' clinical features and responses to TBS and M1 excitability variables. These findings suggest impaired M1 plasticity in MSA. © 2013 International Parkinson and Movement Disorder Society     

Does abnormal interhemispheric inhibition play a role in mirror dystonia?

The presence of mirror dystonia (dystonic movement induced by a specific task performed by the unaffected hand) in the dominant hand of writer's cramp patients when the nondominant hand is moved suggests an abnormal interaction between the 2 hemispheres. In this study we compare the level of interhemispheric inhibition (IHI) in 2 groups of patients with writer's cramp, one with the presence of a mirror dystonia and the other without as well as a control group. The level of bidirectional IHI was measured in wrist muscles with dual‐site transcranial magnetic stimulation with a 10‐millisecond (short IHI) and a 40‐millisecond (long IHI) interstimulus interval during rest and while holding a pen in 9 patients with mirror dystonia 7 without mirror dystonia, and 13 controls. The group of patients without mirror dystonia did not differ from the controls in their IHI level. In contrast, IHI was significantly decreased in the group of patients with mirror dystonia in comparison with the group without mirror dystonia and the controls in both wrist muscles of both the dystonic and unaffected hand whatever the resting or active condition (P = 0.001). The decrease of IHI level in the group of patients with mirror dystonia was negatively correlated with the severity and the duration of the disease: the weaker the level of IHI, the more severe was the disease and the longer its duration. Interhemispheric inhibition disturbances are most likely involved in the occurrence of mirror dystonia. This bilateral deficient inhibition further suggests the involvement of the unaffected hemisphere in the pathophysiology of unilateral dystonia. © 2013 International Parkinson and Movement Disorder Society     

Combat-related upper extremity injuries: Surgical management specificities on the theatres of operations

This review presents the current surgical management of combat-related upper extremity injuries during the acute phase. The strategy consists of saving the life, saving the limb and retaining function. Surgical tactics are based on damage control orthopaedics techniques of haemorrhage control, wound debridement, and temporary bone stabilization prior to evacuation out of the combat zone. Features of the definitive management of local casualties in battlefield medical facilities are also discussed. In this situation, reconstructive procedures have to take into account the limited resources and operational constraints.     

Emotional Control,Styles of Coping with Stress and Acceptance of Illness among Patients Suffering from Chronic Somatic Diseases

The purpose of this study was to analyse the associations of emotional control with sociodemographic and clinical variables in a sample of patients with a range of chronic somatic diseases. The relationships between emotional control, coping styles and adjustment to the disease were investigated. The sample consisted of 300 patients with the mean age of 54.60 ± 17.57 years. Courtauld Emotional Control Scale was used to measure the patients' tendency to suppress negative emotions, Coping Inventory for Stressful Situations was used to measure coping styles and Acceptance of Illness Scale was applied to determine adjustment to the disease. Patients with neurological conditions showed significantly lower suppression of anger. Levels of emotional control were found to be related to gender, age and educational level but not to the place of residence. Task‐oriented style of coping with stress correlated positively with suppression of depression and anxiety, whereas acceptance of illness correlated negatively with suppression of anger. Levels of emotional control are only weakly related to the type of diagnosis; however, some clinical samples may show lower suppression of anger. Suppression of negative emotions is weakly related to adjustment indicators such as certain coping styles and acceptance of illness. Copyright © 2013 John Wiley & Sons, Ltd.     

Developing a framework for meaningful use of personal health records (PHRs)

Significant advancements have been made in the technological development of the personal health record (PHR). The goal of the PHR is to encourage patients and health consumers to take individual responsibility for their health by being more engaged in the health care process through the use of the PHR. Many PHR applications are extensions of the electronic health record (EHR) and have limited patient input in their design. As more patients and health consumers use PHRs, there is an increasing need to understand the ways in which patients or health consumers use them. The major objective of this paper is to introduce a framework for understanding meaningful use of PHRs and to discuss the associated challenges that may impede meaningful use. The primary challenges that may hinder meaningful use of PHRs relate to health system challenges such as health care regulatory and managerial policies and multiple institutional, societal, cultural, and economic issues. Additional challenges, such as technology, design, usability, and implementation, still exist that relate to socio-technical issues.     

Age Cohort Differences in the Nonmedical Use of Prescription Zolpidem: Findings from a Nationally Representative Sample

Background

Recent warnings from the FDA have highlighted the potential risks associated with zolpidem use. These risks may be especially acute in nonmedical users of zolpidem, but little work has examined the characteristics of such nonmedical users. This study aims to investigate the correlates of nonmedical use of zolpidem (NUPZ) across the lifespan and potential age cohort-based differences in NUPZ correlates.

Methods

Data from the 2009–2011 versions of the National Survey on Drug Use and Health were used (n = 174,667). Analyses used weighted design-based logistic regressions to examine a set of substance use and mental health correlates within five separate age cohorts and differences in correlate magnitude between these cohorts.

Results

Most examined substance use and mental health variables were significant correlates of NUPZ, though odds ratio (OR) magnitude tended to drop with increasing age. Age-based differences were most apparent for substance use correlates of both lifetime and past year NUPZ, with significantly higher ORs in adolescent nonmedical users. Mental health variables operated more consistently across age, with OR magnitudes that were generally in the same range, regardless of age cohort.

Conclusions

Age-based differences in NUPZ correlates suggest motives may change for NUPZ through the lifespan, though this cannot be established with the cross-sectional data used in this work. Clinicians screening for NUPZ should emphasize such screening in high-risk individuals with substance use and/or mental health problems.