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Context: Individuals with chronic ankle instability (CAI) demonstrate reduced spinal reflex modulation and corticospinal excitability of the soleus, which may contribute to decreased balance performance. Objective: To determine the effects of a single session of balance training on Spinal-reflexive excitability modulation and corticospinal excitability in those with CAI. Design: Randomized controlled trials. Setting: Research laboratory. Participants: Thirty participants with CAI were randomly assigned to the balance training (BAL) or control (CON) group. Main Outcome Measures: Modulation of soleus spinal-reflexive excitability was measured by calculating relative change in normalized Hoffmann reflexes (ratio of the H-reflex to the M-wave) from prone to single-leg standing. Corticospinal excitability was assessed during single-leg stance using transcranial magnetic stimulation, outcomes of which included active motor threshold (AMT), motor evoked potential, and cortical silent period (CSP). Balance performance was measured with center of pressure velocity in anterior to posterior and medial to lateral directions. Separate 2x2 repeated-measures analyses of variance were employed to determine the effect of group (BAL and CON) and time (baseline and posttraining) on each dependent variable. Results: There were significant group by time interactions in the modulation of soleus spinal-reflexive excitability (F1.27 = 4.763, P=-04); CSP at 100% AMT (F F1.27 = 4.727, P = .04); and CSP at 120% AMT (F F1.27 16.057, f < .01). A large effect size suggests increased modulation of spinal-reflexive excitability (d = 0.81 [0.03 to 1.54]) of the soleus in BAL compared with CON at posttest, while CSP at 100% (d = 0.95 [0.17 to 1.70]) and 120% AMT (d = 1.10 [0.29 to 1.84]) was reduced in BAL when compared with CON at posttest. Conclusion: After a single session of balance training, individuals with CAI initiated increases in spinal reflex modulation and corticospinal excitability of the soleus. Thus, individuals with CAI who undergo balance training exhibit positive neural adaptations that are linked to improvements in balance performance. [ABSTRACT FROM AUTHOR]

Interoception, the sensation and perception of internal bodily states, should be conceptualized through specialized modalities like cardioception, pulmoception, gastroception, and uroception. This NeuroView emphasizes cardioception, exploring heart-brain interactions, cardiac reflexes, and their influence on mental states and behavior. [ABSTRACT FROM AUTHOR]

In quadrupeds, such as cats, cutaneous afferents from the forepaw dorsum signal external perturbations and send inputs to spinal circuits to co‐ordinate the activity in muscles of all four limbs. How these cutaneous reflex pathways from forelimb afferents are reorganized after an incomplete spinal cord injury is not clear. Using a staggered thoracic lateral hemisections paradigm, we investigated changes in intralimb and interlimb reflex pathways by electrically stimulating the left and right superficial radial nerves in seven adult cats and recording reflex responses in five forelimb and ten hindlimb muscles. After the first (right T5–T6) and second (left T10–T11) hemisections, forelimb–hindlimb co‐ordination was altered and weakened. After the second hemisection, cats required balance assistance to perform quadrupedal locomotion. Short‐, mid‐ and long‐latency homonymous and crossed reflex responses in forelimb muscles and their phase modulation remained largely unaffected after staggered hemisections. The occurrence of homolateral and diagonal mid‐ and long‐latency responses in hindlimb muscles evoked with left and right superficial radial nerve stimulation was significantly reduced at the first time point after the first hemisection, but partially recovered at the second time point with left superficial radial nerve stimulation. These responses were lost or reduced after the second hemisection. When present, all reflex responses, including homolateral and diagonal, maintained their phase‐dependent modulation. Therefore, our results show a considerable loss in cutaneous reflex transmission from cervical to lumbar levels after incomplete spinal cord injury, albeit with preservation of phase modulation, probably affecting functional responses to external perturbations. Key points: Cutaneous afferent inputs co‐ordinate muscle activity in the four limbs during locomotion when the forepaw dorsum contacts an obstacle.Thoracic spinal cord injury disrupts communication between spinal locomotor centres located at cervical and lumbar levels, impairing balance and limb co‐ordination.We investigated cutaneous reflexes from forelimb afferents during quadrupedal locomotion by electrically stimulating the superficial radial nerve bilaterally, before and after staggered lateral thoracic hemisections in cats.We showed a loss/reduction of mid‐ and long‐latency homolateral and diagonal reflex responses in hindlimb muscles early after the first hemisection that partially recovered with left superficial radial nerve stimulation, before being reduced after the second hemisection.Targeting cutaneous reflex pathways from forelimb afferents projecting to the four limbs could help develop therapeutic approaches aimed at restoring transmission in ascending and descending spinal pathways. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims/Introduction Materials and Methods Results Conclusions We investigated the association between the ankle reflex and the estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes.This was a single‐center, retrospective, observational cohort study. A total of 1,387 patients who underwent an ankle reflex examination between January 2005 and December 2015 were included in the analysis for the primary outcome. The findings of the ankle reflex examination were classified into three groups: normal, decreased, or absent. The primary outcome was defined as the incidence of a 40% loss of eGFR from baseline. A survival time analysis using the Kaplan–Meier method and a regression analysis using a Cox proportional hazards model were conducted to evaluate the association between the ankle reflex test results and loss of eGFR.The ankle reflex test results were as follows: normal, n = 678 (48.9%); decreased, n = 270 (19.5%); and absent, n = 439 (31.6%) patients. The median follow‐up period was 5.6 years in the observational period. In the univariate regression analysis, decreased and absent ankle reflexes were significantly associated with loss of eGFR. Moreover, decreased ankle reflex (hazard ratio: 1.83, 95% confidence interval: 1.16–2.87) and absent ankle reflex (hazard ratio: 2.57, 95% confidence interval: 1.76–3.76) were independently associated with loss of eGFR after adjusting for prognostic risk factors.Decreased and absent ankle reflexes are closely and independently associated with loss of eGFR in patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background: Outcome measures in clinical practice assist in establishing progress for effective quality of care. Physiotherapists in the intensive care unit (ICU) promote lung function and facilitate early mobilization to prevent ICU-related complications. Objectives: To determine the physical functional outcomes in critically ill patients in the trauma and medical critical care units at three hospitals in the Tshwane District. Method: This was a quantitative prospective observational cohort study. Adult patients admitted in the trauma, medical ICU, and high care (HC) units were recruited. Ethical clearance was obtained from the [Masked for blind review], the National Department of Health Research (NHRD), and the Chief Executive Officers (CEOs) of the hospitals. Written consent was obtained from the recruited patients. Assessments were done on Mondays, Wednesdays, and Fridays using the Chelsea Critical Care Physical Assessment (CPAx) Tool until discharge from the units. Data were analyzed using SPSS version 28. Results: Functional outcomes that improved quicker were respiratory function, cough reflex, rolling in the bed, and grip strength. An increase in CPAx scores correlated with improvement in the Glasgow coma scale (GCS) in both groups. Median and inter-quartile CPAx scores in the medical ICU for the initial assessments were 3(2–8) with an increase to 8(3.75–28.25) in the final assessment (p = 0.003). The median and interquartile CPAxs scores for initial assessments in the trauma ICU were 2(1–11.75) and 5(3.25–14) for the final assessments, with a p-value of 0.005 which showed statistical significance. Conclusion: CPAx mean scores in the trauma ICU were higher than in the medical ICU. There were significant positive changes in the scoring of both populations but this was slightly better in the trauma ICU. Using the CPAx tool in a HC setting seemed feasible and patients showed higher scores compared to both trauma and medical ICU. Clinical implications : The CPAX tool assists in the development of rehabilitation goals in the ICU and HC by physiotherapists. The tool can be adapted in the medical and trauma critical care units to assess functional outcomes. Trial registration: Pan African Clinical Trials Registry, PACTR202305860988637, Registered 7 May 2023-Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25542. [ABSTRACT FROM AUTHOR]

Study objective was to evaluate whether the application of a lip twitch could be proposed as conditioning stimulus in the context of a novel Conditioned Pain Modulation (CPM) assessment paradigm for use in horses. The study was a prospective, experimental, randomized trial. Twelve healthy horses were evaluated in two experimental sessions. The lip twitch was used as the conditioning stimulus in both sessions; electrical stimulation was used as the test stimulus in one session, while mechanical and thermal stimulations were used in the other. Differences between thresholds recorded before and during twitching (Δ) as well as their percent (%) change were computed for each stimulation modality as a measure of CPM. Heart rate and respiratory rate were recorded throughout the experiments to monitor physiological reactions, while the general level of stress and aversiveness toward twitching were scored using ad hoc behavioural scales. Based on these scores, interruption criteria were defined. Ten and seven horses completed the electrical and mechanical/thermal experimental sessions respectively. For electrical stimulation, median (IQR) Δ was −2.8 (−3.9, −1.1) mA and% change 87.9 (65.7–118.2)%; for mechanical stimulation, Δ was −18.2 (−6.4, −21.4) N and% change 343.5 (140, 365.3)%; for thermal stimulation, Δ was −3.1 (−9.2, −2.1)°C, while% change was not calculated. Heart rate and respiratory rates varied significantly over time, with higher values recorded during twitching. Median stress and aversion scores did not differ between the two sessions. As lip twitching consistently affected thresholds to all stimulation modalities, it can be proposed as effective conditioning method for CPM assessment in horses. The exclusion of subjects due to severe aversion shows that this paradigm cannot be indistinctively applied to all horses and that stringent interruption criteria are necessary to guarantee adequate welfare during testing. [ABSTRACT FROM AUTHOR]

Muscle spindles are stretch‐sensitive mechanoreceptors found in the skeletal muscles of most four‐limbed vertebrates. They are unique amongst sensory receptors in the ability to regulate their sensitivity by contraction of the intrafusal muscle fibres on which the sensory endings lie. Muscle spindles have revealed a remarkable diversity of functions, including reflex action in posture and locomotion, contributing to bodily self awareness, and influencing wound healing. What were the circumstances which gave rise to the evolution of such complex end‐organs? We argue that spindles first appeared in early amniotes and only later in frogs and toads. This was considered an example of convergent evolution. Spindles in amphibians and reptiles are characterised by their simple structure, pointing to key features essential for spindle function. Spindle sensitivity in amphibians and reptiles is controlled by intrafusal fibre contractions evoked by branches of motor axons supplying extrafusal muscle. Modern phylogenetic evidence has revised our views on the origin of birds, placing them closer to the dinosaurs than had previously been thought. Birds are the only group, other than mammals, which has a dedicated fusimotor innervation of spindles, another example of convergent evolution, given the widely different origins of the two groups. One factor that may have played a role here was that both groups are endotherms, allowing motor control to develop further in an optimal internal environment. This, as well as other changes within the spindle, has led to the astonishing sophistication of motor control observed especially in many modern mammals. [ABSTRACT FROM AUTHOR]

Background: In the neurological examination, it is crucial to identify the possible location of the lesion in order to determine the appropriate treatment process. In aggressive animals, chemical restraint may be necessary due to their non‐cooperative behaviour. However, sedatives may distort the results of examinations. Therefore, a drug should be found that has minimal impact on the examination results. Objectives: To investigate the effects of acepromazine, xylazine, and propofol on spinal reflexes in healthy dogs. Methods: In a randomized, blinded study, ten native adult mixed‐breed dogs were participated in three groups with a 1‐week washout period between each group. Before performing each step, the spinal reflexes were evaluated. Then, in the first group, acepromazine (0.05 mg/kg, IM), in the second group, xylazine (1 mg/kg, IM), and in the third group, propofol (3 mg/kg, IV for initial bolus and 0.1 mg/kg/min for maintenance) were injected for sedation. The spinal reflexes were reevaluated at maximum sedation and at 15, 30, and 45 min thereafter. Results: Acepromazine increased the patellar reflex and decreased the panniculus reflex. Xylazine increased the cranial tibial reflex and decreased the panniculus reflex, while propofol decreased the withdrawal, and extensor carpi radialis reflexes, and suppressed the palpebral and gag reflexes. Conclusions: The drugs used in the present study did not have a significant impact on the most important reflexes evaluated in neurological examinations. Among the drugs, acepromazine has the least effects compared to other drugs, making it a suitable choice for sedation. [ABSTRACT FROM AUTHOR]

Purpose: A relevant aspect of listening is the effort required during speech processing, which can be assessed by pupillometry. Here, we assessed the pupil dilation response of normal-hearing (NH) and hard of hearing (HH) individuals during listening to clear sentences and masked or degraded sentences. We combined this assessment with functional magnetic resonance imaging (fMRI) to investigate the neural correlates of the pupil dilation response. Method: Seventeen NH participants (Mage = 46 years) were compared to 17 HH participants (Mage = 45 years) who were individually matched in age and educational level. Participants repeated sentences that were presented clearly, that were distorted, or that were masked. The sentence intelligibility level of masked and distorted sentences was 50% correct. Silent baseline trials were presented as well. Performance measures, pupil dilation responses, and fMRI data were acquired. Results: HH individuals had overall poorer speech reception than the NH participants, but not for noise-vocoded speech. In addition, an interaction effect was observed with smaller pupil dilation responses in HH than in NH listeners for the degraded speech conditions. Hearing impairment was associated with higher activation across conditions in the left superior temporal gyrus, as compared to the silent baseline. However, the region of interest analysis indicated lower activation during degraded speech relative to clear speech in bilateral frontal regions and the insular cortex, for HH compared to NH listeners. Hearing impairment was also associated with a weaker relation between the pupil response and activation in the right inferior frontal gyrus. Overall, degraded speech evoked higher frontal activation than clear speech. Conclusion: Brain areas associated with attentional and cognitive-control processes may be increasingly recruited when speech is degraded and are related to the pupil dilation response, but this relationship is weaker in HH listeners. [ABSTRACT FROM AUTHOR]

The muscle metaboreflex effect on pulmonary ventilation (V̇E) regulation is more apparent during rhythmic exercise than rest, possibly because this reflex interacts with other mechanisms regulating V̇E during voluntary contractions, such as central command. Therefore, we tested whether one part of central command, the descending component of motor execution (i.e., descending motor drive), and the muscle metaboreflex interact synergistically to regulate V̇E. Thirteen healthy adults (9 men) completed four experiments in random order under isocapnia. The muscle metaboreflex was activated by rhythmic handgrip exercise at 60% maximal voluntary contraction (MVC) force with the dominant hand. Then, the muscle metaboreflex remained active during a 4-min recovery period via postexercise circulatory occlusion (PECO), or it was inactivated, maintaining free blood flow to the dominant upper limb. During the last 2 min of the handgrip exercise recovery, participants either performed rhythmic voluntary plantar flexion with the dominant leg at 30% MVC torque to generate descending motor drive or the dominant leg's calf muscles were involuntarily activated by electrical stimulation at a similar torque level (i.e., without descending motor drive). V̇E increased to a similar level during handgrip exercise in all conditions (≈22 L/min, P = 0.364). PECO maintained V̇E elevated above recovery with free blood flow (≈17 L/min vs. ≈13 L/min, P = 0.009). However, voluntary and involuntary plantar flexion with or without PECO evoked similar V̇E responses (Δ ≈ 4 L/min, P = 0.311). Therefore, an interaction between descending motor drive and muscle metaboreflex is not ubiquitous for V̇E regulation during rhythmic exercise. NEW & NOTEWORTHY: Voluntary (i.e., with descending motor drive) and involuntary (i.e., no descending motor drive) plantar flexion elicited similar ventilatory responses when postexercise circulatory occlusion was or was not used in an upper limb. These results indicate that the descending motor drive component of the central command and the muscle metaboreflex do not interact to regulate pulmonary ventilation during rhythmic exercise, which suggests that a supposed interaction between central command-muscle metaboreflex is more complex than previously thought. [ABSTRACT FROM AUTHOR]

A given dose of hypoxia causes a greater increase in pulmonary ventilation during physical exercise than during rest, representing an exercise‐induced potentiation of the acute hypoxic ventilatory response (HVR). This phenomenon occurs independently from hypoxic blood entering the contracting skeletal muscle circulation or metabolic byproducts leaving skeletal muscles, supporting the contention that neural mechanisms per se can mediate the HVR when humoral mechanisms are not at play. However, multiple neural mechanisms might be interacting intricately. First, we discuss the neural mechanisms involved in the ventilatory response to hypoxic exercise and their potential interactions. Current evidence does not support an interaction between the carotid chemoreflex and central command. In contrast, findings from some studies support synergistic interactions between the carotid chemoreflex and the muscle mechano‐ and metaboreflexes. Second, we propose hypotheses about potential mechanisms underlying neural interactions, including spatial and temporal summation of afferent signals into the medulla, short‐term potentiation and sympathetically induced activation of the carotid chemoreceptors. Lastly, we ponder how exercise‐induced potentiation of the HVR results in hyperventilation‐induced hypocapnia, which influences cerebral blood flow regulation, with multifaceted potential consequences, including deleterious (increased central fatigue and impaired cognitive performance), inert (unchanged exercise) and beneficial effects (protection against excessive cerebral perfusion). What is the topic of this review?What neural mechanisms are involved in the ventilatory response to hypoxic exercise and do they interact? What are the mechanisms underlying neural interactions during hypoxic exercise?What advances does it highlight?Current evidence does not support an interaction between the carotid chemoreflex and central command. In contrast, findings from some studies support synergistic interactions between the carotid chemoreflex and the muscle mechano‐ and metaboreflexes. Medullary signal summation, short‐term potentiation and sympathetic carotid chemoreceptor activation probably contribute to potentiation of the hypoxic ventilatory response during exercise, impacting cerebral blood flow and oxygenation via hyperventilation‐induced hypocapnia. [ABSTRACT FROM AUTHOR]

Although many studies have shown a long‐term negative impact of early life adversity (ELA) in rodents, literature regarding its effects on maturational milestones in rats is scarce. Available evidence suggests that ELA interferes with normal growth and development in rodents and that effects may be sex‐dependent even at an early age. In accordance, we hypothesized that early life scarcity‐adversity would impair physical and reflex development in male and female rats. To test this, we used an early life resource scarcity paradigm based on reducing home cage bedding during postnatal days (PND) 2–9 and assessed physical landmarks by measuring weight gain, incisor presence, fur development, and eye opening. We also evaluated the impact of early life scarcity‐adversity on developmental reflexes by measuring surface righting and grasp reflexes, negative geotaxis, cliff avoidance, bar holding, and auditory startle. Early life scarcity‐adversity resulted in earlier complete lower incisor presence in males (PND 6), impaired surface righting (PND 6) and grasp reflexes (PND 8) in both sexes, and impaired cliff avoidance responses in females (PND 12). These results extend previous research examining the effects of ELA on developing male and female rodents by showing that it negatively impacts a subset of physical landmarks and developmental reflexes in a sex‐dependent manner. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Materials and Methods Results Conclusions Although macrophage polarisation in the trigeminal ganglion (TG) is crucial in orofacial pain hypersensitivity, the effect of ageing‐related changes and their involvement in intra‐oral nociception remains unclear. We assessed the effect of ageing‐related macrophage polarisation in TG on intra‐oral mechanical pain hypersensitivity following palatal mucosal incision using senescence‐accelerated mice (SAM)‐prone8 (SAMP8) and SAM‐resistant 1 (SAMR1).Mechanical head‐withdrawal reflex threshold (MHWRT) of the palatal mucosa was measured for 21 days after palatal mucosal incision. On days 3 and 14, the abundance of Iba‐1‐immunoreactive (IR) cells, CD11c‐IR cells (pro‐inflammatory macrophages (M1)), C‐C motif chemokine ligand 2 (CCL2)‐IR M1‐macrophages, CD206‐IR cells (anti‐inflammatory macrophages (M2)) and transforming growth factor‐β (TGF‐β)‐IR M2‐macrophages in the TG was analysed. The effect of continuous intra‐TG administration of CCL2‐neutralising antibody or recombinant‐CCL2 on MHWRT was examined.Incision‐induced decrease in MHWRT was enhanced in SAMP8 compared with that in SAMR1. On days 3 and 14, the number of CCL2‐IR M1‐macrophages in TG was increased in SAMP8 compared with that in SAMR1. CCL2‐neutralising antibody suppressed, whereas recombinant‐CCL2 increased pain hypersensitivity in SAMP8.Mechanical pain hypersensitivity after oral mucosal injury is potentiated and sustained by age‐related enhancement of CCL2 signalling via M1‐macrophage hyperactivation in TG. [ABSTRACT FROM AUTHOR]

An overactive orexin (OX) system is associated with neurogenic hypertension and an exaggerated chemoreflex in spontaneously hypertensive rats (SHRs). However, the chronology and mechanism of this association is unclear. We hypothesized that increased postnatal neurogenesis of OX neurons in SHRs precedes and contributes to the aberrant increase in mean arterial blood pressure (MAP) and the exaggerated response to hypercapnia during postnatal development. Using immunohistochemical methods and bromodeoxyuridine, we mapped the timeline of orexin neuron neurogenesis and maturation during early postnatal development. We then used whole-body plethysmography with EEG and EMG to map the development of mean arterial pressure (MAP) and state regulation. Finally, we used OX-targeted saporin toxin to determine the effects of eliminating excess OX neurons on the elevated MAP and exaggerated chemoreflex in adult SHRs. We found that both SHRs and Wistar-Kyoto (WKY) rats experienced postnatal increases in OX neurons. However, SHRs experienced a greater increase than WKY rats before P15, which led to significantly more OX neurons in SHRs than age-matched WKY controls by P15-16 (3,720 ± 780 vs. 2,406 ± 363, p = 0.005). We found that neurogenesis, as evidenced by BrdU staining in OX-positive neurons, was the primary contributor to the excess OX neurons in SHRs during early postnatal development. While SHRs develop more OX neurons by P15-16, SHRs and normotensive WKY control rats have similar MAP during postnatal development until P25 in wakefulness (81.6 ± 6.6 vs. 67.5 ± 6.8 mmHg, p = 0.006) and sleep (79.3 ± 6.1 vs. 66.6 ± 6.5, p = 0.009), about 10 days after the surge of OX neurons. By selectively eliminating excess (~30%) OX neurons in SHRs, we saw a significantly lowered MAP and hypercapnic ventilatory chemoreflex compared to non-lesioned SHRs at P40. Additionally, we found unique signatures in state indicative of the attention defecit phenotype commonly associated with this model. We suggest that the postnatal increase of OX neurons, primarily attributed to exaggerated postnatal OX neurogenesis, may be necessary for the development of higher MAP and exaggerated chemoreflex in SHRs, and modulation of the overactive OX system may have a potential therapeutic effect during the pre-hypertensive period. [ABSTRACT FROM AUTHOR]

AbstractObjectiveDesignStudy SampleResultsConclusions\nHIGHLIGHTSThe present study aimed to objectively assess the charge integration efficiency (CIE) of the auditory nerve using electrically-evoked stapedial reflex threshold (eSRT) measurements in paediatric cochlear implant users.The eSRT was estimated in two ways: by keeping pulse width constant while increasing pulse amplitude and vice versa. The electrical dynamic range (EDR) obtained for eSRT was measured with increasing pulse amplitude (EDRPA) and pulse width (EDRPW) by calculating the difference in charge units between eSRT and behavioural thresholds; further, CIE was estimated.Fifteen paediatric cochlear implant users.EDRPW was 1.4 to 1.7 times larger than EDRPA. The EDRPW was significantly greater than the EDRPA. A significant correlation was observed between both EDR measures. However, the CIE measure did not significantly correlate with the behavioural threshold. Further, there was no significant effect of electrode location on the CIE.The CIE estimated with objective measures such as eSRT is comparable to those estimated using behavioural loudness judgments. eSRT can serve as a quick method to estimate the CIE, which can be easily implemented in the paediatric population. The CIE could be a valuable tool for differentiating electrodes with excellent and poor charge integration efficiency.In cochlear implants, loudness perception can be increased with an increase in pulse amplitude or width.Charge integration efficiency can be a valuable measure to assess the ability of the auditory nerve to integrate the charge over time.Electrically evoked stapedial reflex measurement can be used as an objective method to measure charge integration efficiency.In cochlear implants, loudness perception can be increased with an increase in pulse amplitude or width.Charge integration efficiency can be a valuable measure to assess the ability of the auditory nerve to integrate the charge over time.Electrically evoked stapedial reflex measurement can be used as an objective method to measure charge integration efficiency. [ABSTRACT FROM AUTHOR]

AbstractWaiting lists are a standard approach to managing excess demand in elective health care. While waiting times are an important policy issue, the ethical validity of the first come, first served (FCFS) principle as such is rarely questioned. Presenting a psychiatric day hospital where all eligible patients have roughly equal claims as a case study, we criticize the reflex use of FCFS for allocation of elective psychiatric care, consider conditions under which this may not be the optimal strategy, and discuss alternatives. We conclude that in our example prioritizing more recent referrals (last come, first served [LCFS]) makes more sense, clinically and ethically. Where several referrals arrive (near-)simultaneously under LCFS, we propose that a higher level of scrutiny be applied to detect possible good reasons for prioritizing one of them. We believe that our observations can be applied to other health care settings that share relevant characteristics with our case. [ABSTRACT FROM AUTHOR]

Background: Chronic pain from peripheral neuromas is difficult to manage and often requires surgical excision, though intraoperative identification of neuromas can be challenging due to anatomical ambiguity. Mechanical manipulation of the neuroma during surgery can elicit a characteristic "startle sign", which can help guide surgical management. However, it is unknown how anesthetic management affects detection of the startle sign. Methods: We performed a retrospective cohort study of 73 neuroma excision surgeries performed recently at Massachusetts General Hospital. Physiological changes in the anesthetic record were analyzed to identify associations with a startle sign event. Anesthesia type and doses of pharmacological agents were analyzed between startle sign and no-startle sign groups. Results: Of the 64 neuroma resection surgeries included, 13 had a startle sign. Combined intravenous and inhalation anesthesia (CIVIA) was more frequently used in the startle sign group vs. no-startle sign group (54% vs. 8%), while regional blockade with monitored anesthetic care was not associated with the startle sign group (12% vs. 0%), p = 0.001 for anesthesia type. Other factors, such as neuromuscular blocking agents, ketamine infusion, remifentanil infusion, and intravenous morphine equivalents showed no differences between groups. Conclusions: Here, we identified hypothesis-generating descriptive differences in anesthetic management associated with the detection of the neuroma startle sign during neuroma excision surgery, suggesting ways to deliver anesthesia facilitating detection of this phenomenon. Prospective trials are needed to further validate the hypotheses generated. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionTo determine the relationship between marginal reflex distance (MRD-1) outcomes and the distance of levator aponeurosis advancementThis retrospective observational study included patients with acquired unilateral aponeurotic ptosis, who underwent small-incision anterior levator advancement. The distance of levator advancement, and intra-operative MRD-1 in the sitting position, were analyzed to determine a correlation between the two.Forty-eight patients were included. Results exhibited no direct relationship between advancement distance and MRD-1 measurements. Median and range of MRD-1 outcomes did not present a linear progression as the distance increased or decreased. A majority of advancement distances exhibited a median MRD-1 outcome of 4.00 mm (n = 3). Success criteria was met in 85.4% of surgeries performed.Due to varying postoperative MRD-1 outcomes, surgical results cannot be accurately predicted using predetermined advancement distances. Confirming the final MRD-1 in the sitting position with subsequent adjustment is still recommended. [ABSTRACT FROM AUTHOR]

Background: Prokinetic agents are effective in increasing gastrointestinal (GI) contractility and alleviating constipation, often caused by slow intestinal motility. Lubiprostone (LUB), known for activating CLC-2 chloride channels, increases the chloride ion concentration in the GI tract, supporting water retention and stool movement. Despite its therapeutic efficacy, the exact mechanisms underlying its pharmacological action are poorly understood. Here, we investigated whether LUB activates the canonical transient receptor potential cation channel type 4 (TRPC4) through stimulation with E-type prostaglandin receptor (EP) type 3. Methods: Using isotonic tension recordings on mouse colon strips, we examined LUB-induced contractility in both proximal and distal colon segments. Quantitative real-time polymerase chain reaction (qRT-PCR) was conducted to determine mRNA levels of EP1-4 receptor subtypes in distal colonic muscular strips and isolated myocytes. The effects of a TRPC4 blocker and EP3 antagonist on LUB-stimulated contractions were also evaluated. Results: LUB showed significant contraction in the distal segment compared to the proximal segment. EP3 receptor mRNA levels were highly expressed in the distal colon tissue, which correlated with the observed enhanced contraction. Furthermore, LUB-induced spontaneous contractions in distal colon muscles were reduced by a TRPC4 blocker or EP3 antagonist, indicating that LUB-stimulated EP3 receptor activation may lead to TRPC4 activation and increased intracellular calcium in colonic smooth muscle. Conclusions: These findings suggest that LUB improves mass movement through indirect activation of the TRPC4 channel in the distal colon. The segment-specific action of prokinetic agents like LUB provides compelling evidence for a personalized approach to symptom management, supporting the defecation reflex. [ABSTRACT FROM AUTHOR]

Concussion assessment in adapted and parasport athletes has continued to evolve with growing considerations in parasports, but little is known about vestibular/ocular performance assessment in this sample. To examine baseline performance on the Vestibular/Ocular Motor Screening (VOMS) in collegiate adapted athletes. A secondary objective was to investigate the role of sex, history of concussion, and functional classification on baseline measures. Cross-sectional study. University adapted athletics facility. Fifty-four collegiate adapted athletes (age = 21.19 ± 2.6 years) from multiple institutions' adapted athletics programs across the United States. Adapted athletes completed a baseline VOMS assessment while at the host university for in-season competition and tournaments. Independent variables were sex, history of concussion and functional classification (1.0–4.5 at 0.5 intervals). Vestibular/Ocular Motor Screening performance consisted of pretest symptoms (headache, dizziness, nausea, and fogginess) and postitem (eg, smooth pursuits, saccades) symptom provocation or change from pretest scores. A proportion of 50.9% reported zero symptom provocation on the VOMS, with 72% having no pretest symptoms. No sex differences were noted on the VOMS (P >.05); however, adapted athletes with a history of concussion reported greater VOMS provocation on horizontal saccades (P =.008) than those with no history. Higher functional classifications (2.0–4.5) reported greater provocation on horizontal saccades (P =.010), horizontal and vertical (P =.043 and.048) vestibular/ocular reflex, and vestibular/ocular reflex cancellation (P =.036) than 1.0–1.5 athletes. Our findings provide context for baseline VOMS performance in collegiate adapted athletes and identifying modifiers at baseline. Special consideration is warranted on vestibular and oculomotor assessment in adapted and parasport athletes with a history of concussion and higher functional classifications. [ABSTRACT FROM AUTHOR]

Competitive swimmers complete 50‐m front crawl swimming without breathing or with a limited number of breaths. Breath holding during exercise can trigger diving reflex including bradycardia and diminished active muscle blood flow, whereas oxygen supply to vital organ such as brain is maintained. We hypothesized that swimmers achieving faster time in 50‐m front crawl with limited number of breaths demonstrate a blunted diving reflex of cardiac and active muscle blood flow responses with elevated cerebral perfusion to counteract peripheral and central fatigues. Twenty‐eight competitive swimmers (12 females) underwent a 50‐m front crawl swimming time trial with minimum respiratory interruptions, following which they were categorized into two groups: Fast (n = 13) and Slow (n = 15). Additionally, they performed knee extension exercises with maximal voluntary breath‐ holding, wherein leg blood flow (Doppler ultrasound), cardiac output (Modelflow), heart rate (electrocardiogram), and middle cerebral artery mean blood velocity (transcranial Doppler ultrasound) were evaluated. The pattern of leg blood flow response differed between the two groups (p = 0.031) with the Fast group experiencing a delayed onset of reductions in leg blood flow (p = 0.035). The onset of bradycardia was also delayed in the Fast group (p = 0.014), with this group demonstrating a higher value of the lowest heart rate (between‐trial difference in average: 15.9 [3.73, 28.2] beats/min) and cardiac output (between‐trial difference in median: 2.84 L/min) (both, p ≤ 0.013). Middle cerebral artery mean blood velocity was similar between the groups (all p ≥ 0.112). We show that swimmers with superior performance in 50‐m front crawl swim with limited breaths display a diminished diving reflex. [ABSTRACT FROM AUTHOR]

Oral contraceptive (OC) use can increase resting blood pressure (BP) in females as well as contribute to greater activation of group III/IV afferents during upper body exercise. It is unknown, however, whether an exaggerated BP response occurs during lower limb exercise in OC users. We sought to elucidate the group III/IV afferent activity-mediated BP and heart rate responses while performing lower extremity tasks during early and late follicular phases in young, healthy females. Females not taking OCs (NOC: n = 8; age: 25 ± 4 yr) and those taking OCs (OC: n = 10; age: 23 ± 2 yr) completed a continuous knee extension/flexion passive stretch (mechanoreflex) and cycling exercise with subsystolic cuff occlusion (exercise pressor reflex), which was followed by a 2-min postexercise circulatory occlusion (PECO) (metaboreflex). Data collection occurred on two occasions: once during the early follicular phase (days 1–4) and once during the late follicular phase (days 10–14) of their menstrual cycle (NOC) or during the placebo and active pill phases (OC). Resting mean arterial BP and heart rate were not different between phases in NOC and OC participants (P > 0.05). Hemodynamic responses to metaboreflex, mechanoreflex, and collective exercise pressor reflex activation were not different between phases in both groups (P > 0.05). In conclusion, although OCs are known to increase BP at rest, our findings indicate that neither endogenous nor exogenous (OC) sex hormones modulate BP during large, lower limb muscle exercise with or without group III/IV afferent activation in young, healthy females. NEW & NOTEWORTHY: Sex differences in the cardiovascular response to exercise have been demonstrated and may be dependent on sex hormone levels. Furthermore, oral contraceptives (OCs) have been shown to exaggerate the blood pressure response to upper extremity exercise. The results of this study indicate that neither endogenous nor exogenous (OC) sex hormones modulate BP during lower extremity dynamic exercise or with group III/IV afferent activation in young, healthy females. [ABSTRACT FROM AUTHOR]

There is evidence that astrocytes modulate synaptic transmission in the nucleus tractus solitarius (NTS) interacting with glutamatergic and purinergic mechanisms. Here, using in situ working heart-brainstem preparations, we evaluated the involvement of astrocyte and glutamatergic/purinergic neurotransmission in the processing of autonomic and respiratory pathways in the NTS of control and rats exposed to sustained hypoxia (SH). Baseline autonomic and respiratory activities and the responses to chemoreflex activation (KCN) were evaluated before and after microinjections of fluorocitrate (FCt, an astrocyte metabolic inhibitor), kynurenic acid, and pyridoxalphosphate-6-azophenyl-2′,4′-disulfonate (PPADS) (nonselective antagonists of glutamatergic and purinergic receptors) into the rostral aspect of the caudal commissural NTS. FCt had no effects on the baseline parameters evaluated but reduced the bradycardic response to chemoreflex activation in SH rats. FCt combined with kynurenic acid and PPADS in control rats reduced the baseline duration of expiration, which was attenuated after SH. FCt produced a large increase in PN frequency discharge in control rats, which was reduced after SH, indicating a reduction in the astrocyte modulation after SH. The data show that 1) the bradycardic component of the peripheral chemoreflex is reduced in SH rats after astrocytes inhibition, 2) the inhibition of astrocytes in the presence of double antagonists in the NTS affects the modulation of baseline duration of expiration in control but not in SH rats, and 3) the autonomic and respiratory responses to chemoreflex activation are mediated by glutamatergic and purinergic receptors in the rostral aspect of the caudal commissural NTS. NEW & NOTEWORTHY: Our findings indicate that the neurotransmission of autonomic and respiratory components of the peripheral chemoreflex in the nucleus tractus solitarius (NTS) is mediated by glutamatergic and purinergic mechanisms and reveal a selective involvement of NTS astrocytes in controlling the chemoreflex parasympathetic response in rats exposed to sustained hypoxia (SH) and the baseline duration of expiration mainly in control rats, indicating a selective role for astrocytes modulation in the NTS of control and SH rats. [ABSTRACT FROM AUTHOR]

Background: Neck reflex points (NRPs) are 2 × 6 potentially tender areas of the neck, denominated NRP-C0 to NRP-C7. They are different from muscular trigger points and become tender in response to chronic trigeminal irritation. NRP examination has a high inter-rater reproducibility. We investigated the prevalence of NRPs in two populations to investigate their usefulness as a clinical test for trigeminal irritation. Methods: In total, 165 patients with chronic pain and 431 students were examined for NRP tenderness using a three-level pain scale: absent pain (PI = 0), mild tenderness (PI = 1), or marked tenderness (PI = 2). Results: In patients, we found more tender NRPs than in the student group (p < 0.001), and on the left side, more tender NRPs were found in NRP-C0–C4. Left and right NRPs appeared independently (kappa 0.1–0.4), except for NRP-C7 (kappa 0.55). Females had more tender NRPs (p < 0.001). Tenderness was independent of age, BMI, and pre-existing diseases. Conclusions: NRP tenderness occurs more frequently in patients than in students, independent from potential covariates. Our results, together with previous findings, support the use of NRP examination as a clinical test for chronic silent inflammation of the trigeminal region. These data provide a base for further studies investigating correlations of NRPs with clinical findings. [ABSTRACT FROM AUTHOR]

Effective regulation of emotions is essential in coping with everyday stressors. Although cognitive reappraisal and acceptance are both commonly employed to downregulate negative emotions, they differ in many aspects. Their effectiveness in real‐life situations can also be influenced by prior stress or a person's trait preferences for certain emotion regulation (ER) strategies. In the present study, we compared the effectiveness of both ER strategies in a laboratory setting, while focussing on the effect of stress and trait moderators. Ninety‐eight healthy participants aged 18–40 were randomly divided into three groups with instructions to use reappraisal, acceptance, or nothing while viewing distressing pictures from the IAPS database. Half of the participants in each group underwent a laboratory stressor (socially evaluated cold pressor test) 20–30 min before the ER task. The effectiveness of ER was measured subjectively on the visual analog scale, and by measuring heart rate, skin conductance, and pupil responses. The data show that cognitive reappraisal lowered subjectively experienced negative emotion, while acceptance did not. These group differences were however not supported by psychophysiological indicators. Secondly, although the laboratory stressor elicited cortisol stress responses in our participants, we did not find any effect on ER. Furthermore, the data has not supported the moderation effect by trait reappraisal and acceptance. The present findings show that deliberate usage of ER strategies when viewing emotionally charged pictures leads to a decrease in experienced emotion. On the other hand, the effects of stress and trait moderators were not supported, therefore they may be smaller and more variable than expected. [ABSTRACT FROM AUTHOR]

Recognition memory, the ability to recognise previously encountered information, correlates with pupil diameter changes during the recognition period. This physiological response, known as the pupil old/new effect, generally reflects the variation in pupil dilation when encountering previously studied (old) stimuli compared to new stimuli. To develop a more precise understanding of the pupil old/new effect, we conducted a meta-analysis of 17 eye-tracking experiments (across 12 articles spanning from 2008 to 2023) involving 560 healthy adults with a mean age of 22.31 years. Analysis of publication bias showed a rather low risk of bias in the selected articles. The main meta-analysis revealed a significant and large pooled pupil old/new effect (Cohen's dz = 0.73, 95% CI [0.50, 0.95]). Further analysis of moderators showed that the number of participants included in the experiments and the criteria for selecting trials (only correct trials vs. all trials) had a significant impact on the meta-analytic results. In general, the analyses revealed a robust pupil old/new effect across all selected articles. This finding underscores its potential utility as a marker of recognition memory across different stimuli type, and various experimental designs. [ABSTRACT FROM AUTHOR]

Local vibration (LV) mainly stimulates primary afferents (Ia) and can induce a tonic vibration reflex (TVR) and an illusion of movement. This study aimed to evaluate the effect of these two phenomena on maximal voluntary isometric contraction (MVIC) capacity. LV (80 Hz) was applied to the wrist flexor muscles in two randomized experiments for 6 min. LV conditions were adjusted to promote either TVR (visual focus on the vibrated wrist) or ILLUSION [hand hidden, visual focus on electromyographic activity of the flexor carpi radialis muscle (FCR)]. Mechanical and electromyographic (EMG) responses of the FCR and extensor carpi radialis muscles were recorded during MVIC in flexion and extension and during electrically evoked contractions at supramaximal intensity. Measurements were performed before (10 min and just before) and after (0 and 30 min) LV protocol. An increase in FCR EMG was observed during LV in the TVR condition (+340%) compared with the illusion condition (P = 0.003). In contrast, the movement illusion was greater in the ILLUSION condition (assessed through subjective scales) (P = 0.004). MVIC was reduced in flexion only after the TVR condition (≈ − 7 % , all P < 0.034). Moreover, the decrease in force was correlated with the amount of TVR recorded on the FCR muscle (r = −0.64, P = 0.005). Although potentiated doublets of each muscle did not evolve differently between conditions, a decrease was observed between the first and the last measure. In conclusion, when conducting research to assess maximal strength, it is necessary to have better control and reporting of the phenomena induced during LV. NEW & NOTEWORTHY: The maximal force production of the vibrated muscle is reduced after 6 min of LV only in TVR condition. Furthermore, the amount of TVR is negatively correlated with this force decrease. When measuring the effects of LV on maximal force production, it is important to control and report any phenomena induced during vibration, such as TVR or movement illusion, which can be achieved by recording EMG activity of vibrated muscle and quantifying illusion. [ABSTRACT FROM AUTHOR]

In many languages, a subject/non-subject Ā-extraction asymmetry can be observed: While non-subject extraction is unproblematic, long extraction of the subject requires repair strategies. This phenomenon is known as the that-trace effect. Two broad types of approaches to this effect have been proposed in the literature: (a) structural accounts that prohibit subject extraction in the syntax; (b) surface-oriented PF accounts according to which nothing blocks long subject movement in the syntax, but a surface filter prohibits the output string where a trace follows the complementizer. In this paper, we argue for a syntactic cause of the effect in Igbo (Benue-Congo, Nigeria). The empirical evidence centers around the distribution of resumptive pronouns in the language. We show that Igbo has all the ingredients required for a PF approach to the that-trace effect (viz., long Ā-movement and trace spell-out); nevertheless, it does not apply them to enable long subject extraction but rather resorts to prolepsis (among other strategies). Further evidence against a PF account comes from the impossibility of short subject extraction. Finally, we provide evidence from subextraction from subjects for an antilocality component underlying the subject extraction restriction in Igbo. [ABSTRACT FROM AUTHOR]

Background: Local anaesthesia in dental procedures is generally safe, although the occurrence of transient bradycardia (TB) has occasionally been reported. TB is often associated with two reflexes, the trigeminal cardiac reflex (TCR) and the vasovagal reflex (VVR) and is characterised by a rapid decrease in heart rate (HR) and blood pressure (BP). The prevalence of TCR is considered low, and its predictors have not been thoroughly investigated, although an association with the gag reflex has been suggested in recent years. Methods: This prospective study assessed TB occurrence during local anaesthesia and its potential associated factors. A comprehensive questionnaire was used to categorise discomforts during dental treatment, and various anxiety scales were used to measure patients' anxiety levels. We investigated HR variability during local anaesthesia administration under sedation and the association between the incidence of TB and gag reflex. Subsequently, logistic regression analysis was performed to assess factors associated with TB occurrence. Results: The prospective analysis included 188 patients of 234 initial patients. The analysis revealed a high TB incidence rate of 41% during local anaesthesia administration under sedation. No severe hypotensive events occurred, indicating a relatively benign nature of TB during local anaesthesia. TB occurrence was significantly higher in the group of patients with the gag reflex. Further analysis revealed that both gag reflex and trait anxiety were significantly associated with TB occurrence, whereas dental phobia did not directly correlate with TB. Conclusion: This study highlights the prominent occurrence of TB during local anaesthesia in dental treatment, which is primarily attributed to TCR activation. The identification of gag reflex and trait anxiety as independent factors associated with TB development may pave the way for TB prevention measures. Further research is required to clarify the mechanisms of TCR and perform safer dental procedures under sedation. Future studies should also aim to elucidate the precise mechanisms underlying TB during local anaesthesia through direct measurements of neural activity. A better understanding of TB in dentistry is crucial for improving patient safety and optimising dental practice protocols. [ABSTRACT FROM AUTHOR]

This review delves into the complexities of insect behaviour, particularly the interplay between innate and learned behaviours and the factors influencing learning in organisms. Innate behaviours, such as reflex actions and fixed action patterns are genetically hard-wired and manifest without prior experience. In contrast, learned behaviours, acquired through experience, include habituation, imprinting, classical conditioning, and operant conditioning. The propensity to learn is influenced by environmental variability, with organisms benefiting from learning in environments with predictable patterns. The study explores the specialization versus generalization in behaviour, highlighting how coevolution and mutualism drive specialization in certain organisms, but also how this can lead to co-extinction due to interdependence. Conversely, generalists may exhibit better learning abilities in environments with greater variability. The role of lifespan, body size and the size of mushroom bodies in the brain, which store sensory memories, are also considered, suggesting that larger organisms with longer lifespans might have higher learning capacities. However, smaller organisms, like hover flies, demonstrate that learning ability is not solely dependent on size or lifespan. The social brain hypothesis is examined, proposing that social insects may have advanced learning abilities due to task specialization, but solitary insects, performing multiple tasks, may be more adept learners overall. [ABSTRACT FROM AUTHOR]

In Autism Spectrum Disorder (ASD) children feeding problems can be categorized as behavioural feeding disorders including food refusal, choking, gagging, expulsion and sensory-based feeding problems such as textural aversions. The oral stimulation increases oral motor organization improve muscle contractility as a result increases oral intake. Sensory characteristics of food such as taste, texture and aroma have effects on food acceptance. We present a case of 3.3 year old male with ASD having feeding issues such as refusal to consume food and would spit when tried to feed him forcefully and accepting only liquids in small quantities as compared to earlier since 55 days. The outcome measure used was Sensory Profile (Dunn, 1999) and Pediatric Eating Assessment Tool (PediEAT). Combined oral motor stimulation and aroma therapy was provided to the child for developing successful feeding skill. Conclusion: From the above pilot study it may be concluded that combination of oro-motor stimulation and aroma therapy is an effective intervention in decreasing oral sensory issues and thus improving feeding skills in children with ASD. [ABSTRACT FROM AUTHOR]

Ivane Beritashvili has been regarded as an “anti-Pavlovian” for nearly a century. One respect in which Beritashvili is said to be anti-Pavlovian is in granting an explanatory role to subjective mental states in his doctrine of image-driven behavior. In this article, I aim to problematize the anti-Pavlovian assessment and argue that Beritashvili did not deviate from Pavlovian scientific norms, minor points of theoretical and methodological differences between them notwithstanding. Furthermore, several respects in which Beritashvili is claimed to be anti-Pavlovian are ways in which he resembles Pavlov. Turning my attention to Beritashvili’s critics in the Soviet Union, those responsible for his censure, I argue that it is the critique of Beritashvili that runs counter to the norms Pavlov embraced. I contest the claim that his alleged deviations from Pavlovian orthodoxy justify classification as anti-Pavlovian in a sense that is either historically accurate or philosophically interesting, and submit that the grounds on which Beritashvili is derided as anti-Pavlovian would also justify labeling Pavlov himself as anti-Pavlovian. Informed by the case of Beritashvili and others who were politically persecuted for their scientific work in the Soviet Union, I conclude with reflections on science, politics, and the intrusion of the latter in the former. [ABSTRACT FROM AUTHOR]

Aim: A clinical study was performed to test the usability of a smartphone eyescanning app at a needle exchange facility to detect drug use to support therapy. Methods: The study recruited 24 subjects who visited the facility one to three times, making a total of 40 visits. During each visit the subjects underwent testing for non-convergence (NC), nystagmus (NY), and pupillary light reflex (PLR) using a smartphone-based eHealth system. The collected eye data were transformed into key features that represent eye characteristics. During each visit, a time-line follow-back interview on recent drug use and a usability questionnaire were completed. Results: Technical usability of the smartphone eye-scanning app was good for PLR and NC, where key features were generated in 82%-91% of the cases. For NY, only 60% succeeded due to cognitive problems to follow instructions. In most cases, subjects were under the influence of drugs when participating in the tests, with an average of 2.4 different drugs ingested within the last 24 h. The key features from PLR could distinguish use of opioids from central stimulants. The usability questionnaire results indicate that 23 of the 24 subjects could perform the eye-scanning by themselves after a short training, even when under severe influence of drugs. The caregiver assessed that 20 out of the 24 challenging subjects could potentially perform these tests in an indoors, home-like environment. Conclusions: Smartphone-based eye-scanning is functional in a patient population with heavy drug use, also when under the influence of drugs. The use of central stimulants can be distinguished from the use of opioids. [ABSTRACT FROM AUTHOR]

Key points We tested the hypothesis that in human hypertension, an increased tonicity/sensitivity of the peripheral chemoreflex causes a sympathetically mediated restraint of nutritive blood flow to the exercising muscles. Fourteen patients with treated hypertension (age 69 ± 11 years, 136 ± 12/80 ± 11 mmHg; mean ± SD) were studied under conditions of intravenous 0.9% saline (control) and low‐dose dopamine (2 µg kg−1 min−1) to inhibit the peripheral chemoreflex, at baseline, during isocapnic hypoxic rebreathing and during rhythmic handgrip exercise (3 min, 50% maximum voluntary contraction). At baseline, dopamine did not change mean blood pressure (95 ± 10 vs. 98 ± 10 mmHg, P = 0.155) but increased brachial artery blood flow (59 ± 20 vs. 48 ± 16 ml min−1, P = 0.030) and vascular conductance (0.565 ± 0.246 vs. 0.483 ± 0.160 ml min−1 mmHg−1; P = 0.039). Dopamine attenuated the increase in mean blood pressure (∆3 ± 4 vs. ∆8 ± 6 mmHg, P = 0.007) to isocapnic hypoxic rebreathing and reduced peripheral chemoreflex sensitivity by 28 ± 37% (P = 0.044). Rhythmic handgrip exercise induced increases in brachial artery blood flow and vascular conductance (both P < 0.05 vs. rest after 45 s) that were greater with dopamine than saline (e.g. Δ76 ± 54 vs. Δ60 ± 43 ml min−1 and Δ0.730 ± 0.440 vs. Δ0.570 ± 0.424 ml min−1 mmHg−1, respectively, at 60 s; main effect of condition both P < 0.0001). Our results indicate that the peripheral chemoreflex is tonically active at rest and restrains the blood flow and vascular conductance increases to exercise in treated human hypertension. It was hypothesised that in human hypertension, an increased tonicity/sensitivity of the peripheral chemoreflex causes a sympathetically mediated restraint of nutritive blood flow to the exercising muscles. Treated patients with hypertension (n = 14) were studied under conditions of intravenous 0.9% saline (control) and low‐dose dopamine (2 µg kg−1 min−1) to inhibit the peripheral chemoreflex. Low‐dose dopamine reduced resting ventilation and peripheral chemoreflex sensitivity, and while mean blood pressure was unchanged, brachial artery blood flow and vascular conductance were increased. Low‐dose dopamine augmented the brachial artery blood flow and vascular conductance responses to rhythmic handgrip. These findings indicate that the peripheral chemoreflex is tonically active at rest and restrains the blood flow, and vascular conductance increases to exercise in treated human hypertension. [ABSTRACT FROM AUTHOR]

Endothelin‐1 (ET‐1) and its receptors are linked to increases in sensitivity of the chemoreceptors to hypoxic stress and the development of hypertension in preclinical models. We hypothesized ET receptor antagonism would lower resting blood pressure (BP) as well as the acute BP response to chemoreflex stress. Twenty‐four men (31 ± 5 years, 26 ± 3 kg/m2) completed two study visits (control, bosentan). On each visit, BP was assessed under three conditions: (1) normoxia (FiO2 0.21), (2) chemoreflex excitation via hypoxia (FiO2 0.05–0.21), (3) chemoreflex inhibition via hyperoxia (FiO2 1.00). Bosentan increased plasma ET‐1 (0.94 ± 0.90 to 1.27 ± 0.62 pg/mL, p = 0.004), supporting receptor blockade. Resting diastolic (73 ± 5 to 69 ± 7 mmHg, p = 0.007) and mean (93 ± 7 to 88 ± 7 mmHg, p = 0.005) BP were reduced following bosentan compared to control with no change in systolic BP (p = 0.507). The mean BP response to both acute hypoxia (−0.48 ± 0.38 to −0.25 ± 0.31 mmHg/%, p = 0.004) and hyperoxia (area under the curve −93 ± 108 to −27 ± 66 AU, p = 0.018) were attenuated following bosentan. Acute ET receptor inhibition attenuates the rise in BP during chemoreflex excitation as well as the fall in BP during chemoreflex inhibition in healthy young men. These data support a role for ET‐1 in control of resting BP, possibly through a chemoreceptor‐mediated mechanism. [ABSTRACT FROM AUTHOR]

Purpose: Cough reflex testing (CRT) is an adjunct to the clinical swallowing evaluation (CSE), providing information on patients' risk of silent aspiration. CRT has been shown to influence diet recommendations, but in previous work, the many varied patient characteristics are not controlled. Therefore, the specific role of CRT results in these decisions remains unclear as this relationship has not been directly assessed. Method: An online survey was sent to speech language therapists working in dysphagia. Two patient cases were presented that differed only by the presence of risk factors for the development of aspiration pneumonia. For each patient case, there were three assessment scenarios: CSE information only, CSE information with a "pass" CRT result, and CSE information with a "fail" CRT result. Clinicians outlined their patient management plans for each of the six scenarios. Results: Ninety-seven data sets were used in the final analysis. A "fail" result was found to lead to the most restrictive patient management. Decisions made when provided with only CSE information were very similar to decisions made for a CSE with a "pass" result. Aspiration pneumonia risk factors were shown to influence decision making, with the low-risk patient more likely to be recommended a less restrictive diet. Conclusions: When information was available regarding silent aspiration risk, clinicians factored the results into their decision making. However, in the absence of a CRT result, airway sensation was assumed to be intact in the absence of information. This finding warrants further investigation given the impact this assumption may have on a patient's pulmonary health. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine whether providing realistic auditory or somatosensory cues to spatial location would affect measures of vestibulo-ocular reflex gain in a rotary chair testing (RCT) context. Method: This was a fully within-subject design. Thirty young adults age 18-30 years (16 men, 14 women by self-identification) completed sinusoidal harmonic acceleration testing in a rotary chair under five different conditions, each at three rotational frequencies (0.01, 0.08, and 0.32 Hz). We recorded gain as the ratio of the amplitude of eye movement to chair movement using standard clinical procedures. The five conditions consisted of two without spatial information (silence, tasking via headphones) and three with either auditory (refrigerator sound, tasking via speaker) or somatosensory (fan) information. Two of the conditions also included mental tasking (tasking via headphones, tasking via speaker) and differed only in terms of the spatial localizability of the verbal instructions. We used linear mixed-effects modeling to compare pairs of conditions, specifically examining the effects of the availability of spatial cues in the environment. This study was preregistered on Open Science Framework (https://osf.io/2gqcf/). Results: Results showed significant effects of frequency in all conditions (p < .05), but the only pairs of conditions that were significantly different were those including tasking in one condition but not the other (e.g., tasking via headphones vs. silence). Post hoc equivalence testing showed that the lack of significance in the other comparisons could be confirmed as not meaningfully different. Conclusions: These findings suggest that the presence of externally localizable sensory information, whether auditory or somatosensory, does not affect measures of gain in RCT to any relevant degree. However, these findings also contribute to the increasing body of evidence suggesting that mental engagement ("tasking") does increase gain whether or not it is provided via localizable instructions. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to determine the normative vestibulo- ocular reflex gain output values of the computerized rotational head impulse test (crHIT) with stationary visual targets (earth bound) in healthy participants in each decade age band of life: 10-19, 20-29, 30-39, 40-49, 50-59, 60-69, and 70+ years. Method: Seventy-seven community-dwelling participants (10-85 years of age) with normal lateral semicircular canal (SCC) functioning and no symptoms or history of vestibular dysfunction were recruited through convenience sampling and assessed with the crHIT using stationary targets. These participants were assessed using two standard protocols in a randomized order. Results: Results from 77 participants (Mage = 46 years; 43 women, 34 men) were analyzed. Pearson's correlation coefficient and simple linear regression indicated a statistically significant relationship between crHIT gain output and age (p >.05) for right gain, 1030°/s², and left gain, 1005°/s². Although a statistically significant relationship was found, the slope was minor, demonstrating that the clinical effect of age on crHIT gain output was insignificant. Furthermore, no statistically significant relationship exists between crHIT gain output and gender (p > .05). Age-dependent normative data were calculated using the 2.5th and 97.5th confidence interval (CI) percentile method. The responses of angular vestibulo-ocular reflex (aVOR) gain values for crHIT are expected to occur within the range for lower limit reference interval (RI) of 0.85-0.9 and upper limit RI of 1.11-1.18 for 1030°/s² and lower limit RI of 0.86-0.92 and upper limit RI of 1.13-1.16 for 1005°/s² .It can be expected that 90% CI of the population with normal lateral SCC function- ing will have aVOR gain values that fall within this range. Conclusion: Despite a statistically significant relationship that exists with aVOR gain output and age, the changes are minor, declining by 0.0088 units per 10 years, justifying the same normative data for all decade age bands. [ABSTRACT FROM AUTHOR]

Objectives: To investigate roles of brain carbon monoxide (CO), an endogenous gasotransmitter, in regulation of the rat micturition reflex. Methods: In urethane‐anesthetized (0.8 g/kg, ip) male rats, evaluation of urodynamic parameters was started 1 h before intracerebroventricular administration of CORM‐3 (CO donor) or ZnPP (non‐selective inhibitor of heme oxygenase, a CO producing enzyme) and continued for 2 h after the administration. We also investigated effects of centrally pretreated SR95531 (GABAA receptor antagonist) or SCH50911 (GABAB receptor antagonist) on the CORM‐3‐induced response. Results: CORM‐3 significantly prolonged intercontraction intervals (ICIs) without changing maximal voiding pressure (MVP), while ZnPP significantly shortened ICI and reduced single‐voided volume and bladder capacity without affecting MVP, post‐voided residual volume, or voiding efficiency. The ZnPP‐induced ICI shortening was reversed by CORM‐3. The CORM‐3‐induced ICI prolongation was significantly attenuated by centrally pretreated SR95531 or SCH50911, respectively. Conclusions: Brain CO can suppress the rat micturition reflex through brain γ‐aminobutyric acid (GABA) receptors. [ABSTRACT FROM AUTHOR]

Context Increasing numbers of patients and caregivers are requesting transition to blenderized tube feeding. There is a lack of systematic reviews addressing the outcomes of blenderized tube feeding. Objective The aim was to evaluate the association of blenderized tube feeding on feeding tolerance in enterally fed pediatric patients. Data Sources A literature search for articles from 2012–2022 using PubMed, Medline, Embase, and CINAHL yielded 78 articles. Data Extraction A description and evaluation of the study's sample, purpose, and results were summarized for 9 studies using the Academy of Nutrition and Dietetics Evidence Analysis Library Worksheet. Data Analysis Nine studies were evaluated using the Evidence Analysis Library Quality Criteria checklist. Conclusions Studies demonstrated an improvement in vomiting (n = 7), gagging/retching and heartburn (n = 6), abdominal pain/upset and distension (n = 3), and diarrhea (n = 6) with blenderized tube feeding. The outcomes of blenderized tube feeding on gas (n = 5) and constipation (n = 9) are variable and remain unclear. Systematic Review Registration PROSPERO registration no. CRD42022369247. [ABSTRACT FROM AUTHOR]

(1) Background: Contracting diseases or being exposed to adverse environmental factors in the first year of life may impair the development of body posture and motor coordination. The purpose of this study was to evaluate the correlation between data on the speed of passive verticalization, the number of risk factors and the quality of development in the first year of life, and the results of the functional examination of these individuals in adolescence. (2) Methods: Two groups of 60 volunteers, aged 9–14 years, were examined by performing functional tests and the retrospective analysis of their development up to the age of 1 year. The first group consisted of patients diagnosed with postural defects. The control group consisted of healthy people of the same age who volunteered for this study. (3) Results: Statistical analysis showed statistically significant differences between groups in terms of posture (p = 0.001), motor coordination (p = 0.001), and accumulated primitive reflexes (p = 0.001), as well as a high correlation between these disorders and the quality of development in the first year of life. In the first group, for the ages of 3–6 months (r = 0.96; p = 0.001), 6–9 months (r = 0.871; p = 0.001), and 9–12 months (r = 0.806; p = 0.001), no significant correlations were found with the age of 0–3 months. In the second group, the results were as follows: 0–3 months (r = 0.748; p = 0.001), 3–6 months (r = 0.862 p = 0.001), 6–9 months (r = 0.698; p = 0.001), and 9–12 months (r = 0.740; p = 0.001). In the group of adolescents with posture defects, we observed an earlier time of passive verticalization and sitting, as well as more frequent use of loungers, seats, and walkers (p = 0.026). (4) Conclusions: The analysis of this study's data indicates that the development of body posture and motor coordination may be impaired due to accelerated and passive verticalization in the first year of life. [ABSTRACT FROM AUTHOR]

BackgroundObjectiveMethodsResultsConclusionDiabetic Peripheral Neuropathy (DPN) impairs balance due to sensory loss, proprioceptive deficits, muscle weakness, altered gait, and delayed reflexes. Targeted aerobic and balance training seem promising to mitigate these issues. However, the exact content of a recommended training regime is yet to be determined.To delineate and synthesise balance training content and efficacy for people with DPN.The literature search was conducted on PubMed and Embase in accordance with the PRISMA-checklist. Last search was performed on April 29, 2024. Inclusion criteria were established using the PICO-framework. Methodological quality was assessed using the TESTEX Scale. Meta-analyses were exclusively applied to studies featuring a passive control group.A total of 2007 articles were identified. Twelve studies were included in the qualitative synthesis. Seven studies were included in the meta-analyses. Two studies were of high quality. Most studies reported the frequency, session time, duration, and setting of balance training, while none reported the intensity. The meta-analyses showed a standardized mean difference in favor of balance training compared to passive control for One-Legged Stance (openeyes) (0.89[0.5,1.28]), One-Legged Stance (closed eyes) (1.48[0.36, 2.60]), Postural sway (−0.71[−1.04, −0,37]), Timed Up and Go(−0.94[−1.78, −0.10]), and Berg Balance Scale (2.26[0.48, 4.05]), respectively.Studies are few and generally of low methodological quality. The content of balance training interventions is minimally described, especially concerning the applied intensity. However, balance training does seem to improve balance outcomes in people with DPN, but given the methodological limitations, interpretation must be cautious. [ABSTRACT FROM AUTHOR]

This paper explores the deliberate use of temporal ambiguities and discrepancies in Defoe’s The Fortunate Mistress to convey the disturbed retrospections of a guilt/shame-ridden narrator and the relationship between moral injury and temporal narrative techniques, highlighting the gendered nature of the fictional narrator’s moral injury. Drawing on Pederson’s model of moral injury in literature, which deals with perpetrator trauma, it argues that the narrator’s moral injury and its temporal reflexes in the narrative serve to reinforce the thematic and narratorial (re)iterations of female trauma and subsequent moral injury. Ultimately, this analysis provides compelling evidence of Defoe’s astute understanding of the psychology of shame, guilt, and narration, as well as his preference for psychological realism over traditional sequential narration, as he crafts stories that explore the human and psychological consequences of traumatic experiences. [ABSTRACT FROM AUTHOR]

The nociceptive withdrawal reflex (NWR) is a protective limb withdrawal response triggered by painful stimuli, used to assess spinal nociceptive excitability. Conventionally, the NWR is understood as having two reflex responses: a short-latency Aβ-mediated response, considered tactile, and a longer-latency Aδ-mediated response, considered nociceptive. However, nociceptors with conduction velocities similar to Aβ tactile afferents have been identified in human skin. In this study, we investigated the effect of a preferential conduction block of Aβ fibers on pain perception and NWR signaling evoked by intradermal electrical stimulation in healthy participants. We recorded a total of 198 NWR responses in the intact condition, and no dual reflex responses occurred within our latency bandwidth (50–150 ms). The current required to elicit the NWR was higher than the perceptual pain threshold, indicating that NWR did not occur before pain was felt. In the block condition, when the Aβ-mediated tuning fork sensation was lost while Aδ-mediated nonpainful cooling was still detectable (albeit reduced), we observed that the reflex was abolished. Further, short-latency electrical pain intensity at pre-block thresholds was greatly reduced, with any residual pain sensation having a longer latency. Although electrical pain was unaffected at suprathreshold current, the reflex could not be evoked despite a two-fold increase in the pre-block current and a five-fold increase in the pre-block pulse duration. These observations lend support to the possible involvement of Aβ-fiber inputs in pain and reflex signaling. [ABSTRACT FROM AUTHOR]

The proprioceptive sensory reflex (e.g. stretch reflex) plays an important role in perturbed arm stabilization. Neuroscience studies have widely identified the heteronymous spinal pathways in the human arm, which may contribute to stabilized movement. However, their interactions in living systems pose challenges for specific functional investigations through human experiments. Therefore, this paper concentrates on understanding the effects of two heteronymous pathways, specifically the transmission of monoarticular sensory feedback to innervate biarticular muscles, using the robot. We replicate specific reflex pathways on a 2-DoF musculoskeletal robot equipped with pneumatic artificial muscles. By adjusting the weights of pathways, which resemble human motor control, we evaluate our robot arm performance under the forearm and upper arm disturbances. The outcomes validate their effects on regulating biarticular muscle stimulation, resulting in more stable and coordinated end-effectory trajectories. These reflexive pathways provide insights into the mechanisms underlying human arm perturbations and stabilization. Additionally, the proposed bioinspired system with applicable reflex weights holds great potential in the adaptive response of musculoskeletal robots, guiding robotics researchers in controller design. [ABSTRACT FROM AUTHOR]

ObjectiveMethodsResultsConclusionTo present marginal reflex distance (MRD-1) outcomes based on intra-operative quantification of levator aponeurosis advancement.Forty-eight patients with unilateral aponeurotic ptosis underwent anterior levator aponeurosis advancement. Distance of advancement intra-operatively was compared with MRD-1 outcomes at the immediate postoperative sitting, approximately 1 week, and 1 month period. Surgical success was defined as a symmetric MRD-1 or an MRD-1 within 1 millimeter of the contralateral eyelid.Most MRD-1 exhibited the following trends: 1) initial decrease at about 1 week and increase at 1 month (n = 11), 2) initial increase at about 1 week with levelling at 1 month (n = 8), and 3) increasing through time (n = 7). Success rate significantly decreased through time (p = .0464). The change in proportion of successful and failed surgeries was insignificant. Surgical revision rate was 10.4%.Levator aponeurosis advancement distances do not correlate with MRD-1 outcomes linearly. MRD-1 exhibited stability over time with a satisfactory success rate at 1 month. [ABSTRACT FROM AUTHOR]

Background: Acute and complete unilateral vestibular deafferentation induces a significant change in ipsilateral vestibuloocular reflex gain, making the patient unable to stabilize gaze during active or passive head movements. This inability creates the illusion that the visual environment is moving, resulting in persistent visual discomfort during rapid angular or linear acceleration of the head. This is known as oscillopsia. Our objective was to understand if the spontaneous sensation of oscillopsias after complete unilateral vestibular deafferentation by vestibular neurotomy at 5 days (D5) and at 3 months (M3) is correlated with the loss of vestibuloocular reflex gain and dynamic visual acuity. Methods: Retrospective cohort study was conducted in an otolaryngology tertiary care center (2019-2022) on patients with complete unilateral vestibular loss by vestibular neurotomy. They were divided into 2 groups according to the presence (group G1) or absence (group G2) of a spontaneous complaint of oscillopsia assessed at M3. Severity of oscillopsias evaluated by Oscillopsia Severity Questionnaire. Vestibuloocular reflex gain based on video head impulse test (vHIT) and the dynamic visual acuity were measured for each group at D5 and M3. Categorical variables were compared using χ2 test and quantitative variables using the nonparametric Wilcoxon-Mann-Whitney test. Results: All patients have a complete vestibular deafferentation at D5 and M3. At D5 (G1 = 8 patients, G2 = 5 patients), there is no significant difference for ipsilateral and contralateral vestibuloocular reflex gains and dynamic visual acuity losses. The Oscillopsia Severity Questionnaire was 2.68 ± 1.03 in G1 and 1.23 ± 1.03 in G2 (P <.05). At M3 (G1 = 9 patients, G2 = 6 patients), there is no significant difference between groups for epidemiologic and clinical data and for vestibuloocular reflex and dynamic visual acuity losses. The Oscillopsia Severity Questionnaire was 2.10 ± 0.63 in G1 and 1.24 ± 0.28 in G2 (P <.05). Conclusions: The spontaneous disabling sensation of oscillopsia after complete unilateral vestibular loss is well assessed by the Oscillopsia Severity Questionnaire but cannot be explained by objective vestibular tests assessing vestibuloocular reflex gain (vHIT) or dynamic visual acuity loss at D5 or M3. Further studies are needed to measure the sensation of oscillopsia under real-life conditions and to identify the factors responsible for its persistence. Trial registration: Retrospectively registered. [ABSTRACT FROM AUTHOR]

A 62-year-old woman had 6 months of proximal weakness, fatigue and occasional diplopia, symptoms normally suggesting myasthenia gravis or inflammatory myopathy. Postexercise reflex facilitation is a bedside clinical sign that points to a diagnosis of the rarer alternative, Lambert-Eaton myasthenic syndrome (LEMS). We confirmed this diagnosis using electrodiagnostic short exercise testing and serum assay for voltage-gated calcium channel antibodies. Further investigation identified a small cell neuroendocrine carcinoma of the gallbladder, not previously associated with LEMS. Postexercise reflex facilitation is an important bedside clinical finding that helps clinicians to distinguish LEMS from its mimics. [ABSTRACT FROM AUTHOR]

• Involvement of exogenous factors in the development of VVR remains unknown. • Meteorological conditions may play a role in blood donation-associated VVR onset. • Large diurnal temperature range may be a major risk factor. [ABSTRACT FROM AUTHOR]