Neurophysiological methods for the assessment of spasticity: the Hoffmann reflex, the tendon reflex, and the stretch reflex

Purpose: To review the literature concerning neurophysiological methods to assess spasticity with respect to mechanisms and methodology, and to describe the three most commonly used methods: the Hoffmann reflex (H-reflex), the Tendon reflex (T-reflex), and the Stretch Reflex (SR).\ud Method: A systematic internet database search was performed to identify neurophysiological measurement methods of spasticity. A systematic exclusion procedure resulted in 185 included references, completed by additional informal search. For this paper, information about the H-, T- and stretch reflexes was extracted from these references. \ud Results: Although the reflexes are basically monosynaptic, there are many supraspinal pathways which modulate the responses in terms of their amplitude and latency. As a consequence the methods are sensitive to a considerable number of experimental conditions and are characterized by a moderate reliability and sensitivity. Correlations with other (i.e. biomechanical, neurophysiological or clinical) spasticity assessment parameters are moderate to poor. Standardised and broadly accepted protocols are still largely lacking preventing an effective exchange of knowledge. \ud Conclusions: The clinical and experimental use of the three methods is restricted due to moderate reliability and sensitivity. It is recommended to perform combined neurophysiological – biomechanical assessment of spasticity during active, functional movement

Effects of liraglutide on obesity-associated functional hypogonadism in men

Lifestyle measures (LSMs) should be the first-line approach offered for obesity-related functional hypogonadism (FH). When LSMs fail, the role of testosterone replacement treatment (TRT) is unclear. GLP1 receptor agonist liraglutide is linked to progressive and sustained weight loss. A potential direct impact of GLP1 on hypothalamus-pituitary-testicular (HPT) axis was reported in animal models. We aimed to compare the effects of liraglutide and TRT on FH in obese men that had been poor responders to LSM, by means of reversal of FH and weight reduction. We designed a 16-week prospective randomized open-label study with 30 men (aged 46.5 ± 10.9 years, BMI 41.2 ± 8.4 kg/m2, mean ± s.d.) that were randomized to liraglutide 3.0 mg QD (LIRA) or 50 mg of 1% transdermal gel QD (TRT). Sexual function and anthropometric measures were assessed. Fasting blood was drawn for determination of endocrine and metabolic parameters followed by OGTT. Model-derived parameters including HOMAIR and calculated free testosterone (cFT) were calculated. Total testosterone significantly increased in both arms (+5.9 ± 7.2 in TRT vs +2.6 ± 3.5 nmol/L in LIRA) and led to improved sexual function. LIRA resulted in a significant increase of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) (P < 0.001 for between-treatment effect). Subjects treated with LIRA lost on average 7.9 ± 3.8 kg compared with a 0.9 ± 4.5 kg loss in TRT (P < 0.001). Metabolic syndrome was resolved in two patients in LIRA and in no subjects in TRT. Liraglutide was superior to TRT in improving an overall health benefit in men with obesity-associated FH after LSM failed

COVID-19 and Blood Clots: A Report of Massive Pulmonary Embolism in COVID-19 Patient Supported on Veno-Venous ECMO and the Utility of Thrombolysis

COVID-19 morbidity and mortality are not equivalent to other etiologies of acute respiratory distress syndrome (ARDS) as fulminant activation of coagulation can occur, thereby resulting in widespread microvascular thrombosis and consumption of coagulation factors. A 53-year-old female presented to an emergency center on two occasions with progressive gastrointestinal and respiratory symptoms. She was diagnosed with COVID-19 pneumonia and admitted to a satellite intensive care unit with hypoxemic respiratory failure. She was intubated and mechanically ventilated, but her ARDS progressed over the next 48 hours. The patient was emergently cannulated for veno-venous extracorporeal membrane oxygenation (V-V ECMO) and transferred to our hospital. She was in profound shock requiring multiple vasopressors for hemodynamic support with worsening clinical status on arrival. On bedside echocardiography, she was found to have a massive pulmonary embolism with clot-in-transit visualized in the right atrium and right ventricular outflow tract. After a multidisciplinary discussion, systemic thrombolytic therapy was administered. The patient\u27s hemodynamics improved and vasopressors were discontinued. This case illustrates the utility of bedside echocardiography in shock determination, the need for continued vigilance in the systematic evaluation of unstable patients in the intensive care unit, and the use of systemic thrombolytics during V-V ECMO in a novel disease process with evolving understanding

Clinicopathological correlations in heart transplantation recipients complicated by death or re-transplantation.

Purpose This study aimed to identify and correlate pathological findings with clinical outcomes in patients after orthotopic heart transplantation (OHT) who either died or underwent a re-transplantation. Methodology and study design Single-center retrospective analysis of primary OHT patients who died or were re-transplanted between October 2012 and July 2021. Clinical data were matched with corresponding pathological findings from endomyocardial biopsies on antibody-mediated rejection, cellular rejection, and cardiac allograft vasculopathy. Re-assessment of available tissue samples was performed to investigate acute myocardial injury (AMI) as a distinct phenomenon. These were correlated with clinical outcomes, which included severe primary graft dysfunction. Patients were grouped according to the presence of AMI and compared. Results We identified 47 patients with truncated outcomes after the first OHT. The median age was 59 years, 36 patients (76%) were male, 25 patients (53%) had a prior history of cardiac operation, and 21 patients (45%) were supported with a durable assist device before OHT. Of those, AMI was identified in 22 (47%) patients (AMI group), and 25 patients had no AMI (non-AMI group). Groups were comparable in baseline and perioperative data. Histopathological observations in AMI group included a non-significant higher incidence of antibody-mediated rejection Grade 1 or higher (pAMR ≥ 1) (32% vs. 12%, P = 0.154), and non-significant lower incidence of severe acute cellular rejection (ACR ≥ 2R) (32% vs. 40%, P = 0.762). Clinical observations in the AMI group found a significantly higher occurrence of severe primary graft dysfunction (68% vs. 20%, P = 0.001) and a highly significant shorter duration from transplantation to death or re-transplantation (42 days [IQR 26, 120] vs. 1,133 days [711-1,664], P < 0.0001). Those patients had a significantly higher occurrence of cardiac-related deaths (64% vs. 24%, P = 0.020). No difference was observed in other outcomes. Conclusion In heart transplant recipients with a truncated postoperative course leading to either death or re-transplantation, AMI in endomyocardial biopsies was a common pathological phenomenon, which correlated with the clinical occurrence of severe primary graft dysfunction. Those patients had significantly shorter survival times and higher cardiac-related deaths. The presence of AMI suggests a truncated course after OHT

Segno IO: solución integral de firma digital en la administración pública

La implementación de la firma digital en el Honorable Tribunal de Cuentas de la Provincia de Buenos Aires, la cual se desarrolla en el contexto del Proyecto de Notificación Electrónica de acuerdo a la Ley Nacional N° 25.506, favorece la gestión digital de los documentos, el cambio cultural y aumenta notablemente la eficiencia de los procesos involucrados. Segno IO, surge como mejora de la investigación y desarrollo previo (Segno), teniendo en cuenta las necesidades propias del organismo y la integración con los sistemas web ya implementados. La solución presentada, conserva las ventajas de la versión anterior: una fácil adaptación a la infraestructura web existente, componentes tecnológicos con soporte para todos los navegadores, y mejora aspectos de la seguridad y la transparencia al usuario utilizando nuevas tecnologías.Sociedad Argentina de Informática e Investigación Operativa (SADIO

Segno IO: solución integral de firma digital en la administración pública

La implementación de la firma digital en el Honorable Tribunal de Cuentas de la Provincia de Buenos Aires, la cual se desarrolla en el contexto del Proyecto de Notificación Electrónica de acuerdo a la Ley Nacional N° 25.506, favorece la gestión digital de los documentos, el cambio cultural y aumenta notablemente la eficiencia de los procesos involucrados. Segno IO, surge como mejora de la investigación y desarrollo previo (Segno), teniendo en cuenta las necesidades propias del organismo y la integración con los sistemas web ya implementados. La solución presentada, conserva las ventajas de la versión anterior: una fácil adaptación a la infraestructura web existente, componentes tecnológicos con soporte para todos los navegadores, y mejora aspectos de la seguridad y la transparencia al usuario utilizando nuevas tecnologías.Sociedad Argentina de Informática e Investigación Operativa (SADIO

Segno IO: solución integral de firma digital en la administración pública

La implementación de la firma digital en el Honorable Tribunal de Cuentas de la Provincia de Buenos Aires, la cual se desarrolla en el contexto del Proyecto de Notificación Electrónica de acuerdo a la Ley Nacional N° 25.506, favorece la gestión digital de los documentos, el cambio cultural y aumenta notablemente la eficiencia de los procesos involucrados. Segno IO, surge como mejora de la investigación y desarrollo previo (Segno), teniendo en cuenta las necesidades propias del organismo y la integración con los sistemas web ya implementados. La solución presentada, conserva las ventajas de la versión anterior: una fácil adaptación a la infraestructura web existente, componentes tecnológicos con soporte para todos los navegadores, y mejora aspectos de la seguridad y la transparencia al usuario utilizando nuevas tecnologías.Sociedad Argentina de Informática e Investigación Operativa (SADIO