Mapping of hormones and cortisol responses in patients after Lyme neuroborreliosis

<p>Abstract</p> <p>Background</p> <p>Persistent symptoms after treatment for neuroborreliosis are common for reasons mainly unknown. These symptoms are often unspecific and could be caused by dysfunctions in endocrine systems, an issue that has not been previously addressed systematically. We therefore mapped hormone levels in patients with previous confirmed Lyme neuroborreliosis of different outcomes and compared them with a healthy control group.</p> <p>Methods</p> <p>Twenty patients of a retrospective cohort of patients treated for definite Lyme neuroborreliosis were recruited 2.3 to 3.7 years (median 2.7) after diagnosis, together with 23 healthy controls. Lyme neuroborreliosis patients were stratified into two groups according to a symptom/sign score. All participants underwent anthropometric and physiological investigation as well as an extensive biochemical endocrine investigation including a short high-dose adrenocorticotropic hormone stimulation (Synacthen^®) test. In addition to hormonal status, we also examined electrolytes, 25-hydroxy-vitamin D and interleukin-6.</p> <p>Results</p> <p>Eight patients (40%) had pronounced symptoms 2-3 years after treatment. This group had a higher cortisol response to synacthen as compared with both controls and the Lyme neuroborreliosis patients without remaining symptoms (p < 0.001 for both comparisons). No other significant differences in the various baseline biochemical parameters, anthropometric or physiological data could be detected across groups.</p> <p>Conclusions</p> <p>Apart from a positive association between the occurrence of long-lasting complaints after Lyme neuroborreliosis and cortisol response to synacthen, no corticotropic insufficiency or other serious hormonal dysfunction was found to be associated with remaining symptoms after treatment for Lyme neuroborreliosis.</p

Brain-computer interfacing in disorders of consciousness.

Background: Recent neuroimaging research has strikingly demonstrated the existence of covert awareness in some patients with disorders of consciousness (DoC). These findings have highlighted the potential for the development of simple brain-computer interfaces (BCI) as a diagnosis in behaviourally unresponsive patients. Objectives: This study here reviews current EEG-based BCIs that hold potential for assessing and eventually assisting patients with DoC. It highlights key areas for further development that might eventually make their application feasible in this challenging patient group. Methods: The major types of BCIs proposed in the literature are considered, namely those based on the P3 potential, sensorimotor rhythms, steady state oscillations and slow cortical potentials. In each case, a brief overview of the relevant literature is provided and then their relative merits for BCI applications in DoC are considered. Results: A range of BCI designs have been proposed and tested for enabling communication in fully conscious, paralysed patients. Although many of these have potential applicability for patients with DoC, they share some key challenges that need to be overcome, including limitations of stimulation modality, feedback, user training and consistency. Conclusion: Future work will need to address the technical and practical challenges facing reliable implementation at the patient's bedside

Effect of Apomorphine on the relationship between local cerebral glucose-utilization and local cerebral blood-flow (with an appendix on its statistical-analysis)

The alterations in local glucose utilization and local blood flow in 36 discrete regions of the central nervous system (CNS) that occur following the intravenous administration of the putative dopaminergic agonist, apomorphine (0.5 mg/kg), have been measured using the quantitative autoradiographic &lt;sup&gt;14&lt;/sup&gt;C-2-deoxyglucose and &lt;sup&gt;14&lt;/sup&gt;C-iodoantipyrine techniques. In eight of the regions examined (frontal and sensory-motor cortices, ventral thalamus, caudate nucleus, globus pallidus, substantia nigra, subthalamic nucleus, and posterior cerebellar hemisphere), significant elevations of local cerebral blood flow (CBF) were observed following apomorphine administration. In these eight regions, proportionately similar, significant elevations in local glucose utilization were observed following apomorphine. In two of the regions investigated (anterior cingulate cortex and lateral habenular nucleus), significant reductions in both local blood flow and glucose utilization were observed following apomorphine administration. In the majority of regions examined (26 of the total 36), apomorphine did not alter significantly either blood flow or glucose use. Using a Statistical approach, described in detail in an appendix, the relationship between local rates of glucose utilization and local levels of tissue blood flow was analyzed. A relationship between local CBF and local glucose utilization was found following apomorphine, and the nature of this relationship was indistinguishable from that observed in control animals. In no region of the CNS was a significant deviation from the normal CBF-glucose use relationship demonstrated following apomorphine administration. These results point to the greater importance of the effects of apomorphine upon tissue metabolic activity, rather than its direct vascular action, as being the major mechanism underlying the observed alterations in local CBF. The Statistical methods provide a rigorous analytical approach to the analysis of alterations in the relationship, both locally and globally, of blood supply to glucose utilization

A new conservative-dynamic treatment for the acute ruptured Achilles tendon.

INTRODUCTION: There is a trend towards surgical treatment of acute ruptured Achilles tendon. While classical open surgical procedures have been shown to restore good functional capacity, they are potentially associated with significant complications like wound infection and paresthesia. Modern mini-invasive surgical techniques significantly reduce these complications and are also associated with good functional results so that they can be considered as the surgical treatment of choice. Nevertheless, there is still a need for conservative alternative and recent studies report good results with conservative treatment in rigid casts or braces. PATIENTS/METHOD: We report the use of a dynamic ankle brace in the conservative treatment of Achilles tendon rupture in a prospective non-randomised study of 57 consecutive patients. Patients were evaluated at an average follow-up time of 5 years using the modified Leppilahti Ankle Score, and the first 30 patients additionally underwent a clinical examination and muscular testing with a Cybex isokinetic dynamometer at 6 and 12 months. RESULTS: We found good and excellent results in most cases. We observed five complete re-ruptures, almost exclusively in case of poor patient's compliance, two partial re-ruptures and one deep venous thrombosis complicated by pulmonary embolism. CONCLUSION: Although prospective comparison with other modern treatment options is still required, the functional outcome after early ankle mobilisation in a dynamic cast is good enough to ethically propose this method as an alternative to surgical treatment

Preliminary findings of cerebral responses on transcutaneous vagal nerve stimulation on experimental heat pain

Transcutaneous vagal nerve stimulation (TVNS) is a promising complementary method of pain relief. However, the neural networks associated with its analgesic effects are still to be elucidated. Therefore, we conducted two functional magnetic resonance imaging (fMRI) sessions, in a randomized order, with twenty healthy subjects who were exposed to experimental heat pain stimulation applied to the right forearm using a Contact Heat-Evoked Potential Stimulator. While in one session TVNS was administered bilaterally to the concha auriculae with maximal, non-painful intensity, the stimulation device was switched off in the other session (placebo condition). Pain thresholds were measured before and after each session. Heat stimulation elicited fMRI activation in cerebral pain processing regions. Activation magnitude in the secondary somatosensory cortex, posterior insula, anterior cingulate and caudate nucleus was associated with heat stimulation without TVNS. During TVNS, this association was only seen for the right anterior insula. TVNS decreased fMRI signals in the anterior cingulate cortex in comparison with the placebo condition; however, there was no relevant pain reducing effect over the group as a whole. In contrast, TVNS compared to the placebo condition showed an increased activation in the primary motor cortex, contralateral to the site of heat stimulation, and in the right amygdala. In conclusion, in the protocol used here, TVNS specifically modulated the cerebral response to heat pain, without having a direct effect on pain thresholds

Transcranial magnetic stimulation highlights the sensorimotor side of empathy for pain

Pain is intimately linked with action systems that are involved in observational learning and imitation. Motor responses to one's own pain allow freezing or escape reactions and ultimately survival. Here we show that similar motor responses occur as a result of observation of painful events in others. We used transcranial magnetic stimulation to record changes in corticospinal motor representations of hand muscles of individuals observing needles penetrating hands or feet of a human model or noncorporeal objects. We found a reduction in amplitude of motor-evoked potentials that was specific to the muscle that subjects observed being pricked. This inhibition correlated with the observer's subjective rating of the sensory qualities of the pain attributed to the model and with sensory, but not emotional, state or trait empathy measures. The empathic inference about the sensory qualities of others' pain and their automatic embodiment in the observer's motor system may be crucial for the social learning of reactions to pain

Effect of Action Verbs on the Performance of a Complex Movement

The interaction between language and motor action has been approached by studying the effect of action verbs, kinaesthetic imagery and mental subtraction upon the performance of a complex movement, the squat vertical jump (SVJ). The time of flight gave the value of the height of the SVJ and was measured with an Optojump® and a Myotest® apparatuses. The results obtained by the effects of the cognitive stimuli showed a statistically significant improvement of the SVJ performance after either loudly or silently pronouncing, hearing or reading the verb saute (jump in French language). Action verbs specific for other motor actions (pince = pinch, lèche = lick) or non-specific (bouge = move) showed no or little effect. A meaningless verb for the French subjects (tiáo = jump in Chinese) showed no effect as did rêve (dream), tombe (fall) and stop. The verb gagne (win) improved significantly the SVJ height, as did its antonym perds (lose) suggesting a possible influence of affects in the subjects’ performance. The effect of the specific action verb jump upon the heights of SVJ was similar to that obtained after kinaesthetic imagery and after mental subtraction of two digits numbers from three digits ones; possibly, in the latter, because of the intervention of language in calculus. It appears that the effects of the specific action verb jump did seem effective but not totally exclusive for the enhancement of the SVJ performance. The results imply an interaction among language and motor brain areas in the performance of a complex movement resulting in a clear specificity of the corresponding action verb. The effect upon performance may probably be influenced by the subjects’ intention, increased attention and emotion produced by cognitive stimuli among which action verbs