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Summary: Surgical resection of intramedullary spinal cord tumors carries significant risks of neurologic deficits, especially in cases of infiltrative tumors. In pediatric patients, this type of surgery may be associated with a high risk of poor neurologic outcome. Intraoperative neurophysiologic monitoring has been adopted as part of the clinical routine by many centers as a useful adjunct for intraoperative assessment of neurologic integrity. To what extent intraoperative neurophysiologic mapping strategies may further support intraoperative decision-making is still a matter of debate. Here, we report on a small cohort of five pediatric patients in whom mapping with the double-train paradigm was used to identify the dorsal column and corticospinal tract and to guide the surgical resection. We also discuss the possible benefits and challenges regarding the available literature., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 by the American Clinical Neurophysiology Society.)

Hospice research with Hispanics mostly focuses on cultural barriers. Mindful of social justice and structural violence, we used critical grounded theory in a postcolonial theory framework to develop a grounded theory of hospice decision making in US Mexicans with terminal cancer. Findings suggest that hospice avoidance is predicted by mistrust, rather than culture, whereas hospice enrollers felt a sense of belonging. Cultural accommodation may do little to mitigate hospice avoidance rooted in discrimination-fueled mistrust. Future research with nondominant populations should employ research designs mitigating Eurocentric biases. Policy makers should consider concurrent therapy for nondominant populations with low trust in the health care system., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: A central fatigue theory proposes that force output during fatiguing exercise is limited to maintain homeostasis. The self-awareness of the body's homeostatic state is known as interoception. Brain regions thought to play a role in interoception, such as the insular and orbital frontal cortex, have been proposed as sites for the upstream regulation of fatiguing exercise. Methylphenidate (MPH) can improve force output during exercise and may alter central processes during fatiguing exercise. However, the ergogenic neural underpinnings of MPH are unknown. This study examines the effect of MPH on force output and brain functional connectivity during a muscle-fatiguing handgrip task., Methods: In a double-blind, crossover design, 15 subjects (mean age = 28.4 ± 5.2; 9 males and 6 females) ingested MPH or placebo before performing a muscle-fatiguing handgrip task during functional magnetic resonance imaging. We examined force output and brain connectivity (psychophysiological interactions and functional connectivity) throughout the task as well as in the few seconds just before releasing the grip dynamometer (i.e., pretask failure)., Results: We show that in the MPH condition, subjects increased grip force throughout but not during pretask failure. Brain connectivity was altered throughout the task between the insular and the hand motor cortex, as well as between the insular and the orbital frontal cortex. There were no differences in connectivity during pretask failure., Conclusion: For the first time, we show that brain connectivity can be influenced by MPH during muscle-fatiguing exercise. This study provides additional support that the CNS acts to regulate motor drive subservient to homeostasis.

Objective: Based on recent findings of microhemorrhages (MHs) in the corpus callosum (CC) in 3 individuals after nonfatal high-altitude cerebral edema (HACE), we hypothesized that hemosiderin depositions in the brain after high-altitude exposure are specific for HACE and remain detectable over many years., Methods: This was a cross-sectional study involving 37 mountaineers in 4 groups: 10 had experienced HACE, 8 high-altitude pulmonary edema, 11 severe acute mountain sickness, and 8 had climbed to altitudes ≥6,962 m without developing any high-altitude illness. HACE was defined as ataxia necessitating assistance with walking and/or decreased consciousness. Within <1 to 38 months after the qualifying incident, MRI of the brain was performed using a 3-tesla scanner and high-resolution susceptibility-weighted magnetic resonance sequences for detection of hemosiderin depositions, which were quantified by a score., Results: Unequivocal MHs located in the splenium of the CC were found in 8 subjects and questionable MHs were found in 2 subjects 1 to 35 months after HACE. They were located outside the CC in 5 more severe cases. MHs remained unchanged in those reexamined after 12 to 50 months. A few unequivocal MHs in the splenium of the CC were found in one subject after severe acute mountain sickness, while one subject with high-altitude pulmonary edema and 2 of the extreme altitude climbers had questionable lesions. In all other subjects, MHs were unequivocally absent., Conclusions: MHs detectable by susceptibility-weighted MRI predominantly in the splenium of the CC are long-lasting footprints of HACE.

Maximum-speed movements have been suggested to put maximum neural control demands on the primary motor cortex; hence, we are asking how primary motor cortex function changes to enable enhanced maximum movement rates induced by long-lasting practice. Cortical function was assessed by recording task-related spectral electroencephalogram alpha-power. Low-resolution brain electromagnetic tomography was used to localize intracortical neuronal sources. The main result is a decrease in neural activity in the left hemisphere (ipsilateral to trained hand) from pretraining to posttraining, whereas right hemispheric activity remained constant across training. This likely reflects the initially limited capacity of the right hemisphere to control demanding left-hand movements, but also highlights its ability to become more efficient with training, indicated by reduced involvement of the left primary motor cortex after training.

Using functional magnetic imaging techniques and neuropsychological tests, we studied a young male musician (C.S.) who performs at a professional level both on a regular piano keyboard and on a reverse keyboard (reversed right to left). The participant was left-handed, had left dominance for language but, remarkably, right dominance for the control of piano playing on both keyboards. With respect to music perception, C.S. showed left-sided activation dominance within the left superior temporal sulcus, which is normally associated with higher order auditory processing and right-sided activations in the secondary sensory cortex extending into the supramarginal gyrus. We suggest that C.S.'s pattern of functional asymmetry, characterized by audio-motor control using a right-sided network, could be a factor in his exceptional piano-playing ability on both the standard and reversed keyboard.

Applying functional magnetic resonance imaging techniques, hemodynamic responses elicited by slowly flashing checkerboards (0.25 Hz) were measured both before and after a block of rapidly presented checkerboards (9 Hz -- a 'photic tetanus') was delivered. It has been shown previously, using electroencephalography, that this photic tetanus potentiates components of the visual-evoked potential. In the present study, hemodynamic responses in the extrastriate visual cortex were significantly increased to checkerboards presented at a low frequency after the administration of the photic tetanus. These results support the idea that long-term potentiation can be demonstrated non-invasively within the human visual cortex and provide evidence that the plastic changes are localized within the secondary visual cortex.

To study the role of the right dorsal premotor cortex in visuomotor association learning (association of four visual stimuli to four buttons), transcranial magnetic stimulation was applied to this area to interfere with the ongoing learning processes. Two transcranial magnetic stimulation pulses to the right dorsal premotor cortex at 150 and 200 ms after onset of the imperative stimulus resulted in the abolishing of reaction time decreases during learning. Transcranial magnetic stimulation applied to a control region revealed no influence on reaction time decreases. During both conditions, however, there were similar increases of accuracy scores. We conclude that the right dorsal premotor cortex is not directly involved in associating visual with motor cues. We suggest that this area is intimately involved in selection and preparation of forthcoming movements.

We studied cerebellar hemodynamic responses in highly skilled keyboard players and control subjects during complex tasks requiring unimanual and bimanual finger movements. Both groups showed strong hemodynamic responses in the cerebellum during the task conditions. However, non-musicians showed generally stronger hemodynamic responses in the cerebellum than keyboard players. We conclude that, due to long-term motor practice a different cortical activation pattern can be visualized in keyboard players. For the same movements fewer neurons need to be recruited. The different volume of the activated cortical areas might therefore reflect the different effort necessary for motor performance in both groups., (Copyright 2004 Lippincott Williams and Wilkins)

Whole-head functional MR images were acquired while 10 subjects were asked to tap with their right index finger in synchrony with a visual stimulus appearing regularly with a frequency of 1.5 Hz, or irregularly with a mean frequency of 1.5 Hz. Performance data show that during regular tapping most taps were close to stimulus onset. However, when the subjects paced their tapping according to the irregular stimuli, most taps appeared about 300 ms after the onset of the pacing stimuli. Comparing the brain activations resulting from regular tapping with those from irregular tapping, we found increased activation in left precuneus only. Comparing irregular versus regular tapping shows increased activity in right cerebellar nuclei and vermis, left ventrolateral thalamus, left sensorimotor cortex, left and right pre-SMA and left SMA proper. These results show that during irregular pacing the motor areas are more strongly activated than during regular pacing. In addition, further neural systems are involved in the motor control during irregular pacing: cerebellar vermis and a cerebello-thalamo-cortical system. The latter is supposedly involved in error correction in the context of visually guided movements.

Nursing science continues to debate the adequacy of various philosophic paradigms for their ability to forward the discipline. Nursing must embrace multiple paradigms, methodologies, and their philosophic assumptions to adequately address the complex and multifaceted human phenomena that is the focus of clinical inquiry in nursing. This article examines the differences in interpretive and critical approaches to clinical inquiry relative to praxis, expanding how praxis can be used to inform nursing practice. Differences in the nature of knowledge, goals of inquiry, and claims to praxis between the interpretive and critical traditions are discussed. Praxis, realized through clinical inquiry in both the interpretive and the critical paradigms, may contribute important pieces of the puzzle to improve the human condition. Expanding the praxis debate challenges nurses to consider the emancipatory possibilities of clinical inquiry within both interpretive and clinical paradigms.

This study investigated the relationship between isokinetic muscle strength and bone density (SPA and DPA) in men and women aged 45-77 yr. Regression models were adjusted for age, weight, smoking status, and calcium supplementation. Elbow extensors (but not flexors) peak torque was correlated with radial density in men (partial r = 0.26, P < 0.05) and women (partial r = 0.24, P < 0.05). Knee flexor (but not extensor) peak torque in women was significantly correlated with spine density (partial r = 0.28, P < 0.05), and muscle mass was significantly correlated with Ward's triangle density (partial r = 0.35, P < 0.05). No associations between knee flexor or extensor muscle strength and spine or femur bone density were observed in men. Fat-free mass (FFM, hydrodensitometry) was associated with all bone density sites in males and females (partial r = 0.30-0.55; P < 0.05). These results demonstrate that 1) significant associations observed between elbow extensor strength and radial bone density in men and women may reflect loading along the longitudinal axis of the radius associated with elbow extensor activity; and 2) significant associations exist between knee flexor muscle strength and lumbar density in women only. Additionally, the associations between FFM and bone density do not necessarily reflect associations between isokinetic muscle strength and bone density.