Physical therapy and deep brain stimulation in Parkinson’s Disease: Protocol for a pilot randomized controlled trial

Abstract Background Subthalamic nucleus deep brain stimulation (STN-DBS) reduces tremor, muscle stiffness, and bradykinesia in people with Parkinson’s Disease (PD). Walking speed, known to be reduced in PD, typically improves after surgery; however, other important aspects of gait may not improve. Furthermore, balance may worsen and falls may increase after STN-DBS. Thus, interventions to improve balance and gait could reduce morbidity and improve quality of life following STN-DBS. Physical therapy (PT) effectively improves balance and gait in people with PD, but studies on the effects of PT have not been extended to those treated with STN-DBS. As such, the efficacy, safety, and feasibility of PT in this population remain to be determined. The purpose of this pilot study is to address these unmet needs. We hypothesize that PT designed to target balance and gait impairment will be effective, safe, and feasible in this population. Methods/design Participants with PD treated with STN-DBS will be randomly assigned to either a PT or control group. Participants assigned to PT will complete an 8-week, twice-weekly PT program consisting of exercises designed to improve balance and gait. Control group participants will receive the current standard of care following STN-DBS, which does not include prescription of PT. The primary aim is to assess preliminary efficacy of PT on balance (Balance Evaluation Systems Test). A secondary aim is to assess efficacy of PT on gait (GAITRite instrumented walkway). Participants will be assessed OFF medication/OFF stimulation and ON medication/ON stimulation at baseline and at 8 and 12 weeks after baseline. Adverse events will be measured over the duration of the study, and adherence to PT will be measured to determine feasibility. Discussion To our knowledge, this will be the first study to explore the preliminary efficacy, safety, and feasibility of PT for individuals with PD with STN-DBS. If the study suggests potential efficacy, then this would justify larger trials to test effectiveness and safety of PT for those with PD with STN-DBS. Trial registration NCT03181282 (clinicaltrials.gov). Registered on 7 June 2017

Aligned gold nanorods in silica made by ion irradiation of core-shell colloidal particles

Colloidal particles with a 14 nm diameter Au core surrounded by a 72 nm thick silica shell have been irradiated with 30 MeV heavy ions. The shell deforms into an oblate ellipsoid, while the core becomes rod-shaped (aspect ratio up to 9) with the major axis along the beam. Optical extinction measurements show evidence for split plasmon bands, characteristic for anisotropic metal nanoparticles

Driven to snack: simulated driving increases subsequent consumption

When individuals eat while distracted, they may compensate by consuming more afterwards. Here, we examined the effect of eating while driving, and explored potential underlying mechanisms. Participants (N = 116, 73.3% female) were randomly allocated to complete a driving simulation (distraction condition) or to watch someone else drive (control condition) while consuming 10g (50.8 kcal) of potato chips. Afterwards, participants rated the taste intensity and hedonic experience, reported stress levels, and were then given the opportunity to eat more chips. As hypothesized, participants consumed more chips after the driving simulation. Stress levels were higher in the driving compared to control condition, but were inversely related to consumption amount, ruling out stress as explanatory mechanism. Saltiness ratings differed between the driving and passive viewing condition, only when controlling for stress. The current findings converge with earlier work showing that distracted eating can drive overconsumption, which in turn can lead to long-term health implications.  Limitations, implications and potential directions are discussed.Social decision makin

Sensory imagery in craving: From cognitive psychology to new treatments for addiction

Sensory imagery is a powerful tool for inducing craving because it is a key component of the cognitive system that underpins human motivation. The role of sensory imagery in motivation is explained by Elaborated Intrusion (EI) theory. Imagery plays an important role in motivation because it conveys the emotional qualities of the desired event, mimicking anticipated pleasure or relief, and continual elaboration of the imagery ensures that the target stays in mind. We argue that craving is a conscious state, intervening between unconscious triggers and consumption, and summarise evidence that interfering with sensory imagery can weaken cravings. We argue that treatments for addiction can be enhanced by the application of EI theory to maintain motivation, and assist in the management of craving in high-risk situations

Expression of granzyme B during primary cytomegalovirus infection after renal transplantation

CD8+ T cells employ granzyme B (GrB) to induce apoptosis in target cells. Increased expression of GrB has been put forward as a diagnostic marker in transplant rejection and viral infection. Three-color flow cytometric analysis revealed that peripheral blood CD8+ T lymphocytosis during primary cytomegalovirus infection after renal transplantation resulted from expansion of a CD8+GrB+CD62L+ T cell subset that was almost absent during stable transplant function or acute rejection. This expansion coincided with a temporary increase in systemic soluble GrB (sGrB) levels. No such increase was observed during stable transplant function or acute rejection. Thus, the primary immune response to cytomegalovirus infection is accompanied by appearance of CD8+GrB+CD62L+ T cells and increased sGrB levels in the peripheral blood compartment. Determination of the latter may provide a novel approach for monitoring viral infection