Critical Illness Myopathy: Diagnostic Approach and Resulting Therapeutic Implications.

Purpose of review Critical illness myopathy (CIM) is a common neuro-muscular complication of intensive care treatment associated with increased morbidity and mortality. The current guidelines for diagnosis include clinical and electrophysiological criteria as well as a muscle biopsy, and allow diagnosis only at an advanced stage of the disease. To date, there is no treatment for CIM available, apart from symptomatic and rehabilitative interventions. In this review, we discuss different diagnostic approaches and describe new treatment possibilities for CIM. Recent findings Of the diagnostic approaches evaluated, a new electrophysiological technique for measuring muscle excitability has the greatest potential to allow earlier diagnosis of CIM than the current guidelines do and thereby may facilitate the conduction of future pathophysiological and therapeutic studies. Although clinical trials are still lacking, in animal models, BGP-15, vamorolone, and ruxolitinib have been shown to have anti-inflammatory effects, to reduce muscle wasting and to improve muscle function and survival. Summary In recent years, promising methods for early and confirmatory diagnosis of CIM have been developed, but still need validation. Experimental studies on novel pharmacological interventions show promising results in terms of preventive CIM treatments, but future clinical studies will be needed to study the effectiveness and safety of these drugs

Motor Representations and Practice Affect Brain Systems Underlying Imagery: An fMRI Study of Internal Imagery in Novices and Active High Jumpers

This study used functional magnetic resonance imaging (fMRI) to investigate differences in brain activity between one group of active high jumpers and one group of high jumping novices (controls) when performing motor imagery of a high jump. It was also investigated how internal imagery training affects neural activity. The results showed that active high jumpers primarily activated motor areas, e.g. pre-motor cortex and cerebellum. Novices activated visual areas, e.g. superior occipital cortex. Imagery training resulted in a reduction of activity in parietal cortex. These results indicate that in order to use an internal perspective during motor imagery of a complex skill, one must have well established motor representations of the skill which then translates into a motor/internal pattern of brain activity. If not, an external perspective will be used and the corresponding brain activation will be a visual/external pattern. Moreover, the findings imply that imagery training reduces the activity in parietal cortex suggesting that imagery is performed more automatic and results in a more efficient motor representation more easily accessed during motor performance

Про розсудливість у юридичному тлумаченні дефініції «телекомунікації»

A method based on focused ion beam milling and analytical electron microscopy to investigate the nature of the tool-chip interface is presented. It is employed to study tool-chip interfaces of the rake face of a (Ti0.83Si0.17)N coated PCBN insert after turning of case-hardened steel. Analytical electron microscopy shows the presence of a smeared adhered layer on the coating, which consists of steel elements from the work-piece, oxygen, and Si and N, most likely originating from the coating.Original Publication:Axel Flink, R M Saoubi, Finn Giuliani, J Sjolen, T Larsson, Per Persson, M P Johansson and Lars Hultman, Microstructural characterization of the tool-chip interface enabled by focused ion beam and analytical electron microscopy, 2009, WEAR, (266), 11-12, 1237-1240.http://dx.doi.org/10.1016/j.wear.2009.03.001Copyright: Elsevier Science B.V., Amsterdam.http://www.elsevier.com

Custom versus Cell-Based ASIC Design for Many-Channel Correlators

While ASICs are efficient in terms of area utilization, performance, and power dissipation, ASIC design requires significant development resources. We compare two approaches to implementing ASIC correlators for interferometric imagers and spectrometers: The first approach, custom design, gives very high performance and area utilization, but is complex and time consuming. The second approach, cell-based design, reduces design time, but leads to lower performance and area utilization. In our evaluation, we consider two different correlator architectures: Autocorrelators for spectrometry, and cross-correlators for synthetic aperture imaging. Based on both 65-nm CMOS and 28-nm FD-SOI process technologies, our results show that for implementations for a limited number of channels, the cell-based approach may prove useful since it offers relatively short development time while still providing acceptable area utilization and performance. For larger designs, however, the area overhead of cell-based design becomes a major concern, especially for autocorrelator architectures

Factors Underlying the Early Limb Muscle Weakness in Acute Quadriplegic Myopathy Using an Experimental ICU Porcine Model

The basic mechanisms underlying acquired generalized muscle weakness and paralysis in critically ill patients remain poorly understood and may be related to prolonged mechanical ventilation/immobilization (MV) or to other triggering factors such as sepsis, systemic corticosteroid (CS) treatment and administration of neuromuscular blocking agents (NMBA). The present study aims at exploring the relative importance of these factors by using a unique porcine model. Piglets were all exposed to MV together with different combinations of endotoxin-induced sepsis, CS and NMBA for five days. Peroneal motor nerve conduction velocity and amplitude of the compound muscle action potential (CMAP) as well as biceps femoris muscle biopsy specimens were obtained immediately after anesthesia on the first day and at the end of the 5-day experimental period. Results showed that peroneal nerve motor conduction velocity is unaffected whereas the size of the CMAP decreases independently of the type of intervention, in all groups after 5 days. Otherwise, despite a preserved size, muscle fibre specific force (maximum force normalized to cross-sectional area) decreased dramatically for animals exposed to MV in combination with CS or/and sepsis. These results suggest that the rapid declines in CMAP amplitude and in force generation capacity are triggered by independent mechanisms with significant clinical and therapeutic implications

Predisposing factors for bacterial vaginosis, treatment efficacy and pregnancy outcome among term deliveries; results from a preterm delivery study

<p>Abstract</p> <p>Background</p> <p>Bacterial vaginosis (BV) during pregnancy is associated with an increased risk of preterm delivery but little is known about factors that could predict BV. We have analyzed if it is possible to identify a category of pregnant women that should be screened for BV, and if BV would alter the pregnancy outcome at term; we have also studied the treatment efficacy of clindamycin.</p> <p>Methods</p> <p>Prospective BV screening and treatment study of 9025 women in a geographically defined region in southeast Sweden. BV was defined as a modified Nugent score of 6 and above. Data was collected from the Swedish Medical Birth Register. Women allocated to treatment were supplied with vaginal clindamycin cream. The main outcome goals were to identify factors that could predict BV.</p> <p>Results</p> <p>Vaginal smears were consistent with BV criteria in 9.3%. Logistic regression indicates a significant correlation between smoking and BV (p < 0.001) and a greater prevalence of BV in the lower age groups (p < 0.001). We found no correlation between BV and history of preterm deliveries, previous miscarriages, extra-uterine pregnancies, infertility problems or reported history of urinary tract infections–factors that earlier have been associated with BV. Treatment with clindamycin cream showed a cure rate of 77%. Less than 1% of women with a normal vaginal smear in early pregnancy will develop BV during the pregnancy. There was no association between BV and the obstetric outcome among women who delivered at term. Women with BV, both treated patients and nontreated, had the same obstetric outcome at term as women with normal vaginal flora.</p> <p>Conclusion</p> <p>BV is more than twice as common among smokers, and there is a higher prevalence in the younger age group. However these two markers for BV do not suffice as a tool for screening, and considering the lack of other risk factors associated with BV, screening of all pregnant women might be a strategy to follow in a program intended to reduce the number of preterm births.</p