The effects of waveform and current direction on the efficacy and test–retest reliability of transcranial magnetic stimulation

[Abstract] The pulse waveform and current direction of transcranial magnetic stimulation (TMS) influence its interactions with the neural substrate; however, their role in the efficacy and reliability of single- and paired-pulse TMS measures is not fully understood. We investigated how pulse waveform and current direction affect the efficacy and test–retest reliability of navigated, single- and paired-pulse TMS measures. 23 healthy adults (aged 18–35 years) completed two identical TMS sessions, assessing resting motor threshold (RMT), motor-evoked potentials (MEPs), cortical silent period (cSP), short- and long-interval intra-cortical inhibition (SICI and LICI), and intracortical facilitation (ICF) using either monophasic posterior–anterior (monoPA; n = 9), monophasic anterior–posterior (monoAP; n = 7), or biphasic (biAP-PA; n = 7) pulses. Averages of each TMS measure were compared across the three groups and intraclass correlation coefficients were calculated to assess test–retest reliability. RMT was the lowest and cSP was the longest with biAP-PA pulses, whereas MEP latency was the shortest with monoPA pulses. SICI and LICI had the largest effect with monoPA pulses, whereas only monoAP and biAP-PA pulses resulted in significant ICF. MEP amplitude was more reliable with either monoPA or monoAP than with biAP-PA pulses. LICI was the most reliable with monoAP pulses, whereas ICF was the most reliable with biAP-PA pulses. Waveform/current direction influenced RMT, MEP latency, cSP, SICI, LICI, and ICF, as well as the reliability of MEP amplitude, LICI, and ICF. These results show the importance of considering TMS pulse parameters for optimizing the efficacy and reliability of TMS neurophysiologic measures

Dendroclimatologia na Amazônia: aplicações e potencialidades

The effects of climatic changes in the Amazon basin can be studied through dendroclimatology, from the analysis of the relations between climatic and meteorological variables and the growth of the xylem of arboreal species. The xylem constitutes a true natural file because it allows the recording of these variables in the wood, which can be very useful for understanding the potential impacts that anthropic activities may have on the climate. The objective of this article is to discuss aspects inherent to the state of the art on dendroclimatic methods and their application in the tropical forests of the Amazon region for analysis of the formation of growth rings in woody plants. The review on the subject was carried out in several bibliographic bases, both classic and more recent, and it was found that, although it is an ancient science, there are still few dendroclimatic studies conducted in the Amazon basin. Forests are sensitive ecosystems and studies related to the effects they may suffer from climate change are relevant to socioeconomic planning and the development of public policies.Os efeitos de mudanças climáticas na Amazônia podem ser estudados a partir de análises das relações entre variáveis climáticas e meteorológicas com o crescimento do xilema de espécies arbóreas, por meio da dendroclimatologia. O objetivo deste trablho foi abordar aspectos inerentes ao estado da arte sobre a formação de anéis de crescimento em plantas lenhosas, aos métodos dendroclimatológicos e as aplicações feitas nas florestas tropicais da Amazônia. A revisão sobre o tema foi feita a partir da busca por referências tanto clássicas como mais recentes, em diversas bases bibliográficas. Embora seja uma ciência antiga, ainda são poucos os estudos dendroclimatológicos conduzidos na Amazônia, existindo uma lacuna sobre esse conhecimento em diferentes sítios da região. Suas florestas são ecossistemas sensíveis e estudos relacionados aos efeitos que podem sofrer em virtude de mudanças climáticas são relevantes para o planejamento socioeconômico e o desenvolvimento de políticas públicas. Portanto, o arquivo natural sobre o clima registrado na madeira é de grande utilidade para a compreensão dos impactos potenciais que as atividades antrópicas podem exercer sobre o clima e a sustentabilidade da vida na Amazônia

DYNAMICS OF HEAT FLUXES BY BOWEN AND MATMNXFLX AND NOAH FLDAS PRODUCTS IN THE PANTANAL OF MATO GROSSO.

This paper aimed to analyze the dynamics of the energy budget components: latent heat flux (LE), sensible heat flux (H) and soil heat flux (G), in the Mato Grosso Pantanal. The estimates of LE, H, and G were obtained by the Bowen ratio methods, using data from the micrometeorological tower located in the Baía das Pedras Park of SESC-Pantanal Ecological Resort, for the years 2011 to 2013. The normality of the variables Rn, LE, H and G, were tested by Kolmogorov-Smirnov test at 5% significance, and the seasonal differences of the fluxes were verified by the KruskalWallis test, α = 0.05. LE and H data from the remote sensing products MATMNXFLX and FLDAS_NOAH of the MERRA model was also acquired, and their comparison with the tower data was performed by the statistics of Spearman correlation (r), Mean Absolute Error (MAE), Root Mean Squared Erro (RMSE), bias, and Willmott's Concordance Index (d). It was observed that most of the available energy is used for evapotranspiration (latent heat), followed by sensible heat and soil heat flux. In the rainy season there is an increase in the partition of LE and G and reduction of H. Only the estimates of LE of MATMNXFLX and FLDAS_NOAH products correlate with the data observed in the meteorological tower. It is concluded that the energy partitions have a seasonal behavior and that the MATMNXFLX and FLDAS_NOAH products, after being calibrated, can be used to estimate LE in the Mato Grosso Pantanal

Brain structures identification based on feature descriptor

Traumatic Brain Injury -TBI- -1- is defined as an acute event that causes certain damage to areas of the brain. TBI may result in a significant impairment of an individuals physical, cognitive and psychosocial functioning. The main consequence of TBI is a dramatic change in the individuals daily life involving a profound disruption of the family, a loss of future income capacity and an increase of lifetime cost. One of the main challenges of TBI Neuroimaging is to develop robust automated image analysis methods to detect signatures of TBI, such as: hyper-intensity areas, changes in image contrast and in brain shape. The final goal of this research is to develop a method to identify the altered brain structures by automatically detecting landmarks on the image where signal changes and to provide comprehensive information to the clinician about them. These landmarks identify injured structures by co-registering the patient?s image with an atlas where landmarks have been previously detected. The research work has been initiated by identifying brain structures on healthy subjects to validate the proposed method. Later, this method will be used to identify modified structures on TBI imaging studies

Laceration of the muscle ventral serrato

La presentación es informar al profesional veterinario sobre el desgarro bilateral del músculo serrato ventral, una afección de escasa incidencia en la clínica de pequeños animales, a través de la descripción detallada de un caso clínico y su resolución quirúrgica exitosa.The presentation of the work has as objective to inform the veterinary professional on an affection of scarce incidence in the clinic of the small animals, like is the bilateral laceration of the muscle ventral serrato, describing a clinical case in detail, its successful surgical resolution and carrying out an upgrade of this illness.Facultad de Ciencias Veterinaria

Mother's and newborn's plasmatic concentration of micronutrients at the moment of childbirth

Trata-se de estudo transversal com uma amostra sequencial de conveniência de 73 gestantes, não fumantes, sem intercorrências durante a gravidez e seus recém-nascidos normais, objetivando comparar concentrações plasmáticas de retinol, β caroteno, licopeno, α tocoferol e cobre entre mães e recém-nascidos. Colheu-se sangue da parturiente e do cordão umbilical (após dequitação) para dosagem dos micronutrientes. Retinol, β caroteno, licopeno e α tocoferol foram dosados por HPLC e o cobre por espectrofotometria de absorção atômica. Para análise foram separados 2 grupos:- grupo 1, 38 gestantes com suplementação vitaminico-mineral pelo menos no último trimestre da gravidez e grupo 2, 35 gestantes que não haviam recebido suplementação. As comparações estatísticas foram pelo teste t de Student ou pelo teste de Wilcoxon, com um α crítico de 0,05. Os dois grupos de mães eram símiles quanto a idade, paridade, IMC e a baixa ingestão de calorias e de micronutrientes. Os grupos de recém-nascidos não evidenciaram diferença quanto a sexo, peso, comprimento e perímetro cefálico. As concentrações plasmáticas maternas do grupo 1 foram maiores para o retinol(p = 0,0034) e a tocoferol(p = 0,0279). β caroteno, licopeno e cobre não evidenciaram diferenças entre os dois grupos de mães. Nos dois grupos de recém-nascidos as concentrações de retinol, tocoferol e cobre foram semelhantes e praticamente não houve concentrações detectáveis de licopeno e α caroteno. Em ambos os grupos retinol, a tocoferol e cobre apresentaram maiores concentrações nas mães do que nos recém-nascidos, p = 0,0003, p = 0,0001, p = 0,0001, respectivamente. Conclui-se que as concentrações nos recém-nascidos foram sempre menores do que as maternas, independentemente da ingestão e da suplementação durante a gravidez.Cross sectional study of a sequential convenience sample of 73 non smokers' pregnant women with uncomplicated pregnancies and their normal newborns. The aim of the study was to compare plasmatic concentrations of retinol, β-carotene, licopen and α-tocopherol between mothers and their infants. Blood was obtained from parturient and umbilical cord for micronutrient analysis. HPLC was used for retinol, α-carotene, licopen and α-tocopherol analysis. Atomic absorption spectrophotometry was used for copper measurements. The sample was divided into 2 groups: group 1, with 38 women that had received vitamin and mineral supplementation during the last gestational trimester and group 2, with 35 women who have had no supplementation. Statistic comparison used Student t test or Wilcoxon test (alpha = 0.05). The groups of mothers were similar regarding age, parity, BMI and ingestion (low) of calories and micronutrients. The newborn groups had no differences according to sex, head circumference, weight and length. Plasmatic concentrations in group 1 of mothers were greater for retinol (p = 0.0034) and α-tocopherol (p = 0.0279). β-carotene, licopen and cupper showed no differences between the groups at mothers. In both newborn groups concentration of retinol, α-tocopherol and copper were quite similar and there was no clearly detectable licopen and ² carotene. In both, retinol, α-tocopherol and cupper showed larger concentration in mothers than in newborns (respectively p = 0.0003 and p = 0.0001). The conclusion is that newborn concentrations were systematically smaller than their mothers', independently of ingestion or supple-mentation during pregnancy

Laceration of the muscle ventral serrato

La presentación es informar al profesional veterinario sobre el desgarro bilateral del músculo serrato ventral, una afección de escasa incidencia en la clínica de pequeños animales, a través de la descripción detallada de un caso clínico y su resolución quirúrgica exitosa.The presentation of the work has as objective to inform the veterinary professional on an affection of scarce incidence in the clinic of the small animals, like is the bilateral laceration of the muscle ventral serrato, describing a clinical case in detail, its successful surgical resolution and carrying out an upgrade of this illness.Facultad de Ciencias Veterinaria

Home peritoneal dialysis: interlocations between users and health care network services / Diálise peritoneal domiciliar: interlocuções entre usuários e serviços da rede de atenção à saúde

Objetivo: compreender as interlocuções entre os usuários que realizam a diálise peritoneal domiciliar e os serviços da Rede de Atenção à Saúde. Método: pesquisa desenvolvida em um serviço de diálise e domicílios com 19 pessoas em tratamento dialítico distribuídas em três grupos amostrais conforme o método da Grounded Theory realizando-se observação participante e 23 entrevistas abertas. Análise através da codificação aberta, axial e seletiva. Resultado: o contexto assistencial estudado expõe a descontinuidade do cuidado dialítico nas esferas da atenção primária e hospitalar, analisada pela categoria “Realizando a Diálise Peritoneal no domicílio, estando inserido na Rede de Atenção à Saúde”. Conclusão: na ótica dos entrevistados a principal interlocução é com o serviço de terapia renal substitutiva, principal referência para o cuidado e intercorrências com a dialise domiciliar. As interlocuções com os outros pontos assistenciais da Rede visam obter serviços de apoio, não implicados com o procedimento de dialise peritoneal domiciliar.

Clinical implications

Funding: GC was funded by Fundaçao para a Ciência e Tecnologia (FCT; Portugal) through a PhD Scholarship (SFRH/BD/130210/2017). AJOM was funded by FCT (Portugal) through a Junior Research and Career Development Award from the Harvard Medical School e Portugal Program (HMSP-ICJ/0020/2011). GC and AJO-M were supported by grant PTDC/MED-NEU/31331/2017, and AJO-M by grant PTDC/MED-NEU/30302/2017, funded by national funds from FCT/MCTES and co-funded by FEDER, under the Partnership Agreement Lisboa 2020 - Programa Operacional Regional de Lisboa. The content of this study is solely the responsibility of the authors and does not necessarily represent the official views of the Fundaçao para a Ciência e Tecnologia, Harvard University or its affiliated academic health care centers. AJO-M was national coordinator for Portugal of a noninterventional study (EDMS-ERI-143085581, 4.0) to characterize a Treatment-Resistant Depression Cohort in Europe, sponsored by Janssen-Cilag, Ltd (2019e2020), is recipient of a grant from Schuhfried GmBH for norming and validation of cognitive tests, and is national coordinator for Portugal of trials of psilocybin therapy for treatment-resistant depression, sponsored by Compass Pathways, Ltd (EudraCT number 2017-003288-36 and 2020-001348- 25), and of esketamine for treatment-resistant depression, sponsored by Janssen-Cilag, Ltd (EudraCT NUMBER: 2019-002992-33). AP-L is a co-founder of Linus Health and TI Solutions AG; serves on the scientific advisory boards for Starlab Neuroscience, Neuroelectrics, Magstim Inc., Nexstim, Cognito, and MedRhythms; and is listed as an inventor on several issued and pending patents on the real-time integration of noninvasive brain stimulation with electroencephalography and magnetic resonance imaging. None of the aforementioned agencies had a role in the design and conduct of the study, in the collection, management, analysis, and interpretation of the data, in the preparation, review, or approval of the manuscript, nor in the decision to submit the manuscript for publication. The remaining authors have declared that they have no potential conflicts of interest involving this work, including relevant financial activities outside the submitted work and any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing what is written.Background: When repetitive transcranial magnetic stimulation (rTMS) is used to treat medication refractory depression, the treatment pulse intensity is individualized according to motor threshold (MT). This measure is often acquired only on the first day of treatment, as per the protocol currently approved by Food and Drug Administration. Objective: Here, we aimed to assess daily MT variability across an rTMS treatment course and simulate the effects of different schedules of MT assessment on treatment intensity. Methods: We conducted a naturalistic retrospective study with 374 patients from a therapeutic rTMS program for depression that measures MT daily. Results: For each patient, in almost half the TMS sessions, MT varied on average more than 5% as compared to the baseline MT acquired in the first treatment day. Such variability was only minimally impacted by having different TMS technicians acquiring MT in different days. In a smaller cohort of healthy individuals, we confirmed that the motor hotspot localization method, a critical step for accurate MT assessment, was stable in different days, arguing that daily MT variability reflects physiological variability, rather than an artifact of measurement error. Finally, in simulations of the effect of one-time MT measurement, we found that half of sessions would have been 5% or more above or below target intensity, with almost 5% of sessions 25% above target intensity. The simulated effects of weekly MT measurements were significantly improved. Conclusions: In conclusion, MT varies significantly across days, not fully dependent on methods of MT acquisition. This finding may have important implications for therapeutic rTMS practice regarding safety and suggests that regular MT assessments, daily or at least weekly, would ameliorate the effect.publishersversionpublishe