Effect of exercise on pain processing and motor output in people with knee osteoarthritis: a systematic review and meta-analysis.

OBJECTIVE: Guidelines recommend exercise as a core treatment for knee osteoarthritis. However, it is unclear how exercise affects measures of pain processing and motor function. The aim was to evaluate the effect of exercise on measures of pain processing and motor function in people with knee osteoarthritis. METHODS: We searched five electronic databases (MEDLINE, EMBASE, CINAHL, SCOPUS and Cochrane Central Register of Controlled Trials) for studies on knee osteoarthritis, of any design, evaluating pain processing and motor function before and after exercise. Data were pooled with random-effects meta-analysis. Study quality was assessed using the Downs and Black and quality of evidence was assessed using the GRADE. RESULTS: Eighteen studies were eligible and 16 were included. Following acute exercise, pressure pain threshold increased local to the study limb (standardised mean difference [95% confidence interval (CI)] 0.26, [0.02, 0.51], n = 159 from 5 studies), but there was no statistically significant change remote from the study limb (0.09, [-0.11, 0.29], n = 90 from 4 studies). Following an exercise program (range 5-12 weeks) there were no statistically significant changes in pressure pain threshold (local 0.23, [-0.01, 0.47], n = 218 from 8 studies; remote 0.33 [-0.13, 0.79], n = 76 from 4 studies), temporal pain summation (0.38 [-0.08, 0.85], n = 122 from 3 studies) or voluntary quadriceps muscle activation (4.23% [-1.84 to 10.30], n = 139 from 4 studies). CONCLUSION: Very-low quality evidence suggests that pressure pain threshold increases following acute exercise. Very-low quality evidence suggests that pressure pain threshold, temporal pain summation or voluntary quadriceps activation do not change statistically significantly following exercise programs.

[Typhoid fever in adult patients in Ouagadougou (analytic study of 124 cases) (author's transl)]. / La fièvre typhoïde de l'adulte à Ouagadougou. Etude analytique de 124 observations.

The authors study clinical and evolutive aspects of 124 cases of typho-paratyphoïdic fever carried out in Ouagadougou. Main features are emphasized and compared to series previously recorded in other tropical countries: -the most frequent form is the conventional one with fever-diarrhoea-vomiting, headache and abdominal pain; -10,4 p. 100 of the cases present further complication, with 13 fatal issues, mostly due to acute encephalitis and to the delay reporting to the hospital; -treatment raised no special problem, Eberth bacillus which is the most frequently detected germ, being still very sensible to phenicoles derivatives.

Crescent-shaped necrosis: a new imaging sign suggestive of stromal tumor of the small bowel.

We report three cases of unsuspected stromal tumors of the small bowel (STSB). These cases were diagnosed preoperatively by sonography, the imaging was completed for some with barium studies, computed tomography, magnetic resonance imaging, or angiography. To our knowledge, the use of this noninvasive technique for detecting this type of tumor has not been described in the literature. Moreover, we believe that some sonographic findings such as crescentic tumoral necrosis may appear highly suggestive of STSB.

The "Poffenberger" and "Dimond" paradigms: interrelated approaches to the study of interhemispheric dynamics?

Brown and Jeeves (1993) found that an evoked potential estimate of interhemispheric transfer time, from the left to the right hemisphere, correlated negatively with a bilateral field advantage (BFA) in a response-choice letter matching task. We implemented a go no-go dot size matching task to determine whether the crossed-uncrossed difference (CUD) in reaction time, commission errors and omission errors (estimates of the "cost" of interhemispheric transfer) would correlate with BFAs in data from the same experiment and whether the type of decision ("same" versus "different") would modulate the CUDs and/or BFAs. Sixteen normal right-handed subjects were tested. The CUDs were negatively correlated with the BFAs. Canonical correlation analysis of this set of relations was highly significant (r = .95). Estimates of left-to-right relay were far more strongly related to BFA (p = .0001) than were estimates of right-to-left relay (p = .03). "Same" decisions yielded a unilateral field advantage and "different" decisions a bilateral field advantage in omission error data, this crossed interaction reaching significance. More efficient interhemispheric relay favored BFAs, i.e., strongly suggesting in such cases an advantage of interhemispheric over intrahemispheric integration. This effect appeared to be markedly asymmetric. Furthermore, resource sharing within and between the hemispheres was a function of the "same" versus "different" dimensions of the decision to be made, especially in omission errors. The opposite dissociation occurred less markedly in the reaction times, this double dissociation reaching significance, revealing presence of a subtle speed-accuracy trade-off in interhemispheric dynamics.

Brain metabolic differences as a function of hemisphere, writing hand preference, and gender.

A total of 35 university-educated normal men (24 right handwriters and 11 left handwriters) and 36 age- and education-matched women (25 right handwriters and 11 left handwriters) underwent a proton magnetic resonance spectroscopy examination in seven 8 cm(3) voxels including the right and left frontal lobe tips, the right and left mid-temporal lobes, the right and left thalami, and the hypothalamus. Dependent measures were N-acetylaspartate (NAA), choline-containing compounds (Cho) and creatine/phosphocreatine (Cr) metabolite peak area ratios relative to total H(2)O. As expected, thalamic grey matter contained higher NAA ratios than telencephalic voxels (containing white and grey matter) (p < .001). The thalamic Cr/ H(2)O ratio was higher on the right, but the opposite asymmetry was observed for the temporal lobe (p < .05). Women had a higher left frontal NAA/ H(2)O ratio than men, but men had a higher hypothalamic NAA/ H(2)O ratio than women. Right-handers had a higher temporal lobe NAA/H(2)O ratio than left-handers, particularly in the left hemisphere. In addition, several significant 2- and 3-way interactions between writing hand preference, gender, and hemisphere were observed, but only in the frontal lobe.