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Greenhouse gas (GHG) and ammonia (NH3) emissions, land and water use associated with feedlot cattle (n = 40 hd treatment−1 trial−1) treated with or without productivity-enhancing technologies were modelled for a multiyear study (n = 4). Heifers (H) were assigned to the following treatments: (1) implanted (HTBA); (2) provided with melengestrol acetate (HMGA); (3) nonimplanted control, weight-adjusted (CON_Adj) to achieve the same final carcass weight (CW) as 1 (HCON_AdjTBA); or (4) CON_Adj to achieve the CW as 2 (HCON_AdjMGA). Steers (S) were assigned as follows: (1) implanted (STBA); (2) implanted and provided with ractopamine hydrochloride (SRAC; conducted in the last 2 years); (3) CON_Adj to achieve the same CW as 1 (SCON_AdjTBA); or (4) CON_Adj to achieve the same CW as 2 (SCON_AdjRAC). The GHG and NH3 emissions from HTBA, HMGA, STBA, and SRAC were 3.8%, 3.0%, 10.1%, and 8.5% lower and 4.3%, 2.9%, 7.4%, and 7.6% lower, respectively, than the respective control cattle. The land required to produce feed was also reduced by 6.6%, 4.8%, 9.9%, and 10.9%, while water use was reduced by 6.4%, 4.8%, 10.1%, and 11.1% for HTBA, HMGA, STBA, and SRAC, respectively. This modelling study clearly demonstrates that conventional beef production systems have a lower environmental footprint than nonconventional systems. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the effects of using conventional productivity-enhancing technologies (PETs) with or without other natural PETs on the growth performance, carcass traits, and environmental impacts of feedlot cattle. A total of 768 cross-bred yearling steers (499 ± 28.6 kg; n  = 384) and heifers (390 ± 34.9 kg; n  = 384) were offered a barley grain-based basal diet and divided into implanted or non-implanted groups. Steers were then allocated to diets that contained either: (i) no additive (control); natural feed additives including (ii) fibrolytic enzymes (Enz), (iii) essential oil (Oleo), (iv) direct-fed microbial (DFM), (v) DFM + Enz + Oleo combination; conventional feed additives including (vi) Conv (monensin, tylosin, and beta-adrenergic agonists [βAA]); or Conv with natural feed additives including (vii) Conv + DFM + Enz; (viii) Conv + DFM + Enz + Oleo. Heifers received one of the first three dietary treatments or the following: (iv) probiotic (Citr); (v) Oleo + Citr; (vi) Melengesterol acetate (MGA) + Oleo + βAA; (vii) Conv (monensin, tylosin, βAA, and MGA); or (viii) Conv + Oleo (ConvOleo). Data were used to estimate greenhouse gas (GHG) and ammonia (NH3) emissions, as well as land and water use. Implant and Conv-treated cattle exhibited improvements in growth and carcass traits as compared to the other treatments (P  < 0.05). Improvements in the performance of Conv-cattle illustrated that replacing conventional feed additives with natural feed additives would increase both the land and water required to satisfy the feed demand of steers and heifers by 7.9% and 10.5%, respectively. Further, GHG emission intensity for steers and heifers increased by 5.8% and 6.7%, and NH3 emission intensity by 4.3% and 6.7%, respectively. Eliminating the use of implants in cattle increased both land and water use by 14.6% and 19.5%, GHG emission intensity by 10.5% and 15.8%, and NH3 emission intensity by 3.4% and 11.0% for heifers and steers, respectively. These results demonstrate that the use of conventional PETs increases animal performance while reducing the environmental impacts of beef production. Restricting use would increase the environmental footprint of beef produced for both domestic and international markets. [ABSTRACT FROM AUTHOR]

Abstract: Between November 2001 and January 2008, 56 patients (68 hands) out of 110 patients operated for spastic hand deformities, presented with spasticity of the intrinsic muscles of the long fingers (interosseii and the abductor pollicis brevis). All patients were adults (mean age 42.1 years). The surgical indication was discussed during multidisciplinary consultations with selective nerve blocks enabling us to distinguish between extrinsic and intrinsic pathologies on the one hand and muscular spasticity and tendon retractions on the other hand. The aim of the treatment was defined in a “contract” signed with the patient and/or his family. It was hygienic, aesthetic and analgesic in 15 cases, hygienic and analgesic in 32 cases and functional in 21 cases. Four hands were treated by neurectomy of the ulnar nerve''s motor ramus, 54 by tenotomies of the interosseous muscles, 18 by tenotomy of the abductor digiti minimi, six by metacarpal disinsertion of the interosseous muscles. On a total of 67 hands operated associating surgery of the extrinsic and intrinsic flexors, 63 had good primary results as defined in the contract. We noted four relapses, two of which required revision. The authors emphasize the frequency of mixed spastic hands in adults after cerebral palsy. However modest the functional results may be, correction of hygienic and pain problems of non-functional hands as well as aesthetic improvements make surgery of the mixed spastic hand a successful intervention, which should be shared. [Copyright &y& Elsevier]

The temporal and spectral analysis of nine bright X-ray flares out of a sample of 113 flares observed by Swift reveals that the flare phenomenology is strictly analogous to the prompt γ-ray emission: high-energy flare profiles rise faster, decay faster and peak before the low-energy emission. However, flares and prompt pulses differ in one crucial aspect: flares evolve with time. As time proceeds, flares become wider, with larger peak lag, lower luminosities and softer emission. The flare spectral peak energy evolves to lower values following an exponential decay which tracks the decay of the flare flux. The two flares with best statistics show higher than expected isotropic energy and peak luminosity when compared to the and prompt correlations. is found to correlate with within single flares, giving rise to a time-resolved . Like prompt pulses, flares define a lag–luminosity relation: . The lag–luminosity is proven to be a fundamental law extending ∼5 decades in time and ∼5 decades in energy. Moreover, this is direct evidence that γ-ray burst (GRB) X-ray flares and prompt γ-ray pulses are produced by the same mechanism. Finally we establish a flare–afterglow morphology connection: flares are preferentially detected superimposed to one-break or canonical X-ray afterglows. [ABSTRACT FROM AUTHOR]

GRB 080503 was classified as a short gamma-ray burst (GRB) with extended emission. The origin of such extended emission (found in about a quarter of Swift short GRBs) is still unclear and may provide some clues to the identity of the elusive progenitors of short GRBs. The extended emission from GRB 080503 is followed by a rapid decay phase (RDP) that is detected over an unusually large dynamical range (one decade in time and decades in flux), making it ideal for studying the nature of the extended emission from short GRBs. We model the broad envelope of extended emission and the subsequent RDP using a physical model for the prompt GRB emission and its high latitude emission tail, in which the prompt emission (and its tail) is the sum of its individual pulses (and their tails). For GRB 080503, a single pulse fit is found to be unacceptable, even when ignoring short time-scale variability. The RDP displays very strong spectral evolution and shows some evidence for the presence of two spectral components with different temporal behaviour, likely arising from distinct physical regions. A two pulse fit (a first pulse accounting for the gamma-ray extended emission and decay phase, and the second pulse accounting mostly for the X-ray decay phase) provides a much better (though not perfect) fit to the data. The shallow gamma-ray and steep hard X-ray decays are hard to account for simultaneously, and require the second pulse to deviate from the simplest version of the model we use. Therefore, while high latitude emission is a viable explanation for the RDP in GRB 080503, it does not pass our tests with flying colours, and it is quite plausible that another mechanism is at work here. Finally, we note that the properties of the RDP following the extended emission of short GRBs (keeping in mind the very small number of well-studied cases so far) appear to have different properties than that following the prompt emission of long GRBs. However, a larger sample of short GRBs with extended emission is required before any strong conclusion can be drawn. [ABSTRACT FROM AUTHOR]

The prompt emission from gamma-ray burst is the brightest electromagnetic emission known, yet its origin is not understood. The flux density of individual prompt pulses of a GRB can be represented by an analytical expression derived assuming the emission is from a thin, ultrarelativistically expanding, uniform, spherical shell over a finite range of radii. We present the results of fitting this analytical expression to the light curves from the four standard Swift Burst Alert Telescope energy bands and two standard Swift X-ray Telescope energy bands of 12 bursts. The expression includes the high latitude emission (HLE) component and the fits provide a rigorous demonstration that the HLE can explain the rapid decay phase of the prompt emission. The model also accommodates some aspects of energy-dependent lag and energy-dependent pulse width, but there are features in the data which are not well represented. Some pulses have a hard, narrow peak which is not well fitted or a rise and decay which are faster than expected using the standard indices derived assuming synchrotron emission from internal shocks, although it might be possible to accommodate these features using a different emission mechanism within the same overall framework. The luminosity of pulses is correlated with the peak energy of the pulse spectrum, , and anticorrelated with the time since ejection of the pulse, . [ABSTRACT FROM AUTHOR]

Swift captured for the first time a smoothly rising X-ray re-brightening of clear non-flaring origin after the steep decay in a long gamma-ray burst (GRB): GRB 081028. A rising phase is likely present in all GRBs but is usually hidden by the prompt tail emission and constitutes the first manifestation of what is later to give rise to the shallow decay phase. Contemporaneous optical observations reveal a rapid evolution of the injection frequency of a fast cooling synchrotron spectrum through the optical band, which disfavours the afterglow onset (start of the forward shock emission along our line of sight when the outflow is decelerated) as the origin of the observed re-brightening. We investigate alternative scenarios and find that the observations are consistent with the predictions for a narrow jet viewed off-axis. The high on-axis energy budget implied by this interpretation suggests different physical origins of the prompt and (late) afterglow emission. Strong spectral softening takes place from the prompt to the steep decay phase: we track the evolution of the spectral peak energy from the γ-rays to the X-rays and highlight the problems of the high latitude and adiabatic cooling interpretations. Notably, a softening of both the high and low spectral slopes with time is also observed. We discuss the low on-axis radiative efficiency of GRB 081028 comparing its properties against a sample of Swift long GRBs with secure measurements. [ABSTRACT FROM AUTHOR]

Most gamma-ray bursts (GRBs) observed by the Swift satellite show an early steep decay phase (SDP) in their X-ray light curve, which is usually a smooth continuation of the prompt gamma-ray emission, strongly suggesting that it is its tail. However, the mechanism behind it is still not clear. The most popular model for this SDP is high-latitude emission (HLE), in which after the prompt emission from a (quasi-) spherical shell stops photons from increasingly large angles relative to the line of sight still reach the observer, with a smaller Doppler factor. This results in a simple relation between the temporal and spectral indexes, where . While HLE is expected in many models for the prompt GRB emission, such as the popular internal shocks model, there are models in which it is not expected, such as sporadic magnetic reconnection events. Therefore, testing whether the SDP is consistent with HLE can help distinguish between different prompt emission models. In order to adequately address this question in a careful quantitative manner we develop a realistic self-consistent model for the prompt emission and its HLE tail, which can be used for combined temporal and spectral fits to GRB data that would provide strict tests for the HLE model. We model the prompt emission as the sum of its individual pulses with their HLE tails, where each pulse arises from an ultrarelativistic uniform thin spherical shell that emits isotropically in its own rest frame over a finite range of radii. Analytic expressions for the observed flux density are obtained for the internal shock case with a Band function emission spectrum. We find that the observed instantaneous spectrum is also a Band function. Our model naturally produces, at least qualitatively, the observed spectral softening and steepening of the flux decay as the peak photon energy sweeps across the observed energy range. The observed flux during the SDP is initially dominated by the tail of the last pulse, but the tails of one or more earlier pulses can become dominant later on. A simple criterion is given for the dominant pulse at late times. The relation holds also as β and α change in time. Modelling several overlapping pulses as a single wider pulse would overpredict the emission tail. [ABSTRACT FROM AUTHOR]

We propose to explain the recent observations of gamma-ray burst early X-ray afterglows with SWIFT by the dissipation of energy in the reverse shock that crosses the ejecta as it is decelerated by the burst environment. We compute the evolution of the dissipated power and discuss the possibility that a fraction of it can be radiated in the X-ray range. We show that this reverse shock contribution behaves in a way very similar to the observed X-ray afterglows if the following two conditions are satisfied. (i) The Lorentz factor of the material which is ejected during the late stages of source activity decreases to small values and (ii) a large part of the shock-dissipated energy is transferred to a small fraction of the electron population. We also discuss how our results may help to solve some puzzling problems raised by multiwavelength early afterglow observations such as the presence of chromatic breaks. [ABSTRACT FROM AUTHOR]

We study the evolution of the circumstellar medium of massive stars. We pay particular attention to Wolf-Rayet stars that are thought to be the progenitors of some long gamma-ray bursts (GRBs). We detail the mass-loss rates we use in our stellar evolution models and how we estimate the stellar wind speeds during different phases. With these details we simulate the interactions between the wind and the interstellar medium to predict the circumstellar environment around the stars at the time of core-collapse. We then investigate how the structure of the environment might affect the GRB afterglow. We find that when the afterglow jet encounters the free-wind/stalled-wind interface, rebrightening occurs and a bump is seen in the afterglow light curve. However, our predicted positions of this interface are too distant from the site of the GRB to reach while the afterglow remains observable. The values of the final wind density, , from our stellar models are of the same order (≲1) as some of the values inferred from observed afterglow light curves. We do not reproduce the lowest values below 0.5 inferred from afterglow observations. For these cases, we suggest that the progenitors could have been a WO-type Wolf–Rayet (WR) star or a very low-metallicity star. Finally, we turn our attention to the matter of stellar wind material producing absorption lines in the afterglow spectra. We discuss the observational signatures of two WR stellar types, WC and WO, in the afterglow light curve and spectra. We also indicate how it may be possible to constrain the initial mass and metallicity of a GRB progenitor by using the inferred wind density and wind velocity. [ABSTRACT FROM AUTHOR]

The Xiashu loess is an important aeolian deposit in eastern China. Research on the provenance of the Xiashu loess, located along the lower reaches of the Yangtze River, has entered into a new stage, compelling us to review the previous research findings in order to provide direction for future research. In this study, we enumerate three different viewpoints regarding the major sources of the loess in eastern China, including distant sources, proximal sources, and mixed sources. We also discuss disturbance factors, methods, and research on the provenance of the Xiashu loess. Previous research has showed that, on the basis of geochronology and meticulous grain grading data, good results as to the loess' provenance can be obtained using immobile geochemical index tracers that are not affected by chemical weathering or grain size effects. Examples include detrital zircon U-Pb age spectra, major and trace element ratios, stable isotopic composition, and slowly weatherable minerals. However, differences in the data do exist, e.g., for the immobile geochemical provenance tracing indexes of the loess. Also still under debate is the age of the lower boundary of the loess. Therefore, exploring the spatial-temporal variations of the provenance, along with the coupling relationship between the paleoclimate environment evolution and the onset of the loess accumulation, should be comprehensively considered in future research. [ABSTRACT FROM AUTHOR]

Background: Pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) is a treatment for preventing febrile neutropenia (FN) in patients with early breast cancer. However, the optimal injection timing of PEG-rhG-CSF after chemotherapy is obscure. The trial was designed to explore the best administration timing of PEG-rhG-CSF when breast cancer patients could benefit most. Methods: Patients with early breast cancer were randomly assigned to receive a preventive injection on the 7th or 3rd day following chemotherapy. The experimental group (n = 80) received PEG-rhG-CSF treatment on day 7 after chemotherapy, whereas the control group (n = 80) received it on day 3. The occurrence of grades 3–4 neutropenia and FN in the first cycle was the primary endpoint. The secondary endpoint was the frequency of PEG-rhG-CSF dose reduction. Results: In comparison to the control group, the experimental group exhibited higher white blood cell count (WBC) and absolute neutrophil count (ANC) on the 9th and 13th days following chemotherapy (P < 0.05). Additionally, the incidence of grade 3–4 neutropenia was significantly lower in the experimental group (P = 0.038). Furthermore, a greater proportion of patients in the experimental group met the criteria for reducing the PEG-rhG-CSF dose compared to the control group (69.74% vs. 35.06%, P < 0.001). Conclusions: In comparison with PEG-rhG-CSF injection on day 3 after chemotherapy, the incidence of grade 3–4 myelosuppression is lower, and the safety is more manageable after the injection on day 7. This approach potentially allows for a wider adoption of PEG-rhG-CSF dose reduction, leading to a consequential decrease in overall medical costs for patients. Trial registration: Clinical Trials: NCT04477616. Registered July 16, 2020. [ABSTRACT FROM AUTHOR]

Introduction: This study evaluates the gait analysis obtained by Inetial Measurement Units (IMU) before and after surgical management of Spastic Equino Varus Foot (SEVF) in hemiplegic post-stroke patients and to compare it with the functional results obtained in a monocentric prospective cohort. Methods: Patients with post-stroke SEVF, who underwent surgery in a single hospital between November 2019 and December 2021 were included. The follow-up duration was 6 months and included a functional analysis using Goal Attainment Scaling (GAS) and a Gait analysis using an innovative Multidimensional Gait Evaluation using IMU: the semiogram. Results: 20 patients had a gait analysis preoperatively and at 6 months postoperatively. 90% (18/20) patients had a functional improvement (GAS T score ≥ 50) and 50% (10/20) had an improvement in walking technique as evidenced by the cessation of the use of a walking aid (WA). In patients with functional improvement and modification of WA the change in the semiogram area was + 9.5%, sd = 27.5%, and it was + 15.4%, sd = 28%. In the group with functional improvement without change of WA. For the 3 experiences (two patients) with unfavorable results, the area under the curve changed by + 2.3%, -10.2% and − 9.5%. The measurement of the semiogram area weighted by average speed demonstrated very good reproducibility (ICC(1, 3) = 0.80). Discussion: IMUs appear to be a promising solution for the assessment of post-stroke hemiplegic patients who have undergone SEVF surgery. They can provide a quantified, objective, reliable in individual longitudinal follow up automated gait analysis solution for routine clinical use. Combined with a functional scale such as the GAS, they can provide a global analysis of the effect of surgery. [ABSTRACT FROM AUTHOR]

Muscle tone is defined as the resistance to passive stretch, but this definition is often criticized for its ambiguity since some suggest it is related to a state of preparation for movement. Muscle tone is primarily regulated by the central nervous system, and individuals with neurological disorders may lose the ability to control normal tone and can exhibit abnormalities. Currently, these abnormalities are mostly evaluated using subjective scales, highlighting a lack of objective assessment methods in the literature. This study aimed to use surface electromyography (sEMG) and machine learning (ML) for the objective classification and characterization of the full spectrum of muscle tone in the upper limb. Data were collected from thirty-nine individuals, including spastic, healthy, hypotonic and rigid subjects. All of the classifiers applied achieved high accuracy, with the best reaching 96.12%, in differentiating muscle tone. These results underscore the potential of the proposed methodology as a more reliable and quantitative method for evaluating muscle tone abnormalities, aiming to address the limitations of traditional subjective assessments. Additionally, the main features impacting the classifiers' performance were identified, which can be utilized in future research and in the development of devices that can be used in clinical practice. [ABSTRACT FROM AUTHOR]

Background: This study evaluated the effectiveness of radio electric asymmetric conveyer (REAC) neurobiological optimization treatments on muscle strength (MS) in individuals with post-polio syndrome (PPS), a condition causing new muscle weakness in polio survivors. Traditional treatments focus on symptom management, whereas REAC technology uses radio electric symmetric conveyed fields to modulate neurotransmission and cellular function. Methods: This open-label study involved 17 PPS patients who maintained their existing medications. The participants underwent four REAC treatment protocols: neuro-postural optimization (NPO), neuro-psycho-physical optimization (NPPO), neuro-psycho-physical optimization—cervical brachial (NPPO-CB), and neuromuscular optimization (NMO). MS was assessed using manual muscular tests (MMT) before and after each protocol. Results: A statistical analysis via repeated measures ANOVA showed significant MS improvements, particularly in the proximal muscles of the left lower limb (LLL), distal muscles of both lower limbs (LLs), and distal muscles of the left upper limb. The LLL, the most severely affected limb at this study's start, exhibited the greatest improvement. Conclusions: These results suggest REAC treatments could enhance MS in PPS patients, potentially reorganizing motor patterns and reducing functional overload on less affected limbs. [ABSTRACT FROM AUTHOR]

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Background: The quantification of electromyographic activity using surface electrodes is invaluable for understanding gait disorders in patients with central nervous system lesions. We propose to evaluate a commercially available low-cost system compared to a reference system in participants with stroke-related movement disorders in functional situations. Methods: Three hemiparetic participants performed three functional tasks: two treadmill walks at different speeds and a sit-to-stand test. The vastus lateralis and gastrocnemius medialis muscles were equipped with two EMG sensors. The comparison between the two EMG systems was based on 883 identified cycles. Spearman's correlation coefficients (SCs), linear correlation coefficients (LCCs), and cross-correlation coefficients (CCCs) were calculated. Results: The main results indicate good to very good similarity of the EMG signals collected from the two tested sEMG systems. In the comfortable-walking condition, an SC of 0.894 ± 0.091 and an LCC of 0.909 ± 0.094 were noted. In the fast-walking condition, an SC of 0.918 ± 0.064 and an LCC of 0.935 ± 0.056 were observed. For the 1 min sit-to-stand test, an SC of 0.880 ± 0.058 and an LCC of 0.881 ± 0.065 were noted. Conclusions: This study demonstrates good to very good similarity between the two sEMG systems, enabling the analysis of muscle activity during functional tasks. [ABSTRACT FROM AUTHOR]

The resilience of coral reefs in oligotrophic, (sub)tropical oceans is largely due to the symbiotic relationship between scleractinian corals and Symbiodiniaceae algae, which enables efficient internal nutrient recycling. Investigating the history of this coral symbiosis can provide insights into its role in sustaining the health of both present and future coral reefs. The isotopic composition of organic nitrogen (15N/14N or δ15N) bound within coral skeletons has been utilized to trace the existence of symbiosis in fossil corals, suggesting that coral symbiosis dates back to at least 210 million years ago. The basis of this proxy is that symbiotic corals are expected to exhibit lower δ15N compared to their non-symbiotic (aposymbiotic) counterparts within the same environments, owing to internal nitrogen recycling between the coral host and algal symbiont, and reduced leakage of low-δ15N ammonium into seawater. However, this hypothesis has not been adequately tested in contemporary settings. In a laboratory experiment, we examined the δ15N differences between the symbiotic and aposymbiotic branches within the same genetic backgrounds of the facultatively symbiotic coral Oculina arbuscula under well-fed conditions. Across five different genotypes in two separate experiments, symbiotic branches consistently showed lower δ15N than their aposymbiotic counterparts. These findings corroborate the use of δ15N as a proxy for identifying coral symbiosis in the past, particularly when multiple species of corals coexisted in the same environments. [ABSTRACT FROM AUTHOR]

X-ray flare (XRF) is a common phenomenon in the X-ray afterglow of gamma-ray bursts (GRBs). Although it is commonly believed that XRFs may share a common origin with prompt emission, i.e., the "internal" origin, the origin of XRFs is still unknown. In this work, we compile a GRB sample containing 31 GRBs with a single XRF, a well-measured spectrum, and a redshift, and investigate the intrinsic properties and correlations between prompt emission and the XRFs of these events. We find that the distributions of main physical parameters of prompt emission and XRFs are basically log-normal. The median value of the rise time is shorter than the decay time for all flares, with a ratio of about 1:2, which is similar to the fast rise and exponential decay structure of prompt emission pulses. We also find that the prompt emission energy ( E iso ) and peak luminosity ( L iso ) have tight correlations with XRF energy ( E X , iso ) and peak luminosity ( L X , p ), E iso ∝ E X , iso 0.74 ( L X , p 0.62 ) and L iso ∝ E X , iso 0.85 ( L X , p 0.68 ). However, the durations of prompt emissions are independent of the temporal properties of XRFs. Furthermore, we also analyze the three-parameter correlations between prompt emissions and XRFs, and find that there are tight correlations among the XRF peak time ( T p , z ), L X , p , and E iso / L iso , L X , p ∝ T p , z − 1.08 E iso 0.84 and L X , p ∝ T p , z − 1.09 L iso 0.71 . Interestingly, these results are very similar to the properties of an X-ray plateau in GRBs, which indicates that X-ray flares and plateaus may have the same physical origin, and strongly supports that the two emission components originate from the late-time activity of the central engine. [ABSTRACT FROM AUTHOR]

One of the aims of diagnostic nerve blocks is to identify the overactive muscles that lead to a specific spasticity pattern. However, to date, there is no evidence on how nerve blocks may affect botulinum neurotoxin-A (BoNT-A) dose in patients with spasticity. This case-control study aims to assess the role of diagnostic nerve block in defining BoNT-A starting dose at first treatment. Patients with upper and lower limb spasticity treated for the first time with BoNT-A were retrospectively divided into two groups: Group 1 (n = 43) was evaluated with clinical assessment and diagnostic nerve block; Group 2 (n = 56) underwent clinical assessment only. Group 1 was injected with higher BoNT-A doses in some muscles (i.e., flexor digitorum profundus, soleus), and received a higher BoNT-A cumulative dose with a larger number of injected muscles for some spasticity patterns (i.e., "clenched fist", "flexed fingers", "adducted thigh"). Diagnostic nerve block may help the clinician to optimize and personalize the BoNT-A dose since the first BoNT-A treatment. [ABSTRACT FROM AUTHOR]

Botulinum neurotoxin-A (BoNT-A) injections are effective for focal spasticity. However, the impact on muscle strength is not established. This study aimed to investigate the effect of BoNT-A injections on muscle strength in adult neurological conditions. Studies were included if they were Randomised Controlled Trials (RCTs), non-RCTs, or cohort studies (n ≥ 10) involving participants ≥18 years old receiving BoNT-A injection for spasticity in their upper and/or lower limbs. Eight databases (CINAHL, Cochrane, EMBASE, Google Scholar, Medline, PEDro, Pubmed, Web of Science) were searched in March 2024. The methodology followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in the Prospective Register of Systematic Reviews (PROSPERO: CRD42022315241). Quality was assessed using the modified Downs and Black checklist and the PEDro scale. Pre-/post-injection agonist, antagonist, and global strength outcomes at short-, medium-, and long-term time points were extracted for analysis. Following duplicate removal, 8536 studies were identified; 54 met the inclusion criteria (3176 participants) and were rated as fair-quality. Twenty studies were analysed as they reported muscle strength specific to the muscle injected. No change in agonist strength after BoNT-A injection was reported in 74% of the results. Most studies' outcomes were within six weeks post-injection, with few long-term results (i.e., >three months). Overall, the impact of BoNT-A on muscle strength remains inconclusive. [ABSTRACT FROM AUTHOR]

Trauma patients in the emergency department experience severe pain that is not always easy to manage. The risk of acute compartment syndrome further complicates the analgesic approach. The purpose of this review is to discuss relevant bibliography and highlight current guidelines and recommendations for the safe practice of peripheral nerve blocks in this special group of patients. According to the recent bibliography, peripheral nerve blocks are not contraindicated in patients at risk of acute compartment syndrome, as long as there is surveillance and certain recommendations are followed. [ABSTRACT FROM AUTHOR]

Spasticity is a very common sign in the neurological field. It can be defined as "a motor disorder marked by a velocity-dependent increase in muscle tone or tonic stretch reflexes" associated with hypertonia. It leads to a high risk of limb deformities and pain that prejudices residual motor function, impairing quality of life". The treatment of spasticity depends on its severity and its location and, in general, it is based on rehabilitation, oral therapies (the gamma-aminobutyric acid b agonist baclofen) and injectable medications (i.e., botulin toxins, acting on polysynaptic reflex mechanisms). The botulin toxin type A (BoNT-A) injection has been effectively used to improve different types of spasticity. However, when BoNT-A is not sufficient, a combination of nonpharmacological approaches could be attempted. Therefore, additional intervention, such as conventional physical therapy by itself or further combined with robotic gait training, may be needed. Indeed, it has been shown that combination of BoNT-A and robotics has a positive effect on activity level and upper limb function in patients with stroke, including those in the chronic phase. The aim of this review is to evaluate the efficacy of pharmacological or nonpharmacological treatment in combination with BoNT-A injections on spasticity. The combined therapy of BoNT with conventional or adjunct activities or robot-assisted training, especially with end-effectors, is a valid tool to improve patients' performance and outcomes. The combined strategies might rise the toxin's effect, lowering its dosages of botulinum and reducing side effects and costs. [ABSTRACT FROM AUTHOR]

Ultrasound guidance can enhance existing landmark-based injection methods, even through a brief and single exposure during a cadaveric training course. A total of twelve participants were enrolled in this training program, comprising nine physical medicine and rehabilitation specialists, one pediatrician, and two physician assistants. For each participant, one upper-limb muscle and one lower-limb muscle were randomly chosen from the preselected muscle group. Subsequently, participants were tasked with injecting both of their chosen cadaveric muscles with 1 mL of acrylic paint using a manual needle palpation technique, relying solely on their knowledge of anatomic landmarks. Participants then underwent a personalized, one-to-one ultrasound teaching session, lasting approximately five minutes, conducted by two highly experienced instructors. Following this instructive phase, participants were tasked with a second round of injections, targeting the same two muscles in the lower and upper limbs. However, this time, the injections were performed using anatomical landmarks and ultrasound guidance. To facilitate differentiation from the initial injections, a distinct color of acrylic paint was employed. When employing the anatomical landmark-based approach, the overall success rate for injections was 67%, with 16 out of 24 targeted muscles accurately injected. With the incorporation of ultrasound guidance, the success rate was 92%, precisely targeting 22 out of the 24 muscles under examination. There was an improvement in injection accuracy achievable through the integration of ultrasound guidance, even with minimal training exposure. Our single cadaveric ultra-sound training program contributes valuable insights to the utilization of ultrasound for anatomy training to help optimize the targeting of BoNT-A. [ABSTRACT FROM AUTHOR]

We report the implementation of effective quantum electrodynamics (QED) potentials for all-electron four-component relativistic molecular calculations using the DIRAC code. The potentials are also available for two-component calculations, being properly picture-change transformed. The latter point is important; we demonstrate through atomic calculations that picture-change errors are sizable. Specifically, we have implemented the Uehling potential [E. A. Uehling, Phys. Rev. 48, 55 (1935)] for vacuum polarization and two effective potentials [P. Pyykkö and L.-B. Zhao, J. Phys. B: At., Mol. Opt. Phys. 36, 1469 (2003) and V. V. Flambaum and J. S. M. Ginges, Phys. Rev. A 72, 052115 (2005)] for electron self-energy. We provide extensive theoretical background for these potentials, hopefully reaching an audience beyond QED specialists. We report the following sample applications: (i) We first confirm the conjecture of P. Pyykkö that QED effects are observable for the AuCN molecule by directly calculating ground-state rotational constants B0 of the three isotopomers studied by microwave spectroscopy; QED brings the corresponding substitution Au–C bond length rs from 0.23 to 0.04 pm agreement with experiment. (ii) In regard to spectroscopic constants of van der Waals dimers M2 (M = Hg, Rn, Cn, Og), QED induces bond length expansions on the order of 0.15(0.30) pm for row 6(7) dimers. (iii) We confirm that there is a significant change of valence s population of Pb in the reaction PbH4 → PbH2 + H2, which is thereby a good candidate for observing QED effects in chemical reactions, as proposed in [K. G. Dyall et al., Chem. Phys. Lett. 348, 497 (2001)]. We also find that whereas in PbH4 the valence 6s1/2 population resides in bonding orbitals, it is mainly found in nonbonding orbitals in PbH2. QED contributes 0.32 kcal/mol to the reaction energy, thereby reducing its magnitude by −1.27%. For corresponding hydrides of superheavy flerovium, the electronic structures are quite similar. Interestingly, the QED contribution to the reaction energy is of quite similar magnitude (0.35 kcal/mol), whereas the relative change is significantly smaller (−0.50%). This curious observation can be explained by the faster increase in negative vacuum polarization over positive electron self-energy contributions as a function of nuclear charge. [ABSTRACT FROM AUTHOR]

The goal-setting process is pivotal in managing patients with disabling spasticity. This case–control study assessed the role of diagnostic nerve blocks in guiding the goal-setting process within goal-targeted treatment of spasticity with botulinum neurotoxin-A. In this case–control study, patients with disabling spasticity underwent either a goal-setting process based on the patient's needs and clinical evaluation (control group) or additional diagnostic nerve block procedures (case group). All enrolled patients underwent a focal treatment with botulinum neurotoxin-A injection and a 1-month follow-up evaluation during which goal achievement was quantified using the goal attainment scaling-light score system. Data showed a higher goal achievement rate in the case group (70%) than in the control group (40%). In conclusion, diagnostic nerve blocks may help guide the goal-setting process within goal-targeted treatment of spasticity with botulinum neurotoxin-A towards more realistic and achievable goals, thereby improving the outcomes of botulinum neurotoxin-A injection. Future studies should better explore the role of diagnostic nerve blocks to further personalize botulinum neurotoxin-A according to individual patients' preferences and requirements. [ABSTRACT FROM AUTHOR]