Fatigue induces altered spatial myoelectric activation patterns in the medial gastrocnemius during locomotion.

This research investigates the effects of muscle fatigue on spatial myoelectric patterns in the lower limb during locomotion. Both spatial and frequency aspects of neuromuscular recruitment in the medial gastrocnemius change in response to fatigue, resulting in altered myoelectric patterns during walking and running. These data may help us better understand the adaptations that occur in lower limb muscles to avoid overuse injuries caused by fatigue.

Improving health visitor emollient prescribing using a CQUIN-based approach.

Prescribing is an essential element of health visiting practice. This initiative used the payment framework of Commissioning for Quality and Innovation (CQUIN) to develop health visiting practice across a large health visiting workforce in the East Midlands. A focus on emollient prescribing practice was agreed and a guidance booklet regarding preferred emollient products was produced, based on the local formulary Each health visitor benefitted from receiving additional training and was given a guidance booklet to inform their practice. Targets were set for each quarter to demonstrate an improved prescribing adherence to the preferred product list.The targets were achieved for each quarter. Prescribing rates and confidence improved across the service. Therefore, it was demonstrated that specific guidance and ongoing support can improve prescribing practice within the health visiting service.

Chronic cerebrospinal venous insufficiency is not associated with cognitive impairment in multiple sclerosis.

BACKGROUND: Chronic cerebrospinal venous insufficiency (CCSVI) has been reported in multiple sclerosis (MS) yet its significance in relation to cognitive function is undetermined.This study measured the association between the presence and severity of CCSVI and cognitive impairment in patients with MS. METHODS: CCSVI was assessed using extra-cranial and trans-cranial Doppler sonography in 109 MS patients (79 with relapsing-remitting, 23 with secondary-progressive and 7 with primary-progressive disease subtype). A subject was considered CCSVI-positive if ≥2 venous hemodynamic criteria were fulfilled. The Minimal Assessment of Cognitive Function in MS (MACFIMS) battery was administered assessing the full spectrum of cognitive domains known to be affected by MS. Depression was quantified using the Beck Depression Inventory Fast Screen (BDIFS). Partial correlations, analysis of variance (or covariance) and linear regression were used to examine the hypothesis that CCSVI status is related to cognition or depression after controlling for education and gender. RESULTS: There were 64 (58.7%) patients who were considered CCSVI-positive. The regression models predicting venous hemodynamic insufficiency severity score were not statistically significant for any of the MACFIMS predictor variables. The analysis of variance tests showed a significant effect of CCSVI-positive diagnosis on cognitive ability in only one of the 10 MACFIMS outcomes, and that one was in the opposite direction of the tested hypothesis. There was no correspondence between CCSVI diagnosis and depression, as measured by the BDIFS. CONCLUSIONS: We find no evidence of an association between the presence and severity of CCSVI with cognitive impairment and depression in patients with MS.

Developing health visitor prescribing.

Prescribing is an essential element of the health visitor's role. However, in one inner-city locality prescribing in practice was evaluated to be at a low level. A number of barriers to prescribing were identified through a focus group. A project to support health visitors was planned and delivered. The project involved clinical updates and improvement to the registration process, thereby reducing delays for practitioners in getting prescribing pads. The result was that prescribing confidence improved and prescribing activity increased.

Clinical correlates of chronic cerebrospinal venous insufficiency in multiple sclerosis.

BACKGROUND: Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular condition characterized by anomalies of the primary veins outside the skull that has been reported to be associated with MS. In the blinded Combined Transcranial (TCD) and Extracranial Venous Doppler Evaluation (CTEVD) study, we found that prevalence of CCSVI was significantly higher in multiple sclerosis (MS) vs. healthy controls (HC) (56.1% vs. 22.7%, p < 0.001).The objective was to evaluate the clinical correlates of venous anomalies indicative of CCSVI in patients with MS. METHODS: The original study enrolled 499 subjects; 163 HC, 289 MS, 21 CIS and 26 subjects with other neurological disorders who underwent a clinical examination and a combined Doppler and TCD scan of the head and neck. This analysis was restricted to adult subjects with MS (RR-MS: n = 181, SP-MS: n = 80 and PP-MS: n = 12). Disability status was evaluated by using the Kurtzke Expanded Disability Status Scale (EDSS) and MS severity scale (MSSS). RESULTS: Disability was not associated with the presence (≥2 venous hemodynamic criteria) or the severity of CCSVI, as measured with venous hemodynamic insufficiency severity score (VHISS). However, the severity of CCSVI was associated with the increased brainstem functional EDSS sub-score (p = 0.002). In logistic regression analysis, progressive MS (SP-MS or PP-MS) vs. non-progressive status (including RR-MS) was associated with CCSVI diagnosis (p = 0.004, OR = 2.34, CI = 1.3-4.2). CONCLUSIONS: The presence and severity of CCVSI in multiple sclerosis correlate with disease status but has no or very limited association with clinical disability.

Risk factors for chronic cerebrospinal venous insufficiency (CCSVI) in a large cohort of volunteers.

BACKGROUND: The role of intra- and extra-cranial venous system impairment in the pathogenesis of various vascular, inflammatory and neurodegenerative neurological disorders, as well as in aging, has not been studied in detail. Nor have risk factors been determined for increased susceptibility of venous pathology in the intra-cranial and extra-cranial veins. The aim of this study was to investigate the association between presence of a newly proposed vascular condition called chronic cerebrospinal venous insufficiency (CCSVI) and environmental factors in a large volunteer control group without known central nervous system pathology. METHODS AND FINDINGS: The data were collected in a prospective study from 252 subjects who were screened for medical history as part of the entry criteria and participated in the case-control study of CCSVI prevalence in multiple sclerosis (MS) patients, and then were analyzed post-hoc. All participants underwent physical and Doppler sonography examinations, and were assessed with a structured environmental questionnaire. Fullfilment of ≥ 2 positive venous hemodynamic (VH) criteria on Doppler sonography was considered indicative of CCSVI diagnosis. Risk and protective factors associated with CCSVI were analyzed using logistic regression analysis. Seventy (27.8%) subjects presented with CCSVI diagnosis and 153 (60.7%) presented with one or more VH criteria. The presence of heart disease (p = .001), especially heart murmurs (p = .007), a history of infectious mononucleosis (p = .002), and irritable bowel syndrome (p = .005) were associated with more frequent CCSVI diagnosis. Current or previous smoking (p = .029) showed a trend for association with more frequent CCSVI diagnosis, while use of dietary supplements (p = .018) showed a trend for association with less frequent CCSVI diagnosis. CONCLUSIONS: Risk factors for CCSVI differ from established risk factors for peripheral venous diseases. Vascular, infectious and inflammatory factors were associated with higher CCSVI frequency.

Use of MR venography for characterization of the extracranial venous system in patients with multiple sclerosis and healthy control subjects.

PURPOSE: To investigate the differences in the extracranial venous system in patients with multiple sclerosis (MS) and healthy control (HC) subjects by using magnetic resonance (MR) venography. MATERIALS AND METHODS: This HIPAA-compliant, prospective study was approved by the local institutional review board, and all participants gave informed consent. Fifty-seven patients, 41 (72%) with relapsing-remitting MS and 16 (28%) with secondary-progressive MS, and 21 HC subjects were imaged with a 3-T MR unit by using two-dimensional (2D) time-of-flight (TOF) and three-dimensional (3D) time-resolved imaging of contrast kinetics (TRICKS) sequences. In addition, six MS patients and six HC subjects underwent two sequential MR venographic examinations during 1 week to test image-reimage reproducibility. The morphologic features of internal jugular vein flow were classified as absent, pinpoint, flattened, crescentic, or ellipsoidal flow. Only absent and pinpoint flow were considered abnormal. The flow of the vertebral veins was classified as absent or present. The prominence of collateral neck veins and venous asymmetries between the left and right sides were assessed. Differences among groups were tested with a two-tailed Mann-Whitney two-sample rank-sum test. RESULTS: No significant differences in morphologic features of flow in the internal jugular veins and vertebral veins were found between MS patients and HC subjects in any of the examined MR venographic parameters. No differences in asymmetry or prominence were found between MS patients and HC subjects. There was modest agreement (κ = 0.67) between 2D TOF and 3D TRICKS sequences. Image-reimage reproducibility showed modest agreement (κ = 0.66) for 2D TOF and low agreement for 3D TRICKS (κ = 0.33). CONCLUSION: No significant differences in the extracranial venous systems between MS patients and HC subjects were detected by using MR venography. Standardized guidelines are needed to define parameters for the presence of venous anomalies.