Persistent orocutaneous and anal fistulae induced by nicorandil: a case report

<p>Abstract</p> <p>Introduction</p> <p>Although nicorandil is prescribed widely, awareness of its potential to cause serious complications to the gastrointestinal tract mucosa is limited. Whilst nicorandil-induced oral and anal ulceration is well documented in the literature, nicorandil-induced fistulation is not. This is the first report in the literature of a single patient demonstrating simultaneous orocutaneous and anal fistulae during nicorandil therapy. Two separate cases of orocutaneous and anal fistulae associated nicorandil usage have previously been documented in specialist journals.</p> <p>Case presentation</p> <p>A 71-year-old Caucasian man presented with a 3-year history of concurrent orocutaneous and anal fistulae. He had been exposed to 30 mg twice-daily nicorandil therapy for 4 years. Both fistulae responded poorly to intensive and prolonged conventional treatment but healed promptly on reduction and eventual withdrawal of nicorandil therapy.</p> <p>Conclusion</p> <p>Management of resistant cases of orocutaneous and anal fistulae in patients on high-dose nicorandil therapy may be impossible without reduction or even withdrawal of nicorandil.</p

Processing of Hand-Related Verbs Specifically Affects the Planning and Execution of Arm Reaching Movements

Even though a growing body of research has shown that the processing of action language affects the planning and execution of motor acts, several aspects of this interaction are still hotly debated. The directionality (i.e. does understanding action-related language induce a facilitation or an interference with the corresponding action?), the time course, and the nature of the interaction (i.e. under what conditions does the phenomenon occur?) are largely unclear. To further explore this topic we exploited a go/no-go paradigm in which healthy participants were required to perform arm reaching movements toward a target when verbs expressing either hand or foot actions were shown, and to refrain from moving when abstract verbs were presented. We found that reaction times (RT) and percentages of errors increased when the verb involved the same effector used to give the response. This interference occurred very early, when the interval between verb presentation and the delivery of the go signal was 50 ms, and could be elicited until this delay was about 600 ms. In addition, RTs were faster when subjects used the right arm than when they used the left arm, suggesting that action–verb understanding is left-lateralized. Furthermore, when the color of the printed verb and not its meaning was the cue for movement execution the differences between RTs and error percentages between verb categories disappeared, unequivocally indicating that the phenomenon occurs only when the semantic content of a verb has to be retrieved. These results are compatible with the theory of embodied language, which hypothesizes that comprehending verbal descriptions of actions relies on an internal simulation of the sensory–motor experience of the action, and provide a new and detailed view of the interplay between action language and motor acts

Changes in corticospinal excitability and the direction of evoked movements during motor preparation: A TMS study

BACKGROUND: Preparation of the direction of a forthcoming movement has a particularly strong influence on both reaction times and neuronal activity in the primate motor cortex. Here, we aimed to find direct neurophysiologic evidence for the preparation of movement direction in humans. We used single-pulse transcranial magnetic stimulation (TMS) to evoke isolated thumb-movements, of which the direction can be modulated experimentally, for example by training or by motor tasks. Sixteen healthy subjects performed brisk concentric voluntary thumb movements during a reaction time task in which the required movement direction was precued. We assessed whether preparation for the thumb movement lead to changes in the direction of TMS-evoked movements and to changes in amplitudes of motor-evoked potentials (MEPs) from the hand muscles. RESULTS: When the required movement direction was precued early in the preparatory interval, reaction times were 50 ms faster than when precued at the end of the preparatory interval. Over time, the direction of the TMS-evoked thumb movements became increasingly variable, but it did not turn towards the precued direction. MEPs from the thumb muscle (agonist) were differentially modulated by the direction of the precue, but only in the late phase of the preparatory interval and thereafter. MEPs from the index finger muscle did not depend on the precued direction and progressively decreased during the preparatory interval. CONCLUSION: Our data show that the human corticospinal movement representation undergoes progressive changes during motor preparation. These changes are accompanied by inhibitory changes in corticospinal excitability, which are muscle specific and depend on the prepared movement direction. This inhibition might indicate a corticospinal braking mechanism that counteracts any preparatory motor activation

Effect of terminal accuracy requirements on temporal gaze-hand coordination during fast discrete and reciprocal pointings

Background\ud \ud Rapid discrete goal-directed movements are characterized by a well known coordination pattern between the gaze and the hand displacements. The gaze always starts prior to the hand movement and reaches the target before hand velocity peak. Surprisingly, the effect of the target size on the temporal gaze-hand coordination has not been directly investigated. Moreover, goal-directed movements are often produced in a reciprocal rather than in a discrete manner. The objectives of this work were to assess the effect of the target size on temporal gaze-hand coordination during fast 1) discrete and 2) reciprocal pointings.\ud \ud Methods\ud \ud Subjects performed fast discrete (experiment 1) and reciprocal (experiment 2) pointings with an amplitude of 50 cm and four target diameters (7.6, 3.8, 1.9 and 0.95 cm) leading to indexes of difficulty (ID = log2[2A/D]) of 3.7, 4.7, 5.7 and 6.7 bits. Gaze and hand displacements were synchronously recorded. Temporal gaze-hand coordination parameters were compared between experiments (discrete and reciprocal pointings) and IDs using analyses of variance (ANOVAs).\ud \ud Results\ud \ud Data showed that the magnitude of the gaze-hand lead pattern was much higher for discrete than for reciprocal pointings. Moreover, while it was constant for discrete pointings, it decreased systematically with an increasing ID for reciprocal pointings because of the longer duration of gaze anchoring on target.\ud \ud Conclusion \ud \ud Overall, the temporal gaze-hand coordination analysis revealed that even for high IDs, fast reciprocal pointings could not be considered as a concatenation of discrete units. Moreover, our data clearly illustrate the smooth adaptation of temporal gaze-hand coordination to terminal accuracy requirements during fast reciprocal pointings. It will be interesting for further researches to investigate if the methodology used in the experiment 2 allows assessing the effect of sensori-motor deficits on gaze-hand coordination

Avoiding moving obstacles

To successfully move our hand to a target, we must consider how to get there without hitting surrounding objects. In a dynamic environment this involves being able to respond quickly when our relationship with surrounding objects changes. People adjust their hand movements with a latency of about 120 ms when the visually perceived position of their hand or of the target suddenly changes. It is not known whether people can react as quickly when the position of an obstacle changes. Here we show that quick responses of the hand to changes in obstacle position are possible, but that these responses are direct reactions to the motion in the surrounding. True adjustments to the changed position of the obstacle appeared at much longer latencies (about 200 ms). This is even so when the possible change is predictable. Apparently, our brain uses certain information exceptionally quickly for guiding our movements, at the expense of not always responding adequately. For reaching a target that changes position, one must at some time move in the same direction as the target did. For avoiding obstacles that change position, moving in the same direction as the obstacle is not always an adequate response, not only because it may be easier to avoid the obstacle by moving the other way, but also because one wants to hit the target after passing the obstacle. Perhaps subjects nevertheless quickly respond in the direction of motion because this helps avoid collisions when pressed for time. © 2008 Springer-Verlag

The what and why of perceptual asymmetries in the visual domain

Perceptual asymmetry is one of the most important characteristics of our visual functioning. We carefully reviewed the scientific literature in order to examine such asymmetries, separating them into two major categories: within-visual field asymmetries and between-visual field asymmetries. We explain these asymmetries in terms of perceptual aspects or tasks, the what of the asymmetries; and in terms of underlying mechanisms, the why of the asymmetries. Tthe within-visual field asymmetries are fundamental to orientation, motion direction, and spatial frequency processing. between-visual field asymmetries have been reported for a wide range of perceptual phenomena. foveal dominance over the periphery, in particular, has been prominent for visual acuity, contrast sensitivity, and colour discrimination. Tthis also holds true for object or face recognition and reading performance. upper-lower visual field asymmetries in favour of the lower have been demonstrated for temporal and contrast sensitivities, visual acuity, spatial resolution, orientation, hue and motion processing. Iin contrast, the upper field advantages have been seen in visual search, apparent size, and object recognition tasks. left-right visual field asymmetries include the left field dominance in spatial (e.g., orientation) processing and the right field dominance in non-spatial (e.g., temporal) processing. left field is also better at low spatial frequency or global and coordinate spatial processing, whereas the right field is better at high spatial frequency or local and categorical spatial processing. All these asymmetries have inborn neural/physiological origins, the primary why, but can be also susceptible to visual experience, the critical why (promotes or blocks the asymmetries by altering neural functions)

Control of goal-directed movements: the contribution of orienting of visual attention and motor preparation.

Three experiments investigated the role of attention and motor preparation for the control of goal-directed movements. In Experiment 1 (double step paradigm), a movement correction was required on 25% of the trials towards the left or right of the initial target. Within these 25% of trials, the probability of location of the second target was manipulated. The efficiency of movement control increased when increasing the probability of correcting the movement in a given direction. In Experiment 2, attentional processes were isolated by asking the subjects to verbally detect the more or less probable target displacement, without correcting their movement. Subjects were able to orient visual attention during movement execution, thus improving the processing of visual feedbacks from target displacement. In Experiment 3, motor preparation processes were isolated by asking the subjects to correct their movement towards a fixed target in response to a more or less probable mechanical perturbation. It was shown that motor preparation not only specifies the initial movement parameters but may also include some parameters of the most probable movement modulations. Overall, these results highlight the role of both attentional and motor preparation processes in the control of goal-directed movements and suggest that the feedback-based corrections of the movement are modulated by a feedforward control

The gap effect for eye and hand movements in double-step pointing.

The existence of a temporal gap between the offset of a fixation target and the onset of a peripheral target generally reduces the saccadic and manual reaction time in response to the peripheral target. Using a double-step paradigm, the present experiment investigated whether a temporal gap between the extinction of the first target and the presentation of the second target can help in reducing the time to trigger the corrective eye movements and to correct the arm trajectory towards the final target position. A gap was introduced between the presentation of the initial target and a new unexpected goal-target during the movement. The results replicated the gap effect for the corrective saccade to the second target, but revealed an opposite effect for the correction of the reaching movements as the arm correction occurred later in the Gap than in the No-Gap conditions. These results suggest that the information available for the arm motor system to correct the trajectory in relation to the second target was different in the Gap and No-Gap conditions. In the No-Gap condition, the correction of reaching movements would be based on retinal errors between the first and the second targets whereas, in the Gap condition, the correction would be based on information derived from the corrective saccade-related signals to the second target