Priming Pharyngeal Motor Cortex by Repeated Paired Associative Stimulation: Implications for Dysphagia Neurorehabilitation

Background. Several stimulation parameters can influence the neurophysiological and behavioral effects of paired associative stimulation (PAS), a neurostimulation paradigm that repeatedly pairs a peripheral electrical with a central cortical (transcranial magnetic stimulation [TMS]) stimulus. This also appears to be the case when PAS is applied to the pharyngeal motor cortex (MI), with some variability in excitatory responses, questioning its translation into a useful therapy for patients with brain injury. Objective. To investigate whether repeated PAS in both “responders” and “nonresponders” could enhance cortical excitability in pharyngeal MI more robustly. Methods. Based on their responses after single PAS, healthy participants were stratified into 2 groups of “responders” and “nonresponders” and underwent 2 periods (60 minutes inter-PAS interval) of active and sham PAS in a randomized order. Neurophysiological measurements with single TMS pulses from pharyngeal motor representation were collected up to 90 minutes after the second PAS period. Results. Repeated PAS increased cortical excitability up to 95% at 60 minutes following the second PAS in both the “responders” and “nonresponders.” Moreover, cortical excitability in the “nonresponders” was significantly different after repeated PAS compared with single and sham application (P = .02; z = −2.2). Conclusions. Double dose PAS switched “nonresponders” to “responders.” These results are important for PAS application to dysphagic stroke patients who do not initially respond to a single application

Optimum Remedial Operation of Permanent Magnet Synchronous Motor

In critical systems, the reliability of the drive is very important. The faults are unwanted. The faults may be lead to loss of the human life and capital. This paper is addressed this problem and suggested two models to solve it. The first model doesn’t contain any special tools to improve the torque ripple and THD. The second model contains 2PI current controllers to improvement the performance at fault and remedial operation. One is for the torque and the other is for the flux. The first PI controller is feeding from the torque error between the reference and estimated torques to get new q-axis current component representing modifier current arises from uncertain things inside the machine and drive system such as temperature and parameters variations. This current will add to reference q-axis current to get robust new q-axis current to satisfy the drive requirement and solve the torque problem (ripple torque). With robust current, the total harmonic distortion is a decrease but doesn’t reach the best value so the other PI controller is used to adjust the THD. In this PI controller, the d-axis flux is compared to rotor permanent magnet flux to solve this problem arises from non-sinusoidal of the magnetic flux. The output of the PI controller is introduced to the reference d-axis current. The new d-axis current will reach the best value of THD. The simulation of the second controller is compared to the simulation of first controller to show if the second controller strong or weak. Matlab simulink is used to simulate the drive system.DOI:http://dx.doi.org/10.11591/ijece.v2i5.72

Evaluation of the diagnostic value of brain natriuretic peptide for detection of left ventricular systolic dysfunction and pulmonary hypertension in patients with acute exacerbation of chronic obstructive pulmonary disease

Background: One of the most critical health concerns of our day is acute deterioration of chronic obstructive lung disease (COPD). Detecting concurrent heart illness in these individuals might be challenging.Objective: Aims of this study were determining the diagnostic value of B-type natriuretic peptide (BNP) levels in the identification of acute COPD exacerbations (AECOPD) that were linked with left ventricular (LV) dysfunction and pulmonary hypertension. Methods: a prospective study of 100 patients with acute COPD exacerbations was done. All research participants were subjected to history taking, clinical examination, laboratory testing, blood gas analysis, echocardiography, and NT-pro BNP plasma level estimation.Results: Receiver operating characteristic (ROC) curve for BNP as a diagnostic for LV systolic dysfunction showed that area under the curve (AUC) was 0.923 at cut off point of 72.1 ng/ml with sensitivity of 93.3% and specificity of 84.6% (P<0.001).Conclusion: Heart failure is confirmed when the average natriuretic (NT)-BNP level in the left ventricle during AECOPD is higher than normal, which should prompt quick treatment for both conditions

Bone metastasis in breast cancer: The story of RANK-Ligand

AbstractThe primary cellular mechanism responsible for osteolytic bone metastases is osteoclastic activation. Preclinical models have shown that breast cancer cells can produce parathyroid hormone-related protein (PTHrP), and other osteolytic molecules, which stimulate excessive osteoclastic bone resorption and establishment of osteolytic lesions. It has been shown that PTHrP by itself cannot directly induce osteoclastic activation, but it mediates its effect through the transactivation of RANK-ligand (RANKL) gene on stromal and osteoblastic cells. Accordingly RANKL up-regulation has been considered as a prerequisite in virtually all conditions of cancer induced bone destruction. Hence, therapeutic targeting of RANKL seems to be a rational approach to treat or even to prevent the process of bone metastases.In this review, we will focus on the unique patho-physiological aspects related to the evolution of bone metastases in breast cancer, emphasizing the pivotal role of RANKL and some other key molecules in osteoclastic bone resorption. We will discuss the therapeutic interventions using bisphosphonates and RANKL inhibitors in patients with bone metastases and the outcome of this novel approach

Pharyngeal electrical stimulation for treatment of poststroke dysphagia: individual patient data meta-analysis of randomised controlled trials

Background. Dysphagia after stroke is common, associated independently with poor outcome, and has limited treatment options. Pharyngeal electrical stimulation (PES) is a novel treatment being evaluated for treatment of poststroke dysphagia. Methods. We searched electronically for randomised controlled trials of PES in dysphagic patients within 3 months of stroke. Individual patient data were analysed using regression, adjusted for trial, age, severity, and baseline score. The coprimary outcomes were radiological aspiration (penetration aspiration score, PAS) and clinical dysphagia (dysphagia severity rating scale, DSRS) at 2 weeks; secondary outcomes included functional outcome, death, and length of stay in hospital. Results. Three completed trials were identified: 73 patients, age 72 (12) years, severity (NIHSS) 11 (6), DSRS 6.7 (4.3), mean PAS 4.3 (1.8). Compared with no/sham stimulation, PES was associated with lower PAS, 3.4 (1.7) versus 4.1 (1.7), mean difference −0.9 (), and lower DSRS, 3.5 (3.8) versus 4.9 (4.4), mean difference −1.7 (). Length of stay in hospital tended to be shorter: 50.2 (25.3) versus 71.2 (60.4) days (). Functional outcome and death did not differ between treatment groups. Conclusions. PES was associated with less radiological aspiration and clinical dysphagia and possibly reduced length of stay in hospital across three small trials

Prevention and management of type 2 diabetes: dietary components and nutritional strategies

In the past couple of decades, evidence from prospective observational studies and clinical trials has converged to support the importance of individual nutrients, foods, and dietary patterns in the prevention and management of type 2 diabetes. The quality of dietary fats and carbohydrates consumed is more crucial than is the quantity of these macronutrients. Diets rich in wholegrains, fruits, vegetables, legumes, and nuts; moderate in alcohol consumption; and lower in refined grains, red or processed meats, and sugar-sweetened beverages have been shown to reduce the risk of diabetes and improve glycaemic control and blood lipids in patients with diabetes. With an emphasis on overall diet quality, several dietary patterns such as Mediterranean, low glycaemic index, moderately low carbohydrate, and vegetarian diets can be tailored to personal and cultural food preferences and appropriate calorie needs for weight control and diabetes prevention and management. Although much progress has been made in development and implementation of evidence-based nutrition recommendations in developed countries, concerted worldwide efforts and policies are warranted to alleviate regional disparities