Vocal and tongue exercise in early to mid-stage Parkinson disease using the Pink1-/- rat.

Vocal and swallowing deficits are common in Parkinson disease (PD). Because these impairments are resistant to dopamine replacement therapies, vocal and lingual exercise are the primary treatment, but not all individuals respond to exercise and neural mechanisms of treatment response are unclear. To explore putative mechanisms, we used the progressive Pink1-/- rat model of early to mid-stage PD and employed vocal and lingual exercises at 6- and 10-months of age in male Pink1-/- and wild type (WT) rats. We hypothesized that vocal and lingual exercise would improve vocal and tongue use dynamics and increase serotonin (5HT) immunoreactivity in related brainstem nuclei. Rats were tested at baseline and after 8 weeks of exercise or sham exercise. At early-stage PD (6 months), vocal exercise resulted in increased call complexity, but did not change intensity, while at mid-stage (10 months), vocal exercise no longer influenced vocalization complexity. Lingual exercise increased tongue force generation and reduced relative optical density of 5HT in the hypoglossal nucleus at both time points. The effects of vocal and lingual exercise at these time points are less robust than in prodromal stages observed in previous work, suggesting that early exercise interventions may yield greater benefit. Future work targeting optimization of exercise at later time points may facilitate clinical translation.

Hair glucocorticoids during pregnancy in the context of trauma exposure and their predictive value for the development of childbirth-related posttraumatic stress disorder symptoms.

BACKGROUND: Childbirth-related posttraumatic stress disorder (CB-PTSD) is gaining attention as a mental disorder with negative sequela for mothers and their offspring. Maternal trauma history is a well-known vulnerability factor for CB-PTSD symptoms (CB-PTSS). Furthermore, alterations of the hypothalamus-pituitary-adrenal axis have been linked to both trauma exposure and PTSD development. Hence, we investigated whether trauma history was associated with long-term glucocorticoid (GC) levels during pregnancy and their predictive role for CB-PTSS. Further, we examined whether GCs act as a mediator in the relationship between trauma history and CB-PTSS and whether this was moderated by the subjective birth experience. METHODS: 212 women participating in the prospective cohort study DREAMHAIR provided hair samples for quantification of long-term integrated cortisol and cortisone levels prior to their anticipated birth date accompanied by measures of trauma history. CB-PTSS and subjective birth experience were assessed two months postpartum. FINDINGS: Trauma history predicted elevated hair cortisol and hair cortisone during the third trimester of pregnancy, however associations did not remain significant when Bonferroni correction due to multiple testing was applied. Trauma history also predicted higher CB-PTSS. Hair GC levels during pregnancy neither predicted CB-PTSS two months after birth nor mediated the relationship between trauma history and CB-PTSS. The subjective birth experience moderated the relationship of hair cortisol and cortisone with CB-PTSS. CONCLUSION: Our data suggest that a history of trauma contributes to a higher risk to develop CB-PTSS and elevated long-term GC levels during the third pregnancy trimester. Further, the predictive role of hair cortisol and cortisone levels for CB-PTSS may depend on subjective birth experience. This highlights the need to consider the latter in future investigations when examining the role of stress-related biomarkers in more severely affected samples.

Research-based Updates in Swallowing and Communication Dysfunction in Parkinson Disease: Implications for Evaluation and Management.

PURPOSE: Individuals with Parkinson disease (PD) present with complex and variable symptoms, with recent findings suggesting that the etiology of PD extends beyond the involvement of just the basal ganglia. These symptoms include significant impairments in the speech and swallowing domains, which can greatly affect quality of life and therefore require therapeutic attention. This research-based update reviews the neurophysiological basis for swallowing and speech changes in PD, the effectiveness of various types of treatments, and implications for symptom evaluation and management. CONCLUSION: The mechanisms responsible for swallowing and speech symptoms in PD remain largely unknown. Dopaminergic medication and deep-brain-stimulation do not provide consistent benefits for these symptoms suggesting a non-dopaminergic network is involved. Importantly, evidence suggests that symptoms of dysphagia and hypokinetic dysarthria may be early indications of PD, so it is critical to investigate the cause of these changes.

Contingent negative variation indicates phasic arousal for externally cued unilateral eye blink in human subjects.

The contingent negative variation (CNV) as a slow cortical potential was used to investigate cortical processing of externally cued, voluntary unilateral eye blink. Probands blinked as a response within a modified two-stimulus reaction time paradigm. Reaction time and amplitudes of CNV were determined. The activity of the orbicularis oculi muscles (OO) was registered by surface electromyography (EMG). Probands who performed unilateral eye blinks with accurately inhibiting contralateral OO activity showed a significantly higher negativity of the early CNV component compared with the bilateral eye blink condition. This effect was confined to the beginning of unilateral blinking performance. It is suggested that the unilateral eye blink is a challenging motor task, initially requiring an increased cortically driven arousal and attention as revealed by increased early CNV components.

Computer-aided breast cancer detection and diagnosis of masses using difference of Gaussians and derivative-based feature saliency.

A new model-based vision (MBV) algorithm is developed to find regions of interest (ROI's) corresponding to masses in digitized mammograms and to classify the masses as malignant/benign. The MBV algorithm is comprised of five modules to structurally identify suspicious ROI's, eliminate false positives, and classify the remaining as malignant or benign. The focus of attention module uses a difference of Gaussians (DoG) filter to highlight suspicious regions in the mammogram. The index module uses tests to reduce the number of nonmalignant regions from 8.39 to 2.36 per full breast image. Size, shape, contrast, and Laws texture features are used to develop the prediction module's mass models. Derivative-based feature saliency techniques are used to determine the best features for classification. Nine features are chosen to define the malignant/benign models. The feature extraction module obtains these features from all suspicious ROI's. The matching module classifies the regions using a multilayer perceptron neural network architecture to obtain an overall classification accuracy of 100% for the segmented malignant masses with a false-positive rate of 1.8 per full breast image. This system has a sensitivity of 92% for locating malignant ROI's. The database contains 272 images (12 b, 100 microm) with 36 malignant and 53 benign mass images. The results demonstrate that the MBV approach provides a structured order of integrating complex stages into a system for radiologists.

Three-dimensional surface reconstructions using a general purpose image processing system.

A general purpose two-dimensional (2-D) image processing software system was used to produce high quality three-dimensional (3-D) surface reconstructions from serial sections such as CT scan slices. Depth-encoded 3-D surface images, gradient-shaded 3-D surface images, and weighted sums of these two images were computed. Images that simulate transmission radiographs ("volumetric" views) were created from the same slice data. Hidden surfaces were displayed by reconstructing in 3-D only subvolumes of the original data set. The 2-D image processing functions used were limited to: planar subimage selection and merge, arithmetic and boolean operations, piecewise linear gray scale transform, convolution (1-D), and format conversion (byte-integer-float). Using these methods any user with a general purpose 2-D image processing system can analyze and view multi-slice data as 3-D volume and surface projections.

Biomechanics of the arterial wall under simulated flow conditions.

A perfusion apparatus is employed to reproduce quantifiable pulsatile hemodynamics within freshly excised canine carotid arteries. From measurements of pulsatile intraluminal and transmural pressure and the dynamic radial motion of the vessel wall, calculations are made of the vascular incremental modulus of elasticity and hoop, axial, and radial wall stresses. The results of this investigation suggest that an increase in transmural pressure from 120/80 to 240/120 mmHg produces a marked elevation in incremental modulus and arterial wall stress. These parameters are reduced when transmural pressure is lowered while maintaining intraluminal pressure at physiologic values.

A statistical method for development of subconcepts in nursing.

Achievement tests, whether cognitive or performance, often are not analyzed with the intent of detecting subtests within the total test. Subtests should represent unitary concepts. A step-by-step process for detecting subconcepts is proposed and exemplified. Concepts arrived at by the proposed methodology can provide insight to learner strategies for learning and can refine outcome measures to detect effects of the independent variable in teaching-learning investigations.

Continuous pump-tube enteric hyperalimentation.

The enteric route remains an overlooked site of alimentation. An intact functioning gastrointestinal tract can and should be used, even if the patient will not or cannot eat. The use of continuous pump-tube feeding of liquid diets through a small caliber feeding tube into the distal part of the duodenum or proximal portion of the jejunum is superior to previous methods of bolus tube feeding through large bore tubes placed in the stomach. A small tube has been developed which is inserted easily and positioned in the distal portion of the duodenum or proximal part of the jejunum. This tube has excellent patient tolerance. A suitable pump is essential to success. Elemental diets are not needed for routine enteric alimentation. They are expensive and, because of their hyperosmolarity, require a period of patient adaptation. Isocal, a complete liquid diet, essentially isotonic and lactose-free, provides 1 calorie per milliliter and has been used successfully as a pump-tube feeding diet. It rapidly converts the nitrogen balance of patients from negative to positive when given in quantities exceeding 30 calories per kilogram of body weight.