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Background Sufficient and timely spinal cord decompression is a critical surgical objective for neurological recovery in spinal cord injury (SCI). Residual cord compression may be associated with disturbed cerebrospinal fluid pressure (CSFP) dynamics. Objectives This study aims to assess whether intrathecal CSFP dynamics in SCI following surgical decompression are feasible and safe, and to explore the diagnostic utility. Methods Prospective cohort study. Bedside lumbar CSFP dynamics and cervical MRI were obtained following surgical decompression in N = 9 with mostly cervical acute-subacute SCI and N = 2 patients with non-traumatic SCI. CSFP measurements included mean CSFP, cardiac-driven CSFP peak-to-valley amplitudes (CSFPp), Valsalva maneuver, and Queckenstedt’s test (firm pressure on jugular veins, QT). From QT, proxies for cerebrospinal fluid pulsatility curve were calculated (ie, relative pulse pressure coefficient; RPPC-Q). CSFP metrics were compared to spine-healthy patients. computer tomography (CT)-myelography was done in 3/8 simultaneous to CSFP measurements. Results Mean age was 45 ± 9 years (range 17-67; 3F), SCI was complete (AIS A, N = 5) or incomplete (AIS B-D, N = 6). No adverse events related to CSFP assessments. CSFP rise during QT was induced in all patients [range 9.6-26.6 mmHg]. However, CSFPp was reduced in 3/11 (0.1-0.3 mmHg), and in 3/11 RPPC-Q was abnormal (0.01-0.05). Valsalva response was reduced in 8/11 (2.6-23.4 mmHg). CSFP dynamics corresponded to CT-myelography. Conclusions Comprehensive bedside lumbar CSFP dynamics in SCI following decompression are safe, feasible, and can reveal distinct patterns of residual spinal cord compression. Longitudinal studies are required to define critical thresholds of impaired CSFP dynamics that may impact neurological recovery and requiring surgical revisions.

Background and purpose: The timing of decision-making for a surgical intervention in patients with mild degenerative cervical myelopathy (DCM) is challenging. Spinal cord motion phase contrast MRI (PC-MRI) measurements can reveal the extent of dynamic mechanical strain on the spinal cord to potentially identify high-risk patients. This study aims to determine the comparability of axial and sagittal PC-MRI measurements of spinal cord motion with the prospect of improving the clinical workup.Methods: Sixty-four DCM patients underwent a PC-MRI scan assessing spinal cord motion. The agreement of axial and sagittal measurements was determined by means of intraclass correlation coefficients (ICCs) and Bland-Altman analyses.Results: The comparability of axial and sagittal PC-MRI measurements was good to excellent at all cervical levels (ICCs motion amplitude: .810-.940; p < .001). Significant differences between axial and sagittal amplitude values could be found at segments C3 and C4, while its magnitude was low (C3: 0.07 ± 0.19 cm/second; C4: -0.12 ± 0.30 cm/second). Bland-Altman analysis showed a good agreement between axial and sagittal PC-MRI scans (coefficients of repeatability: minimum -0.23 cm/second at C2; maximum -0.58 cm/second at C4). Subgroup analysis regarding anatomic conditions (stenotic vs. nonstenotic segments) and different velocity encoding (2 vs. 3 cm/second) showed comparable results.Conclusions: This study demonstrates good comparability between axial and sagittal spinal cord motion measurements in DCM patients. To this end, axial and sagittal PC-MRI are both accurate and sensitive in detecting pathologic cord motion. Therefore, such measures could identify high-risk patients and improve clinical decision-making (ie, timing of decompression).

The purpose of this study was to quantify the effect of the flexor carpi ulnaris and the extensor carpi ulnaris muscles on distal radioulnar joint stability. The anteroposterior ulnar head translation in relation to the radius was measured sonographically when the forearm was in a neutral resting position and when the hand was actively pressed on to a surface, with and without intentional flexor carpi ulnaris and extensor carpi ulnaris activation, while also being monitored by an electromyogram. Data on 40 healthy participants indicated a mean anteroposterior translation in the distal radioulnar joint of 4.1 mm (SD 1.08) without and 1.2 mm (SD 0.54) with muscle activation. Our results indicate that intentional ulnar forearm muscle activation results in 70% less anteroposterior ulnar head translation and greater distal radioulnar joint stability. Therefore, the flexor carpi ulnaris and extensor carpi ulnaris muscles serve as dynamic stabilizers of the distal radioulnar joint. This finding may be clinically significant since ulnar forearm muscles strengthening may increase distal radioulnar joint stability.

Recognition of typical patterns of brain response to external stimuli using near-infrared spectroscopy (fNIRS) may become a gateway to detecting covert consciousness in clinically unresponsive patients. This is the first fNIRS study on the cortical hemodynamic response to favorite music using a frequency domain approach. The aim of this study was to identify a possible marker of cognitive response in healthy subjects by investigating variations in the oscillatory signal of fNIRS in the spectral regions of low-frequency (LFO) and very-low-frequency oscillations (VLFO). The experiment consisted of two periods of exposure to preferred music, preceded and followed by a resting phase. Spectral power in the LFO region increased in all the subjects after the first exposure to music and decreased again in the subsequent resting phase. After the second music exposure, the increase in LFO spectral power was less distinct. Changes in LFO spectral power were more after first music exposure and the repetition-related habituation effect strongly suggest a cerebral origin of the fNIRS signal. Recognition of typical patterns of brain response to specific environmental stimulation is a required step for the concrete validation of a fNIRS-based diagnostic tool.

Background. Given individuals with spinal cord injury (SCI) approaching 2 million, viable options for regenerative repair are desperately needed. Human central nervous system stem cells (HuCNS-SC) are self-renewing, multipotent adult stem cells that engraft, migrate, and differentiate in appropriate regions in multiple animal models of injured brain and spinal cord. Preclinical improved SCI locomotor function provided rationale for the first-in-human SCI clinical trial of HuCNS-SC cells. Evidence of feasibility and long-term safety of cell transplantation into damaged human cord is needed to foster translational progression of cellular therapies. Methods. A first-ever, multisite phase I/IIa trial involving surgical transplantation of 20 million HuCNS-SC cells into the thoracic cord in 12 AIS A or B subjects (traumatic, T2-T11 motor-complete, sensory-incomplete), aged 19 to 53 years, demonstrated safety and preliminary efficacy. Six-year follow-up data were collected (sensory thresholds and neuroimaging augmenting clinical assessments). Findings. The study revealed short- and long-term surgical and medical safety (well-tolerated immunosuppression in population susceptible to infections). Preliminary efficacy measures identified 5/12 with reliable sensory improvements. Unfortunately, without thoracic muscles available for manual muscle examination, thoracic motor changes could not be measured. Lower limb motor scores did not change during the study. Cervical cord imaging revealed, no tumor formation or malformation of the lesion area, and secondary supralesional structural changes similar to SCI control subjects. Interpretation. Short- and long-term safety and feasibility support the consideration of cell transplantation for patients with complete and incomplete SCI. This report is an important step to prepare, foster, and maintain the therapeutic development of cell transplantation for human SCI.

This report documents the first-in-man investigational trial and long-term follow-up of HuCNS-SC transplantation in chronic SCI. The small study size and open-label design reflect the pilot nature of this investigation, and the focus on determining feasibility, safety and preliminary efficacy. Based on the short- and long-term safety profile established in this study for individuals with thoracic SCI, a larger-scale, randomized, study in people with cervical SCI was approved in the US. These trials have established that the human spinal cord is a promising target for neural stem cell transplantation.

Background: Given the large number of individuals living with disabling sensorimotor impairment due to spinal cord injury (SCI) approaching 2 million, viable options for regenerative repair strategies of the injured spinal cord are desperately needed. Human central nervous system stem cells (HuCNS-SC®) are self-renewing, multi-potent adult stem cells exhibiting successful engraftment, migration, and region-appropriate differentiation as demonstrated in multiple animal models for the injured brain and spinal cord. In preclinical SCI models, improved locomotor function provided the rationale for the first human thoracic SCI clinical trial of HuCNS-SC cells. Methods: Safety and preliminary efficacy data were collected within a first ever multi-site phase I/IIa trial involving surgical transplantation of 20 million HuCNS-SC cells into the thoracic cord in 12 subjects with sensory or motor complete traumatic paraplegia. Up to 6 years follow-up data was collected applying an extended protocol design augmenting clinical assessments through corroborating measures of sensory thresholds and neuroimaging to improve readouts of safety and efficacy. Findings: The study revealed promising short and long term surgical and medical safety. Measures of preliminary efficacy could discern responders (5/12 patients) with reliable improvements in sensory function albeit without measurable motor changes in thoracic injuries. Imaging of the spinal cord at and rostral the site of injection revealed dynamic structural changes similar to findings in non-transplanted SCI subjects. Interpretation: Findings of safety and feasibility supported the regulatory approval for a Phase II HuCNS-SC transplantation study in cervical spinal cord injured patients. Funding: The initial study (short term follow-up of the first year; STFU) and part of the second study (long term follow-up; LTFU) was funded by Stem Cells Inc, Newark, California, USA. After dissolution of Stem Cells Inc. Q3 2016 grants from Wings for Life (WfL), and the Bright Oceans Corporation (BOCO) enabled completion of the LTFU, compilation of the full set of monitored data (initial Phase I/IIa STFU trial and LTFU study), data analysis and manuscript completion. Declaration of Interest: Armin Curt has no competing interests. Principal Investigator for multi-site Phase I/IIa trial of 12 subjects and primary author (corresponding author). Jane Hsieh, with no competing interests, is an independent consultant to the Spinal Cord Injury Center Balgrist initiating data analysis and the first draft of the manuscript, as well as coordinating contributions from collaborating authors. Martin Schubert with no competing interests, participated in care of 9 enrolled subjects, data analysis and review of manuscript. Markus Hupp has no competing interests. Participated in the care of 9 enrolled subjects and reviewed the manuscript. Susi Friedl has no competing interests. Participated in the care of 9 enrolled subjects and reviewed the manuscript. Patrick Freund has no competing interests. Collected and analyzed neuroimaging data for 9 enrolled subjects and reviewed the manuscript. Eveline Huber has no competing interests. Collected and analyzed neuroimaging data for 9 enrolled subjects and reviewed the manuscript. Dario Pfyffer has no competing interests. Collected and analyzed neuroimaging data for 9 enrolled subjects, assisted with figure creation and reviewed the manuscript. Safety of neural stem cell transplantation into the human spinal cord Draft version: V6.1 20190128 Reto Sutter has no competing interests. Collected and analysed neuroimaging data for 9 enrolled subjects and reviewed the manuscript. Catherine Jutzeler has no competing interests. Collected and analysed electrophysiological data for 9 enrolled subjects and reviewed the manuscript. Rudolf P. Wuthrich has no competing interests. Provided immunosuppression for 9 enrolled subjects and reviewed the manuscript. Kan Min has no competing conflicts of interest. Performed orthopaedic spinal surgery for 9 HuCNS-SC transplantations at Balgrist site and reviewed the manuscript. Steve Casha has no competing interests. Site investigator at University of Calgary with 2 patients enrolled and transplanted, and reviewed the manuscript. Michael Fehlings has no competing interests. Site investigator at University of Toronto with 1 patient enrolled and transplanted, and reviewed the manuscript. Raphael Guzmann has no competing interests. Performed neurosurgery and HuCNS-SC transplantation for 9 enrolled subjects and reviewed the manuscript. Ethical Approval: The study protocol and all amendments were approved by related Ethics Committees and regulatory agencies in accordance with the Declaration of Helsinki.

Level-, age-, and gender-matched controlled cross-sectional cohort study. To investigate alterations of spinal cord (SC) motion within cervical spondylotic myelopathy (CSM) across the cervical spinal segments and its relation to cerebrospinal fluid (CSF)-flow, anatomic conditions, and clinical parameters. University Hospital Balgrist, Zurich, Switzerland. Overall, 12 patients suffering from CSM at level C5 and 12 controls underwent cardiac-gated 2D phase-contrast-MRI at level C2 and C5 and standard MRI sequences. Parameters of interest: Velocity measurements of SC and CSF (area under the curve = total displacement (normalization for duration of the heart cycle), total displacement ratio (C5/C2; intraindividual normalization for confounders)), spinal canal diameters, clinical motor- and sensory scores, and performance measures. Interrater reliability was excellent for SC motion at both levels and for CSF flow at C2, but not reliable for CSF flow at C5. Within controls, SC motion at C2 positively correlated with SC motion at C5 (p = 0.000); this correlation diminished in patients (p = 0.860). SC total displacement ratio was significantly increased in patients (p = 0.029) and correlated with clinical impairment (p = 0.017). Morphometric measures of the extent of stenosis were not related to SC motion or clinical symptoms. The findings revealed physiological interactions of CSF flow and SC motion across the cervical spine in healthy controls while being diminished in CSM patients. Findings of focally increased SC motion at the level of stenosis were related to clinical impairment and might be promising as a diagnostic and prognostic marker in CSM. CRPP Neurorehab of the University of Zurich, Switzerland.

Today's workplaces are dynamic and complex. Digital data sources such as email and video conferencing aim to support workers but also add to their burden of multitasking. Psychophysiological sensors such as Electroencephalography (EEG) can provide users with cues about their cognitive state. We introduce BrainAtWork, a workplace engagement and task logger which shows users their cognitive state while working on different tasks. In a lab study with eleven participants working on their own real-world tasks, we gathered 16 hours of EEG and PC logs which were labeled into three classes: central, peripheral and meta work. We evaluated the usability of BrainAtWork via questionnaires and interviews. We investigated the correlations between measured cognitive engagement from EEG and subjective responses from experience sampling probes. Using random forests classification, we show the feasibility of automatically labeling work tasks into work classes. We discuss how BrainAtWork can support workers on the long term through encouraging reflection and helping in task scheduling.

In this prospective study, we made an unbiased voxel-based analysis to investigate above-stenosis spinal degeneration and its relation to impairment in patients with cervical spondylotic myelopathy (CSM). Twenty patients and 18 controls were assessed with high-resolution MRI protocols above the level of stenosis. Cross-sectional areas of grey matter (GM), white matter (WM), and posterior columns (PC) were measured to determine atrophy. Diffusion indices assessed tract-specific integrity of PC and lateral corticospinal tracts (CST). Regression analysis was used to reveal relationships between MRI measures and clinical impairment. Patients showed mainly sensory impairment. Atrophy was prominent within the cervical WM (13.9%, p = 0.004), GM (7.2%, p = 0.043), and PC (16.1%, p = 0.005). Fractional anisotropy (FA) was reduced in the PC (-11.98%, p = 0.006) and lateral CST (-12.96%, p = 0.014). In addition, radial (+28.47%, p = 0.014), axial (+14.72%, p = 0.005), and mean (+16.50%, p = 0.001) diffusivities were increased in the PC. Light-touch score was associated with atrophy (R(2) = 0.3559, p = 0.020) and FA (z score 3.74, p = 0.003) in the PC, as was functional independence and FA in the lateral CST (z score 3.68, p = 0.020). This study demonstrates voxel-based degeneration far above the stenosis at a level not directly affected by the compression and provides unbiased readouts of tract-specific changes that relate to impairment.

Commercially available aroma samples were evaluated for their olfactory quality by professional perfumers and tested for their antimicrobial activity. Agar diffusion and agar-dilution were used as test methods and a set of two Gram-positive ( Staphylococcus Aureus and Enterococcus faecalis) and four Gram-negative bacterial strains ( Escherichia coli, Pseudomonas aeruginosa, Proteus vulgaris G, Klebsiella pneumoniae and Salmonella abony) and a yeast, Candida albicans, were the test microorganisms. All the investigated compounds were active against Gram-positive bacteria, especially β-caryophyllene against Enterococcus faecalis (MIC 6 ppm), but only few substances showed activity towards Gram-negative bacteria, except for cinnamic acid, which was active against all (MIC 60 ppm) and Candida albicans, against which cinnamic acid and caryophyllene oxide showed high activity (MIC < 60 ppm).

Erstellung eines Kommunikationstrainingsprogammes für Paare zur Behandlung dysfunktionaler Kommunikation in der Partnerschaft als primär Prävention zur Vermeidung physischer und psychischer und sozialer Folgen von mangelnder oder ungenügender Paarzufriedenheit., Debelopement of an interactive - film based couples communication training program as a concept of health maintenance.

The synthesis and odor properties of cyclopropano-beta-santalol, a new santalol analogue, are described. The exocyclic double bond of the original molecule, beta-santalol, is replaced by a cyclopropane ring. Despite the analogies in the binding properties between the double bond and cyclopropane this change in the bulky hydrophobic part of the molecule leads to the complete loss of the characteristic sandalwood odor: in an olfactory evaluation the (Z)-product appears spicy and sweet, the (E)-isomer woody, but neither of them exhibits the typical sandalwood character.

The aim of this investigation was to develop a fast and convenient method for the determination of (-)-linalool in human whole blood to facilitate pharmacokinetic studies. Analytical protocols were elaborated for three different GC/MS sampling techniques, i.e., static headspace (s-HS), headspace solid phase micro extraction (HS-SPME), and liquid-liquid partition. In principle, all tested methods were feasible, but s-HS had the greatest benefit because of the easy handling of the blood samples and its short analysis time. For s-HS two different incubation temperatures were tested (40 degrees C and 60 degrees C). The limit of detection was slightly lower when samples were incubated at 60 degrees C, but the same quantitative results were achieved using alpha-terpineol as internal standard. An accurate and sensitive method for the quantification of (-)-linalool in blood samples after either inhalation or percutaneous application, as well as pharmacokinetic data are presented.