Exploring Methodological Issues in Mental Practice for Upper-Extremity Function Following Stroke-Related Paralysis: A Scoping Review.

In this scoping review, we aimed to comprehensively clarify the methodology of Mental practice (MP) by systematically mapping studies documenting the application of MP to post-stroke paralytic upper-extremity function. Specifically, when is an MP intervention most commonly applied after stroke onset? What is the corresponding MP load (intervention time, number of intervention days, and intervention period)? What are the most common methods of Motor Imagery (MI) recall and MI tasks used during the application of MP? Is MP often used in conjunction with individual rehabilitation? What are the paralyzed side's upper-limb and cognitive function levels at the start of an MP intervention? The research questions were identified according to PRISMA-ScR. The PubMed, Scopus, Medline, and Cochrane Library databases were used to screen articles published until 19 July 2022. In total, 694 English-language articles were identified, of which 61 were finally included. Most of the studies were conducted in the chronic phase after stroke onset, with limited interventions in the acute or subacute phase. The most common intervention time was ≤30 min and intervention frequency was 5 times/week in MP. An audio guide was most commonly used to recall MI during MP, and 50 studies examined the effects of MP in combination with individual rehabilitation. The Fugl-Meyer Assessment mean for the 38 studies, determined using the Fugl-Meyer Assessment, was 30.3 ± 11.5. Additional research with the aim of unifying the widely varying MP methodologies identified herein is warranted.

Incidental finding of extramammary Paget's disease during active surveillance for early-stage prostate cancer in a prostate biopsy.

Introduction: Skin tissue contamination within transcutaneous visceral organ biopsies is seldom found. We encountered a rare case of extramammary Paget's disease incidentally diagnosed by prostate biopsy during active surveillance for prostate cancer. Case presentation: A 71-year-old Japanese patient was diagnosed with prostate cancer, and active surveillance was selected. After 1 year, prostate biopsy was performed by a transperitoneal approach, and 16 biopsy cores were taken. One biopsy core contained skin tissue showing extramammary Paget's disease. Careful skin examination confirmed the presence of an extramammary Paget's disease lesion in the left perineum, and curative surgical resection was performed. Recurrence and metastasis did not occur after 6 months of follow-up. Conclusion: Although the perianal region is a common site of extramammary Paget's disease, early-stage extramammary Paget's disease is often asymptomatic. Thus, during a transcutaneous biopsy, it is important to consider the appearance of the skin and the pathological features of migrating skin tissue.

Differences in Cortical Area Activity and Motor Imagery Vivid-Ness during Evaluation of Motor Imagery Tasks in Right and Left Hemiplegics.

The ability to develop vivid motor imagery (MI) is important for effective mental practice. Therefore, we aimed to determine differences in the MI clarity and cortical area activity between patients with right hemiplegia and left hemiplegia after stroke in an MI task. In total, 11 participants with right hemiplegia and 14 with left hemiplegia were categorized into two groups. The MI task required the flexion and extension of the finger on the paralyzed side. Considering that MI vividness changes with MI practice, we measured the MI vividness and cortical area activity during the task before and after MI practice. MI vividness was evaluated subjectively using the visual analog scale, and cerebral hemodynamics during the task were measured using near-infrared spectroscopy in cortical regions during the MI task. The MI sharpness and cortical area activity in the MI task were significantly lower in the right hemiplegia group than in the left hemiplegia group. Therefore, when practicing mental practices with right hemiplegia, it is necessary to devise ways by which to increase MI vividness.

Effects of a virtual reality-based mirror therapy system on upper extremity rehabilitation after stroke: a systematic review and meta-analysis of randomized controlled trials.

Introduction: Virtual reality-based mirror therapy (VRMT) has recently attracted attention as a novel and promising approach for treating upper extremity dysfunction in patients with stroke. However, the clinical efficacy of VRMT has not been investigated. Methods: This study aimed to conduct a meta-analysis to evaluate the effects of VRMT on upper extremity dysfunction in patients with stroke. We screened articles published between January 2010 and July 2022 in PubMed, Scopus, MEDLINE, and Cochrane Central Register of Controlled Trials. Our inclusion criteria focused on randomized controlled trials (RCTs) comparing VRMT groups with control groups (e.g., conventional mirror therapy, occupational therapy, physical therapy, or sham therapy). The outcome measures included the Fugl-Meyer assessment upper extremity test (FMA-UE), the box and block test (BBT), and the manual function test (MFT). Risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool 2.0. We calculated the standardized mean differences (SMD) and 95% confidence intervals (95% CI). The experimental protocol was registered in the PROSPERO database (CRD42022345756). Results: This study included five RCTs with 148 stroke patients. The meta-analysis showed statistical differences in the results of FMA-UE [SMD = 0.81, 95% CI (0.52, 1.10), p < 0.001], BBT [SMD = 0.48, 95% CI (0.16, 0.80), p = 0.003], and MFT [SMD = 0.72, 95% CI (0.05, 1.40), p = 0.04] between the VRMT and the control groups. Discussion: VRMT may play a beneficial role in improving upper extremity dysfunction after stroke, especially when combined with conventional rehabilitation. However, there were differences in the type of VRMT, stage of disease, and severity of upper extremity dysfunction. Multiple reports of high-quality RCTs are needed to clarify the effects of VRMT. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022345756.

Continuous Repetition Motor Imagery Training and Physical Practice Training Exert the Growth of Fatigue and Its Effect on Performance.

Continuous repetition of motor imagery leads to mental fatigue. This study aimed to examine whether fatigue caused by motor imagery training affects improvement in performance and the change in corticospinal excitability. The participants were divided into "physical practice training" and "motor imagery training" groups, and a visuomotor task (set at 50% of maximal voluntary contraction in participants) was performed to assess the training effect on fatigue. The measurements were recorded before and after training. Corticospinal excitability at rest was measured by transcranial magnetic stimulation according to the Neurophysiological Index. Subjective mental fatigue and muscle fatigue were assessed by using the visual analog scale and by measuring the pinch force, respectively. Additionally, the error area was evaluated and calculated at pre-, mid-, and post-terms after training, using a visuomotor task. After training, muscle fatigue, subjective mental fatigue, and decreased corticospinal excitability were noted in both of the groups. Moreover, the visuomotor task decreased the error area by training; however, there was no difference in the error area between the mid- and post-terms. In conclusion, motor imagery training resulted in central fatigue by continuous repetition, which influenced the improvement in performance in the same manner as physical practice training.

Incidental Bladder Cancer Found on Cystoscopy during Prostate Biopsy: Prevalence, Pathological Findings, and Oncological Outcome.

INTRODUCTION: We examined the prevalence, pathological findings, and oncological outcomes of incidental bladder cancer found on cystoscopy among patients eligible for prostate biopsy (PB). METHODS: We retrospectively reviewed 803 patients who underwent cystoscopy prior to PB between January 2010 and September 2020. In cases of bladder tumor-like findings on cystoscopy, biopsy or transurethral resection of the bladder tumor was performed. The primary and secondary outcomes were the prevalence of incidental bladder cancer and pathological and oncological outcomes of incidental bladder cancer, respectively. RESULTS: Incidental findings were observed in 31/803 patients (3.9%). Bladder tumor-like findings were found in 24/803 patients (3%), while 9/803 patients (1.1%) were pathologically diagnosed with urothelial carcinoma. The stage and grade of incidental bladder cancer were pTa in 8/9 patients and pT1 in 1/9 and low grade in 8/9 and high in 1/9, respectively. The median tumor size of the papillary pedunculated type was 0.5 cm. At 26-month median follow-up, no recurrence was observed. CONCLUSION: Cystoscopy during PB may yield incidental bladder cancer findings, although the prevalence is very low. Incidental bladder cancer was of low stage and grade, which seemed unrelated to survival. Moreover, performing routine cystoscopy in conjunction with PB is not recommended as it may lead to overdiagnosis of low-risk bladder cancer.

A Method for Using Video Presentation to Increase Cortical Region Activity during Motor Imagery Tasks in Stroke Patients.

Previous studies have reported that stroke patients have difficulty recalling the motor imagery (MI) of a task, also known as MI vividness. Research on combining MI with action observation is gaining importance as a method to improve MI vividness. We enrolled 10 right-handed stroke patients and compared MI vividness and cortical activity under different presentation methods (no inverted image, inverted image of another individual's hand, and an inverted image of the patient's nonparalyzed hand) using near-infrared spectroscopy. Images of the nonparalyzed upper limb were inverted to make the paralyzed upper limb appear as if it were moving. Three tasks (non inverted image, AO + MI (other hand), AO + MI (own hand)) were randomly performed on 10 stroke patients. MI vividness was significantly higher when the inverted image of the nonparalyzed upper limb was presented compared to the other conditions (p < 0.01). The activity of the cortical regions was also significantly enhanced (p < 0.01). Our study highlights the potential application of inverted images of a stroke patient's own nonparalyzed hand in mental practice to promote the motor recovery of stroke patients. This technique achieved higher levels of MI vividness and cortical activity when performing motor tasks.

Positive Culture Prior to Transperineal Prostate Biopsy Was Not Associated with Post-Biopsy Febrile Urinary Tract Infection Development.

PURPOSE: To investigate the association between urine culture before transperineal prostate biopsy and post-biopsy febrile urinary tract infection (fUTI). PATIENTS AND METHODS: We retrospectively reviewed 307 patients who underwent urine culture before transperineal prostate biopsy between April 2017 and September 2020. Patients with indwelling urinary catheters (n=7) were excluded. Urine culture was performed 1-3 days before the biopsy, and all patients received prophylactic cefazolin regardless of culture results. A urine culture was defined as positive if cell density was more than 1×105 colony-forming units per mL. Baseline characteristics and the incidence of post-biopsy fUTI were compared between patients showing positive pre-biopsy culture results and those showing negative findings. RESULTS: Out of 300, seven patients (2.3%) had positive urine culture results before the biopsy. Age (p=0.077); prostate-specific antigen at diagnosis (p=0.267); prostate volume (p=0.78); number of biopsy cores (p=0.277); percentage of patients testing positive for cancer on biopsy (p=0.71); and percentages of patients with a history of biopsy (p>0.999), diabetes mellitus (p=0.604), and immunosuppressive medication use (p>0.999) were similar between the two groups. No patient in the positive urine culture group had post-biopsy fUTI. However, 1.7% (five patients) of the negative urine culture group had the disease (p>0.999) (four patients with prostatitis and one with pyelonephritis). Among them, two patients were diagnosed by urine culture at the time of post-biopsy fUTI. CONCLUSION: In asymptomatic patients, positive pre-biopsy cultures were not associated with the development of post-biopsy fUTI.

Hemodynamic Signal Changes During Motor Imagery Task Performance Are Associated With the Degree of Motor Task Learning.

PURPOSE: This study aimed to investigate whether oxygenated hemoglobin (oxy-Hb) generated during a motor imagery (MI) task is associated with the motor learning level of the task. METHODS: We included 16 right-handed healthy participants who were trained to perform a ball rotation (BR) task. Hemodynamic brain activity was measured using near-infrared spectroscopy to monitor changes in oxy-Hb concentration during the BR MI task. The experimental protocol used a block design, and measurements were performed three times before and after the initial training of the BR task as well as after the final training. The BR count during training was also measured. Furthermore, subjective vividness of MI was evaluated three times after NIRS measurement using the Visual Analog Scale (VAS). RESULTS: The results showed that the number of BRs increased significantly with training (P < 0.001). VAS scores also improved with training (P < 0.001). Furthermore, oxy-Hb concentration and the region of interest (ROI) showed a main effect (P = 0.001). An interaction was confirmed (P < 0.001), and it was ascertained that the change in oxy-Hb concentrations due to training was different for each ROI. The most significant predictor of subjective MI vividness was supplementary motor area (SMA) oxy-Hb concentration (coefficient = 0.365). DISCUSSION: Hemodynamic brain activity during MI tasks may be correlated with task motor learning levels, since significant changes in oxy-Hb concentrations were observed following initial and final training in the SMA. In particular, hemodynamic brain activity in the SMA was suggested to reflect the MI vividness of participants.

A method for using video presentation to increase the vividness and activity of cortical regions during motor imagery tasks.

In recent years, mental practice (MP) using laterally inverted video of a subject's non-paralyzed upper limb to improve the vividness of presented motor imagery (MI) has been shown to be effective for improving the function of a paralyzed upper limb. However, no studies have yet assessed the activity of cortical regions engaged during MI task performance using inverse video presentations and neurophysiological indicators. This study sought to investigate changes in MI vividness and hemodynamic changes in the cerebral cortex during MI performance under the following three conditions in near-infrared spectroscopy: MI-only without inverse video presentation (MI-only), MI with action observation (AO) of an inverse video presentation of another person's hand (AO + MI (other hand)), and MI with AO of an inverse video presentation of a participant's own hand (AO + MI (own hand)). Participants included 66 healthy right-handed adults (41 men and 25 women; mean age: 26.3 ± 4.3 years). There were 23 patients in the MI-only group (mean age: 26.4 ± 4.1 years), 20 in the AO + MI (other hand) group (mean age: 25.9 ± 5.0 years), and 23 in the AO + MI (own hand) group (mean age: 26.9 ± 4.1 years). The MI task involved transferring 1 cm × 1 cm blocks from one plate to another, once per second, using chopsticks held in the non-dominant hand. Based on a visual analog scale (VAS), MI vividness was significantly higher in the AO + MI (own hand) group than in the MI-only group and the AO + MI (other hand) group. A main effect of condition was revealed in terms of MI vividness, as well as regions of interest (ROIs) in certain brain areas associated with motor processing. The data suggest that inverse video presentation of a person's own hand enhances the MI vividness and increases the activity of motor-related cortical areas during MI. This study was approved by the Institutional Ethics Committee of Nagasaki University Graduate School of Biomedical and Health Sciences (approval No. 18121303) on January 18, 2019.

A Study on the Effect of Mental Practice Using Motor Evoked Potential-Based Neurofeedback.

This study aimed to investigate whether the effect of mental practice (motor imagery training) can be enhanced by providing neurofeedback based on transcranial magnetic stimulation (TMS)-induced motor evoked potentials (MEP). Twenty-four healthy, right-handed subjects were enrolled in this study. The subjects were randomly allocated into two groups: a group that was given correct TMS feedback (Real-FB group) and a group that was given randomized false TMS feedback (Sham-FB group). The subjects imagined pushing the switch with just timing, when the target circle overlapped a cross at the center of the computer monitor. In the Real-FB group, feedback was provided to the subjects based on the MEP amplitude measured in the trial immediately preceding motor imagery. In contrast, the subjects of the Sham-FB group were provided with a feedback value that was independent of the MEP amplitude. TMS was applied when the target, moving from right to left, overlapped the cross at the center of the screen, and the MEP amplitude was measured. The MEP was recorded in the right first dorsal interosseous muscle. We evaluated the pre-mental practice and post-mental practice motor performance in both groups. As a result, a significant difference was observed in the percentage change of error values between the Real-FB group and the Sham-FB group. Furthermore, the MEP was significantly different between the groups in the 4th and 5th sets. Therefore, it was suggested that TMS-induced MEP-based neurofeedback might enhance the effect of mental practice.

The predictive factor for pathological downgrading after prostatectomy in patients with biopsy Gleason score 4+3 or 4+4 prostate cancer.

The proportion of Gleason pattern (GP) 4 prostate cancers at prostate biopsy has a clinically significant impact on risk stratification for patients with prostate cancer. In pathological diagnosis including GP 4, a biopsy Gleason score (GS) of 3+4 has a more favorable prognosis than a GS of 4+3 and 4+4. However, the discrepancy between biopsy and prostatectomy specimens is well known. The current study investigated the clinical parameters and biopsy specimens associated with pathological downgrading after prostatectomy in biopsies with a GS of 4+3 or 4+4 prostate cancer. A total of 302 patients with prostate cancer who underwent robot-assisted radical prostatectomy between August 2013 and May 2019 were retrospectively reviewed. A total of 103 patients had biopsies with GSs of 4+3 and GS 4+4 (unfavorable pathology). The proportion of patients who were downgraded from unfavorable disease to GS ≤3+4 (favorable pathology) in prostatectomy specimens was investigated. Logistic regression analysis was used to explore the association between clinical parameters and downgrading in prostatectomy specimens. A total of 43 patients (41.7%) were downgraded from biopsy GS to prostatectomy GS. The proportions of downgrade in biopsy GS 4+4 and 4+3 were 14.6 and 27.1%, respectively. The percentage of highest GS out of positive biopsy cores and the maximum percentage of cancer involvement within a positive core with the highest GS were lower in the downgrade group than in the no downgrade group (45 vs. 66.7%, P=0.025; 20 vs. 30%, P=0.048, respectively). When performing multivariate logistic regression analysis, the only significant predictor for downgrade was lower percentage of highest GS cores out of positive biopsy cores (odds ratio, 2.469; 95% confidence interval, 1.029-5.925 P=0.043). In conclusion, patients with biopsy GS 4+4 and 4+3 often exhibit a downgrade to GS 3+4 or less in prostatectomy specimens. The lower percentage of highest GS cores out of positive biopsy cores was associated with downgrade.

Comparison of cerebral activation between motor execution and motor imagery of self-feeding activity.

Motor imagery is defined as an act wherein an individual contemplates a mental action of motor execution without apparent action. Mental practice executed by repetitive motor imagery can improve motor performance without simultaneous sensory input or overt output. We aimed to investigate cerebral hemodynamics during motor imagery and motor execution of a self-feeding activity using chopsticks. This study included 21 healthy right-handed volunteers. The self-feeding activity task comprised either motor imagery or motor execution of eating sliced cucumber pickles with chopsticks to examine eight regions of interest: pre-supplementary motor area, supplementary motor area, bilateral prefrontal cortex, premotor area, and sensorimotor cortex. The mean oxyhemoglobin levels were detected using near-infrared spectroscopy to reflect cerebral activation. The mean oxyhemoglobin levels during motor execution were significantly higher in the left sensorimotor cortex than in the supplementary motor area and the left premotor area. Moreover, significantly higher oxyhemoglobin levels were detected in the supplementary motor area and the left premotor area during motor imagery, compared to motor execution. Supplementary motor area and premotor area had important roles in the motor imagery of self-feeding activity. Moreover, the activation levels of the supplementary motor area and the premotor area during motor execution and motor imagery are likely affected by intentional cognitive processes. Levels of cerebral activation differed in some areas during motor execution and motor imagery of a self-feeding activity. This study was approved by the Ethical Review Committee of Nagasaki University (approval No. 18110801) on December 10, 2018.

Cerebral haemodynamics during motor imagery of self-feeding with chopsticks: differences between dominant and non-dominant hand.

Purpose: Motor imagery is defined as a dynamic state during which a subject mentally simulates a given action without overt movements. Our aim was to use near-infrared spectroscopy to investigate differences in cerebral haemodynamics during motor imagery of self-feeding with chopsticks using the dominant or non-dominant hand.Materials and methods: Twenty healthy right-handed people participated in this study. The motor imagery task involved eating sliced cucumber pickles using chopsticks with the dominant (right) or non-dominant (left) hand. Activation of regions of interest (pre-supplementary motor area, supplementary motor area, pre-motor area, pre-frontal cortex, and sensorimotor cortex was assessed.Results: Motor imagery vividness of the dominant hand tended to be significantly higher than that of the non-dominant hand. The time of peak oxygenated haemoglobin was significantly earlier in the right pre-frontal cortex than in the supplementary motor area and left pre-motor area. Haemodynamic correlations were detected in more regions of interest during dominant-hand motor imagery than during non-dominant-hand motor imagery.Conclusions: Haemodynamics might be affected by differences in motor imagery vividness caused by variations in motor manipulation.

Primary Motor Cortex Activation during Action Observation of Tasks at Different Video Speeds Is Dependent on Movement Task and Muscle Properties.

The aim of the present study was to investigate how the video speed of observed action affects the excitability of the primary motor cortex (M1), as assessed by the size of motor-evoked potentials (MEPs) induced by transcranial magnetic stimulation (TMS). Twelve healthy subjects observed a video clip of a person catching a ball (Experiment 1: rapid movement) and another 12 healthy subjects observed a video clip of a person reaching to lift a ball (Experiment 2: slow movement task). We played each video at three different speeds (slow, normal and fast). The stimulus was given at two points of timing in each experiment. These stimulus points were locked to specific frames of the video rather than occurring at specific absolute times, for ease of comparison across different speeds. We recorded MEPs from the first dorsal interosseous muscle (FDI) and abductor digiti minimi muscle (ADM) of the right hand. MEPs were significantly different for different video speeds only in the rapid movement task. MEPs for the rapid movement task were higher when subjects observed an action played at slow speed than normal or fast speed condition. There was no significant change for the slow movement task. Video speed was effective only in the ADM. Moreover, MEPs in the ADM were significantly higher than in the FDI in a rapid movement task under the slow speed condition. Our findings suggest that the M1 becomes more excitable when subjects observe the video clip at the slow speed in a rapid movement, because they could recognize the elements of movement in others. Our results suggest the effects of manipulating the speed of the viewed task on the excitability of the M1 during passive observation differ depending on the type of movement task observed. It is likely that rehabilitation in the clinical setting will be more efficient if the video speed is changed to match the task's characteristics.

S-15176 and its methylated derivative suppress the CsA-insensitive mitochondrial permeability transition and subsequent cytochrome c release induced by silver ion, and show weak protonophoric activity.

A recent report has described that S-15176 (N-[(3,5-di-tert-butyl-4-hydroxy-1-thiophenyl)]-3-propyl-N'-(2,3,4-trimethoxybenzyl) piperazine), an anti-ischemic agent, inhibits the mitochondrial permeability transition (PT) induced by not only Ca(2+) and inorganic phosphate, but also by tert-butylhydroperoxide or phenylarsine oxide [Morin et al. (Biochem Pharmacol 72:911-918, 2006)]. In the present study, we tested the effects of S-15176 on the PT induced by Ag(+), PT of which is not suppressed by cyclosporin A or oligomycin. S-15176 was effective in suppressing the PT and the subsequent cytochrome c release induced by Ag(+), and hence, it was concluded to be a more universal PT inhibitor than cyclosporin A or oligomycin. In addition to the PT-suppression activity, S-15176 also showed weak protonophoric activity. Thus, we further tested to investigate whether the hydroxyl group of S-15176 was involved in its PT-suppression or weak protonophoric activities. The methylated derivative of S-15176 also showed both PT suppression and weak protonophoric activities; hence, the hydroxyl group of S-15176 was concluded not to be involved in these activities.