The effect of task symmetry on bimanual reach-to-grasp movements after cervical spinal cord injury.

Injury to the cervical spinal cord results in deficits in bimanual control, reducing functional independence and quality of life. Despite this, little research has investigated the control strategies which underpin bimanual arm/hand movements following cervical spinal cord injury (cSCI). Using kinematics and surface electromyography this study explored how task symmetry affects bimanual control, in patients with an acute cSCI (< 6 m post injury), as they performed naturalistic bimanual reach-to-grasp actions (to objects at 50% and 70% of their maximal reach distance), and how this differs compared to uninjured age-matched controls. Twelve adults with a cSCI (mean age 69.25 years), with lesions at C3-C8, categorized by the American Spinal Injury Impairment Scale (AIS) at C or D and 12 uninjured age-matched controls (AMC) (mean age 69.29 years) were recruited. Participants with a cSCI produced reach-to-grasp actions which took longer, were slower, less smooth and had longer deceleration phases than AMC (p < 0.05). Participants with a cSCI were less synchronous than AMC at peak velocity and just prior to object pick up (p < 0.05), but both groups ended the movement in a synchronous fashion. Peak muscle activity occurred just prior to object pick up for both groups. While there seems to be a greater reliance on the deceleration phase of the movement, we observed minimal disruption of the more impaired limb on the less impaired limb and no additional effects of task symmetry on bimanual control. Further research is needed to determine how to take advantage of this retained bimanual control in therapy.

Recovery of several cell pellet-associated antibiotics produced by Bacillus amyloliquefaciens NJN-6.

UNLABELLED: In this study, six antibiotics which are antagonistic to phytopathogens were extracted from the water-washed cell pellets of Bacillus amyloliquefaciens NJN-6. They were purified by HPLC and identified using electrospray ionization mass spectroscopy (ESI-MS). Besides three iturin A homologous and macrolactin A, two other kinds of antibiotics were extracted from the cell pellets of B. amyloliquefaciens NJN-6. An antifungal compound with the molecular mass of 1072 Da was identified as bacillomycin D, and the antibacterial compound with the molecular mass of 400 Da was identified as macrolactin E. We also quantified iturin A in both cell pellets and culture media, and the concentrations were 751·12 mg kg(-1) and 21·02 mg l(-1) , respectively. These results show that in addition to the culture medium, the cell pellets could also be a potential resource for antibiotics and the strain B. amyloliquefaciens NJN-6 might be an attractive source for antibiotic production and an antagonist for plant diseases. SIGNIFICANCE AND IMPACT OF THE STUDY: The novelty of this work is the production of several antimicrobial substances associated with cell pellets and the production of antibiotic macrolactin E by B. amyloliquefaciens strain. Here, cell pellet-associated antimicrobial compounds were identified, and strain NJN-6 was able to produce three cell pellet-associated iturin A family homologues, bacillomycin D, macrolactin A and macrolactin E. With the exception of macrolactin E, all other antimicrobial compounds were identified in the liquid culture. The production of macrolactin E by any B. amyloliquefaciens strain has not been previously reported; therefore, this is the first report about macrolactin E production by B. amyloliquefaciens.

Management of acute overdose or withdrawal state in intrathecal baclofen therapy.

STUDY DESIGN: Individuals who are treated with intrathecal Baclofen (ITB) pump delivery system for intractable spasticity can suffer from severe morbidity as a result of acute overdose or withdrawal of ITB, which can also be life threatening. Current literature has a number of single case studies with different approaches to the management in such states. OBJECTIVES: The aim of this article is to consolidate available evidence and develop treatment pathways for acute ITB overdose and withdrawal states. METHODS: We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library databases using the keywords 'intrathecal', 'baclofen', 'withdrawal', 'overdose' to identify studies (published up to December 2010) that focused on presentation or treatment of acute overdose and withdrawal state in ITB therapy. Only original articles in English involving adult population were included. RESULTS: Initial search revealed 130 articles. After reading the abstract, 13 studies on ITB overdose and 23 studies on ITB withdrawal were deemed suitable for inclusion. All studies were either single-case studies or case series. CONCLUSION: Acute ITB overdose is managed with immediate cessation of baclofen delivery through the system, reducing the baclofen load by cerebrospinal fluid aspiration and by providing supportive treatment in an intensive care setting. There is no specific antidote for reversing overdose symptoms. Acute ITB withdrawal is managed by restoring the delivery of ITB, providing supportive care in an intensive care setting and using drugs like low dose propofol or benzodiazepines in selected cases. Early involvement of ITB physicians is strongly recommended.

Prevalence of pressure sores in a community sample of spinal injury patients.

OBJECTIVES: To estimate the point prevalence of pressure sores in a community sample of spinal cord injured patients who were followed up by a spinal injuries unit and to evaluate whether self-management strategies were associated with decreased risk of pressure sores. SETTING: A regional spinal injuries unit, UK. DESIGN: Postal questionnaire survey. MAIN OUTCOME MEASURE: Presence of pressure sores. SUBJECTS: All patients who were being followed up on a regular basis by the unit. RESULTS: Out of 760, 520 replied to the questionnaire; 472 were eligible for analysis. Point prevalence of pressure sores was 23% (99). Failure to inspect the skin daily for pressure damage was associated with decreased prevalence of pressure sores (odds ratio (OR) 0.5; 95% confidence interval (CI) 0.2-0.83). Those who inspected their skin daily, however, had a higher proportion of stage I pressure sores, but this was not statistically significant. Smoking (OR 1.8; 95% CI 1-3.3) and pre-existing medical problems (OR 1.8; 95% CI 1-3) were associated with increased prevalence of pressure sores. Regular lifting of weight at least once in an hour while seated, age, gender, neurological level, employment status, living alone and faecal and urinary incontinence were not significant predictors of pressure sores. CONCLUSIONS: Nearly one-quarter of participants had pressure sores at the time of the survey. Periodic weight lifts and daily inspection of skin for pressure damage were not associated with decreased prevalence of pressure sores in this sample. However, those who inspected skin daily tended to detect pressure damage early.