Improved Selectivity in Eliciting Evoked Electromyography Responses With High-Resolution Spinal Cord Stimulation.

BACKGROUND AND OBJECTIVES: As spinal cord stimulation (SCS) offers a therapy for increasing numbers of patients with chronic pain and spinal cord injury, it becomes increasingly important to better understand its somatotopy. In this prospective study, we investigate whether high-resolution SCS (HR-SCS) offers improved selectivity assessed through elicitation of evoked electromyography (EMG) responses as compared with commercial paddle leads. METHODS: Vertical tripole configurations were used to elicit EMG responses in both types of paddles placed for standard-of-care indications between T6 and T10. In HR-SCS, evoked EMG responses in lower extremity/abdominal muscle groups were monitored at 6 to 8 mediolateral sites. All commercial paddle columns were tested. Percentage change in the maximum root mean square value was calculated at a group level. Heat maps were generated to identify responders for each muscle group. Responders were considered patients who had a >50% change in root mean square over baseline. RESULTS: We demonstrated significantly greater motor responses across medial and lateral contacts and greater responder rates consistently at the T6 and T9 levels with HR-SCS as compared with commercial paddles in 18 patients. Distal muscle groups (gastrocnemius and tibialis anterior) and proximal muscle groups (biceps femoris and quadriceps) were selectively activated at both levels. CONCLUSION: We demonstrate that HR-SCS has greater selectivity in eliciting evoked EMG responses in an intraoperative setting. HR-SCS offers recruitment of muscle groups at lateral contacts concurrently with medial contacts. We provide data that HR-SCS may provide higher spatial resolution, which has the potential to allow for personalization of care and treatment of pain syndromes/symptoms which to date have not been effectively treated.

Depresión mayor en población general de Envigado (Colombia): prevalencia y factores asociados / Major depression in the general population of Envigado (Colombia): prevalence and associated factors

Resumen Introducción: La depresión afecta a más de 300 millones de personas en el mundo, es la principal causa de discapacidad y contribuye de forma importante a la carga mundial de morbilidad. Objetivo: Determinar la prevalencia y algunos factores personales, sociales y familiares asociados al trastorno de depresión mayor en población de 15 a 65 años del municipio de Envigado (Colombia) en el año 2017. Método: Estudio transversal con intención analítica, a partir de la información de 905 participantes del "Estudio Poblacional de Salud Mental, Envigado 2017", recopilada a través de entrevistas realizadas con la World Health Organization Composite International Diagnostic Interview -CIDI-OMS. El procesamiento se realizó mediante el programa SPSS versión 23. Resultados: Cuatro factores explican la probabilidad de depresión mayor en el último año, en la población de estudio: el abuso de drogas diferentes al alcohol (ORaj=4,43 [1,164-16,833]), la muerte o enfermedad de un familiar cercano (ORaj=4,15 [1,583-10,880]), presentar altos niveles de resiliencia (ORaj=0,22 [0,112-0,425]) y una percepción excelente o buena de su salud mental (ORaj=0,19 [0,098-0,378]). Conclusiones: Los factores que aumentan la probabilidad de depresión mayor en la población de estudio son: abuso de drogas diferentes al alcohol y la muerte o enfermedad de un familiar de primer grado de consanguinidad; y los factores protectores son altos niveles de resiliencia y una percepción excelente o buena de la propia salud mental. Esta evidencia refuerza la necesidad de implementar programas de promoción centrados en el mejoramiento de habilidades para la vida, que propicien estrategias adecuadas frente a los desafíos.

Abstract Introduction: Depression affects more than 300 million people in the world, it is the leading cause of disability and contributes significantly to the global burden of disease. Objective: To determine the prevalence and some social, personal, and family factors associated with major depressive disorder in a population aged from 15 to 65 in Envigado (Colombia) in 2017. Methods: A cross-sectional study with analytical intent was conducted, based on the information from 905 participants for the "Population study of mental health 2017", collected through interviews administered by means of the World Health Organization Composite International Diagnostic Interview -CIDI-OMS. The processing was performed using the SPSS program version 23. (CES University License). Results: Four factors correlate with major depression in the last year in the study population: drug abuse other than alcohol (ORaj = 4,43 [1,164-16,833]), a close relative´s death or illness (ORaj = 4,15 [1,583-10,880]), high resilience (ORaj = 0.22 [0,112-0,425]) and an excellent or good mental health perception (ORaj = 0.19 [0.098-0.378]). Conclusions: the factors that increase the probability of major depression in the study population are drug abuse other than alcohol and the death or illness of a first-degree relative; and the protective factors are high levels of resilience and an excellent or good perception of one's own mental health. This evidence reinforces the need to implement promotion programs focused on improvement of life skills, which provide adequate strategies to face the challenges.

Chronic Stress Detrimentally Affects In Vivo Maturation in Rat Oocytes and Oocyte Viability at All Phases of the Estrous Cycle.

BACKGROUND: Stress has been considered as one of the causes of decreased reproductive function in women. However, direct evidence of the effect of chronic stress on oocytes depending on estrous cycle phases is limited. OBJECTIVE: The present study aimed to evaluate the impact of chronic stress on the viability, integrity, and maturation of rat oocytes depending on estrous cycle phases, specifically proestrus, estrus, and diestrus. METHODS: For this purpose, adult female rats were stressed daily by cold water immersion (15 °C) for 30 consecutive days. RESULTS: In chronically stressed female rats, irregular estrous cyclicity, increased corticosterone levels, decreased oocyte viability, and an increased percentage of abnormal oocytes were obtained in all the estrous cycle phases, resulting in reduced oocyte maturation during proestrus. CONCLUSION: Oocyte maturation disturbed by chronic stress is a crucial factor by which chronic stress disrupts female reproduction.

Pregnant Agencies: Movement and Participation in Maternal-Fetal Interactions.

Pregnancy presents some interesting challenges for the philosophy of embodied cognition. Mother and fetus are generally considered to be passive during pregnancy, both individually and in their relation. In this paper, we use the enactive operational concepts of autonomy, agency, individuation, and participation to examine the relation between mother and fetus in utero. Based on biological, physiological, and phenomenological research, we explore the emergence of agentive capacities in embryo and fetus, as well as how maternal agency changes as pregnancy advances. We show that qualitatively different kinds of agency have their beginnings already in utero, and to what extent fetal and maternal movement modulate affectivity and individuation in pregnancy. We thus propose that mother and fetus are both agents who participate in pregnancy. Pregnancy then emerges as a relational developmental organization that anchors and holds its developing participants. We end the paper with reflections on ethical implications of this proposal, and suggestions for future research.

Neuroendocrine disruption is associated to infertility in chronically stressed female rats.

Infertility is a growing worldwide public health problem, and stress is a main factor exerting detrimental effects on female reproduction. However, knowledge regarding the neuroendocrine changes caused by chronic stress in females is limited. Therefore, this study assessed the effects of stress on hormones that control female reproduction during the proestrus and diestrus stages of the estrous cycle, as well as its effects on fertility. Adult females were assigned to either a control or a stress group. Stress consisted of exposure, for 15 min, to cold-water immersion daily for 30 days. Estrous cyclicity, female sexual behavior, as well as hypothalamic kisspeptin, gonadotropin releasing hormone (GnRH) content, serum luteinizing hormone (LH), estradiol (E2), progesterone (P4), corticosterone (CORT) and fertility were assessed after chronic stress. The results show that chronically stressed females exhibited disrupted estrous cyclicity, decreased receptivity, low pregnancy rates and lower numbers of fetuses. The content of Kisspeptin and GnRH in the Anteroventral Periventricular/medial Preoptic Area decreased during proestrus, while Kisspeptin increased in the Arcuate nucleus in proestrus and diestrus. Serum LH decreased only during proestrus, whereas E2 and P4 concentrations decreased during proestrus and diestrus, with a concomitant increase in CORT levels in both stages. As a whole, these results indicate that chronic stress decreases Kisspeptin content in AVPV nucleus and GnRH in POA in females, and might induce disruption of the LH surge, consequently disrupting estrous cyclicity and fertility, leading to lower rates of pregnancy and number of fetuses.

Effect of co-infection with a small intestine-restricted helminth pathogen on oral prion disease pathogenesis in mice.

The early replication of some orally-acquired prion strains upon stromal-derived follicular dendritic cells (FDC) within the small intestinal Peyer's patches is essential to establish host infection, and for the disease to efficiently spread to the brain. Factors that influence the early accumulation of prions in Peyer's patches can directly influence disease pathogenesis. The host's immune response to a gastrointestinal helminth infection can alter susceptibility to co-infection with certain pathogenic bacteria and viruses. Here we used the natural mouse small intestine-restricted helminth pathogen Heligmosomoides polygyrus to test the hypothesis that pathology specifically within the small intestine caused by a helminth co-infection would influence oral prion disease pathogenesis. When mice were co-infected with prions on d 8 after H. polygyrus infection the early accumulation of prions within Peyer's patches was reduced and survival times significantly extended. Natural prion susceptible hosts such as sheep, deer and cattle are regularly exposed to gastrointestinal helminth parasites. Our data suggest that co-infections with small intestine-restricted helminth pathogens may be important factors that influence oral prion disease pathogenesis.