Physical activity and the frequency of acute exacerbations in patients with chronic obstructive pulmonary disease.

PURPOSE: Acute exacerbations (AE) in patients with COPD are associated with a decline in lung function, increased risk of hospitalization, and mortality. In this cross-sectional study we tested whether the level of objectively measured daily physical activity and exercise capacity are associated with the number of COPD exacerbations. METHODS: In 210 patients with COPD (67 % men; mean (SD) age: 63 (8) years) enrolled in The Obstructive Pulmonary Disease Outcomes Cohort of Switzerland (TOPDOCS) physical activity (PA) (steps per day, physical activity level, (PAL)), exercise capacity (6-min walking distance, (6MWD)), comorbidities, lung function, and medication were assessed. Differences between COPD patients with frequent (≥2 year) and infrequent (0-1 year) exacerbations were assessed. Univariate and multivariate analyses were performed to investigate whether the level of objectively measured daily physical activity and exercise capacity are associated with the number of COPD exacerbations. RESULTS: Patients with frequent AE had a significantly lower FEV1 and 6MWD compared to patients with infrequent AE. In univariate analysis, the number of exacerbations was inversely associated with FEV1, 6MWD, BMI, and smoking status while there was a positive association with RV/TLC and combined inhaled medication. However, there was no significant association with PAL and steps per day. In multivariate analysis, FEV1 and the use of combined inhaled medication were independently associated with the number of AE, after correction for covariates. CONCLUSIONS: The findings of this study imply that FEV1, independent of inhaled medication, is significantly associated with COPD exacerbations. Neither physical activity nor exercise capacity was independently associated with COPD exacerbations.

Communication with emblematic gestures: shared and distinct neural correlates of expression and reception.

Emblematic (or symbolic) gestures allow individuals to convey a variety of thoughts and emotions ranging from approval to hostility. The use of such gestures involves the execution of a codified motor act by the addresser and its perception and decoding by the addressee. To examine underlying common and distinct neural correlates, we used fMRI tasks in which subjects viewed video clips of emblematic one-hand gestures. They were asked to (1) take the perspective of the addresser and imagine executing the gestures ("expression" condition), and to (2) take the perspective of the addressee and imagine being confronted with the gestures ("reception" condition). Common areas of activation were found in inferior frontal, medial frontal, and posterior temporal cortices with left-hemispheric predominance as well as in the cerebellum. The distinction between regions specifically involved in the expression or reception condition partly resembled the dorsal and ventral stream dichotomy of visual processing with junctions in inferior frontal and medial prefrontal cortices. Imagery of gesture expression involved the dorsal visual stream as well as higher-order motor areas. In contrast, gesture reception encompassed regions related to semantic processing, and medial prefrontal areas known to be involved in the process of understanding the intentions of others. In conclusion, our results provide evidence for a dissociation in representations of emblematic gesture processing between addresser and addressee in addition to shared components in language-related areas.

Distinct cortico-cerebellar activations in rhythmic auditory motor synchronization.

We investigated the role of the cerebellum in differential aspects of temporal control of rhythmic auditory motor synchronization using positron emission tomography (PET). Subjects tapped with their right index finger to metronome tones at a mean frequency of .8 Hz during 5 conditions: (1) an isochronous rhythm condition, (2) random changes in interval durations, and while the duration of rhythmic intervals was continuously time-modulated following a cosine-wave function at (3) 3%, (4) 7%, and (5) 20% of base interval. Anterior lobe cerebellar neuronal populations showed similar motor-associated activity across all conditions regardless of rhythmic time structure in vermal and hemispheric parts ipsilateral to the movements. Neuronal populations in bilateral anterior posterior lobe, especially in the simple lobule, increased their activity stepwise with each increase in tempo modulation from a steady beat. Neuronal populations in other parts of the posterior lobe showed an increase of activity only during the 20% condition, which involved conscious monitoring of rhythmic pattern synchronization, especially on the left side contralateral to the movements. Differential cerebellar activation patterns correspond to those in contralateral primary (primary sensorimotor), ipsilateral secondary (inferior parietal close to the intraparietal sulcus) and bilateral tertiary (dorsolateral prefrontal cortex) sensorimotor areas of the cerebral cortex, suggesting that distinct functional cortico-cerebellar circuits subserve differential aspects of rhythmic synchronization in regard to rhythmic motor control, conscious and subconscious response to temporal structure, and conscious monitoring of rhythmic pattern tracking.

Studying the human somatosensory hand area: A new way to compare fMRI and MEG.

Valid localization is a prerequisite to study plasticity of the somatosensory cortex in humans. We compared the localizations of left and right thumb and little finger in the primary somatosensory cortex obtained with fMRI and MEG. Representations were investigated in 11 healthy right-handed subjects using echoplanar fMRI and 122-channel MEG together with electric finger stimulation. Activation observed with fMRI was based on an increase in the BOLD signal. Most of the activation clusters (71.1%) were located on the lateral surface of the postcentral gyrus. Representations of thumb and little finger were 17mm apart on average and consistently showed a somatotopic arrangement with the thumb representation inferior, lateral, and anterior to the representation of the little finger. Activation observed with MEG was modelled by equivalent current dipoles. Dipole localization was compatible with an assumed origin of activation within the posterior wall of the central sulcus. The Euclidian distance between corresponding dipoles was 11.5mm on average with deviations from the expected spatial arrangement of 35, 30, and 20% in the x-, y- und z-direction, respectively. Our study demonstrates how relative localization of somatosensory activations can serve as an indicator for localization validity when comparing different methods or studying somatosensory plasticity.

Dynamics in the ultrastructure of asymmetric axospinous synapses in the frontal cortex of hibernating European ground squirrels (Spermophilus citellus).

Recent theories on the function of arousals from torpor in hibernating mammals focus on the repair of the central nervous system from damage accumulating during prolonged hypothermia. In this framework, we investigated the synaptic ultrastructure in Layer 2 of the frontal cortex from hibernating European ground squirrels (Spermophilus citellus) sacrificed at four different phases in the torpor-arousal cycle. Using electron microscopy, we quantified synapse number and morphometric data on asymmetric axospinous synapses. Length, width, and surface area of postsynaptic densities (PSDs), and the synaptic apposition length of the analyzed synapse were measured. Five groups of animals were compared during entrance into torpor (Torpor Early, TE, n = 6), late torpor (Torpor Late, TL, n = 5), beginning of euthermic arousal episodes (Arousal Early, AE, n = 5), late in the euthermic arousal episode (Arousal Late, AL, n = 5), and during continuous euthermy in spring (EU, n = 6). The results showed that during torpor and at the beginning of arousals the PSD length and synaptic apposition length are significantly increased compared to synapses during late arousal and in spring conditions. In contrast, the width and surface area of the PSDs are decreased in torpor. At the beginning of an arousal the width of the PSD increases and gains maximum value in late arousals (AL), returning to spring (EU) values. No differences were found in total number of synapses during the torpor-arousal cycle. The results indicate reversible changes in ultrastructure of (asymmetric axospinous) synapses in the frontal cortex, which may be critical for the maintenance of cortical neuronal networks and for protection against potential deleterious effects of prolonged hypothermic phases of hibernation.

Patellar component stability improves with pulsatile lavage in total knee arthroplasty.

In a cadaver study, we prepared 37 fresh frozen human patella pairs to determine the efficacy of jet lavage in comparison to syringe lavage with respect to cement penetration and stability of the polyethylene patellar component after patellar resurfacing. For 12 patella pairs, sagittal sections were obtained at predefined levels using a diamond saw. Cement penetration was significantly greater (P<0.0001) in the jet lavage specimens compared to the syringe lavage specimens. For the remaining 25 patella pairs, pullout tests were performed on patellar components using a traction-compression device. The maximum force required to cause mechanical failure was significantly greater (P<0,0001) in jet lavage specimens compared to syringe lavage specimens. Our results support the routine use of jet lavage for cleansing the patellar bed prior to cement application in cemented patellar resurfacing.

Functional organization of the brain with malformations of cortical development.

We examined the localization of cerebral functions in 28 patients with focal epilepsy and malformations of cortical development (MCDs). Polymicrogyria occurred in nine, hemimegalencephaly in four, heterotopia in eight, and focal cortical dysplasia (FCD) in nine cases. We used simple (sensomotor, visual) or complex (language, memory) functional magnetic resonance imaging (fMRI) paradigms. Two thirds of MCDs were activated by simple fMRI paradigms, whereas they less frequently showed activity during complex cognitive fMRI paradigms. During simple paradigms, all disturbances of cortical organization (polymicrogyria, schizencephaly, and mild-type FCD) showed activity, whereas other MCDs (disturbances of earlier steps of cortical development: hemimegalencephaly, Taylor-type FCD, and heterotopia) showed activity in only 44% (p < 0.01). The association between the pathophysiology and morphology of MCDs confirms the recently proposed classification system. Both focal neurological signs (p < 0.05) and focal electroencephalogram slowing (p < 0.05) independently correlated with MCD inactivity, confirming that fMRI showed neuronal functions of MCDs. Conclusively, fMRI visualizes the MCD functions and their relationship to the eloquent cortex, providing useful information before epilepsy surgery. Surgery of cortical organization disturbances should be cautiously performed because these malformations may participate to some degree in brain functions.