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Conditioned pain modulation (CPM) can discriminate between healthy and chronic pain patients. However, its relationship with neurophysiological pain mechanisms is poorly understood. Brain oscillations measured by electroencephalography (EEG) might help gain insight into this complex relationship. Objective To investigate the relationship between CPM response and self-reported pain intensity in non-specific chronic low back pain (NSCLBP) and explore respective EEG signatures associated to these mechanisms. Design Cross-sectional analysis. Participants Thirty NSCLBP patients participated. Methods Self-reported low back pain, questionnaires, mood scales, CPM (static and dynamic quantitative sensory tests), and resting surface EEG data were collected and analyzed. Linear regression models were used for statistical analysis. Results CPM was not significantly correlated with self-reported pain intensity scores. Relative power of EEG in the beta and high beta bands as recorded from the frontal, central, and parietal cortical areas were significantly associated with CPM. EEG relative power at delta and theta bands as recorded from the central area were significantly correlated with self-reported pain intensity scores while controlling for self-reported depression. Conclusions Faster EEG frequencies recorded from pain perception areas may provide a signature of a potential cortical compensation caused by chronic pain states. Slower EEG frequencies may have a critical role in abnormal pain processing. [ABSTRACT FROM AUTHOR]

Background and Aim: The impact of body posture on vocal emission is well known. Postural changes may increase muscular resistance in tracts of the phono-articulatory apparatus and lead to voice disorders. This work aimed to assess whether and to which extent body posture during singing and playing a musical instrument impacts voice performance in professional musicians. Subjects and Methods: Voice signals were recorded from 17 professional musicians (pianists and guitarists) while they were singing and while they were singing and playing a musical instrument simultaneously. Metrics were extracted from their voice spectrogram using the Multi-Dimensional Voice Program (MDVP) and included jitter, shift in fundamental voice frequency (sF0), shimmer, change in peak amplitude, noise to harmonic ratio, Voice Turbulence Index, Soft Phonation Index (SPI), Frequency Tremor Intensity Index, Amplitude Tremor Intensity Index, and maximum phonatory time (MPT). Statistical analysis was performed using two-tailed t tests, one-way ANOVA, and χ2 tests. Subjects' body posture was visually assessed following the recommendations of the Italian Society of Audiology and Phoniatrics. Thirty-seven voice signals were collected, 17 during singing and 20 during singing and playing a musical instrument. Results: Data showed that playing an instrument while singing led to an impairment of the "singer formant" and to a decrease in jitter, sF0, shimmer, SPI, and MPT. However, statistical analysis showed that none of the MDVP metrics changed significantly when subjects played an instrument compared to when they did not. Shoulder and back position affected voice features as measured by the MDVP metrics, while head and neck position did not. In particular, playing the guitar decreased the amplitude of the "singer formant" and increased noise, causing a typical "raucous rock voice." Conclusions: Voice features may be affected by the use of the instrument the musicians play while they sing. Body posture selected by the musician while playing the instrument may affect expiration and phonation. [ABSTRACT FROM AUTHOR]

Background: Biological nurturing is a neurobehavioral approach to breastfeeding support that encourages women to breastfed in a relaxed, laidback position. This approach has the potential to reduce breast problems (e.g., sore nipples), making good latch easier and thus facilitating the initiation of exclusive breastfeeding. However, its effects have not been adequately investigated in a real-life situation. The aim of this randomized controlled trial was to assess the effectiveness of biological nurturing, compared to usual hospital practices, on the frequency of breast problems and on the prevalence of exclusive breastfeeding at discharge from the maternity ward, after 1 week, and at one and 4 months. Methods: Open randomized parallel controlled trial carried out in a third level maternity ward (IRCCS Burlo Garofolo, Trieste, Italy) between March and December 2018. Two-hundred eight women who planned to give birth at the hospital and who expressed the intention to breastfeed were enrolled during pregnancy and randomized to receive breastfeeding support following either the biological nurturing approach or the usual care protocol based on the WHO/UNICEF 20-h course, in use at the hospital. The primary study outcome was the incidence of breast problems during hospital stay, defined as the presence of one or more of the following outcomes, collected separately: sore nipples, cracked nipples, engorgement and mastitis. The primary analysis was performed by intention to treat. The follow up lasted 4 months. Results: One hundred eighty eight out of 208 women (90.3%) were included in the analysis, 90 allocated to the biological nurturing group and 98 to the usual care group. At discharge from the maternity ward, biological nurturing significantly reduced the risk of breast problems (Relative risk [RR] 0.56, 95% Confidence Interval [CI] 0.40, 0.79), including cracked (RR 0.42, 95% CI 0.24, 0.74) and sore nipples (RR 0.59, 95% CI 0.40, 0.88). No statistically significant difference was observed for exclusive breastfeeding at discharge and up to 4 months. No adverse events occurred. Conclusions: The biological nurturing approach applied in the real-life situation of a third level hospital was effective in preventing breast problems. Trial registration: Clinicaltrials.gov NCT03503500. Date of First Submission: 28 March 2018. [ABSTRACT FROM AUTHOR]

We are expanding the use of the MIT-MANUS robotics to persons with impairments due exclusively to orthopedic disorders, with no neurological deficits. To understand the reliability of repeated measurements of the robotic tasks and the potential for registering changes due to learning is critical. Purposes of this study were to assess the learning effect of repeated exposure to robotic evaluations and to demonstrate the ability to detect a change in protocol in outcome measurements. Ten healthy, unimpaired subjects (mean age = 54.1 ± 6.4 years) performed six repeated evaluations consisting of unconstrained reaching movements to targets and circle drawing (with and without a visual template) on the MIT-MANUS. Reaching outcomes were aiming error, mean and peak speed, movement smoothness and duration. Outcomes for circle drawing were axis ratio metric and shoulder- elbow joint angles correlation metric (was based on a two-link model of the human arm and calculated hand path during the motions). Repeated-measures ANOVA (p ≤ .05) determined if difference existed between the sessions. Intraclass correlations (R) were calculated. All variables were reliable, without learning across testing sessions. Intraclass correlation values were good to high (reaching, R ≥ .80; circle drawing, R ≥ .90). Robotic measurement ability to differentiate between similar but distinct tasks was demonstrated as measured by axis ratio metric (p < .001) and joint correlation metric (p = .001). Outcome measures of the MIT-MANUS proved to be reliable yet sensitive to change in healthy adults without motor learning over the course of repeated measurements. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This study aims to compare the electrical auditory brainstem response (EABR) following cochlear implant (CI) surgery in pediatric subjects with cochlear malformation and a normal cochlea, in order to assess the sensitivity of EABR and to evaluate the surgery outcome. MATERIALS and METHODS: A total of 26 pediatric subjects who were deaf and scheduled for CI surgery were enrolled into this case control study. Group A (n=20) included subjects with a normo-conformed cochlea. Group B (n=6) included subjects with cochlear malformation. Subjects were evaluated with EABR immediately (T0) and 6 months (T1) post-CI surgery. The EABR Waves III and V average amplitude and latency were compared across time, separately for each group, and across groups, separately for each time. RESULTS: Auditory brainstem response (ABR) could only be recorded in Group A. We were able to record EABR from all subjects at T0 and T1, and waves III and V were present in all the recorded signals. There were no statistically significant differences between T0 and T1 in EABR Waves III and V in terms of average amplitude and latency in neither group. When comparing Groups A and B, the only statistically significant difference was the average amplitude of wave V, both at T0 and T1. CONCLUSION: EABR is a valid tool to measure the auditory nerve integrity after CI surgery in patients with a normal and malformed cochlea, as shown by its ability to measure waves III and V when ABR is absent. The EABR testing should be performed before and after CI surgery, and EABR should be used as a measure of outcome, especially in patients with a malformed cochlea. [ABSTRACT FROM AUTHOR]

Background: Central post stroke pain (CPSP) is a highly refractory syndrome that can occur after stroke. Primary motor cortex (M1) brain stimulation using epidural brain stimulation (EBS), transcranial magnetic stimulation (TMS), and transcranial direct current stimulation (tDCS) have been explored as potential therapies for CPSP. These techniques have demonstrated variable clinical efficacy. It is hypothesized that changes in the stimulating currents that are caused by stroke-induced changes in brain tissue conductivity limit the efficacy of these techniques. Methods: We generated MRI-guided finite element models of the current density distributions in the human head and brain with and without chronic focal cortical infarctions during EBS, TMS, and tDCS. We studied the change in the stimulating current density distributions' magnitude, orientation, and maxima locations between the different models. Results: Changes in electrical properties at stroke boundaries altered the distribution of stimulation currents in magnitude, location, and orientation. Current density magnitude alterations were larger for the non-invasive techniques (i.e., tDCS and TMS) than for EBS. Nonetheless, the lesion also altered currents during EBS. The spatial shift of peak current density, relative to the size of the stimulation source, was largest for EBS. Conclusion: In order to maximize therapeutic efficiency, neurostimulation trials need to account for the impact of anatomically disrupted neural tissues on the location, orientation, and magnitude of exogenously applied currents. The relative current-neuronal structure should be considered when planning stimulation treatment, especially across techniques (e.g., using TMS to predict EBS response). We postulate that the effects of altered tissue properties in stroke regions may impact stimulation induced analgesic effects and/or lead to highly variable outcomes during brain stimulation treatments in CPSP. [ABSTRACT FROM AUTHOR]