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Importance: Although research has examined early identification of autism spectrum disorder (ASD), few studies have found behavioral markers during midinfancy associated with later ASD diagnosis. Objective: To examine infants' play behaviors and atypical positions at age 6 mo and later outcome classification among infants at elevated likelihood (EL) and typical likelihood (TL) for ASD. Atypical positions refer to movement patterns indicative of motor delays or deviations, including atypical extension and flexion, poor weight shift and rotation, hypertonicity or hypotonicity, and the presence of primitive reflex patterns. Design: Observational cohort longitudinal design using blinded video analysis. Participants: Fifty-eight infants (41 EL infants and 17 TL infants) 6 mo of age. Results: Infants later diagnosed with ASD needed more support to engage in play at age 6 mo compared with infants who did not receive an ASD diagnosis (U = 130, z = −2.29, p <.05, r =.31). Atypical positions at 6 mo of age were not associated with a later diagnosis of ASD. Conclusions and Relevance: Play behaviors may be early indicators of developmental differences for infants later diagnosed with ASD. The results of this pilot study suggest the need to observe the quality of interaction with a caregiver and objects during early play, which may serve as potential early indicators of ASD. Plain-Language Summary: Few studies have found behavioral markers during midinfancy that are associated with a later diagnosis of autism spectrum disorder (ASD). The results of this study showed that infants who were later diagnosed with ASD were found to have differences in play behaviors compared to infants who were not later diagnosed with ASD. Thus, early play behaviors may be an early indicator of developmental differences for infants who are later diagnosed with ASD. Infants who were later diagnosed with autism spectrum disorder (ASD) were found to have differences in early play behaviors compared to infants who were not later diagnosed with ASD. [ABSTRACT FROM AUTHOR]

Statement of the Problem: Gag reflex is among the most common problems during dental and endoscopic procedures. Benzydamine hydrochloride is a non-steroidal anti-nflammatory medication and a local anesthetic that might be useful in reducing the gag reflex. Purpose: This study aimed to evaluate the effects of benzydamine hydrochloride mouth-wash on the intensity of the gag reflex. Materials and Method: In this randomized clinical trial study, 30 participants aged 21-26 with a gag trigger point index (GTPI) higher than 2 were divided into 2 groups. In the case group, 15 ml of 0.15% benzydamine hydrochloride mouthwash was gargled for 1 minute, and after 10 minutes GTPI test was conducted. In the control group, 4 puffs of 10% lidocaine spray were applied to the mucosa of the targeted area, and after 5 minutes, GTPI was measured. Participants were asked about the taste and smell of the medications. Results: GTPI was significantly reduced in both groups. In the lidocaine group, the GTPI score changed from 4.47 to 2.00 (p< 0.001), and that for the benzydamine group was 4.20 to 1.47 (p< 0.001). The variance rate of the gag reflex was -2.73 and -2.47 in the benzydamine group and lidocaine group, respectively. However, this reduction was not statistically significant between the two groups. Moreover, benzydamine mouthwash has a significantly better taste and smell than lidocaine (p= 0.001). Conclusion: The results of this study showed that benzydamine mouthwash could be used quite effectively in reducing the gag reflex. [ABSTRACT FROM AUTHOR]

Background: Tinnitus is a conscious perception of an auditory sensation in the absence of a corresponding external stimulus. Tinnitus can have a strong impact on the quality of life. The cause of tinnitus is not exactly known. Objectives: To assess the reliability of portable infrared pupillometry. To study the hypothesis that enlarged anterior osteophytes of cervical vertebras influences the parasympathetic nervous system. Methods: Nineteen tinnitus patients were examined with a portable infrared pupillometer and had X-ray examination of the cervical spine. The control patient population included 79 patients who visited the pain clinic for non-tinnitus complaints. Five different pupillometry values were estimated. The intraclass correlation coefficient was used to measure the inter-observer reliability. A multiple linear regression model was used to examine the association between the size of anterior osteophytes of cervical vertebras and pupillometry measurements. Results: Inter-observer reliability was excellent for baseline pupil diameter and maximum constriction amplitude (values>= 0.75), moderate to good for pupillary constriction rate and maximum constriction velocity (values 0.41 - 0.74) and poor for latency constriction. Baseline pupil diameter, maximum constriction amplitude and maximum constriction velocity were significant lower in tinnitus patients. Multiple linear regression showed a significant effect of the size of anterior osteophyte of the sixth and third cervical vertebra and the intervertebral disc space between the third and fourth cervical vertebra on maximum constriction amplitude of the pupillometry measurement. In tinnitus patients a significant effect was found of hearing loss of 8 kHz on maximum constriction amplitude. Conclusion: Inter-observer reliability was excellent for pupil diameter and maximum constriction amplitude (values>= 0.75) measured with a pupillometer. Pupil diameter, maximum constriction amplitude and maximum constriction velocity were significant lower in tinnitus patients. These results indicate that the parasympathetic nervous system is impaired. Large anterior osteophytes on the sixth and third cervical vertebra had a significant effect on maximum constriction amplitude, which we interpreted as an effect on the autonomous nervous system by activating the glossopharyngeal and vagal nerves. Pupillometry is valuable diagnostic measurement for tinnitus patients. [ABSTRACT FROM AUTHOR]

Statement of the Problem: Management of gag reflex is a challenging process during many dental treatments. Various studies have been carried out to evaluate different pharmacological and non-pharmacological techniques to control gagging. Purpose: The aim of this study is to review the available evidence on methods proposed for managing the gag reflex. Materials and Method: This systematic review adheres to the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. A comprehensive search was conducted in English and Persian based on articles published from 2015 to 2022 (February) in PubMed, Scopus, Science Direct, Web of Science, Google Scholar, ISC and SID. All studies were first screened based on their title and abstract. The quality assessment of articles was carried out by two independent authors. Then, risk of bias evaluation was conducted according to Cochrane parameters. Results: In total, 1704 studies were identified via search. After reviewing title and abstract, 16 studies found eligible based on inclusion and exclusion criteria. Following quality and risk of bias assessment, 9 studies included in the systematic review. Conclusion: Based on the finding of this review, distraction techniques, nitrous oxide, and low-level laser therapy were found effective in management of gag reflex. The dentist should consider gag reflex management based on the type of dental treatment, gag severity, patient's age, and available capabilities. [ABSTRACT FROM AUTHOR]

This article analyses the strength and resilience of the European Union (EU) after the "Zeitenwende". The completely new situation of threat emanating from Russia did not lead to the EU falling apart, as might have been expected. To the contrary, it resulted in a community reflex of member states moving closer together and supporting Ukraine actively in its fight for survival, despite a certain leadership weakness of the Franco-German couple. In addition, the EU is reacting in a way with extensive military aid and joint procurement of ammunition that was unthinkable two or three years ago. However, the EU and its member states are lacking a strategy on how to contribute to terminating the war. Such a strategy would be urgently needed in order not to become unravelled between a bellicose Russia and a potentially less Atlantic-minded America after the US presidential election at the end of2024. [ABSTRACT FROM AUTHOR]

This brief note proposes a new Proto-Sino-Tibetan etymon for FIELD-DIKE, the dike between irrigated paddy fields, and provides an etymology relating Chinese and Lahu forms. It also discusses related etymologies with similar rhymes in Lahu and their reflexes in Burmese. There is also a postscript on the Written Burmese rhyme -añ. [ABSTRACT FROM AUTHOR]

Copyright of Revista Brasileira de Medicina do Esporte is the property of Redprint Editora Ltda. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article presents the discussion on Primary Somatosensory Cortex for processing through the dorsal column ascending neural pathway. Topics include vibration resulting in additional excitation of the motor neuron pool increasing the initial firing rates; and areas with skin rash or open wounds and in individuals with hypertension or those at risk for clotting.

Background: Hyperendemic townships of hepatitis C virus (HCV) infection should devote extra efforts to eliminate HCV. We aimed to evaluate efficacy of the screening and linkage to care in two HCV hyperendemic townships.Methods: Village-to-village HCV screening using anti-HCV reflex HCV Ag test was conducted in two HCV hyperendemic rural townships (Lioujiao and Yijhu). All residents aged 30 years or older were invited. Those patients detected as infected were referred to nearby hospitals or clinics in Lioujiao and to an accessible outreach hepatology clinic in Yijhu.Results: The populations of Lioujiao and Yijhu townships at time of survey were 18,389 and 14,787 with 6086 (33.1%) and 4604 (31.1%) having ever been previously screened, and 1517 and 1071 responded to this screening respectively. Their crude screening coverage rates were 41.5% and 38.5%, and adjusted screening coverage rates were 54.3% and 94.6% respectively. The prevalence rates of anti-HCV and HCV Ag were 17.9% and 11.9% in Lioujiao, and 9.2% and 5.6% in Yijhu respectively, with their rates of antigenemia (HCV Ag/anti-HCV) being 62.1% and 60.6% respectively. Numbers needed to test (NNT) to find a candidate for anti-viral treatment were 9 and 18. For linkage to care, treatment rate by referral (Lioujiao) was slightly lower than by accessible outreach hepatology clinic (Yijhu) (84.9% vs. 93.3%, p = 0.093). Overall successful sustained virological response rate at week 12 was 98.2% (161/164) in outreach hepatology clinic.Conclusion: Since NNT was low, it was worthwhile conducting intensive screening in these hyperendemic townships. For high treatment rate, accessible outreach hepatology clinic is feasible especially in areas without adequate medical resources. [ABSTRACT FROM AUTHOR]

The present work was designed to study the modulatory effects of algogen-induced vasosensory reflex responses on short-term heart rate variability (HRV) parameters in naïve and vagotomized rat models. In this study, vasosensory reflex responses were elicited by instilling algogens (bradykinin/histamine), a component of inflammatory mediators into a local segment of medium-sized peripheral blood vessel (femoral artery) while a continuous electrocardiogram (ECG) was recorded. Short-term (5 min) ECG segments obtained from original recordings were examined in detail and relevant data of HRV parameters were pooled. Time domain and frequency domain analyses were performed using dedicated software (LabChart 8, AD Instruments®, Australia) and results were analyzed. Bradykinin-induced vasosensory reflexes caused significant alterations in both time domain and frequency domain HRV parameters as compared to the time-matched saline control group. Instillation of bradykinin caused a transient increase in NN interval, RMSSD, TSP, HF power (HFP) along with a decrease in the standard deviation of all normal NN intervals (SDNN), SDNN/RMSSD, LF power (LFP), LFP/HFP. Histamine produced a similar pattern of responses, but HRV alterations were less pronounced compared to those with bradykinin. Further analysis revealed that algogen-induced vasosensory reflex responses caused an increase in the parasympathetic influence on the heart accompanied by a decrease in sympathetic influence. In addition, HRV modulation by algogen-induced vasosensory reflexes was significantly attenuated in vagotomized rats, illustrating the principal role of vagus in the reflex HRV modulation. The present study proposes a novel hypothesis regarding the cardio-protective role of inflammatory mediators during acute stress, by potentiating the vagal impact and attenuating the sympathetic impact on the heart. [ABSTRACT FROM AUTHOR]

Diminished sensorimotor control of the hand is one of the most common outcomes following stroke. This hand impairment substantially impacts overall function and quality of life; standard therapy often results in limited improvement. Mechanisms of dysfunction of the severely impaired post-stroke hand are still incompletely understood, thereby impeding the development of new targeted treatments. To identify and determine potential relationships among the mechanisms responsible for hand impairment following stroke This cohort study observed stroke survivors (n = 95) with severe, chronic hand impairment (Chedoke-McMaster Hand score = 2–3). Custom instrumentation created precise perturbations and measured kinematic responses. Muscle activation was recorded through electromyography. Strength, spasticity, muscle relaxation time, and muscle coactivation were quantified. Maximum grip strength in the paretic hand was only 12% of that achieved by the nonparetic hand, and only 6 of 95 participants were able to produce any net extension force. Despite force deficits, spastic reflex response of the finger flexor evoked by imposed stretch averaged 90.1 ± 26.8% of maximum voluntary activation, relaxation time averaged 3.8 ± 0.8 seconds, and coactivation during voluntary extension exceeded 30% of maximum contraction, thereby resulting in substantial net flexion. Surprisingly, these hypertonicity measures were not significantly correlated with each other. Survivors of severe, chronic hemiparetic stroke experience profound weakness of both flexion and extension that arises from increased involuntary antagonist activation and decreased voluntary activation. The lack of correlation amongst hypertonicity measures suggests that these phenomena may arise from multiple, potentially independent mechanisms that could require different treatments. [ABSTRACT FROM AUTHOR]

If the eyes are windows into the soul, then the pupils represent at least the gateway to the brain and can provide a unique insight into the human mind from several aspects. The changes in the pupil size primarily mediated by different lighting conditions are controlled by the autonomic nervous system regulated predominantly at the subcortical level. Specifically, parasympathetically-linked pupillary constriction is under the Edinger-Westphal nucleus control and sympathetically-mediated pupillary dilation is regulated from the posterior hypothalamic nuclei. However, the changes in the pupil size can be observed at resting state even under constant lighting, these pupillary changes are mediated by global arousal level as well as by various cognitive factors. In this context, autonomic pathways modulating changes in the pupil size in response to the different light levels can be influenced by multiple central descending inputs driving pupillary changes under steady lighting conditions. Moreover, as the pupillary response is involved in emotional (task-evoked pupillary dilation as an index of emotional arousal) and cognitive (task-evoked pupillary dilation as an index of cognitive workload) stimulation, it can be used to detect the impact of mutual subcortical and cortical structures (i.e. overlapping brain structures included in autonomic, emotional and cognitive regulation) on the pupillary innervation system. Thus, complex understanding of the baseline pupil size' and pupillary dynamics' mechanisms may provide an important insight into the central nervous system functioning pointing to the pupillometry as a promising tool in the clinical application. [ABSTRACT FROM AUTHOR]

Decreasing bag limits is a management mechanism for enhancing size structure of Bluegill Lepomis macrochirus. However, restrictive bag limits can promote culling, where an angler returns a live fish to the water in exchange for another. Little is known about the effect of culling on ice‐angled fishes. Our objective was to compare the effects of Bluegill confinement methods (reference, ice well, and bucket) and holding durations (0, 1, 2, or 5 h) on changes in water quality parameters (dissolved oxygen, pH, carbon dioxide, and water temperature) and Bluegill stress physiology (blood glucose and plasma cortisol), reflex responses (reflex action mortality predictor [RAMP] scores), and mortality while ice angling. In February 2018, 182 Bluegills were angled through the ice and randomly assigned a confinement method and holding duration. Bluegill blood glucose levels were higher in both confinement methods than reference fish at 2‐h and 5‐h holding durations. Bluegills had higher blood glucose levels in buckets than ice wells at 1 and 2 h, but they had higher blood glucose levels in ice wells at 5 h. Water temperature was warmer in buckets than ice wells at all holding durations, while ice wells were cooler than ambient lake temperature. Bucket pH was higher than the lake at 2 h, and ice well pH was higher than the lake at 1 and 2 h. Bluegill RAMP scores were similar across all holding durations and confinement methods, but they were elevated in individuals held for the 24‐h mortality assessment. Two Bluegill mortalities occurred for fish held in ice wells. Our results suggest that confinement method and holding duration while ice angling can result in altered Bluegill blood glucose concentrations, water temperatures, and pH concentrations but that culling while ice angling might not result in mortality. Consequently, culling practices may be compatible with and not negate the intended benefits of reduced Bluegill bag limits. [ABSTRACT FROM AUTHOR]

Mirrorless cameras have seen rapid advancements in recent years. Orthodontists may benefit from these technological advancements in their daily orthodontic practice. This article will explore the advantages and disadvantages of mirrorless cameras, and assess how these camera compare to the tried-and-tested digital single-lens reflex (DSLR) camera. [ABSTRACT FROM AUTHOR]

To investigate vestibulo ocular reflex (VOR) in MS patients without any history of optic neuritis. 26 MS patients without any previous history of optic neuritis and 13 age- matched control subjects were included in this study. Their age ranged from 22 to 50 years old. We evaluated monocular visual evoked potential (VEP), monocular and binocular best corrected static and dynamic visual acuity, near and distance phoria and VOR gain. Mean spherical equivalent (SE) was – 0.40 ± 0.93 D and – 0.04 ± 0.14 D for study and control group, respectively (P = 0.060). There was a significant difference in dynamic visual acuity (DVA) between two groups (P = 0.029). VOR gain was not significantly different in both groups through vHIT measurements (P = 0.338). Duration of MS had a mean of 78.38 ± 75.94 months (ranged from 6 to 336 months). We found no significant correlation between disease duration and VOR (Rho 0.277, P = 0.171) or DVA (Rho 0.782, P = 0.057). Our study showed that although vHIT results decreased in MS patients, there was no significant differences between two groups. [ABSTRACT FROM AUTHOR]

Although several methods have been used to estimate exercise-induced changes in human neuronal networks, there are growing doubts about the methodologies used. This review describes a single motor unit-based method that minimizes the errors inherent in classical methods. With this method, it is now possible to identify human neuronal networks' changes due to exercise. [ABSTRACT FROM AUTHOR]

Black bass Micropterus spp. in North America are commonly targeted by recreational anglers who are participating in catch‐and‐release angling tournaments. In deeper water bodies, Smallmouth Bass M. dolomieu are often caught from depths greater than 6 m and held in a boat's live well until they are weighed in. Smallmouth Bass that are caught from such depths typically display symptoms of barotrauma, where the swim bladder becomes overinflated and the fish cannot maintain proper orientation. We examined the effects of three common practices that are used by tournament anglers who hold fish that exhibit symptoms of barotrauma: no treatment, weighted fin clips (rubber‐coated weighted alligator clips), and fizzing (venting the swim bladder with a hypodermic needle). After receiving a treatment, the Smallmouth Bass were held in experimental live wells for a period of 3 h and their condition was monitored using reflex action mortality predictors. Condition declined for the Smallmouth Bass that received no treatment, whereas both fin clips and fizzing demonstrated improved fish condition. Fizzing was also found to be a more rapid and effective treatment than fin clips. As the weight and capture depth of fish in the control group increased, there was a significant decrease in final condition, as indicated by reflex impairment. For tournaments that hold fish in live wells prior to release, these results demonstrate that interventions shortly after capture can effectively reduce reflex impairment in Smallmouth Bass that experience barotrauma and that fizzing is more effective than fin clips. [ABSTRACT FROM AUTHOR]

The study aimed to correlate between the stimulated nerve, intensity of trigeminovagal reflex (TVR), and neuropathophysiological pathway by which the efferent arc is activated. Material and methods: A retrospective study included patients who developed TVR during the surgical management of mandibular, midface, and orbital fractures. The reflex was divided into type I, II, III, and IV-TVR according to the following nerves: ophthalmic, maxillary, mandibular, and non-trigeminal nerves, respectively. The magnitude of hemodynamic drops was identified at the intraoperative baseline, during reflex, and postoperatively. The needed time to elicit the reflex, frequency and duration, need for medical intervention, and sequence of the drop were also recorded. P - values < 0.05 was considered significant. Out of 260 patients' files were reviewed, the TVR was observed in only 30 (11.55 %) patients. The ophthalmic nerve activation significantly caused the greatest intensity and magnitude of hemodynamic drop, followed by maxillary nerve, then mandibular division, and the lowest one was non-trigeminal nerves. The highest mean of drops in the mean arterial blood pressure (MABP) was 62.92 ± 2.39 with the type ITVR, whereas those of the type II, III, and IV were 75.5 ±3.98, 81.02±1.31, and 82.22±1.85, respectively. Also, the type I-TVR led to the greatest decrease in the heart rate (HR) with the mean equaled to 52.31± 3.91. The drop percentage in the MABP was -30.5, -17.5, -12, -10.08 for type I, II, III, and IV, whereas those of the HR were - 33.9, -27.13, -26.6, and -25 with type I, II, III, and IV, respectively. All results showed highly significant differences with p-values less than 0.001 when comparing between the baseline and intraoperative values of each TVR type. There is a positive correlation between the activated pathway of the TVR and the intensity of its efferent arc response due to the neural pathway of each division in the brainstem circuitry. Understanding of the pathophysiology and mechanism of the TVR, together with the rapid recognition and treatment could prevent serious negative outcomes, especially when the ophthalmic nerve is stimulated. 1Introduction [ABSTRACT FROM AUTHOR]

Heart rate variability (HRV) is often measured during clinical and experimental cardiovascular reflex tests (CRT), as a reflection of cardiac autonomic modulation, despite limited characterization of the rapid responses that occur. Therefore, we evaluated the responsiveness of HRV indices in 20 healthy young adults (age, 27 ± 6 y; mass, 76.9 ± 16.8 kg; height, 1.79 ± 0.12 m) during four separate established CRT. These included the [I] orthostatic challenge, [II] isometric handgrip, [III] cold pressor and [IV] cold diving reflex tests. Electrocardiogram was recorded throughout, with HRV derived from RR intervals at rest and from each CRT. On a separate day, a subgroup of participants (n=9) completed the same protocol for a second time. The maximal slope of heart rate change (dTdt) was significantly different between all CRT, with the orthostatic challenge producing the fastest increase (2.56 ± 0.48) and the cold pressor the fastest reduction (−1.93 ± 0.68) in heart rate. Overall HRV, reflected by Poincaré plot ratio (SD1:SD2), was significantly reduced during all CRT ([I], −0.41 ± 0.12; [II], −0.19 ± 0.05; [III], −0.36 ± 0.12; [IV], −0.44 ± 0.11; p<0.05) relative to baseline and this was reproducible in time-series. However, when HRV indices were correlated to mean-RR an exponential growth-like relationship was evident (R2 ranging from: 0.52–0.62). These unique outcomes demonstrate that short-term alterations in HRV are evident during CRT, while indicating the importance of adjusting for, or at least reporting, underlying heart rate when interpreting such measures. [ABSTRACT FROM AUTHOR]

Background/purpose: The HCV core antigen (HCV Ag) assay displays high sensitivity and strong correlation with HCV RNA. However, the feasibility of anti-HCV reflex HCV Ag screening in a community-wide setting is rarely discussed.Methods: We performed a two-phase community-based hepatitis C screen in an HCV-prone area of central Taiwan. During the training phase, all participants were test for anti-HCV, HCV Ag and HCV RNA to validate sensitivity, specificity, and accuracy of HCV Ag. During the validation phase, an anti-HCV reflex HCV Ag screen was conducted based on the results of training phase. Outcomes of the study were presented as positive and negative predictive values (PPV and NPV).Results: Of 935 training phase participants, the rate of positive anti-HCV and HCV Ag were 175 (18.7%) and 78 (8.3%), respectively. Test sensitivity, specificity, and accuracy of HCV Ag were 97.1%, 98.6%, and 97.8%, respectively. During validation phase, only anti-HCV-positive serum samples were tested for HCV Ag. Of 1932 participant, 285 (14.8%) were anti-HCV-positive. 133 (46.7%) of the 285 anti-HCV-positive samples were HCV Ag-positive. PPV and NPV were 98.4% and 99.3%, respectively. Across the entire participant sample, a significant linear correlation between HCV Ag and HCV RNA concentration was noted (r2 = 0.93, p-value<0.001) following log-log transformation.Conclusion: Anti-HCV reflex HCV Ag screening is a feasible strategy for aiding HCV-prone communities. [ABSTRACT FROM AUTHOR]

A survey was conducted to investigate the development of the Proto-Athabaskan obstruent series, *ts/tš/tšr/k, into present day Tahltan. Results from seven native speakers and quantitative analysis of a larger corpus establish tθ/ts/ts/tš as the standard obstruent system, alongside three alternate systems that relate to independently motivated historical changes. These findings support the longheld view that differences in the obstruent reflexes do not reflect deep phonological differences among Northern Athabaskan languages, but instead represent areal influences and patterns of individual variation in a highly dynamic language network. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare postural control and neurophysiologic components of balance after dry needling of the fibularis longus between individuals with chronic ankle instability (CAI) and a healthy control group. This quasi-experimental university-laboratory study included 50 adult volunteers—25 with CAI (16 female, 9 male; age: 26 ± 9.42 years; height: 173.12 ± 9.85 cm; weight: 79.27 ± 18 kg) and 25 healthy controls (15 female, 10 male; age: 25.8 ± 5.45 years; height: 169.47 ± 9.43 cm; weight: 68.47 ± 13 kg). Participants completed the Star Excursion Balance Test (SEBT), single-leg balance, and assessment of spinal reflex excitability before and after a single treatment of dry needling to the fibularis longus. The anterior, posterolateral, and posteromedial directions of the SEBT were randomized, and reach distances were normalized to a percentage of leg length. A composite SEBT score was calculated by averaging the normalized scores. Postural control was assessed in single-limb stance on a force plate through time-to-boundary measurements in eyes-open and eyes-closed conditions. Fibularis longus and soleus spinal reflexes were obtained by providing electrical stimulation to the common fibular and tibial nerves with participants lying prone. A Group × Time analysis examined changes in performance, and effect sizes were calculated to assess significance. Significant group × time interactions were identified for composite (P =.006) and posteromedial (P =.017) SEBT scores. Significant time effects for all directions of the SEBT, time to boundary with eyes open, and the mediolateral direction with eyes closed indicate improved postural control following treatment (P <.008). Within-group effect sizes for significant time effects ranged from small to large, indicating potential clinical utility. Dry needling demonstrated immediate short-term improvement in measures of static and postural control in individuals with CAI as well as healthy controls. [ABSTRACT FROM AUTHOR]

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Copyright of Konuralp Medical Journal / Konuralp Tip Dergisi is the property of Duzce University Medical School and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

It is assumed that the Attention Deficit Hyperactivity Disorder is associated with the central autonomic dysregulation, however, the studies are rare. Analysis of pupillary light reflex represents a non-invasive tool to provide information related to the central autonomic regulation; thus, we aimed to evaluate potential disturbances in the central autonomic integrity using pupillary light reflex examination in Attention Deficit Hyperactivity Disorder. We have examined 20 children with Attention Deficit Hyperactivity Disorder (10 boys, 13.0±2.3 years) and 20 age/gender-matched healthy subjects. Pupillary light reflex was examined at rest for both eyes using Pupillometer PLR-2000 (NeurOptics, USA). Evaluated parameters were: diameter of the pupil before the application of light stimulus and after illumination at the peak of the constriction, the percentual change of the pupil diameter during constriction, average constriction velocity, maximum constriction velocity and average dilation velocity. We found significantly lower percentual change of the pupil diameter during constriction for both eyes in Attention Deficit Hyperactivity Disorder group compared to controls (right eye: -25.81±1.23 % vs. -30.32±1.31 %, p<0.05, left eye: -25.44±1.65 % vs. -30.35±0.98 %, p˂0.05). The average constriction velocity and maximum constriction velocity were significantly shortened in left eye in Attention Deficit Hyperactivity Disorder group compared to controls (p˂0.05). Our findings revealed altered pupillary light reflex indicating abnormal centrally-mediated autonomic regulation characterized by parasympathetic underactivity associated with relative sympathetic predominance in children suffering from Attention Deficit Hyperactivity Disorder. [ABSTRACT FROM AUTHOR]

Obesity is characterized by chronic, low-grade systemic inflammation. Obesity may also be associated with chronic cough. The aim of this pilot study was to clarify relation of cough reflex sensitivity and body mass index (BMI) in children with chronic cough. Altogether 41 children having symptoms of chronic cough were submitted to cough reflex sensitivity measurement. We assessed the relation of cough reflex sensitivity (CKR) due to BMI. Cough reflex sensitivity was defined as the lowest capsaicin concentration which evoked two (C2) or five (C5) coughs. Capsaicin aerosol in doubling concentrations (from 0.61 to 1250 μmol/l) was inhaled by a single breath method (KoKo DigiDoser; nSpire heath Inc, Louisville, CO, USA), modified by the addition of an inspiratory flow regulator valve (RIFR; nSpire heath Inc, Louisville, CO, USA). BMI was calculated. Pulmonary function was within normal range. Concentrations of capsaicin causing two (C2) and five coughs (C5) were reported. Children' (22 boys and 19 girls, mean age 6.8 years) cough reflex sensitivity (median, with the Inter-Quartile Range) for C2 was 19.5 (73.4) μmol/l; for C5 it was 78.1 (605.5) μmol/l. We have noticed statistically significant relation of the cough reflex sensitivity (C5) and body mass index (P<0.0001); however, the effect size was small, R²=0.03. Increase of body mass index in one unit is associated with -34.959 μmol/l decrease of C5. We did not find a statistically significant relation between C2 and BMI (P=0.41). The median value of CKR (C2) in boys is not statistically significantly different than the median value of CKR (C2) in girls (P-value 0.5). The median value of CKR (C5) in boys is not statistically significantly different than the median value of CKR (C5) in girls (P-value 0.5). Increase of body mass index in children suffering from chronic cough relates to decrease of cough reflex sensitivity (C5 value). [ABSTRACT FROM AUTHOR]

Individual studies have suggested the utility of fractional exhaled nitric oxide (FeNO) measurement in detecting cough-variant asthma and eosinophilic bronchitis in patients with chronic cough. The aim of this study was to clarify a correlation of cough reflex sensitivity and fractional exhaled nitric oxide in asthmatic children. 25 children with asthma and 15 controls were submitted to cough reflex sensitivity measurement – capsaicin aerosol in doubling concentrations (from 0.61 to 1250 μmol/l) was inhaled by a single breath method. Concentrations of capsaicin causing two (C2) and five coughs (C5) were reported. Fractional exhaled nitric oxide (FeNO) measurement was included. Asthmatic children (11 boys and 14 girls, mean age 9±1 years) and control group (unconfirmed diagnosis of asthma) (6 boys and 9 girls, mean age 8±1 years) were included into the study. FeNO vs. C2 in asthma (Spearman´s rank correlation: -0.146, p=0.49); FENO vs. C5 in asthma (Spearman´s rank correlation: -0.777, p=0.71). We found that there is no correlation between cough reflex sensitivity and fractional exhaled nitric oxide either in children with asthma or in the control group. [ABSTRACT FROM AUTHOR]

Introducing a novel approach to overcoming a profound gag reflex and aversion to conventional dental impression procedures when fabricating a removable partial denture. The digital workflow is becoming increasingly popular in the discipline of fixed prosthodontics. Chairside digitization of a patient’s dentition is a less invasive and more comfortable procedure in comparison to conventional dental impression techniques. The advantages can be most relevant to patients with a profound gag-reflex. Currently, certain challenges exist with full digitization in the discipline of removable prosthodontics. Combining digital and conventional workflows may serve as an alternative technique to construct removable prostheses for groups who cannot tolerate conventional methods. [ABSTRACT FROM AUTHOR]

Copyright of Araucaria is the property of Araucaria-Revista Iberoamericana de Filosofia, Politica y Humanidades and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Konuralp Medical Journal / Konuralp Tip Dergisi is the property of Duzce University Medical School and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Nueva Revista del Pacífico is the property of Universidad de Playa Ancha de Ciencias de la Educacion and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Swallowing reflex depression during dental treatment or oral surgery may cause water to enter the lower respiratory tract, leading to coughing, thus hindering these procedures. Based on the hypothesis that dexmedetomidine (DEX) sedation may depress swallowing reflex, we aimed to characterize its effects on swallowing reflex and elucidate the affected functions. Swallowing reflex was induced in 9 young healthy male volunteers using a 5 mL-distilled water bolus injection over 3 s through a polyethylene catheter 3 times, both under wakefulness and DEX sedation. Swallowing EMG burst duration, pre-swallow EMG activity value, swallowing EMG burst peak value, latency time, and swallowing reflex timing in relation to the respiratory cycle were analyzed. The EMG burst duration was significantly prolonged with DEX sedation [206.9 ± 90.3% (1.20 ± 0.98 s)] compared to that with wakefulness [100 ± 00% (0.53 ± 0.28 s), P = 0.007]. No significant differences in the pre-swallow EMG activity value (P = 0.343), swallowing EMG burst peak value (P = 0.218), and latency times were apparent between wakefulness and DEX sedation (P = 0.793). Distributions of timing of the swallows in relation to the respiratory cycle did not significantly differ between the two conditions (P = 0.860). Our data demonstrate that DEX sedation carries a potential risk of aspiration due to swallowing reflex depression during elevation of the larynx; therefore, suctioning of water and saliva should be rigorously performed. However, peripheral muscle contraction of the submental muscle complex, neural organization function, and timing of the swallowing reflex in relation to the respiratory cycle are not affected. [ABSTRACT FROM AUTHOR]

BACKGROUND: Extubation failure may have several causes, including swallowing dysfunction, aspiration, and excessive upper airway secretions. We hypothesized that a bedside global swallowing pattern assessment including 9 criteria (volume of pharyngeal secretions, 5 swallowing motor items, swallowing reflex, and 2 gag reflexes) performed prior to extubation could identify patients at risk of extubation failure. METHODS: In a multicenter prospective observational study, all consecutive patients intubated and mechanically ventilated for>6 d were included. Before a planned extubation, a physiotherapist evaluated the 9 criteria of the swallowing assessment. The final extubation decision was left to the physician's discretion, blinded to the swallowing assessment. Extubation failure was defined as the need for re-intubation related to aspiration or excessive upper airway secretions within the first 72 h after extubation. Results are expressed as median (interquartile range [IQR]). RESULTS: The study included 159 subjects (age 61 y [IQR 48-75]; male/ female ratio 1.5; Simplified Acute Physiologic score II 54 [IQR 42=66]; duration of mechanical ventilation 11 d [IQR 8=17]). A total of 23 subjects (14.5%) required re-intubation, with 16 occurring within the first 72 h after extubation and 7 related to aspiration or excessive secretions. Swallowing assessment was significantly lower in subjects with re-intubation related to aspiration or excessive secretions within the first 72 h after extubation versus those not re-intubated for aspiration or excessive secretions (6 [IQR 5=7] vs 8 [IQR 7=8], P = .008, respectively). Among the 9 swallowing assessment criteria, normal right pharyngeal gag reflex was associated with a lower incidence of re-intubation related to aspiration or excessive secretions (odds ratio 0.12, 95% CI 0.03= 0.59, P = .01), as well as normal left pharyngeal gag reflex (odds ratio 0.13, 95% CI 0.03= 0.63, P = .01), with a negative predictive value of 0.98 for each reflex. CONCLUSIONS: In subjects with prolonged ventilation, the presence of one or both gag reflexes could predict a reduction in extubation failure related to aspiration or excessive upper airway secretions. [ABSTRACT FROM AUTHOR]

We studied the effects of GABA receptor agonists microinjections in medullary raphé on the mechanically induced tracheobronchial cough response in anesthetized, unparalyzed, spontaneously breathing cats. The results suggest that GABA-ergic inhibition significantly contributes to the regulation of cough reflex by action of both GABAA and GABAB receptors. The data are consistent with inhomogeneous occurrence of GABA-ergic neurons in medullary raphé and their different involvement in the cough reflex control. Cells within rostral nucleus raphé obscurus with dominant role of GABAA receptors and neurons of rostral nucleus raphé pallidus and caudal nucleus raphé magnus with dominant role of GABAB receptors participate in regulation of cough expiratory efforts. These cough control elements are distinct from cough gating mechanism. GABA-ergic inhibition in the raphé caudal to obex had insignificant effect on cough. Contradictory findings for GABA, muscimol and baclofen administration in medullary raphé suggest involvement of coordinated activity of GABA on multiple receptors affecting raphé neurons and/or the local neuronal circuits in the raphé modulating cough motor drive. [ABSTRACT FROM AUTHOR]

In order to clear airways and lungs defensive reflexes are provoked rather by the dynamic phase of mechanical stimulus. It is speculated that provocation of defensive response depends not only on stimulus duration but also on stimulus velocity. Fourteen adult rabbits were anaesthetized and tracheotomized. Mechanical stimulus was provoked by a mechanical probe introduced through the tracheotomy and rotated by a small electrical motor using a rotational velocity of 40 rpm/s and 20 rpm/s. Threshold, incidence and intensity of cough reflex (CR) were analyzed for each animal. Statistical comparisons between two velocities were performed using Friedman nonparametric test for repeated measurements. Results are median (25-75 %). The threshold of CR was significantly increased (p=0.005) from 350 ms (300-500 ms) to 550 ms (350-1150 ms) and the incidence of cough reflex was significantly reduced (p=0.002) from 50 % (19-50 %) to 0 % (0-25 %) when the rotational velocity of the mechanical probe was reduced by half. The findings of this study are of interest as they show that protective reflex cough, an important mechanism that allows clearing airways even during sleep or anesthesia, is tuned by mechanical stimulus velocity. [ABSTRACT FROM AUTHOR]

As stated by Korpáš and Tomori (1979), cough is the most important airway protective reflex which provides airway defensive responses to nociceptive stimuli. They recognized that active expiratory efforts, due to the activation of caudal ventral respiratory group (cVRG) expiratory premotoneurons, are the prominent component of coughs. Here, we discuss data suggesting that neurons located in the cVRG have an essential role in the generation of both the inspiratory and expiratory components of the cough reflex. Some lines of evidence indicate that cVRG expiratory neurons, when strongly activated, may subserve the alternation of inspiratory and expiratory cough bursts, possibly owing to the presence of axon collaterals. Of note, experimental findings such as blockade or impairment of glutamatergic transmission to the cVRG neurons lead to the view that neurons located in the cVRG are crucial for the production of the complete cough motor pattern. The involvement of bulbospinal expiratory neurons seems unlikely since their activation affects differentially expiratory and inspiratory muscles, while their blockade does not affect baseline inspiratory activity. Thus, other types of cVRG neurons with their medullary projections should have a role and possibly contribute to the fine tuning of the intensity of inspiratory and expiratory efforts. [ABSTRACT FROM AUTHOR]

Copyright of Slovo (05836255) is the property of Slovo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article focuses on testing cranial nerves related to the pupillary light reflex, discussing the assessment steps and potential abnormalities. Topics include the role of the optic nerve (CN II) in transmitting light stimuli, the automatic stimulation of oculomotor nerves (CN III) causing bilateral pupillary constriction, and the interpretation of findings to identify neurological abnormalities such as Horner's Syndrome or CN III compression.

Anti-ganglioside D1b (GD1b) Immunoglobulin G (IgG) positive Guillain-Barré Syndrome (GBS) is rare and usually presents with acute sensory or cerebellar ataxia, ascending paralysis, and loss of deep tendon reflexes (DTRs). A 19-year-old female individual with recent Influenza A infection had an acute onset of facial diplegia and minimal leg weakness with preserved DTRs. Cerebrospinal fluid analysis showed albuminocytologic dissociation with positive serum anti-GD1b IgG antibody (52 IV; reference range 0--50). Magnetic resonance imaging of the cervical spine showed nerve root enhancement. Following intravenous immunoglobulin therapy and subsequent physiotherapy, the patient reached the nadir of leg weakness by one month and had complete motor recovery after one year. Sensory ataxia was observed in the fourth month of the illness, which subsided by eight months. DTRs were normal throughout the course of the disease. This case showed an unusual evolution of GBS with a positive anti-GD1b antibody presenting with acute facial diplegia, normal DTR and delayed sensory ataxia. [ABSTRACT FROM AUTHOR]

To identify the proportion of patients previously diagnosed with apparent life-threatening events (ALTE) who would meet criteria for brief resolved unexplained events (BRUE) and to identify rates of adverse outcomes in subgroups: ALTE not meeting criteria for BRUE, lower-risk BRUE, and higher-risk ALTE. We performed a secondary analysis of a single-center prospective registry of patients diagnosed with ALTE in a tertiary care emergency department from March 1, 1997 to October 31, 2007. We identified the proportion of patients meeting criteria for BRUE, and the proportion of patients with BRUE meeting lower-risk criteria. We assessed outcomes of patients in subgroups. Seven hundred and sixty-two patients were included. Adverse outcomes included recurrent ALTE (n = 49), aspiration (n = 9), trauma (n = 8), and death (n = 4). Three hundred and twenty-six of 762 (42.8%) met criteria for BRUE. Seventy of 326 (21.5%) met criteria for lower-risk BRUE. Adverse outcomes occurred in 40 of 436 (9.2%) with ALTE not meeting criteria for BRUE, 2 of 70 (2.9%) with lower-risk BRUE, and 23 of 256 (9.0%) with higher-risk BRUE. Of 4 patients who died, 1 had an ALTE not meeting criteria for BRUE and 3 had non–lower-risk BRUE. The BRUE risk criteria identified all BRUE patients that died or had substantial morbidity as higher-risk. Less than half of patients with ALTE meet criteria for BRUE. Of those who do, one-fifth is lower-risk. In this series, the risk-stratification in the BRUE criteria identified those patients at highest risk of adverse outcomes. Further research is required to risk-stratify patients with BRUE. [ABSTRACT FROM AUTHOR]

Background: Until recently, vestibular caloric stimulation was the only objective diagnostic method for isolating the function of the lateral semi-circular canals responsible for maintaining balance. Since 2014, the Video Head Impulse Test (vHIT) has been applied in the Czech Republic to investigate the function of all semi-circular canals. Studies conducted so far have shown that the results of these two methods do not often agree. Methods: The aim of this study was to compare the results of vestibular caloric stimulation and vHIT in a cohort of patients with peripheral vestibular syndrome at a specialized outpatient clinic. The study lasted from July 2016 to August 2017 and included patients with unilateral peripheral vestibular syndrome (n=32; 24 females and 8 males, mean age 49.4 years) and a positive result with either vestibular caloric stimulation or vHIT. Findings: 90% of the patients had a positive vestibular caloric stimulation result, while the vHIT was positive only in 50% of the patients. Both methods were positive in 13 subjects, vestibular caloric stimulation was positive and vHIT was negative in 16 subjects and in 3 cases vestibular caloric stimulation was negative and vHIT was positive. Based on these numbers, both methods concur in 45% of the cases. In 13 patients, apart from lateral canal disorders, vHIT revealed disorders in one of the vertical canals - the front right in 4, the rear right in 2, the front left in 3 and the rear left in 4. When sorted into subgroups of the "TiTrATE" diagnostic algorithm based on the time course and triggering factor, vHIT was found to be positive for acute spontaneous vertigo in 62.5% of cases. vHIT was negative for 70% of chronic and spontaneous episodic complaints. Conclusions: The diagnosis of peripheral vestibular disorders should take the pathophysiological basis of the disease into account, as this can differ in peripheral disorders. This could then explain the discrepancy between the results of the two methods. The time course of the disease can be a predictor of the vHIT outcome. Localizing the impaired function of particular semi-circular canals using vHIT can inform selective vestibular rehabilitation. [ABSTRACT FROM AUTHOR]

The gag reflex, (or the pharyngeal response), is a normal, automated defence mechanism designed to prevent foreign bodies from entering the upper airway. This is a protective response present in most people, but in some it may be absent whilst in others it may be more pronounced. One study of 140 healthy subjects found that in 37%, a gag reflex was absent. In the dental setting, a severe gag reflex may pose challenges both for the patient and the dentist. Various management techniques can be tried to suppress the gag reflex. Sedation is a pharmacological technique often used to manage patients with marked gag reflexes, however, it is not effective in all cases. To help explain this, the science and anatomy of the gag reflex should be explored as well as the mechanism of its action. Understanding how common sedation techniques, namely intravenous and inhalational sedation, impact on the gag reflex may explain why sedation techniques are not always successful in reducing the gag response. Alternative methods such as acupuncture and behaviour modification, and their effects on the gag reflex may also be useful in management. Clearly, a detailed assessment for each patient should always be taken to ensure that the most appropriate techniques are employed to achieve the best outcome in each individual case. [ABSTRACT FROM AUTHOR]