Interpersonal interactions for haptic guidance during balance exercises.

BACKGROUND: Caregiver-patient interaction relies on interpersonal coordination during support provided by a therapist to a patient with impaired control of body balance. RESEARCH QUESTION: The purpose of this study was to investigate in a therapeutic context active and passive participant involvement during interpersonal support in balancing tasks of increasing sensorimotor difficulty. METHODS: Ten older adults stood in semi-tandem stance and received support from a physical therapist (PT) in two support conditions: 1) physical support provided by the PT to the participant's back via an instrumented handle affixed to a harness worn by the participant ("passive" interpersonal touch; IPT) or 2) support by PT and participant jointly holding a handle instrumented with a force-torque transducer while facing each other ("active" IPT). The postural stability of both support conditions was measured using the root-mean-square (RMS) of the Centre-of-Pressure velocity (RMS dCOP) in the antero-posterior (AP) and medio-lateral (ML) directions. Interpersonal postural coordination (IPC) was characterized in terms of cross-correlations between both individuals' sway fluctuations as well as the measured interaction forces. RESULTS: Active involvement of the participant decreased the participant's postural variability to a greater extent, especially under challenging stance conditions, than receiving support passively. In the passive support condition, however, stronger in-phase IPC between both partners was observed in the antero-posterior direction, possibly caused by a more critical (visual or tactile) observation of participants' body sway dynamics by the therapist. In-phase cross-correlation time lags indicated that the therapist tended to respond to participants' body sway fluctuations in a reactive follower mode, which could indicate visual dominance affecting the therapist during the provision of haptic support. SIGNIFICANCE: Our paradigm implies that in balance rehabilitation more partnership-based methods promote greater postural steadiness. The implications of this finding with regard to motor learning and rehabilitation need to be investigated.

Human bipedal instability in tree canopy environments is reduced by "light touch" fingertip support.

Whether tree canopy habitats played a sustained role in the ecology of ancestral bipedal hominins is unresolved. Some argue that arboreal bipedalism was prohibitively risky for hominins whose increasingly modern anatomy prevented them from gripping branches with their feet. Balancing on two legs is indeed challenging for humans under optimal conditions let alone in forest canopy, which is physically and visually highly dynamic. Here we quantify the impact of forest canopy characteristics on postural stability in humans. Viewing a movie of swaying branches while standing on a branch-like bouncy springboard destabilised the participants as much as wearing a blindfold. However "light touch", a sensorimotor strategy based on light fingertip support, significantly enhanced their balance and lowered their thigh muscle activity by up to 30%. This demonstrates how a light touch strategy could have been central to our ancestor's ability to avoid falls and reduce the mechanical and metabolic cost of arboreal feeding and movement. Our results may also indicate that some adaptations in the hand that facilitated continued access to forest canopy may have complemented, rather than opposed, adaptations that facilitated precise manipulation and tool use.

Interpersonal interactions for haptic guidance during maximum forward reaching.

Caregiver-patient interactions rely on interpersonal coordination (IPC) involving the haptic and visual modalities. We investigated in healthy individuals spontaneous IPC during joint maximum forward reaching. A 'contact-provider' (CP; n=2) kept light interpersonal touch (IPT) laterally with the wrist of the extended arm of a forward reaching, blind-folded 'contact-receiver' (CR; n=22). Due to the stance configuration, CP was intrinsically more stable. CR received haptic feedback during forward reaching in two ways: (1) presence of a light object (OBT) at the fingertips, (2) provision of IPT. CP delivered IPT with or without vision or tracked manually with vision but without IPT. CR's variabilities of Centre-of-Pressure velocity (CoP) and wrist velocity, interpersonal cross-correlations and time lags served as outcome variables. OBT presence increased CR's reaching amplitude and reduced postural variability in the reach end-state. CR's variability was lowest when CP applied IPT without vision. OBT decreased the strength of IPC. Correlation time lags indicated that CP retained a predominantly reactive mode with CR taking the lead. When CP had no vision, presumably preventing an effect of visual dominance, OBT presence made a qualitative difference: with OBT absent, CP was leading CR. This observation might indicate a switch in CR's coordinative strategy by attending mainly to CP's haptic 'anchor'. Our paradigm implies that in clinical settings the sensorimotor states of both interacting partners need to be considered. We speculate that haptic guidance by a caregiver is more effective when IPT resembles the only link between both partners.

Report from the kick-off meeting of the Cochrane Skin Group Core Outcome Set Initiative (CSG-COUSIN).

A major obstacle of evidence-based clinical decision making is the use of nonstandardized, partly untested outcome measurement instruments. Core Outcome Sets (COSs) are currently developed in different medical fields to standardize and improve the selection of outcomes and outcome measurement instruments in clinical trials, in order to pool results of trials or to allow indirect comparison between interventions. A COS is an agreed minimum set of outcomes that should be measured and reported in all clinical trials of a specific disease or trial population. The international, multidisciplinary Cochrane Skin Group Core Outcome Set Initiative (CSG-COUSIN) aims to develop and implement COSs in dermatology, thus making trial evidence comparable and, herewith, more useful for clinical decision making. The inaugural meeting of CSG-COUSIN was held on 17-18 March 2015 in Dresden, Germany, as the exclusive theme of the Annual Cochrane Skin Group Meeting. In total, 29 individuals representing a broad mix of different stakeholder groups, professions, skills and perspectives attended. This report provides a description of existing COS initiatives in dermatology, highlights current methodological challenges in COS development, and presents the concept, aims and structure of CSG-COUSIN.

Abnormally speeded saccades to ipsilesional targets in patients with spatial neglect.

We mapped the distribution of saccadic reaction times (SRTs) in the visual field of patients with spatial neglect in order to characterise the topography of the bias in spatial orientation peculiar to this disorder. LED-generated stimuli were lit randomly in one of four positions (+/-5 degrees , +/-10 degrees , +/-20 degrees , +/-30 degrees ) along the horizontal meridian in blocks of either ipsilesional or contralesional presentations. Patients were asked to move the gaze as quickly as possible from central fixation to target upon its appearance. Unlike control subjects, patients with neglect showed an asymmetric distribution of visuo-motor performance in the two hemifields with an increasing impairment in target detection and saccadic reaction at increasing eccentricities in the contralesional field. In contrast, in the ipsilesional field they showed abnormally speeded SRTs at 5 degrees and 10 degrees , outperforming even healthy subjects. Latency of saccades increased again at more peripheral ipsilesional locations (20 degrees and 30 degrees ) where there was also a tendency for a higher omission rate as compared to control groups. These results indicate that in neglect patients the spatial orientation bias, as witnessed by saccadic performance, specifically affects an off-centred sector of the ipsilesional space, and this is in keeping with evidence from a previous study using a manual RT paradigm. The generality of this phenomenon across different types of motor response suggests that it depends upon abnormal mechanisms of spatial coding interfering with perceptual processing and orienting behaviour.

Prognosis of contraversive pushing.

Stroke patients with 'pusher syndrome' actively push away from the non-hemiparetic side leading to a loss of postural balance and falling towards the paralysed side. The behaviour is due to an altered perception of the body's orientation in relation to gravity. Here, we studied the prognosis of the disorder. Twelve pusher patients first investigated immediately after the stroke were re-examined 6 months later. Pusher symptoms had nearly completely recovered. The aim for physiotherapy of patients with contraversive pushing thus is to shorten the period of necessary treatment and enable earlier discharge from residential care.

seco-Cyclothialidines: new concise synthesis, inhibitory activity toward bacterial and human DNA topoisomerases, and antibacterial properties.

seco-Cyclothialidines are a promising class of bacterial DNA gyrase B subunit inhibitors. A new seco-cyclothialidine derivative containing a dioxazine moiety, BAY 50-7952, was synthesized through a new concise pathway. One key step of the synthesis is the straightforward formation of the 2-aminothiazole derivative of S-tritylcysteine. In biological tests, BAY 50-7952 and other known seco-cyclothialidines exhibited high and selective activity toward bacterial DNA gyrase and toward Gram-positive bacteria. The dioxazine moiety and other similar groups were found to be important for the ability of the seco-cyclothialidines to penetrate bacterial membranes. The opposite enantiomer ((S)-form) of BAY 50-7952 was also synthesized, and neither significant target activity nor in vitro antibacterial activity were found, suggesting a highly selective fit of the (R)-form. Despite promising in vitro activity, only poor activity was found in the murine infection model.

Evaluation of patients with symptoms suggestive of chronic polyneuropathy.

OBJECTIVES: The aim of this study was to determine the diagnostic yield and to describe the spectrum of diagnosis encountered by evaluation of patients with symptoms suggestive of chronic polyneuropathy. METHODS: We prospectively evaluated 198 patients referred to a department of neurology with symptoms suggestive of polyneuropathy. The evaluation included nerve conduction studies with near-nerve technique, quantitative examination of temperature sensation, blood tests, chest x-rays, and skin biopsies as well as diagnostic tests for differential diagnoses. RESULTS: Polyneuropathy was found in 147 patients, alternative diagnoses in 25, and 26 remained undiagnosed. The etiology of polyneuropathy could not be identified in 25% of the patients with polyneuropathy. In the remaining 75%, the cause of neuropathy was diabetes and/or alcohol abuse (41%), monoclonal gammopathy of undetermined significance (5%), drugs (5%), connective tissue disease (3%), and a number of less frequent conditions. A previously undiagnosed condition was found in 30% of the patients with polyneuropathy. CONCLUSION: Evaluation of patients with symptoms suggestive of polyneuropathy reveals a high fraction of patients with previously undiagnosed conditions both in patients ending up with a polyneuropathy diagnosis and those without this diagnosis.

Diagnostic yield by testing small fiber function in patients examined for polyneuropathy.

We assessed the diagnostic yield of adding quantitative sensory testing to the standard work-up for polyneuropathy in unselected patients. All patients aged 18 to 70 years referred to our department for electrodiagnosis with a tentative diagnosis of polyneuropathy and symptoms complying with predefined criteria were included in the study. We performed near nerve conduction studies in 4 nerves and determined heat and cold detection thresholds on hand and foot with a Thermotest (Somedic AB, Sweden). In order to uncover CNS diseases, somatosensory-evoked potentials were recorded in patients with abnormal quantitative sensory testing and normal nerve conduction studies. A total of 198 patients completed the study and 149 were considered to have polyneuropathy. Twenty-five patients remained undiagnosed and in 24 patients, other diseases were responsible for the symptoms. Of the patients with either polyneuropathy or no other diagnosis, 76% (n = 174) had abnormal nerve conduction. Abnormal cold sensation, heat sensation or abnormality in at least 1 of these and normal nerve conduction were found in 14, 12 and 17 patients. Of the 174 patients, 86% (95% CI 80-90%) had an abnormality in at least 1 of the tests (i.e. abnormal nerve conduction and/or abnormal quantitative testing of temperature sensation). In conclusion, quantitative testing of temperature sensation improves the diagnostic yield in patients examined for chronic polyneuropathy.

Modification of screening immunoassays to detect sub-threshold concentrations of cocaine, cannabinoids, and opiates in urine: use for detecting maternal and neonatal drug exposures.

Testing for drugs of abuse in urine is commonplace in emergency departments and neonatal units. However, the clinical sensitivity of immunochemical screening methods is limited by the threshold concentrations used to distinguish between positive and negative specimens. Immunochemical screening methods for cocaine metabolite (benzoylecgonine), cannabinoids, and opiates in urine were recalibrated to detect drugs at lower threshold concentrations. The precision and linearity of the signals at the modified thresholds were verified by diluting drug-positive urine specimens to concentrations below the conventional cutoff concentration and measuring the rate signals in triplicate. To assess the clinical performance of the modified methods, specimens that tested negative using the unmodified assays were re-screened at the lower threshold, and specimens that re-screened positive were submitted for gas chromatographic/mass spectrometric (GC/MS) confirmation. Reproducibility of sub-threshold measurements was comparable to the unmodified assays, and rate separations between successive dilutions were sufficient to give semi-quantitative results. Using the lower thresholds, drugs were detected in 4-5% of the subjects that had screened negative at the conventional threshold concentration. GC/MS analysis confirmed the presence of cannabinoids and cocaine metabolite in 74% and 84%, respectively, of urine specimens that re-screened positive. Morphine, codeine, hydromorphone, or hydrocodone was detected by GC/MS analysis in 31% of opiate-positive re-screens.

Microglia digest Staphylococcus aureus into low molecular weight biologically active compounds.

Excess sleep and fever are central nervous system (CNS) facets of the acute phase response; these responses are induced by microbial products, such as muramyl peptides, via their ability to enhance cytokine production. Although peripheral macrophages are known to digest bacteria, thereby releasing muramyl peptides that, in turn, stimulate cytokine production, it was unknown whether CNS phagocytes such as microglia also had this capacity. Primary cultures of microglia were allowed to phagocytize and digest Staphylococcus aureus radiolabeled with a cell wall-specific marker. Radiolabeled low molecular weight substances released into the culture medium were partially purified and tested for the ability to induce excess sleep, fever, and cytokine production. These substances increased non-rapid eye movement sleep, electroencephalographic slow-wave activity, and brain temperature after intracerebroventricular injection into rabbits. They also induced interleukin-1, tumor necrosis factor, and the interleukin-1 receptor antagonist production in human monocytes. Results suggest that microglia perform fundamental macrophage functions and further implicate microglia as resident immunocompetent cells.

Clinically unexpected multiple sclerosis in patients with mental disorders. A series of 7301 psychiatric autopsies.

Some studies have indicated that silent and perhaps pure mental forms of multiple sclerosis (MS) exist. With the aim of examining that, the records of 9478 autopsies from patients with mental disorders were reviewed. A total of 7252 had both clinical and histological diagnosis, and 7301 had only pathoanatomical diagnosis. Twenty-three patients were suspected of having MS, which were confirmed histologically in 14. None had unsuspected, silent or a pure mental form of MS. It is concluded that the risk of mistaking MS for a psychiatric disorder is small in MS high-risk area.

Adolescent abortion and mandated parental involvement.

Laws mandating parental involvement in adolescent abortion decisions are in contrast to laws governing other aspects of adolescent health care. Studies support that adolescents are often capable of making mature, informed health care decisions. Nurses encountering these adolescents have a unique opportunity to support them through the system and enhance the decision-making process.

PIP: Although medical emancipation laws empower mature minors to regulate their own health care, most states in the US have enacted legislation mandating some form of parental involvement in adolescent abortion. Such government intervention runs the risk of jeopardizing adolescents' mental and physical well-being and defies research findings that adolescents are capable of making sound informed treatment decisions. The medical emancipation statutes were enacted to protect adolescents from parental punishment and prevent delays in seeking treatment. This is especially important in the case of pregnant adolescents from dysfunctional, nonsupportive families. Such adolescents are unlikely to be persuaded by law to confide in their parents; more probable outcomes include carrying an unwanted pregnancy to term without adequate prenatal care or travel to a state without parental notification laws for the abortion. Urged is a unified health policy that supports the decision-making capabilities of most adolescents and protects their access to health services.

[Muramyl peptides and sleep]. / Muramil-peptidy i son.

Effects of muramyl peptides from bacterial cell walls (MDP and GMDP), their fragments, steric isomers and structural analogues were studied on sleep in rabbits. An increase in the SWS, decrease in PS, rise in body temperature were found following minimal doses, whereas pathological responses in the EEG and sleep as well as pyrogenic effects occurred after higher doses. The GMDP analogues affected sleep weakly, and isomers and fragments were inactive. Possible role of muramyl peptides in normal and pathological regulation of sleep is discussed.

Liposuction: a surgical intervention to improve body contour.

Liposuction surgery continues to gain popularity despite adverse media attention. The advent of syringe-assisted liposuction is replacing suction machines, offering a more precise surgical technique as well as fewer risks and predictable results. However, aligning patient expectations with realistic goals continues to challenge health professionals involved in the emerging field of cosmetic dermatologic surgery.

Somnogenic activity of muramyl peptide-derived immune adjuvants.

Muramyl peptides (MPs) possess immunostimulatory, pyrogenic and somnogenic activities. The structural requirements of MPs for each of these activities are different though certain MPs, e.g. muramyl dipeptide (NAM-L-ala-D-isogln) possess all three activities. Several MPs are proposed for use as immune adjuvants; somnogenic and pyrogenic activities would be considered adverse side effects of such compounds. We report here that some of the putative adjuvants, GIF101, WG209 and MDP-threonine lack somnogenic and pyrogenic activities. Current results also expand our understanding of the structural requirements for these activities. Major findings are that the addition of the dipeptide L-ala-D-isogln to NAG-NAM-L-ala-D-isogln blocks the activity of the latter compound and that the amino sugar moiety of MPs, NAM, is unnecessary for somnogenic and pyrogenic activity.

Calcitonin gene-related peptide in small cell lung carcinomas.

OBJECTIVE: Calcitonin gene-related peptide (CGRP) is a regulatory peptide encoded by the calcitonin gene. CGRP is expressed in increased amounts by the cells of medullary thyroid carcinomas and has been demonstrated by immunohistochemistry to occur in neuroendocrine cells and nerve fibres of lung tissue. MEASUREMENTS: Serum CGRP levels were measured in patients with small cell lung carcinomas before treatment (n = 74) and immediately before the second course of chemotherapy (n = 30). In-situ hybridization and immunohistochemistry were performed on tumour tissue and CGRP was extracted from two tumours and characterized by gel chromatography and high pressure liquid chromatography. RESULTS: Serum CGRP levels were elevated in small cell lung carcinomas when compared with healthy controls of similar age and sex (median values 55.0 vs 36.6 pmol/l, P < 0.001), and 27% had levels above the upper normal range. Serum CGRP levels decreased following the initial course of chemotherapy (P < 0.05) but remained elevated when compared to the controls (P < 0.001). In-situ hybridization for CGRP mRNA was positive in three of 17 tumours and immunohistochemistry was positive in seven of 31 tumours investigated. CGRP immunoreactivity extracted from two tumours was characterized by gel chromatography and high pressure liquid chromatography. A major part of the immunoreactivity was demonstrated to represent the intact molecule. CONCLUSIONS: We found that patients with small cell lung carcinomas had elevated concentration of serum calcitonin gene-related peptide but only 27% had values above the upper normal range. Serum CGRP is therefore of limited value as a tumour marker. Intact CGRP can be extracted from tumour tissue, but in-situ hybridization and immunohistochemistry showed positive reactions in only a few of the tumours investigated. The elevated serum CGRP levels are therefore likely to be largely of extratumoral origin.

Biological properties of bacterial peptidoglycan.

Synthetic and natural muramyl peptides have a variety of biological actions in mammals, including the abilities to enhance sleep and body temperature. Although muramyl peptides can be detected constitutively in mammalian organisms, no biochemical synthetic pathways are known for muramyl peptides in mammals. However, muramyl peptides are well known as components of bacterial cell wall peptidoglycan (synonym: murein). Isolated bacterial cell walls elicit host responses similar to those produced by bacterial infections or by purified muramyl peptides. Mammalian cells which phagocytize bacteria can digest bacterial cell walls and release biologically active muramyl peptides. The released muramyl peptides then express some or all of the biological effects observed with synthetic muramyl peptides. Also, cell-free systems consisting of isolated bacterial cell walls and lysozyme produce substances with similar biological activities.