H-Reflex Plasticity Following Cast Immobilization of Distal Radius Fractures

PURPOSE: The primary purpose of the study was to track changes in the Hoffman (H-) reflex after a period of cast immobilization following a distal radius fracture (DRF) up to 12-weeks post-fracture. Secondary to tracking the H-reflex, functional measures such as muscle thickness, grip strength, wrist flexion strength, range of motion, pain and function were assessed over the same time frame. METHODS: The study consisted of a fracture group (n = 5) and an age-matched uninjured control (CON) group (n = 5). Both groups were tracked over a 12-week period, with the fracture group undergoing four testing sessions (baseline, week 6, week 9 and week 12) and the CON undergoing three testing sessions at least three weeks apart; baseline testing for the fracture group was collected within two weeks of initial fracture date. Testing was completed on both limbs for the CON group, whereas for the fracture group measures were taken at each time point for the non-fractured (NFX) limb, and within the limits of tolerable pain for the fractured (FX) limb. This meant the fracture group’s FX limb H-reflex measures were completed only at week 9 and 12. Peak-to-peak amplitudes (and stimulus intensities) of H-reflex, Hmax, and maximal M-wave, Mmax, were the key parameters collected. Hmax was normalized and expressed as a ratio of Mmax (Hmax:Mmax). Additionally, the fracture group completed questionnaires to measure FX limb pain and disability (via patient-rated wrist evaluation [PRWE]) at each time point. RESULTS: The fracture group presented a significant effect of time for Hmax:Mmax stimulus intensity (p < 0.05), where the relative current intensity needed to evoke Hmax increased before decreasing as recovery progressed. The CON group demonstrated no significant effects over time or between limbs for all H-reflex parameters (p = 0.859). Functionally, the fracture group demonstrated significant changes over time for all secondary measures (p<0.05), aside from visual analog scale pain scores. With functional measures increasing over time to indicate recovery (i.e. increases in grip strength). CONCLUSIONS: The amplitude of H-reflex did not demonstrate significant changes over time as predicted. The fracture group’s decrease over time for Hmax:Mmax stimulus intensity reflects an unanticipated finding of increased excitability of Hmax. For the control group, this study verifies the stability of Hmax and Mmax over time and between limbs in this population. The fracture group’s functional measures show significant improvements over the 12-week span that were coupled with an initial increase and then decrease in the relative stimulus intensity needed to evoke H reflex, in the absence of detectable changes in H-reflex amplitude. The changes in the nervous system can have a profound impact on function after wrist fracture and cast immobilization. The novel findings in this study can have implications regarding the direction of future studies. As the H-reflex has been shown to have a degree of plasticity, with further study the reflex may be tracked in different interventions such as unilateral training in order to evaluate efficacy or investigate mechanisms of change/recovery

FOCUSING THE BALTIC AGRICULTURAL SECTOR TOWARDS THE NEW CONSUMER: ESTONIA'S CASE

This paper analyses some of the current problems emerging in the Baltic economies with special reference to Estonia and the agricultural sector. The prime objectives are to put forward suggestions for improving the agricultural investment, and to improve the marketing towards the modern international consumer. The major points covered are: 1.National changes following the break from USSR in 1991. 2.Re orientation towards the European Union (EU) and international markets. 3.Changes for long run growth in the Estonian agricultural sector.agricultural sector, Estonia

In vitro interactions of immune lymphocytes and Cryptococcus neoformans.

CBA/J mice immunized subcutaneously with heat-killed Cryptococcus neoformans-complete Freund's adjuvant (HKC-CFA) emulsions developed delayed-type hypersensitivity (DTH) responses to cryptococcal culture filtrate (CneF) antigen, as well as developed sensitized lymphoid cells in their spleens

Hydraulic performance of highway drainage inlets used in pennsylvania

An experimental investigation of the perfomances of some highway drainage inlets is presented

Editorial: Clinical practice can save evidence-based medicine from itself

Although imperfect, the structure of this journal and its publications are demonstrations of clinicians attempting to actualize the wisdom of these foundational thinkers. We need to leave examples and guideposts to the next generation of clinicians of how to fulfill this vision of being excellent clinicians, through both formal education and role modeling

A regulatory code for neurogenic gene expression in the Drosophila embryo

Bioinformatics methods have identified enhancers that mediate restricted expression in the Drosophila embryo. However, only a small fraction of the predicted enhancers actually work when tested in vivo. In the present study, co-regulated neurogenic enhancers that are activated by intermediate levels of the Dorsal regulatory gradient are shown to contain several shared sequence motifs. These motifs permitted the identification of new neurogenic enhancers with high precision: five out of seven predicted enhancers direct restricted expression within ventral regions of the neurogenic ectoderm. Mutations in some of the shared motifs disrupt enhancer function, and evidence is presented that the Twist and Su(H) regulatory proteins are essential for the specification of the ventral neurogenic ectoderm prior to gastrulation. The regulatory model of neurogenic gene expression defined in this study permitted the identification of a neurogenic enhancer in the distant Anopheles genome. We discuss the prospects for deciphering regulatory codes that link primary DNA sequence information with predicted patterns of gene expression

Amiodarone-induced Hypothyroidism with EPO-resistant Anemia in a Patient with Chronic Renal Failure

The overall incidence of amiodarone-induced thyroid dysfunction ranges from 2% to 24%. One third to half of patients with hypothyroidism have anemia due to some decrease in normal red blood cell mass and erythropoietin (EPO) resistance. Therefore, for patients with chronic renal disease under medication with amiodarone, early regular thyroid function test should be checked in order to avoid amiodarone-induced hypothyroidism and EPO-resistant anemia. If amiodarone-induced hypothyroidism and EPO-resistant anemia occur in patients with chronic renal failure, early thyroxine should be given instead of waiting for spontaneous recovery by amiodarone discontinuation only. Here, we report a patient with chronic renal failure who developed EPO-resistant anemia after amiodarone treatment for arrhythmia. The hemoglobin level responded to EPO therapy rapidly after thyroxine administration and amiodarone discontinuation