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Muscle & Nerve Oct 2020Persons with back, neck, and limb symptoms constitute a major referral population to specialists in electrodiagnostic (EDX) medicine. The evaluation of these patients... (Review)
Review
Persons with back, neck, and limb symptoms constitute a major referral population to specialists in electrodiagnostic (EDX) medicine. The evaluation of these patients involves consideration of both the common and less common disorders. The EDX examination with needle electromyography (EMG) is the most important means of testing for radiculopathy. This test has modest sensitivity but high specificity and well complements imaging of the spine. Needle EMG in combination with nerve conduction testing is valuable in excluding entrapment neuropathies and polyneuropathy-conditions that frequently mimic radicular symptoms. In this first of a two-part review, the optimal EDX evaluation of persons with suspected radiculopathy is presented. In part two, the implications of EDX findings for diagnosis and clinical management of persons with radiculopathy are reviewed.
Topics: Anatomic Variation; Cervical Vertebrae; Diagnostic Techniques, Neurological; Electrodiagnosis; Electromyography; Evoked Potentials, Motor; Humans; Low Back Pain; Lumbar Vertebrae; Muscle Weakness; Neck Pain; Needles; Neural Conduction; Neurologic Examination; Physical Examination; Radiculopathy; Reflex, Abnormal; Sacrum; Sciatica; Spinal Nerve Roots
PubMed: 32557709
DOI: 10.1002/mus.26997 -
Journal of Medicine and Life Sep 2023Approximately two-thirds of the Guillain-Barré syndrome (GBS) cases are preceded by upper respiratory tract infection or enteritis. There has been previous...
Approximately two-thirds of the Guillain-Barré syndrome (GBS) cases are preceded by upper respiratory tract infection or enteritis. There has been previous documentation of a clear association between Covid-19 and GBS. Covid-19 can affect the nervous tissue either through direct damage or through triggering a host immune response with subsequent development of autoimmune diseases such as GBS. Covid-19 can affect the host`s immune system through the activation and interaction of the T-and B-lymphocytes with subsequent production of antibodies that cross-react with the gangliosides. Depending on the nature of the neuronal autoimmune destruction, the affected individual may have either a demyelinating or axonal subtype of GBS. These subtypes differ not only in symptoms but also in the likelihood of recovery. This report presents two cases of GBS that developed after the respiratory symptoms of Covid-19. Their neurological features indicated demyelination, axonal damage, irritation of spinal nerve roots, and impaired sensory and motor transmission with additional facial nerve palsy in the second-studied case. This case report highlights the relationship between GBS and Covid-19 infection.
Topics: Humans; Guillain-Barre Syndrome; COVID-19; Research
PubMed: 38107719
DOI: 10.25122/jml-2023-0275 -
BMC Health Services Research Sep 2023Clinical academic allied health professionals can positively impact patient care, organisational performance, and local research culture. Despite a previous national...
BACKGROUND
Clinical academic allied health professionals can positively impact patient care, organisational performance, and local research culture. Despite a previous national drive to increase these roles, they remain low in number with no clear strategy for growth. Reported barriers to this growth cite organisational and economic factors with little recognition of the challenges posed to individuals. There is a lack of research to help allied health professionals understand the personal challenges of clinical academic training and practice. The aim of this study is to explore the character traits and behaviours of clinical academic allied health professionals to understand the individual attributes and strategies taken to pursue a career in this field.
METHODS
A semi-structured interview study design was used to collect data from aspiring and established clinical academic allied health professionals. Participants were recruited voluntarily through social media advertisement (aspiring) and purposively through direct email invitation (established). Participants were asked about their experience of pursuing a clinical academic career. The interviews were conducted virtually using Zoom and were audio recorded. The data were transcribed verbatim prior to reflexive thematic analysis. Informed consent was gained prior to data collection and the study was approved by the university's research ethics committee.
RESULTS
Twenty participants from six allied health professions were interviewed. We developed five themes: risk and reward, don't wait to be invited, shifting motivations, research is a team sport, and staying the course. Clinical academic allied health professionals demonstrated traits including inquisitiveness, intuition, motivation, and resilience. The source of their motivation was rooted in improving clinical services, conducting research, and personal achievement.
CONCLUSION
Clinical academic allied health professionals describe personal traits of high inquisitiveness, opportunism, motivation, and determination in pursuing their career ambitions. The tolerance of rejection, failure, and risk was considered important and viewed as an essential source for learning and professional development. Future research should concentrate on ways to reduce the over-reliance on individual strength of character to succeed in this field and explore programmes to increase the preparedness and support for clinical academics from these professions.
Topics: Humans; Motivation; Qualitative Research; Allied Health Occupations; Allied Health Personnel; Data Collection
PubMed: 37741969
DOI: 10.1186/s12913-023-10044-2 -
Toxicologic Pathology Apr 2022Following implantation of patient-derived xenograft (PDX) breast carcinomas from three separate individuals, 33/51 female NOD./SzJ (NSG) mice presented with progressive,...
Following implantation of patient-derived xenograft (PDX) breast carcinomas from three separate individuals, 33/51 female NOD./SzJ (NSG) mice presented with progressive, unilateral to bilateral, ascending hindlimb paresis to paralysis. Mice were mildly dehydrated, in thin to poor body condition, with reduced to absent hindlimb withdrawal reflex and deep pain sensation. Microscopically, there was variable axonal swelling, vacuolation, and dilation of myelin sheaths within the ventral spinal cord and spinal nerve roots of the thoracolumbar and sacral spinal cord, as well as within corresponding sciatic nerves. Results of PCR screening of PDX samples obtained at necropsy and pooled environmental swabs from the racks housing affected animals were positive for lactate dehydrogenase-elevating virus (LDV). LDV is transmitted through animal-animal contact or commonly as a contaminant of biologic materials of mouse origin. Infection is associated with progressive degenerative myelopathy and neuropathy in strains of mice harboring endogenous retrovirus (AKR, C58), or in immunosuppressed strains (NOD-SCID, Foxn1), and can interfere with normal immune responses and alter engraftment and growth of xenograft tumors in immunosuppressed mice. This is the first reported series of LDV-induced poliomyelitis in NSG mice and should be recognized as a potentially significant confounder to biomedical studies utilizing immunodeficient xenograft models.
Topics: Animals; DNA-Activated Protein Kinase; DNA-Binding Proteins; Disease Models, Animal; Female; Humans; Interleukin Receptor Common gamma Subunit; Lactate dehydrogenase-elevating virus; Mice; Mice, Inbred NOD; Mice, SCID; Severe Combined Immunodeficiency; Spinal Cord Diseases
PubMed: 35450478
DOI: 10.1177/01926233221091747 -
The Journal of Applied Psychology Aug 2020Situational judgment tests (SJTs) have emerged as a staple of assessment methodologies for organizational practitioners and researchers. Despite their prevalence, many...
Situational judgment tests (SJTs) have emerged as a staple of assessment methodologies for organizational practitioners and researchers. Despite their prevalence, many questions regarding how to interpret respondent choices or how variations in item construction and instruction influence the nature of observed responses remain. Existing conceptual and empirical efforts to explore these questions have largely been rooted in reflexive psychometric measurement models that describe participant responses as indicative of (usually multiple) latent constructs. However, some have suggested that a key to better understanding SJT responses lies in unpacking the judgment and decision-making processes employed by respondents and the psychological and contextual factors that shape how those processes play out. To this end, the present article advances an integrative and generalizable process-oriented theory of SJT responding. The framework, labeled situated reasoning and judgment (SiRJ), proposes that respondents engage in a series of conditional reasoning, similarity, and preference accumulation judgments when deciding how to evaluate and respond to an SJT item. To evaluate the theory's plausibility and utility, the SiRJ framework is translated into a formal computational model and results from a simulation study are analyzed using neural network and Bayesian survival analytic techniques that demonstrate its capability to replicate existing and new empirical effects, suggest insights into SJT interpretation and development, and stimulate new directions for future research. An interactive web application that allows users to explore the computational model developed for SiRJ (https://grandjam.shinyapps.io/sirj) as well as all reported data and the full model/simulation code (https://osf.io/uwdfm/) are also provided. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Topics: Adult; Bayes Theorem; Female; Humans; Judgment; Male; Psychological Theory; Psychometrics; Young Adult
PubMed: 31789550
DOI: 10.1037/apl0000468 -
Journal of Clinical Orthopaedics and... Apr 2023After damage to the spinal cord, some of the most frequent and severe complications are due to the neurogenic bladder and bowel, in spite of a variety of methods of...
After damage to the spinal cord, some of the most frequent and severe complications are due to the neurogenic bladder and bowel, in spite of a variety of methods of management. Bladder and bowel emptying is usually impaired, but electrical stimulation of nerves surviving after spinal cord injury can produce controlled contraction of muscle, including the smooth muscle of the bladder and lower bowel, and this can be used to produce safe and effective bladder emptying on demand without catheters. It can also aid emptying of the bowel and reduce constipation. Hyper-reflexia of the bladder and lower bowel after spinal cord injury can produce reflex incontinence of urine and stool, and while this can sometimes be reduced by neuromodulation, it can be more predictably reduced by rhizotomy of the sacral sensory roots, while preserving the motor roots for stimulation. This combination of electrical stimulation and rhizotomy has restored bladder and bowel emptying and continence to several thousand patients, with reduced complications and improved quality of life over many years.
PubMed: 36935732
DOI: 10.1016/j.jcot.2023.102131 -
Der Orthopade Apr 2022Segmental and somatic dysfunction in the thoracic section can lead to various clinical symptoms. It is necessary to distinguish three variants. (Review)
Review
BACKGROUND
Segmental and somatic dysfunction in the thoracic section can lead to various clinical symptoms. It is necessary to distinguish three variants.
CLINICAL PICTURE
1. Local pain Potentially life-threatening differential diagnoses have to be considered, and when in doubt chest pain emergency diagnostics must be initiated. 2. Vertebro-visceral reflex The main segmental roots of the sympathetic trunk are in thoracic segments, this results in a high-grade linking to thoracic and abdominal organs. "Non-specific" thoracic and abdominal symptoms can be caused by segmental and somatic dysfunction in thoracic segments. 3. Viscero-vertebral reflex Visceral nociception is transmitted via vegetative fibers to thoracic segments. Here, painful dysfunction can occur, which might be the first sign of severe structural disease like neoplasia or ulcer in thoracic or abdominal organs.
DIFFERENTIAL DIAGNOSTICS
Differential diagnostics is challenging, and manual medicine can contribute substantially. Biomechanical and neurophysiologic particularities must be known.
Topics: Acute Coronary Syndrome; Diagnosis, Differential; Herpes Zoster; Humans; Ribs; Spine
PubMed: 35267046
DOI: 10.1007/s00132-022-04227-8 -
PloS One 2019Posterior root-muscle (PRM) reflexes are short-latency spinal reflexes evoked by epidural or transcutaneous spinal cord stimulation (SCS) in clinical and physiological...
Posterior root-muscle (PRM) reflexes are short-latency spinal reflexes evoked by epidural or transcutaneous spinal cord stimulation (SCS) in clinical and physiological studies. PRM reflexes share key physiological characteristics with the H reflex elicited by electrical stimulation of large-diameter muscle spindle afferents in the tibial nerve. Here, we compared the H reflex and the PRM reflex of soleus in response to transcutaneous stimulation by studying their recovery cycles in ten neurologically intact volunteers and ten individuals with traumatic, chronic spinal cord injury (SCI). The recovery cycles of the reflexes, i.e., the time course of their excitability changes, were assessed by paired pulses with conditioning-test intervals of 20-5000 ms. Between the subject groups, no statistical difference was found for the recovery cycles of the H reflexes, yet those of the PRM reflexes differed significantly, with a striking suppression in the intact group. When comparing the reflex types, they did not differ in the SCI group, while the PRM reflexes were more strongly depressed in the intact group for durations characteristic for presynaptic inhibition. These differences may arise from the concomitant stimulation of several posterior roots containing afferent fibers of various lower extremity nerves by transcutaneous SCS, producing multi-source heteronymous presynaptic inhibition, and the collective dysfunction of inhibitory mechanisms after SCI contributing to spasticity. PRM-reflex recovery cycles additionally obtained for bilateral rectus femoris, biceps femoris, tibialis anterior, and soleus all demonstrated a stronger suppression in the intact group. Within both subject groups, the thigh muscles showed a stronger recovery than the lower leg muscles, which may reflect a characteristic difference in motor control of diverse muscles. Based on the substantial difference between intact and SCI individuals, PRM-reflex depression tested with paired pulses could become a sensitive measure for spasticity and motor recovery.
Topics: Adult; Female; H-Reflex; Humans; Male; Muscle, Skeletal; Reflex; Spinal Cord; Spinal Cord Injuries; Spinal Cord Stimulation; Young Adult
PubMed: 31877192
DOI: 10.1371/journal.pone.0227057 -
Journal of Ethnopharmacology Jan 2021Zhizhu Xiang (ZZX for short) is the root and rhizome of Valeriana jatamansi Jones, which is a Traditional Chinese Medicine (TCM) used to treat various mood disorders for...
ETHNOPHARMACOLOGICAL RELEVANCE
Zhizhu Xiang (ZZX for short) is the root and rhizome of Valeriana jatamansi Jones, which is a Traditional Chinese Medicine (TCM) used to treat various mood disorders for more than 2000 years, especially anxiety. However, there have been few investigations to clarify the compounds in ZZX for the treatment of anxiety.
AIM OF THE STUDY
Our previous study has identified five anti-anxiety components, including hesperidin, isochlorogenic acid A, isochlorogenic acid B and isochlorogenic acid C and chlorogenic acid, from extract of ZZX. In order to find the optimal combination and the underlying mechanism of these five components in the treatment of anxiety disorder, researches were designed based on uniform design method and proteomic technology.
MATERIALS AND METHODS
The samples with different proportion and content of the five active components were arranged by uniform design method. Then a mathematical model was formulated using partial least square method and stepwise regression analysis. Moreover, the empty bottle stress-induced anxiety rat model was established, and the anti-anxiety effect was recorded by the unconditioned reflex elevated maze test and the open field test. In addition, the isobaric tags for relative and absolute quantitation (iTRAQ) technique, along with the multidimensional liquid chromatography and high-resolution mass spectrometry were applied in proteomic study. At last, the result of proteomic analysis was further confirmed by Western blot.
RESULTS
The optimal combination of the components from the extract of ZZX was 1.153 mg/kg hesperidin, 2.197 mg/kg Isochlorogenic acid A, 0.699 mg/kg Isochlorogenic acid B and 1.249 mg/kg Chlorogenic acid. Total 6818 proteins were identified using proteomic analysis and 80 differentially expressed proteins were used for further bioinformatic analysis. These proteins were involved in the neuroactive ligand-receptor interaction, protein digestion and absorption, cholesterol metabolism, Chagas disease, and AGE/RAGE signaling pathway.
CONCLUSIONS
The composition and proportion of anti-anxiety components in extract of ZZX was disclosed, and there was an anti-anxiety effect for the combined components of flavonoids and phenolic acids. Through proteomic analysis and Western blot, it was found that the effective components of extract of ZZX can exert synergistic anti-anxiety effects via the regulation of multi-signaling pathways. These findings could provide a preliminary research basis for the development of new low-toxic, efficient, stable and controllable anti-anxiety drugs.
Topics: Animals; Anti-Anxiety Agents; Anxiety; Chromatography, Liquid; Disease Models, Animal; Drugs, Chinese Herbal; Male; Mass Spectrometry; Medicine, Chinese Traditional; Models, Theoretical; Plant Roots; Proteomics; Rats; Rats, Sprague-Dawley; Rhizome; Signal Transduction; Valerian
PubMed: 33069789
DOI: 10.1016/j.jep.2020.113452 -
Medical Education Nov 2023Ensuring that students transition smoothly into the identity of a doctor is a perpetual challenge for medical curricula. Developing professional identity, according to...
BACKGROUND
Ensuring that students transition smoothly into the identity of a doctor is a perpetual challenge for medical curricula. Developing professional identity, according to cultural-historical activity theory, requires negotiation of dialectic tensions between individual agency and the structuring influence of institutions. We posed the research question: How do medical interns, other clinicians and institutions dialogically construct their interacting identities?
METHODS
Our qualitative methodology was rooted in dialogism, Bakhtin's cultural-historical theory that accounts for how language mediates learning and identity. Reasoning that the COVID pandemic would accentuate and expose pre-existing tensions, we monitored feeds into the Twitter microblogging platform during medical students' accelerated entry to practice; identified relevant posts from graduating students, other clinicians and institutional representatives; and kept an audit trail of chains of dialogue. Sullivan's dialogic methodology and Gee's heuristics guided a reflexive, linguistic analysis.
RESULTS
There was a gradient of power and affect. Institutional representatives used metaphors of heroism to celebrate 'their graduates', implicitly according a heroic identity to themselves as well. Interns, meanwhile, identified themselves as incapable, vulnerable and fearful because the institutions from which they had graduated had not taught them to practise. Senior doctors' posts were ambivalent: Some identified with institutions, maintaining hierarchical distance between themselves and interns; others, along with residents, acknowledged interns' distress, expressing empathy, support and encouragement, which constructed an identity of collegial solidarity.
CONCLUSIONS
The dialogue exposed hierarchical distance between institutions and the graduates they educated, which constructed mutually contradictory identities. Powerful institutions strengthened their identities by projecting positive affects onto interns who, by contrast, had fragile identities and sometimes strongly negative affects. We speculate that this polarisation may be contributing to the poor morale of doctors in training and propose that, to maintain the vitality of medical education, institutions should seek to reconcile their projected identities with the lived identities of graduates.
PubMed: 37218311
DOI: 10.1111/medu.15109