Hyperexcitability restricted to the lower limb motor system in a patient with stiff-leg syndrome

We report a 29-year-old man who presented with a 2-year history of progressive stiffness and painful spasms limited to the bilateral lower limbs, exaggerated by auditory and tactile stimuli. His deep tendon reflexes were slightly increased in both lower extremities. His plantar response was flexor. His serum and cerebrospinal fluid were negative for anti-glutamic acid decarboxylase antibodies. Electromyography of antagonist muscle pairs in his distal lower limbs revealed a failure of reciprocal inhibition. We used transcranial magnetic stimulation with a paired-pulse paradigm, delivered to the cortical area of the upper and lower limbs, and revealed significantly enhanced facilitation only in the area of his lower limbs, but not that representing his upper limbs. His symptoms were improved substantially by 20mg/day of oral diazepam. To our knowledge this is the first report of a patient with hyperexcitability limited to the lower limb motor system in a patient with stiff-leg syndrome.     

Where do human organs come from? Trends of generalized and restricted altruism in organ donations

The supply of human organs for transplantation is undergoing a dramatic transformation. Using data from 30 countries for the years 1995-2007, this paper suggests that organ supply today is more dependent on direct donations than on the collective organ pool. This trend is analyzed by studying different modes of altruism: "generalized altruism" relates to the procurement of organs through a one-for-all collectivized system of donations whereas "restricted altruism" relates to one-to-one donations with organs considered personal gifts. The data suggest that transplants are becoming less and less social goods and more and more personal gifts. This trend is documented and discussed in light of the linkage that social scientists hypothesize between altruism and social solidarity. Whereas altruism is conceived as generating social solidarity, the rise in direct organ donations restricts the effect of altruism to one-to-one interactions rather than one-for-all giving.     

Depressed intracortical inhibition after long trains of subthreshold repetitive magnetic stimuli at low frequency

OBJECTIVE: Repetitive transcranial magnetic stimulation (rTMS) modulates cortical excitability. These effects outlast the rTMS train, and range from inhibition to facilitation according to the variables used for rTMS. Several studies have demonstrated short and long-term effects on motor evoked potential (MEP) size, whereas the effects on intracortical inhibition (ICI) and facilitation (ICF) are still unclear. We investigated short- (1-15 min), intermediate- (16-30 min), and long-term (6 h) effects on intracortical excitability. METHODS: Fourteen healthy subjects were stimulated with rTMS trains of 900 pulses (1 Hz, 90% resting motor threshold (rMTh)), delivered over the primary motor cortex and the occipital area. MTh, MEP size, silent period, intracortical inhibition at short (ICI) and long inter-stimulus intervals, and ICF were tested before and after rTMS. RESULTS: ICI was reduced 16-30 min after 1 Hz rTMS trains over the primary motor area, whereas the other response variables remained unchanged. The ICI reduction at 16-30 min was reproducible on different days in the same subjects; it was absent at 6 h and after stimulation of the occipital area. CONCLUSIONS: Subthreshold 1 Hz rTMS decreases ICI by reducing the excitability of intracortical inhibitory interneurones or by altering the electrical properties of the facilitatory chain of neurons responsible for the I waves.     

中医药服务产品商品化是开展国际服务贸易的核心要素

本文从国际服务贸易的视角重新审视中医药服务,用商品、价值、贸易、市场、销售、盈利等市场经济的理论,重新认识中医药服务贸易活动。提出了完善服务产品理论,创新服务产品是国际服务贸易发展的驱动力的观点。从商品的形态、商品的价值以及有形和无形产品的特点和关系的阐述,介绍了中医药国际服务贸易与服务产品的特点以及中医药服务产品商品化的基本要求。中医药服务产品商品化的方法包括服务项目单元化和构建服务包等方法。并且介绍了中医药服务产品商品化步骤,包括选项、命名、制定中医药服务产品的标准规范,明确产品的属性、确定服务产品的使用范围、中医药服务产品的市场准入和上市后评价等步骤。     

The proprioceptive neuromuscular facilitation-concept; the state of the evidence,a narrative review

Introduction: The proprioceptive neuromuscular facilitation-concept (PNF-concept) is a widely used rehabilitation concept, and is in many countries part of the undergraduate curriculum of physiotherapy education. It is also offered in postgraduate training worldwide. The modern physiotherapist is confronted with the application of evidence-based practice; therefore, the aim of this review is to summarize the available evidence for this rehabilitation concept.

Method: A search was completed using Pubmed, ScienceDirect, PEDro, Cochrane library and the International PNF Association website. An evidence-based practice approach has been promoted in the field of physiotherapy since the early 1990s, hence we limited the search from 1990 until 2014.

Major findings: Seventy-four sources that were found were categorized in: (A) PNF philosophy, (B) PNF basic principles and procedures, (C) PNF techniques in rehabilitation. In the reviewed publications, a variety of indications and subject populations were identified including: neurological, musculoskeletal, pulmonary, geriatric and mixed disorders. The publications varied in type and quality, ranging from case studies, clinical trials, randomized controlled trials and reviews. This variety of publications, treatment indications and outcome measures in the publications warranted a narrative review

Discussion and conclusion: The scope and diversity of articles in the review make it difficult to study the PNF-concept in a methodical way, since different components of a comprehensive rehabilitation approach may act as confounders when measuring the effects of one specific part of the approach. There is a substantial body of research which supports the use of PNF as a comprehensive rehabilitation concept. The literature also describes that the PNF-concept is applied in clinical practice in a variety of populations and indications; however, efficacy for specific indications and populations requires further investigation.     

Modality-specific facilitation and adaptation to painful tonic stimulation in humans.

The study assessed the influence of stimulus modality on adaptation or facilitation of pain during tonic cold and tourniquet pressure stimulation. Experimental set-up for the cold stimulation consisted of a thermo-tank with water, cooled to 3 degrees C, circulation pump, electronic thermometer and an electronic 10 cm visual analogue scale (VAS). Experimental set-up for the tonic pressure stimulation consisted of a pneumatic tourniquet cuff, a computer-controlled air compressor, and an electronic VAS. The first experiment assessed temporal profiles of pain intensity and skin temperature during immersion of the non-dominant hand and lower arm into cold water for 3 min or until the pain tolerance limit was reached. The second experiment assessed temporal profile of cuff pain intensity during constant compressions for 10 min beginning at pain intensities of 2, 4, and 6 cm on the VAS ("VAS 2", "VAS 4" and "VAS 6" sessions). Subjects enduring cold stimulation for less than 3 min were defined as non-adapting to cold and vice versa. The intensity of cold pain in non-adapting subjects increased significantly faster than in adapting subjects and reached significantly higher magnitude. The course of pain intensity during constant compression, estimated by a linear regression line, was increasing or decreasing, representing facilitation or adaptation of pain, respectively. The typical profile of adaptation consisted of an "overshoot" in pain intensity, followed by a decrease in pain intensity. There was significant correlation in VAS slopes between sessions separated by 2-5 days, suggesting consistent pattern in pain responses to tonic pressure stimulation. Adaptation or facilitation rates and the overshoot magnitude were dependent on the initial pain intensity (2, 4, or 6 cm on the VAS). The facilitation rate was highest and the adaptation rate was lowest during the "VAS 2" session, while the facilitation rate was lowest and the adaptation rate was highest during the "VAS 6" session. The overshoot magnitude was lowest during "VAS 6" session. Adapting and non-adapting/facilitating responses to cold and to pressure during "VAS 6" session were not correlated, suggesting that pain course and therefore stimulus tolerance during tonic stimulation are modality-specific. The results of the study suggest that tolerance of tonic painful pressure and cold stimulations is specific to stimulus modality and may represent separate nociceptive mechanisms.     

Gastrointestinal gene delivery by cyclodextrins – In vitro quantification of extracellular barriers

Local gene delivery represents a promising therapeutic approach for diseases of the intestine. However, the gastrointestinal tract poses significant challenges to successful gene delivery. Cyclodextrins (CDs) have been extensively investigated as non-viral vectors. Here, we assessed the suitability of an amphiphilic cationic CD for intestinal gene transfer, with particular focus on extracellular barriers.     

Profiling biopharmaceutical deciding properties of absorption of lansoprazole enteric-coated tablets using gastrointestinal simulation technology

The aim of the present study was to correlate in vitro properties of drug formulation to its in vivo performance, and to elucidate the deciding properties of oral absorption. Gastrointestinal simulation technology (GST) was used to simulate the in vivo plasma concentration–time curve and was implemented by GastroPlus™ software. Lansoprazole, a typical BCS class II drug, was chosen as a model drug. Firstly, physicochemical and pharmacokinetic parameters of lansoprazole were determined or collected from literature to construct the model. Validation of the developed model was performed by comparison of the predicted and the experimental plasma concentration data. We found that the predicted curve was in a good agreement with the experimental data. Then, parameter sensitivity analysis (PSA) was performed to find the key parameters of oral absorption. The absorption was particularly sensitive to dose, solubility and particle size for lansoprazole enteric-coated tablets. With a single dose of 30 mg and the solubility of 0.04 mg/ml, the absorption was complete. A good absorption could be achieved with lansoprazole particle radius down to about 25 μm. In summary, GST is a useful tool for profiling biopharmaceutical deciding properties of absorption of lansoprazole enteric-coated tablets and guiding the formulation optimization.     

Acute intermittent hypoxia induced neural plasticity in respiratory motor control

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