The current state of intensive care unit discharge practices - Results of an international survey study.

Background: Increasing pressure on limited intensive care capacities often requires a subjective assessment of a patient's discharge readiness in the absence of established Admission, Discharge, and Transfer (ADT) guidelines. To avoid suboptimal care transitions, it is important to define clear guidelines for the admission and discharge of intensive care patients and to optimize transfer processes between the intensive care unit (ICU) and lower care levels. To achieve these goals, structured insights into usual ICU discharge and transfer practices are essential. This study aimed to generate these insights by focusing on involved stakeholders, established processes, discharge criteria and tools, relevant performance metrics, and current barriers to a timely and safe discharge. Method: In 2022, a structured, web-based, anonymous cross-sectional survey was conducted, aimed at practicing ICU physicians, nurses, and bed coordinators. The survey consisted of 29 questions (open, closed, multiple choice, and scales) that were divided into thematic blocks. The study was supported by several national and international societies for intensive care medicine and nursing. Results: A total of 219 participants from 40 countries (105 from Germany) participated in the survey. An overload of acute care resources with ~90% capacity utilization in the ICU and the general ward (GW) leads to not only premature but also delayed patient transfers due to a lack of available ward and intermediate care (IMC) beds. After multidisciplinary rounds within the intensive care team, the ICU clinician on duty usually makes the final transfer decision, while one-third of the panel coordinates discharge decisions across departmental boundaries. By the end of the COVID-19 pandemic, half of the hospitals had implemented ADT policies. Among these hospitals, nearly one-third of the hospitals had specific transfer criteria established, consisting primarily of vital signs and laboratory data, patient status and autonomy, and organization-specific criteria. Liaison nurses were less common but were ranked right after the required IMC capacities to bridge the care gap between the ICU and normal wards. In this study, 80% of the participants suggested that transfer planning would be easier if there was good transparency regarding the capacity utilization of lower care levels, a standardized transfer process, and improved interdisciplinary communication. Conclusion: To improve care transitions, transfer processes should be managed proactively across departments, and efforts should be made to identify and address care gaps.

Mortality and associated factors among children admitted to an intensive care unit in muhimbili national hospital, from the time of admission to three months after discharge: a prospective cohort study.

BACKGROUND: Mortality of children admitted to Intensive Care Units (ICU) is higher in low-to-middle-income countries (LMICs) as compared to high-income countries (HICs). There is paucity of information on outcomes following discharge from ICU, especially from sub-Saharan Africa region. This study was conducted to determine mortality and its associated factors among children admitted to Pediatric ICU (PICU) at Muhimbili National Hospital, from admission to three months after discharge. METHODOLOGY: This was a hospital-based prospective cohort study conducted between July 2021 and May 2022, among children admitted to PICU who were followed up for 3-month after discharge. Structured questionnaires were used to collect data from their medical charts. Telephone interviews were made after discharge. Medical records and verbal autopsy were used to determine the cause of death after discharge. Cox regression analysis was performed to assess the association between variables. A p-value of < 0.05 was considered statistically significant. Survival after PICU discharge was estimated by Kaplan - Meier curve. RESULTS: Of 323 children recruited, 177(54.8%) were male, with a median age of 17 months (1-168). The leading cause of PICU admission was severe sepsis 90/323(27.9%). A total of 161/323 children died, yielding an overall mortality of 49.8%. Of 173 children discharged from PICU, 33(19.1%) died. The leading cause of death among children who died in the general ward or as readmission into PICU was sepsis 4/17(23.5%). Respiratory diseases 4/16(25.0%) were the commonest cause of death among those who died after hospital discharge. Independent predictors of overall mortality included single organ dysfunction with hazard ratio(HR):5.97, 95% confidence interval (CI)(3.05-12.26)] and multiple organ dysfunction [HR:2.77,95%CI(1.03-2.21)]. Chronic illness[HR:8.13,95%CI(2.45-27.02)], thrombocytosis [HR:3.39,95%CI(1.32-8.73)], single[HR:3.57,95%CI(1.42-9.03)] and multiple organ dysfunction[HR:3.11,95%CI(1.01-9.61)] independently predicted post-PICU discharge mortality. CONCLUSION: Overall mortality and post- PICU discharge mortality were high and more likely to affect children with organ dysfunction, chronic illness, and thrombocytosis. The leading causes of mortality post- PICU discharge were sepsis and respiratory diseases. There is a need for a focused follow up plan of children post- PICU discharge, further research on the long term survival and strategies to improve it.

The orderly recruitment of motor units may be modified when a muscle is acting as an antagonist.

Despite the perceived importance of antagonist muscle activity, it is unknown if motor unit (MU) behavior at recruitment differs when a muscle acts as an antagonist versus agonist. Fourteen healthy participants performed ramped, isometric elbow flexor or extensor contractions to 50% or 100% maximal voluntary contraction (MVC) torque. Surface and fine-wire intramuscular electromyographic (EMG) recordings were sampled from biceps and triceps brachii. During agonist contractions, low-threshold MUs (recruited at <10% MVC torque) were sampled in all participants, with a total of 107 and 90 for biceps and triceps brachii, respectively. For ramped MVCs, antagonist surface EMG coactivation (% amplitude during agonist MVC) was 8.3 ± 6.6% for biceps and 15.2 ± 7.3% for triceps brachii. However, antagonist single MU activity was recorded from only four participants, with only one of these individuals having antagonist MUs recorded from both muscles. All antagonist MUs were successfully detected during agonist contractions, but many (∼40%) had a recruitment threshold >10% MVC torque. For MUs recorded during both agonist and antagonist contractions, discharge rate at recruitment was seemingly lower for antagonist than agonist contractions. Coexistence of typical levels of surface EMG-derived coactivation with scant antagonist MU recordings suggests that coactivation in these muscles is primarily the result of cross talk. Based on the limited antagonist MU data detected, MUs recruited early during an agonist contraction are not necessarily among those first recruited during an antagonist contraction. These findings highlight the possibility of a modification of orderly recruitment when a motoneuron pool is acting as an antagonist.NEW & NOTEWORTHY Modest levels of coactivation are widely considered essential for appropriate motor control; however, minimal attention has been given to recruitment patterns of motor units (MUs) from antagonist muscles. Despite the successful recording of many low-threshold MUs during agonist contractions, we recorded no antagonist MUs in most participants. Of the units recorded, only ∼60% matched those recruited at <10% of maximal torque when the muscle acted as an agonist, which suggests a modified recruitment order for antagonist MUs.

Adjustments in the motor unit discharge behavior following neuromuscular electrical stimulation compared to voluntary contractions.

Introduction: The application of neuromuscular electrical stimulation superimposed on voluntary muscle contractions (NMES+) has demonstrated a considerable potential to enhance or restore muscle function in both healthy and individuals with neurological or orthopedic disorders. Improvements in muscle strength and power have been commonly associated with specific neural adaptations. In this study, we investigated changes in the discharge characteristics of the tibialis anterior motor units, following three acute exercises consisting of NMES+, passive NMES and voluntary isometric contractions alone. Methods: Seventeen young participants participated in the study. High-density surface electromyography was used to record myoelectric activity in the tibialis anterior muscle during trapezoidal force trajectories involving isometric contractions of ankle dorsi flexors with target forces set at 35, 50% and 70% of maximal voluntary isometric contraction (MVIC). From decomposition of the electromyographic signal, motor unit discharge rate, recruitment and derecruitment thresholds were extracted and the input-output gain of the motoneuron pool was estimated. Results: Global discharge rate increased following the isometric condition compared to baseline at 35% MVIC while it increased after all experimental conditions at 50% MVIC target force. Interestingly, at 70% MVIC target force, only NMES + led to greater discharge rate compared to baseline. Recruitment threshold decreased after the isometric condition, although only at 50% MVIC. Input-output gain of the motoneurons of the tibialis anterior muscle was unaltered after the experimental conditions. Discussion: These results indicated that acute exercise involving NMES + induces an increase in motor unit discharge rate, particularly when higher forces are required. This reflects an enhanced neural drive to the muscle and might be strongly related to the distinctive motor fiber recruitment characterizing NMES+.

Acute changes in motor unit discharge property after concentric versus eccentric contraction exercise in knee extensor.

This study aimed to investigate the motor unit firing property immediately after concentric or eccentric contraction exercise. Eighteen healthy men performed repetitive maximal isokinetic knee extension exercises with only concentric or eccentric contraction until they exerted less than 80% of the baseline strength. Before and after the fatiguing exercise, high-density surface electromyography of the vastus lateralis was recorded during submaximal ramp-up isometric contraction and individual motor units were identified. Only motor units that could be tracked before and after exercise were analyzed. Muscle cross-sectional area of the vastus lateralis was measured using ultrasound, and electrically evoked torque was recorded before and after the exercise. Sixty-five and fifty-three motor units were analyzed before and after the concentric and eccentric contractions, respectively. The results showed that motor units with moderate to high recruitment thresholds significantly decreased recruitment thresholds under both conditions, and the motor unit discharge rates significantly increased after concentric contraction compared to eccentric contraction. A greater muscle cross-sectional area was observed with concentric contraction. The evoked torque was significantly decreased under both conditions, but no difference between the conditions. These results suggest that fatiguing exercise with concentric contraction contributes to greater neural input to muscles and metabolic responses than eccentric contraction.

The Effect of Resistance Training on Motor Unit Firing Properties: A Systematic Review and Meta-Analysis.

While neural changes are thought to be responsible for early increases in strength following resistance training (RT), the exact changes in motor unit (MU) firing properties remain unclear. This review aims to synthesize the available evidence on the effect of RT on MU firing properties. MEDLINE (OVID interface), EMBASE (OVID interface), Web of Science (all databases), Cochrane Library, EBSCO CINAHL Plus, PubMed, and EBSCO SportDiscus were searched from inception until June 2021. Randomized controlled trials and non-randomized studies of interventions that compared RT to no intervention (control) were included. Two reviewers independently extracted data from each trial, assessed the risk of bias and rated the cumulative quality of evidence. Motor unit discharge rate (MUDR), motor unit recruitment threshold (MURT), motor unit discharge rate variability (MUDRV), MU discharge rate at recruitment vs. recruitment threshold relationship, and MU discharge rate vs. recruitment threshold relationship were assessed. Seven trials including 167 participants met the inclusion criteria. Meta-analysis (four studies) revealed that MUDR did not change significantly (P = 0.43), but with considerable heterogeneity likely to be present (I 2 = 91). Low to moderate evidence supports changes in MUDRV, MUDR at recruitment vs. recruitment threshold relationship, and the MUDR vs. recruitment threshold relationship. Overall, this systematic review revealed that there is a lack of high-quality evidence for the effect of RT on MU firing properties. Heterogeneity across studies undermines the quality of the evidence for multiple outcomes and affects the conclusions that can be drawn.

Distribution of motor unit properties across human muscles.

The purpose of our review was to compare the distribution of motor unit properties across human muscles of different sizes and recruitment ranges. Although motor units can be distinguished based on several different attributes, we focused on four key parameters that have a significant influence on the force produced by muscle during voluntary contractions: the number of motor units, average innervation number, the distributions of contractile characteristics, and discharge rates within motor unit pools. Despite relatively few publications on this topic, current data indicate that the most influential factor in the distribution of these motor unit properties between muscles is innervation number. Nonetheless, despite a fivefold difference in innervation number between a hand muscle (first dorsal interosseus) and a lower leg muscle (tibialis anterior), the general organization of their motor unit pools, and the range of discharge rates appear to be relatively similar. These observations provide foundational knowledge for studies on the control of movement and the changes that occur with aging and neurological disorders.

Nursing Interventions for Patient Empowerment during Intensive Care Unit Discharge: A Systematic Review.

Intensive care unit discharge is an important transition that impacts a patient's wellbeing. Nurses can play an essential role in this scenario, potentiating patient empowerment. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (the PRISMA Statement. Embase), PubMed/MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), CUIDEN Plus, and LILACS databases; these were evaluated in May 2021. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of evidence. Quality of the studies included was assessed using the Cochrane risk-of-bias tool. Of the 274 articles initially identified, eight randomized controlled trials that reported on nursing interventions had mainly focused on patients' ICU discharge preparation through information and education. The creation of ICU nurse-led teams and nurses' involvement in critical care multidisciplinary teams also aimed to support patients during ICU discharge. This systematic review provides an update on the clinical practice aimed at improving the patient experience during ICU discharge. The main nursing interventions were based on information and education, as well as the development of new nursing roles. Understanding transitional needs and patient empowerment are key to making the transition easier.

Sex differences in the modulation of the motor unit discharge rate leads to reduced force steadiness.

The purpose of this study was to evaluate the relationship between the variability in the motor unit inter-pulse interval and force steadiness at submaximal and maximal force outputs between the sexes. Twenty-four male and 24 female participants were recruited to perform isometric dorsiflexion contractions at 20, 40, 60, 80, and 100% maximum voluntary contraction. Tibialis anterior myoelectric signal was recorded by an intramuscular electrode. Females had lower force steadiness (coefficient of variation of force (CoV-Force), 27.3%, p < 0.01) and a greater coefficient of variation of motor unit action potential inter-pulse interval (CoV-IPI), compared with males (9.6%, p < 0.01). There was no significant correlation between the normalized CoV-IPI and CoV-Force (r = 0.19, p > 0.01), but there was a significant repeated measures correlation between the raw scores for root-mean-square force error and the standard deviation of motor unit discharge rate (r = 0.65, p < 0.01). Females also had a greater incidence of doublet discharges on average across force levels (p < 0.01). The sex differences may result from motor unit behaviours (i.e., doublet and rapid discharges, synchronization, rate coding or recruitment), leading to lower force steadiness and greater CoV-IPI in females. Novelty: Sex differences in force steadiness may be due to neural strategies. Females have lower force steadiness compared with males. Greater incidence of doublet discharges in females may result in lesser force steadiness.

The reliability of surface EMG derived motor unit variables.

Motor unit (MU) recordings obtained from surface electromyography (sEMG) decomposition are used to investigate the neural control of muscle in response to interventions, but our understanding of the longer-term reliability of MU variables is limited. This study examined the reliability of MU variables in the flexor carpi radialis (FCR) and tibialis anterior (TA) over a three-month period. Forty college-aged participants completed isometric wrist flexion (n = 20) and dorsiflexion (n = 20). There were 3 maximal isometric voluntary contractions (MVC) and 3 ramp contractions to 60% of MVC on four separate sessions separated by a total of 13 weeks. Intraclass correlation coefficients (ICC) were calculated from a fully nested ANOVA model. Maximal force was highly reliable (ICC = 0.94-0.99). The ICC values ranged from 0.49 to 0.92 for the FCR MU variables and from 0.58 to 0.96 for the TA MU variables. All MU variables exhibited a high degree of stability of means across test session and consistency within subjects, with the exception of the number of MUs detected in the TA. Poor ICC values did not reflect poor reliability but rather, convergence towards a narrow range of physiologically normal values. Surface EMG decomposition of a large population of MUs showed no differences in common drive between FCR (0.273) and for the TA (0.267) across test sessions. Forty percent of the sampled MUs in both muscles had a common drive of 0.30 or greater, which provides indirect support for the validity of the decompositions. MU variables may be used to monitor adaptations to a longer-term intervention study.

Sex differences in motor unit discharge rates at maximal and submaximal levels of force output.

This study evaluated potential sex differences in motor unit (MU) behaviour at maximal and submaximal force outputs. Forty-eight participants, 24 females and 24 males, performed isometric dorsiflexion contractions at 20%, 40%, 60%, 80%, and 100% of a maximum voluntary contraction (MVC). Tibialis anterior electromyography was recorded both by surface and intramuscular electrodes. Compared with males, females had a greater MU discharge rate (MUDR) averaged across all submaximal intensities (Δ 0.45 pps, 2.56%). Males exhibited greater increases in MUDR above 40% MVC, surpassing females at 100% MVC (p's < 0.01). Averaged across all force outputs, females had a greater incidence of doublet and rapid discharges and a greater percentage of MU trains with doublet and rapid (5-10 ms) discharges (Δ 75.55% and 61.48%, respectively; p's < 0.01). A subset of males (n = 8) and females (n = 8), matched for maximum force output, revealed that females had even greater MUDR (Δ 1.38 pps, 7.47%) and percentage of MU trains with doublet and rapid discharges (Δ 51.62%, 56.68%, respectively; p's < 0.01) compared with males at each force output, including 100% MVC. Analysis of the subset of strength-matched males and females suggest that sex differences in MU behaviour may be a result of females needing to generate greater neural drive to achieve fused tetanus. Novelty Females had higher MUDRs and greater percentage of MU trains with doublets across submaximal force outputs (20%-80% MVC). Differences were even greater for a strength matched subset. Differences in motor unit behaviour may arise from musculoskeletal differences, requiring greater neural drive in females.

Is there a primitive reflex residue underlying Marcus Gunn Syndrome? Rat electrophysiology.

AIM: To make an electrophysiological demonstration of a possible jaw muscle afferents-oculomotor neural pathway that was proposed by our previous works on rats, which substantiates an early "release hypothesis" on pathogenesis of human Marcus Gunn Syndrome (MGS). METHODS: Extracellular unit discharge recording was applied and both orthodromic and spontaneous unitary firing were recorded in the oculomotor nucleus (III), and the complex of pre-oculomotor interstitial nucleus of Cajal and Darkschewitsch nucleus (INC/DN), following electric stimulation of the ipsilateral masseter nerve (MN) in rats. RESULTS: Extracellular orthodromic unit discharges, with latencies of 3.7±1.3 and 4.7±2.9ms, were recorded unilaterally in the III, and the INC/DN neurons, respectively. Spontaneous unit discharges were also recorded mostly in the INC/DN and less frequently in the III. Train stimulation could prompt either facilitation or inhibition on those spontaneous unit discharges. The inhibition pattern of train stimulation on the spontaneous discharging was rather different in the III and INC/DN. A slow inhibitory pattern in which spontaneous firing rate decreased further and further following repeated train stimulation was observed in the III. While, some high spontaneous firing rate units, responding promptly to the train stimuli with a short-term inhibition and recovered quickly when stimuli are off, were recorded in the INC/DN. However, orthodromic unit discharge was not recorded in the III and INC/DN in a considerable number of experiment animals. CONCLUSION: A residual neuronal circuit might exist in mammals for the primitive jaw-eyelid reflex observed in amphibians, which might not be well-developed in all experimental mammals in current study. Nonetheless, this pathway can be still considered as a neuroanatomic substrate for development of MGS in some cases among all MGS with different kind of etiology.

Impact of Intensive Care Unit Discharge Delays on Patient Outcomes: A Retrospective Cohort Study.

OBJECTIVE: Patients often overstay in intensive care units (ICU) after they are deemed discharge ready. The objective of this study was to examine the impact of such discharge delays (DD) on subsequent in-hospital morbidity and mortality. DESIGN: Retrospective cohort study. SETTING: Single tertiary academic medical center. PATIENTS: Adult patients admitted to the medical ICU between 2005 and 2011. INTERVENTIONS: For all patients, DD (ie, time between request for a ward bed and time of ICU discharge) was calculated. Discharge delays was dichotomized as long (≥24 hours) or short (<24 hours). Multivariable linear and logistic regressions were used to assess the association between dichotomized DD and post-ICU clinical outcomes. RESULTS: Overall, 9673 discharges were included of which 10.4% patients had long DDs. In the fully adjusted model, a long delay was not associated with increased odds of death (adjusted odds ratio [aOR]: 0.99, 95% confidence interval [CI]: 0.74-1.31, P = .95) but was associated with a shorter log plus one of post-ICU discharge length of stay (LOS; regression coefficient: -0.13, 95% CI: -0.17 to -0.08, P < .001). Longer DD was not associated with more hospital-free days (HFD: a composite of post-ICU LOS and in-hospital mortality). Shorter DDs were associated with shorter LOS when LOS was measured from the time of ward bed request as opposed to the time of ICU discharge. CONCLUSIONS: In this study, long DD was associated with a slight decrease in post-ICU LOS but longer LOS when measured from the point of ward bed request, suggesting a potential role for more aggressive discharge planning in the ICU for patients with long DDs. There was no association between long DD and subsequent mortality or HFD.

Neuromuscular adaptations to healthy aging.

Even in the absence of disease or disability, aging is associated with marked physiological adaptations within the neuromuscular system. An ability to perform activities of daily living and maintain independence with advanced age is reliant on the health of the neuromuscular system. Hence, it is critical to elucidate the age-related adaptations that occur within the central nervous system and the associated muscles to design interventions to maintain or improve neuromuscular function in the elderly. This brief review focuses on the neural alterations observed at both spinal and supraspinal levels in healthy humans in their seventh decade and beyond. The topics addressed are motor unit loss and remodelling, neural drive, and responses to transcranial magnetic stimulation of the motor cortex.

Physiological and methodological aspects of rate of force development assessment in human skeletal muscle.

Rate of force development (RFD) refers to the ability of the neuromuscular system to increase contractile force from a low or resting level when muscle activation is performed as quickly as possible, and it is considered an important muscle strength parameter, especially for athletes in sports requiring high-speed actions. The assessment of RFD has been used for strength diagnosis, to monitor the effects of training interventions in both healthy populations and patients, discriminate high-level athletes from those of lower levels, evaluate the impairment in mechanical muscle function after acute bouts of eccentric muscle actions and estimate the degree of fatigue and recovery after acute exhausting exercise. Notably, the evaluation of RFD in human skeletal muscle is a complex task as influenced by numerous distinct methodological factors including mode of contraction, type of instruction, method used to quantify RFD, devices used for force/torque recording and ambient temperature. Another important aspect is our limited understanding of the mechanisms underpinning rapid muscle force production. Therefore, this review is primarily focused on (i) describing the main mechanical characteristics of RFD; (ii) analysing various physiological factors that influence RFD; and (iii) presenting and discussing central biomechanical and methodological factors affecting the measurement of RFD. The intention of this review is to provide more methodological and analytical coherency on the RFD concept, which may aid to clarify the thinking of coaches and sports scientists in this area.

The protective effects of electro-acupuncture in thoracic surgery on trauma stressed rats involve the rostral ventrolateral medulla and supraoptic nucleus.

The present study was designed to explore whether the rostral ventrolateral medulla (RVLM) and supraoptic nucleus (SON) were involved in the protective effects of electro-acupuncture (EA) in thoracic surgery on trauma-stressed rats. The rats were randomly divided into a non-stressed group (Control), surgical trauma-stressed group (Trauma), and Neiguan EA applied on the surgical trauma-stressed group (Trauma+EA-PC 6). RVLM neuron discharge was observed by using an in vivo electrophysiological method, and micro-dialysis combining high-performance liquid chromatography with fluorometric detection (HPLC-FD) was used to assess expression of amino acids in the RVLM. Immunohistochemical methods were used to assess c-Fos expression in SON neurons. The trauma of surgical stress was shown to dramatically increase the discharge frequency of RVLM neurons and promote the release of glutamate and taurine in the RVLM. The expression of c-Fos was also significantly increased in the SON of traumatized rats. EA application at Neiguan acupoints significantly suppressed trauma-induced increase of discharge frequency of the RVLM neurons, almost completely suppressed the trauma-induced increase of glutamate release but only very slightly reduced the trauma-enhanced taurine release, and inhibited the increase of c-Fos expression in these SON neurons of traumatized rats. These results indicate that Neiguan EA may improve cardiac function by modulating neurons in the RVLM and the SON in surgically traumatized rats. The taurine-mediated negative feedback may be involved in the protective effect of EA on cardiac function.

Robust interactions between the effects of auditory and cutaneous electrical stimulations on cell activities in the thalamic reticular nucleus.

The thalamic reticular nucleus (TRN), a cluster of GABAergic cells, is thought to regulate bottom-up and top-down streams of sensory processing in the loop circuitry between the thalamus and cortex. Provided that sensory inputs of different modalities interact in the TRN, the TRN could contribute to fast and flexible cross-modal modulation of attention and perception that incessantly takes place in our everyday life. Indeed, diverse subthreshold interactions of auditory and visual inputs have been revealed in TRN cells (Kimura, 2014). To determine whether such sensory interaction could extend across modalities as a universal neural mechanism, the present study examined TRN cell activities elicited by auditory and cutaneous electrical stimulations in anesthetized rats. Juxta-cellular recording and labeling techniques were used. Recordings were obtained from 129 cells. Auditory or somatosensory responses were modulated by subthreshold electrical stimulation or sound (noise burst) in the majority of recordings (77 of 85 auditory and 13 of 15 somatosensory cells). Additionally, 22 bimodal cells and seven cells that responded only to combined stimulation were recognized. Suppression was predominant in modulation that was observed in both early and repeatedly evoked late responses. Combined stimulation also induced de novo cell activities. Further, response latency and burst spiking were modulated. Axonal projections of cells showing modulation terminated in first- or higher-order thalamic nuclei. Nine auditory cells projected to somatosensory thalamic nuclei. These results suggest that the TRN could regulate sensory processing in the loop circuitry between the thalamus and cortex through the sensory interaction pervasive across modalities.

Synaptic control of the shape of the motoneuron pool input-output function.

Although motoneurons have often been considered to be fairly linear transducers of synaptic input, recent evidence suggests that strong persistent inward currents (PICs) in motoneurons allow neuromodulatory and inhibitory synaptic inputs to induce large nonlinearities in the relation between the level of excitatory input and motor output. To try to estimate the possible extent of this nonlinearity, we developed a pool of model motoneurons designed to replicate the characteristics of motoneuron input-output properties measured in medial gastrocnemius motoneurons in the decerebrate cat with voltage-clamp and current-clamp techniques. We drove the model pool with a range of synaptic inputs consisting of various mixtures of excitation, inhibition, and neuromodulation. We then looked at the relation between excitatory drive and total pool output. Our results revealed that the PICs not only enhance gain but also induce a strong nonlinearity in the relation between the average firing rate of the motoneuron pool and the level of excitatory input. The relation between the total simulated force output and input was somewhat more linear because of higher force outputs in later-recruited units. We also found that the nonlinearity can be increased by increasing neuromodulatory input and/or balanced inhibitory input and minimized by a reciprocal, push-pull pattern of inhibition. We consider the possibility that a flexible input-output function may allow motor output to be tuned to match the widely varying demands of the normal motor repertoire.NEW & NOTEWORTHY Motoneuron activity is generally considered to reflect the level of excitatory drive. However, the activation of voltage-dependent intrinsic conductances can distort the relation between excitatory drive and the total output of a pool of motoneurons. Using a pool of realistic motoneuron models, we show that pool output can be a highly nonlinear function of synaptic input but linearity can be achieved through adjusting the time course of excitatory and inhibitory synaptic inputs.