Breast surgeons updating on the thresholds of COVID-19 era: results of a multicenter collaborative study evaluating the role of online videos and multimedia sources on breast surgeons education and training.

OBJECTIVE: Current trends show a rise of attention given to breast cancer patients' quality of life and the surgical reconstructive result. Along with this trend, surgical training quality and efficacy are gaining importance and innovative training methods such as online videos shared on social media portals, are becoming main updating tools. In hazardous times like COVID-19 pandemic nowadays, online communication becomes of vital importance and adaptation and innovation are fundamental to keep research and education alive. The authors aimed to investigate the role of video and multimedia sources on the daily activity and surgical training of a representative group of surgeons specifically dedicated to oncologic, oncoplastic and reconstructive breast surgeries. MATERIALS AND METHODS: A survey was produced and administered to 20 major Italian Breast Centers. Collected data were analyzed with Fisher's Exact Test. RESULTS: From October 2019 to March 2020, a total of 320 surveys were collected. Among the responders, there were 188 trainees (intern medical doctors and residents) and 110 faculty, 72% of them belonged to a plastic surgery environment, while 28% to general surgery environment. Almost all respondents have ever watched videos concerning breast surgery. CONCLUSIONS: The results of the study show how breast surgeons rely on videos and web platforms, mostly YouTube, when searching for training info about surgical procedures. Social media offer great opportunities for sharing knowledge and diffusion of new ideas but greater attention to their reliability is mandatory.

Effects of disease progression and L-dopa therapy on the control of reaching-grasping in Parkinson's disease.

The present study aimed to determine whether the bradykinesia of Parkinson's disease (PD) patients during the execution of reaching-grasping movements (i) is related to an impaired implementation of movement parameters and (ii) selectively involves the control of reach and/or grasp movements. We compared the kinematics of reaching to grasp of differently sized objects placed at different positions, among PD patients in the early stage of disease (ESPD), in the advanced stage of disease (ASPD) without L-dopa medication (off-state), and in healthy controls. In addition, we analysed the effects of L-dopa replacement therapy by comparing the kinematics of the patients in the advanced stage of disease after L-dopa administration with those of the other groups. Bradykinesia increased with disease progression, but only in the initial phases of the reach and grasp components. However at both stages of the disease, the kinematics of reaching and grasping responded to extrinsic and intrinsic object properties just as in controls. L-dopa administration improved the performance of PD patients, though this was more evident for the reach than for the grasp. We suggest that the basal ganglia (BG) are involved in implementing kinematic parameters, but neither (or only marginally) in the initial movement parameterization itself, nor in the on-line control of movement. Specifically, the BG dysfunction in PD induces a slowed implementation of movement parameters. The lack of effect of L-dopa administration on grasp kinematics may be because the motor control of distal effectors is less represented in the motor circuitry formed by the supplementary motor area (SMA), thalamus and BG.

Grasp with hand and mouth: a kinematic study on healthy subjects.

Neurons involved in grasp preparation with hand and mouth were previously recorded in the premotor cortex of monkey. The aim of the present kinematic study was to determine whether a unique planning underlies the act of grasping with hand and mouth in humans as well. In a set of four experiments, healthy subjects reached and grasped with the hand an object of different size while opening the mouth (experiments 1 and 3), or extending the other forearm (experiment 4), or the fingers of the other hand (experiment 5). In a subsequent set of three experiments, subjects grasped an object of different size with the mouth, while opening the fingers of the right hand (experiments 6-8). The initial kinematics of mouth and finger opening, but not of forearm extension, was affected by the size of the grasped object congruently with the size effect on initial grasp kinematics. This effect was due neither to visual presentation of the object, without the successive grasp motor act (experiment 2) nor to synchronism between finger and mouth opening (experiments 3, 7, and 8). In experiment 9 subjects grasped with the right hand an object of different size while pronouncing a syllable printed on the target. Mouth opening and sound production were affected by the grasped object size. The results of the present study are discussed according to the notion that in an action each motor act is prepared before the beginning of the motor sequence. Double grasp preparation can be used for successive motor acts on the same object as, for example, grasping food with the hand and ingesting it after bringing it to the mouth. We speculate that the circuits involved in double grasp preparation might have been the neural substrate where hand motor patterns used as primitive communication signs were transferred to mouth articulation system. This is in accordance with the hypothesis that Broca's area derives phylogenetically from the monkey premotor area where hand movements are controlled.

Influence of stimulus color on the control of reaching-grasping movements.

This kinematic study aimed to determine whether color is a stimulus property involved in the control of reaching-grasping movements. Subjects reached and grasped a target-object, located either on the right or on the left of the subject's midline. A distractor, placed along the subject's midline, could be randomly presented. The colors, i.e., both chromaticity (red and green stimuli were presented) and lightness, of the target and distractor were varied in experiment 1. Only stimulus lightness and only stimulus chromaticity were varied in experiments 2 and 3, respectively. In experiment 4 subjects matched with their thumb and index finger the size of the target-stimuli presented in experiment 1. Chromaticity (experiments 1 and 3) of the target and distractor influenced grasp, but not reach. Maximal finger aperture was larger during grasping the red than the green target. Data collected in the matching task (experiment 4) confirmed a trend to overestimate the red target and to underestimate the green one. During grasp, hand shaping was influenced by distractor chromaticity when it was different from target chromaticity. Distractor lightness affected reach, but not grasp (experiments 1 and 2). Reach was slower when the distractor was lighter and arm trajectory veered away from it. The results of the present study suggest that color, that is the ensemble of chromaticity and lightness, is a stimulus property involved in the control of reaching-grasping. The different effects of target color on reach and grasp support the notion that intrinsic object properties, such as color, affect grasp more than reach. In addition, the different effects of distractor chromaticity and lightness on reach and grasp confirm that target-objects are visually extracted from surrounding cues by means of different processes, according to the required motor response.

Visual illusions and the control of children arm movements.

The aim of the present study was to determine whether children like adults (Gentilucci M, Chieffi S, Daprati E, Saetti MC, Toni I. Visual illusion and action. Neuropsychologia 1996;34:369-76; Gentilucci M, Daprati E, Gangitano M, Toni I. Eye position tunes the contribution of allocentric and egocentric information to target localisation in human goal directed arm movements. Neurosci Lett 1997;222:123-6) are influenced by visual illusions when they transform visual information in motor command. Children and adults pointed to a shaft extremity of the Müller-Lyer configurations, as well as to an extremity of a control configuration. Movements were executed in two experimental conditions. In the vision condition subjects saw both the stimulus and their hand before and during movement. In the no vision (memory) condition subjects saw the stimulus and their hand before, but not during movement. Movement started 5 s after vision was precluded. The Müller-Lyer illusion affected pointing kinematics of both children and adults. As found previously (Gentilucci M, Chieffi S, Daprati E, Saetti MC, Toni I. Visual illusion and action. Neuropsychologia 1996;34:369-76; Gentilucci M, Daprati E, Gangitano M, Toni I. Eye position tunes the contribution of allocentric and egocentric information to target localisation in human goal directed arm movements. Neurosci Lett 1997;222:123-6), subjects undershot and overshot the shaft extremity of the closed and of the open configuration, respectively. The illusion effect was greater in the no vision than in the vision condition. These results show that in children like in adults the system underlying visual perception in an object-centered frame of reference and that involved in motor control functionally interact with each other. Although the processes of target localisation were the same, the transformation of target position information in a sequence of motor patterns was different in children from that in adults. Even if both children and adults lengthened duration of the deceleration phase in the vision condition, only adults shortened duration of the acceleration phase in order to maintain constant movement time (Viviani P, Schneider R. A developmental study of the relationship between geometry and kinematics in drawing movements. J Exp Psychol 1991;17:198-218). This result suggests that children are yet unable to co-ordinate temporally acceleration with deceleration phase.

Language and motor control.

We investigated the possible influence of automatic word reading on processes of visuo-motor transformation. Subjects reached and grasped an object on which the following Italian words were printed: "VICINO" (near) or "LONTAN" (far) on an object either near or far from the agent (experiments 1, 2); PICCOLO (small) or "GRANDE" (large) on either a small or a large object (experiment 4); and "ALTO" (high) or "BASSO" (low) on either a high or a low object (experiment 5). The kinematics of the initial phase of reaching-grasping was affected by the meaning of the printed words. Namely, subjects automatically associated the meaning of the word with the corresponding property of the object and activated a reach and/or a grasp motor program influenced by the word. No effect on initial reach kinematics was observed for words related to object properties not directly involved in reach control (experiment 3). Moreover, in all the experiments, the presented words poorly influenced perceptual judgement of object properties. In experiments 5-7, the effects of the Italian adjectives "ALTO" (high) and "BASSO" (low) on reaching-grasping control were compared with those of the Italian adverbs "SOPRA" (up) and "SOTTO" (down). Adjectives influenced visual analysis of target-object properties, whereas adverbs more directly influenced the control of the action. We suggest that these effects resemble the structure of a sentence, where adjectives are commonly referred to nouns, and adverbs to verbs. In other words, class of words and, in a broad sense, grammar influenced motor control. The results of the present study show that cognitive functions such as language can affect visuo-motor transformation. They are discussed according to the notion that a strict relation between language and motor control exists, and that the frontal cortex can be involved in interactions between automatic word reading and visuo-motor transformation.

Modulation of vascular endothelial gene expression by physical training in patients with chronic heart failure.

BACKGROUND: Abnormalities of the skeletal muscle vasculature, such as endothelial dysfunction and reduced microvascular density, can be reversed by physical training in patients with chronic heart failure. The molecular mechanisms that mediate the beneficial effects of physical training on the vascular endothelium are unknown. METHODS: Endothelial nitric oxide synthase (eNOS) and vascular endothelial growth factor (VEGF) gene expression in the skeletal muscle, peak oxygen consumption (VO2) and calf peak reactive hyperemia were measured before and after 12 weeks of supervised physical training in 10 patients with chronic heart failure. Five patients with heart failure of similar severity who did not participate in the training program served as controls. RESULTS: The effects of physical training on eNOS and VEGF gene expression were heterogeneous. eNOS gene expression increased 3-4 fold in 4 patients while it remained constant in 6 patients. VEGF gene expression increased significantly in all patients who were not treated with beta-adrenergic blockade and remained constant in all patients who were treated with beta-adrenergic blockade. In contrast, physical training increased peak VO2 and calf peak reactive hyperemia in all patients. Mean peak VO2 increased from 13.13 +/- 2.21 to 16.19 +/- 2.69 ml/kg/min (p < 0.001) and calf peak reactive hyperemia increased from 19.7 +/- 2.3 to 29.6 +/- 4.0 ml*min(-1)*100 ml(-1) (p < 0.001). CONCLUSIONS: A supervised program of physical training that consistently enhanced peak VO2 and vascular reactivity in patients with chronic heart failure increased or left eNOS and VEGF gene expression unchanged in skeletal muscle. Changes in vascular endothelial gene expression may contribute to the benefits of training on vascular endothelial function but are not solely responsible for these benefits.

Impaired control of an action after supplementary motor area lesion: a case study.

The kinematics of the action formed by reaching-grasping an object and placing it on a second target was studied in a patient who suffered from an acute vascular left brain lesion, which affected the Supplementary Motor Area proper (SMA-proper) (Matelli M, Luppino G. Thalamic input to mesial and superior area 6 in the macaque monkey. Journal of Comparative Neurology 1996;372:59-87, Matelli M, Luppino G, Fogassi L, Rizzolatti G. Thalamic input to inferior area 6 and area 4 in the macaque monkey. Journal of Comparative Neurology 1989;280:468-488), and in five healthy control subjects. The reach kinematics of the controls was affected by the positions of both the reaching-grasping and the placing targets (Gentilucci M, Negrotti A, Gangitano M. Planning an action. Experimental Brain Research 1997;115:116-28). In contrast, the reach kinematics of the patient was affected only by the position of the reaching-grasping target. By comparing these results with those previously found in Parkinson's disease patients executing the same action (Gentilucci M, Negrotti A. Planning and executing an action in Parkinson's disease patients. Movement Disorders 1999;1:69-79, Gentilucci M, Negrotti A. The control of an action in Parkinson's disease. Experimental Brain Research 1999;129:269-277), we suggest that the anatomical "motor" circuit formed by SMA-proper (see above), Basal Ganglia (BG) and Thalamus (Alexander GE, Crutcher MD. Functional architecture of basal ganglia circuits: neural substrates of parallel processing. Trends in the Neurosciences 1990;13:266-271, Hoover JE, Strick PL. Multiple output channels in the basal ganglia. Nature 1993;259:819-821) may be involved in the control of actions: SMA-proper assembles the sequence of the action, whereas BG updates its parameters and stores them.

Recognising a hand by grasp.

The present study aimed to demonstrate that motor representations are used to recognise biological stimuli. In three experiments subjects were required to judge laterality of hands and forearms presented by pictures. The postures of the hands were those assumed when holding a small, medium and large sphere. In experiment 1, the sphere held in hand was presented, whereas in experiment 2 it was absent. In experiment 3, the same images, showing holding-a-sphere hands, as in experiment 1 were presented, but without forearm. In all experiments one finger of each hand could be absent. In experiment 1 recognition time was longer for those hand postures for which the corresponding grasping motor acts required more accuracy. This was confirmed by a control experiment (experiment 4), in which subjects actually grasped the spheres. Absence of fingers did not influence right-left hand recognition. However, the absence of target object in experiment 2, and of forearm in experiment 3 reduced the effects of the type of holding on hand laterality recognition. The results of the present study indicate that grasp representations are used to recognise hand laterality. In particular, the visual description of how hand and object interact in space (the opposition space [M.A. Arbib, Programs, schemas and neural networks for control of hand movement: beyond the RS frameworks, in: M. Jeannerod (Ed.), Attention and Performance XIII: Motor Representation and Control, Lawrence Erlbaum, Hillsdale, NJ, 1990, 111-138; M.A. Arbib, T. Iberall, D. Lyons, Coordinated control programs for movements of the hand, in: A.W. Goodman, I. Darian-Smith (Eds.), Hand function and the neocortex, Springer, Berlin, 1985, pp. 135-170]) and the anchoring of the hand to the agent are the features of the grasp representations used in hand-recognition processes. The data are discussed according to the more general notion that motor representations are automatically extracted in the process of intuiting situations, or people's intentions. These motor representations, which are compared with those of other people, contain concrete information on the actions (the motor program) by which a situation is created and on the aim of the agents executing those actions.

The control of an action in Parkinson's disease.

We studied, in Parkinson's disease (PD) patients and healthy control subjects, the kinematics of the action formed by two successive motor acts: reaching-grasping an object (first target) and placing it on a second target. We examined the effects of extrinsic (i.e., distance) and intrinsic (i.e., size) properties of the second target on the various kinematic phases of reaching-grasping. We randomly varied distance and size of both stimuli across the experimental session. The kinematics of the reach initial phase of both patients and controls was influenced by the distance of both the first and the second target. In particular, peak acceleration increased for farther position of the second target. However, in the subsequent phase, patients, differently from controls, modified their reaching kinematics, removing the effects of second target position. These results were due neither to a visual interference effect of the second target on reaching-grasping nor to the complexity of movement sequence. Finally, the size of the second target did not affect grasp kinematics of both patients and controls. The results of the present study support the hypothesis that PD patients are able to compute the general program of an action in which extrinsic properties of both the actual and the final target are computed. However, PD patients re-program movement during its execution. This suggests a decay of the motor program. That is, basal ganglia can be involved in storing the plan of an action and in controlling its correct execution.

Planning and executing an action in Parkinson's disease.

We evaluated the possible impairment in planning and executing an action in patients with Parkinson's disease (PD). The action considered in the present study was formed by two successive motor acts: reaching-grasping an object (first target) and placing it on a second target of the same shape and size. We examined the effects of extrinsic properties of the second target (that is, distance) on the various kinematic phases of reaching-grasping movements. Distance, position, and size of both stimuli were randomly varied across the experimental session. Movements were executed with and without visual control of both targets and arm. The performance of six patients with PD was compared with an age-matched control group. The kinematics of the initial phase of reaching was influenced by position and size of the first target and by distance of the second target in both patients and control subjects. In particular, peak acceleration was higher for farther position of the second target. However, in the subsequent phase patients, differently from control subjects, removed the effects of the second target distance by modifying their reaching kinematics. This was obtained by varying the duration of the acceleration phase. In summary, the patients reprogrammed the reaching component by taking into account only the properties of the first target. The decreasing influence of second-target distance on reaching kinematics of patients was more evident during movements executed under visual control. Moreover, their movements executed without visual control were slowed down from the beginning. The second target affected the grasping kinematics only of the control subjects. Globally, these results indicate that PD patients are able to compute the general program of an action that takes into account extrinsic properties of the final target. However, the finding that PD patients reprogrammed the movement during its execution suggests a decay of the program during its time course, that is, basal ganglia can be involved in storing the plan of an action and in controlling its correct execution.

Visual distractors differentially interfere with the reaching and grasping components of prehension movements.

In the present study we addressed the issue of how an object is visually isolated from surrounding cues when a reaching-grasping (prehension) movement towards it is planned. Subjects were required to reach and grasp an object presented either alone or with a distractor. In five experiments, different degrees of elaboration of the distractor were induced by varying: (1) the position of the distractor (central or peripheral); (2) the time when the distractor was suppressed (immediately or delayed, with respect to stimulus presentation); and (3) the type of distractor analysis (implicit or explicit). In addition, we tested whether the possible effects of the distractor on reaching-grasping were due to the use of an allocentric reference centered on it. This was obtained by comparing the effects of the distractor with those of a stimulus, the target of a placing movement successive to the reaching-grasping. The results of the five experiments can be summarized as follows. The necessary condition for an interference effect on both the reaching and the grasping components was the central presentation of the distractor. When the information on the distractor could be immediately suppressed, an interference effect was observed only on the grasp component. In the case of delayed suppression, an effect was found on the reaching component. Finally, when an overt analysis of the distractor was required, the interference effect disappeared. Two main conclusions have been drawn from the results of the present study. First, comparison between properties of the target and surrounding cues is performed by two independent processes for reaching and grasping an object. The process for the grasp relies more on allocentric cues than that for the reach. Second, when surrounding stimuli are automatically analyzed during visual search of the target, the process of visuo-motor transformation can incorporate their features into the target. In contrast, overt analysis of surrounding stimuli is performed separately from that of the target. Finally, the data of the present study are discussed in support of the premotor theory of attention.

Implicit visual analysis in handedness recognition.

In the present study, we addressed the problem of whether hand representations, derived from the control of hand gesture, are used in handedness recognition. Pictures of hands and fingers, assuming either common or uncommon postures, were presented to right-handed subjects, who were required to judge their handedness. In agreement with previous results (Parsons, 1987, 1994; Gentilucci, Daprati, & Gangitano, 1998), subjects recognized handedness through mental movement of their own hand in order to match the posture of the presented hand. This was proved by a control experiment of physical matching. The new finding was that presentation of common finger postures affected responses differently from presentation of less common finger postures. These effects could be not attributed to mental matching movements nor related to richness in hand-finger cues useful for handedness recognition. The results of the present study are discussed in the context of the notion that implicit visual analysis of the presented hands is performed before mental movement of one's hand takes place (Parsons, 1987; Gentilucci et al., 1998). In this process, hand representation acquired by experience in the control and observation of one's and other people's hand gestures is used. We propose that such an immediate recognition mechanism belongs to the class of mental processes which are grouped under the name of intuition, that is, the processes by which situations or people's intentions are immediately understood, without conscious reasoning.

Influence of automatic word reading on motor control.

We investigated the possible influence of automatic word reading on processes of visuo-motor transformation. Six subjects were required to reach and grasp a rod on whose visible face the word 'long' or 'short' was printed. Word reading was not explicitly required. In order to induce subjects to visually analyse the object trial by trial, object position and size were randomly varied during the experimental session. The kinematics of the reaching component was affected by word presentation. Peak acceleration, peak velocity, and peak deceleration of arm were higher for the word 'long' with respect to the word 'short'. That is, during the initial movement phase subjects automatically associated the meaning of the word with the distance to be covered and activated a motor program for a farther and/or nearer object position. During the final movement phase, subjects modified the braking forces (deceleration) in order to correct the initial error. No effect of the words on the grasp component was observed. These results suggest a possible influence of cognitive functions on motor control and seem to contrast with the notion that the analyses executed in the ventral and dorsal cortical visual streams are different and independent.

Haptic information differentially interferes with visual analysis in reaching-grasping control and in perceptual processes.

We used an interference paradigm in order to study integration between haptic and visual information in motor control and in perceptual analysis. Subjects either reached and grasped a visually presented sphere or matched its size with their left hand while manipulating with their right hand another sphere whose size could be smaller or greater. In four experiments haptic analysis of the manipulated sphere could be either automatically incorporated with or explicitly dissociated from visual analysis. In a fifth experiment reaching-grasping and matching were executed with the right hand, whereas manipulation was executed with the left hand. Manipulation with the right hand influenced finger shaping during grasping with the left hand when the sizes of the two objects were different. Interference was observed mainly in those experiments in which haptic analysis could be automatically integrated with visual analysis. In the matching task, no effect was observed. Finally, manipulation with the left hand did not produce any interference effect on reaching-grasping and matching executed by the right hand. The results of the present study suggest that somesthetic information is integrated with visual information only in sensorimotor transformations. In addition, they support the notion that the left hemisphere together with the right hemisphere is involved in the control of left hand reaching-grasping movements.

Right-handers and left-handers have different representations of their own hand.

The visual control of our own hand when dealing with an object and the observation of interactions between other people's hand and objects can be involved in the construction of internal representations of our own hand, as well as in hand recognition processes. Therefore, a different effect on handedness recognition is expected when subjects are presented with hands holding objects with either a congruent or an incongruent type of grip. Such an experiment was carried out on right-handed and left-handed subjects. We expected that the different degree of lateralisation in motor activities observed in the two populations [J. Herron, Neuropsychology of left-handedness, Academic Press, New York, 1980.] could account for the construction of different internal hand representations. As previously found [L.M. Parsons, Imaged spatial transformations of one's hands and feet, Cogn. Psychol., 19 (1987) 178-241.], in order to identify handedness, subjects mentally rotated their own hand until it matched with the presented one. This process was confirmatory, being preceded by an implicit visual analysis of the target hand. Presentation of hands holding objects with congruent or incongruent types of grip influenced handedness recognition at different stages in right-handed and left-handed subjects. That is, the mental rotation stage was affected in right-handed subjects, whereas the initial phase of implicit hand analysis was affected in left-handed subjects. We suggest that in handedness recognition, left-handers relied more on a pictorial hand representation, whereas right-handers relied more on a pragmatic hand representation, probably derived from experience in the control of their own movements. The use of different hand representations may be due to differential activation of temporal and premotor areas.

Clinical significance of fossa ovalis membrane aneurysm in adults with cardioembolic cerebral ischemia.

Fossa ovalis membrane aneurysm was diagnosed by transesophageal echocardiography in 45 of 134 consecutive patients (34%) with embolic cerebrovascular ischemic events. A potential cardiovascular source of embolism, other than the fossa ovalis membrane aneurysm, was found in 91% of these patients (41 of 45).

Planning an action.

The motor control of a sequence of two motor acts forming an action was studied in the present experiment. The two analysed motor acts were reaching-grasping an object (first target) and placing it on a second target of the same shape and size (experiment 1). The aim was to determine whether extrinsic properties of the second target (i.e. target distance) could selectively influence the kinematics of reaching and grasping. Distance, position and size of both targets were randomly varied across the experimental session. The kinematics of the initial phase of the first motor act, that is, velocity of reaching and hand shaping of grasping, were influenced by distance of the second target. No kinematic difference was found between movements executed with and without visual control of both hand and targets. These results could be due to computation of the general program of an action that takes into account extrinsic properties of the final target. Conversely, they could depend on a visual interference effect produced by the near second target on the control of the first motor act. In order to dissociate the effects due to second target distance from those due to visual interference, two control experiments were carried out. In the first control experiment (experiment 2) subjects executed movements directed towards spatial locations at different distances from the first target, as in experiment 1. However, the near second target was not presented and subjects were required to place the object on an arbitrary near position. Distance of the second (either real or arbitrary) target affected the reaching component of the first motor act, as in experiment 1, but not the grasp component. In the second control experiment (experiment 3), the pure visual interference effect was tested. Subjects were required to reach and grasp the object and to lift it in either presence or absence of a second near stimulus. No effect on the initial phase of the first motor act was observed. The results of the this study suggest a dissociation in the control of reaching and grasping, concerning not only visual analysis of extrinsic properties of the immediate target but also visual analysis of the final target of the action. In other words, the notion of modularity for the motor control can be extended to the construction of an entire action.

Nonselective beta-adrenergic blockade with carvedilol does not hinder the benefits of exercise training in patients with congestive heart failure.

BACKGROUND: Long-term beta-adrenergic blockade does not appear to be associated with drug-induced training in patients with congestive heart failure (CHF); whether exercise training can increase peak aerobic capacity in patients with CHF who are treated with beta-adrenergic blockers is currently unknown. METHODS AND RESULTS: We studied 23 patients with CHF who were treated with carvedilol or propranolol in addition to ACE inhibitors, furosemide, and digoxin. Of the patients treated with carvedilol, 8 underwent exercise training and 8 remained sedentary. All 7 patients treated with propranolol underwent exercise training. Peak oxygen consumption (mL.kg-1.min-1) was serially measured in trained and sedentary patients. Peak reactive hyperemia (mL.min-1.100 mL-1) was determined in the calf and forearm immediately before and after 12 weeks of training. The peak oxygen consumption of trained patients treated with either carvedilol or propranolol increased from 12.9 +/- 1.4 to 16.0 +/- 1.6 (P < .001) and 12.4 +/- 1.0 to 15.7 +/- 0.9 (P < .001) mL.kg-1.min-1, respectively, whereas it did not change in the sedentary patients. Peak reactive hyperemia increased significantly in the calves but not the forearms of trained patients. CONCLUSIONS: Long-term, nonselective beta-adrenergic blockade with carvedilol or propranolol does not prevent patients with CHF from deriving systemic and regional benefits from physical training.

Tactile input of the hand and the control of reaching to grasp movements.

The role of tactile information of the hand in the control of reaching to grasp movements was investigated. The kinematics of both reaching (or transport) and grasp components were studied in healthy subjects in two experimental conditions. In one condition (control condition) subjects were required to reach and grasp an object that could have two sizes and that could be located at two distances from the viewer. In the other condition (anaesthesia condition) the same movements were executed, but anaesthesia was provided to the subjects' fingertips. In both conditions vision of the hand was prevented during movement. Anaesthesia affected mainly the kinematics of the first phase of grasping, that is, the finger-opening phase. This phase was lengthened and maximal finger aperture increased. In contrast, the duration of the successive phase (finger-closure) was poorly modified. The reaching component was also impaired by anaesthesia. Although the total extent of hand path and the spatial relations between the finger aperture and closure phases did not change between the two conditions, hand path variability increased. This occurred during transport deceleration phase and after the increase in variability of finger path. In addition, the whole movement was slowed down. The results of the present experiment suggest that tactile signals at the beginning and at the end of movement can be used to compute grasp time and to optimise grasp temporal parameters. Alternatively, signals from tactile receptors can be involved in encoding the position sense of the fingers. When this input is lacking, the control of grasp and in particular that of finger-opening phase can be impaired. Finally, the effect of the grasp impairment on the reaching component supports the notion that the coordination between reaching and grasping involves the whole temporal course of the two components.