Computer-controlled electrical stimulation of facial muscles by facial neuromuscular electrical stimulation (fNMES): Hardware and software solutions.

BACKGROUND: Computer controlled electrical stimulation of facial muscles is a promising method to study facial feedback effects, though little guidance is available for new adopters. NEW METHOD: Facial Neuromuscular Electrical Stimulation (fNMES) offers a spatially and temporally precise means of manipulating facial muscles during experiments, and can be combined with EEG to study the neurological basis of facial feedback effects. Precise delivery of stimulation requires hardware and software solutions to integrate stimulators and a stimulus-presenting computer. We provide open-source hardware schematics and relevant computer code in order to achieve this integration, so as to facilitate the use of fNMES in the laboratory. RESULTS: Hardware schematics are provided for the building of a bespoke control module, which allows researchers to finely control stimulator output whilst participants complete computer tasks. In addition, we published code that new adopters of NMES can use within their experiments to control the module and send event triggers to another computer. These hard- and software solutions were successfully used to investigate the effects of facial muscle activation on felt and perceived emotion. We summarise these findings and discuss the integration of fNMES with EEG and peripheral physiological measures. COMPARISON WITH EXISTING METHODS: Our inexpensive hardware solution allows fNMES parameters to be computer controlled, and thus allows to stimulate facial muscles with high precision. This opens up new possibilities to investigate, for example, facial feedback effects. CONCLUSIONS: We provide tools and guidance to build a control module in order to precisely deliver electrical stimulation to facial muscles using a stimulus computer (while recording EEG or other peripheral physiology).

Measurement of the N170 during facial neuromuscular electrical stimulation (fNMES).

BACKGROUND: Studies on facial feedback effects typically employ props or posed facial expressions, which often lack temporal precision and muscle specificity. NEW METHOD: Facial Neuromuscular Electrical Stimulation (fNMES) allows for a controlled influence of contractions of facial muscles, and may be used to advance our understanding of facial feedback effects, especially when combined with Electroencephalography (EEG). However, electrical stimulation introduces significant interference that can mask underlying brain dynamics. Whether established signal processing methods can allow for a reduction of said interference whilst retaining effects of interest, remains unexplored. RESULTS: We addressed these questions focusing on the classic N170 visual evoked potential, a face-sensitive brain component: 20 participants viewed images of houses, and of sad, happy, and neutral faces. On half of the trials, fNMES was delivered to bilateral lower-face muscles during the presentation of visual stimuli. A larger N170 amplitude was found for faces relative to houses. Interestingly, this was the case both without and during fNMES, regardless of whether the fNMES artefact was removed or not. Moreover, sad facial expressions elicited a larger N170 amplitude relative to neutral facial expressions, both with and without fNMES. COMPARISON WITH EXISTING METHODS: fNMES offers a more precise way of manipulating proprioceptive feedback from facial muscles, which affords greater diversity in experimental design for studies on facial feedback effects. CONCLUSIONS: We show that the combining of fNMES and EEG can be achieved and may serve as a powerful means of exploring the impact of controlled proprioceptive inputs on various types of cognitive processing.

A five-year review of cases appearing before the General Dental Council's Professional Conduct Committee.

The General Dental Council (GDC) has as its primary responsibility the protection of the general public by regulating all dental professionals in the United Kingdom. Complaints brought to the attention of the GDC regarding the conduct of members of the dental profession are dealt with in a regulated manner. This study briefly reviews the relevant procedures and analyses 209 cases brought before the Professional Conduct Committee of the GDC over a five-year period. The results show an annual increase from 23 cases in 2003 to 65 cases in 2007 (0.18% of registered dentists) and provide information on the geographic distribution of registrants as well as their country of origin and year of qualification. The charges, outcomes and determinations give an indication of the clinical and non-clinical misdemeanours committed by members of the profession. The outcomes and final determinations handed down (56 erasures and 37 suspensions) reflect the serious view the GDC holds regarding the professional conduct of all dental professionals.

An assessment of serum and urine soluble interleukin-2 receptor concentrations during renal transplant rejection.

During rejection, renal transplant recipients have increased concentrations of soluble interleukin-2 receptors (sIL-2R) in their serum and urine. However, the clinical application of this measurement in the diagnosis of rejection or the assessment of treatment efficacy is limited by the variance of the measurement in sample populations. We examined the serum and urine sIL-2R concentrations in 20 renal transplant recipients, 12 of whom experienced 13 episodes of allograft rejection. There was no statistical difference in the mean serum sIL-2R concentration at the time of rejection compared with the baseline value (2,817 +/- 801 v 1,943 +/- 255 U/mL). By contrast, the urinary excretion rate, expressed as units of sIL-2R per milligram creatinine, was 26.2 +/- 6.4 compared with 14.2 +/- 2.5 (P < 0.05). Furthermore, when urinary sIL-2R was expressed as a fractional excretion (FE), both the absolute measurement (4.4% +/- 1.7%) and the percent increase (+245%) at the time of rejection provided the greatest degree of discrimination of rejection from those values during allograft stability (1.2% +/- .2% and +2.5%, respectively; P < 0.005). We conclude that (1) serum and urine sIL-2R concentrations are affected by a number of factors during rejection; (2) FE calculations of sIL-2R improve discrimination of rejection from graft stability; and (3) serial measurement of sIL-2R excretion may be a useful adjunct to the diagnosis of rejection and, possibly, the subsequent assessment of response to immunotherapy.

Experience with schistosomiasis in renal transplantation.

Schistosomiasis involving the urinary tract has only occasionally been reported in North American literature and rarely from American hospital experience. Chronic infection may result in numerous abnormalities of the urinary tract which may interfere with the function of a transplanted kidney. Our institution has performed a number of renal transplants in patients who are from countries where schistosomiasis is endemic. Six patients in our group had evidence of schistosomal disease during their pretransplant evaluation and were appropriately treated. None of these patients had postoperative complications attributable to the schistosomal disease. We recommend that all patients who are from areas where urinary schistosomiasis is endemic undergo a cystoscopic examination and bladder biopsies in addition to the routine pretransplant urologic evaluation.

Renal transplantation at the Washington Hospital Center: experience with OKT3 and Minnesota antilymphoblast globulin for induction of immunosuppression.

These data demonstrate excellent long-term patient and graft survival rates when cytolytic induction therapy is combined with sequential addition of CsA. OKT3 and MAG produce virtually indistinguishable outcomes with low rates of rejection and DGF. The frequency of serious posttransplant complications, infection, rejection, and malignancy was low. Although both MAG and OKT3 are effective, each has its drawbacks. Problems associated with MAG therapy are leukopenia, thrombocytopenia, cumbersome administration, and difficulty monitoring the patient's specific level of induced immunosuppression. OKT3 is simpler to administer, easy to monitor, but first dose reactions may produce additional graft injury. Furthermore, OKT3 may not protect completely against all mechanisms of cellular rejection. In our patient population, the best results occurred when kidneys functioned immediately, when CsA was introduced promptly, and when there were several days of overlap, with MAG or OKT3, especially when OKT3 was used as the induction agent.

Quadruple immunosuppression: comparison of OKT3 and Minnesota antilymphocyte globulin.

From May 1977 to June 1988, 110 patients receiving cadaveric kidney transplants were selected to receive Orthoclone (OKT3; Ortho Pharmaceutical Corporation, Raritan, NJ; 5 mg intravenous bolus) (n = 43) or Minnesota antilymphocyte globulin (MAG; 20 mg/kg/day) (n = 67) as the induction phase of a quadruple immunosuppressive protocol. The duration of treatment ranged from 5 to 16 days for OKT3 (mean, 8 days) and 7 to 14 days for MAG (mean, 9 days) as dictated by the postoperative recovery of renal function. All patients were followed-up for at least 3 months (maximum, 18 months; mean, 10 months). Of the 43 patients receiving OKT3, 11 (26%) had rejection episodes that were reversed and did not reoccur. Two patients had episodes that could not be reversed, resulting in graft loss. Of the 67 patients receiving MAG, 38 (57%) experienced a first rejection episode within the follow-up period; 16 of these had repeat rejections. Renal function was significantly better in the OKT3 group. Although both OKT3 and MAG were associated with excellent patient (98%) and graft (92%) survival, OKT3 was easier to administer with fewer rejection episodes. It was concluded that OKT3 is superior to MAG as perioperative cytoreductive therapy following cadaveric kidney transplantation.

Renal transplantation from a blood group A1B donor to an A2B recipient: a case report.

This case report describes the transplantation of a kidney from an A1B donor to a recipient who was blood group A2B. The donor/recipient pair were ABO mismatched but compatible. In the majority of cases, A1 antibodies fail to react at 37 degrees C and are of no clinical significance. However, hemolytic transfusion reactions due to A1 antibodies active at 37 degrees C have been reported but are extremely rare. When the opportunity for transplantation arose for this patient, who had received multiple blood transfusions because of dialysis, the question of safety concerning the subject of transplanting across ABO sub-grouping mismatches was presented. Inquiries regarding this matter proved fruitless and the transplant was performed mainly due to the lack of preformed anti-A, antibodies in the recipient at the time of transplant. It was hoped that the A2B recipient would fail to make an anti-A1 antibody due to antigen exposure or if it did, would not pose a hazard to the allograft. Therefore we present our experience with a patient who was successfully transplanted across an ABO incompatible sub-grouping, A1B allograft to an A2B recipient.

[The bioavailability of combination preparations of acetylsalicylic acid and codeine phosphate]. / Untersuchungen zur Bioverfügbarkeit eines Kombinationspräparates von Acetylsalicylsäure und Codeinphosphat.

Plasma levels time curves of acetylsalicylic acid, salicylic acid, salicyluric acid and codeine were monitored after intravenous, oral and rectal application (single dose) of preparations containing acetylsalicylic acid and codeine. The mean absolute bioavailability of acetylsalicylic acid was 68% after oral application and 60% after rectal application. The corresponding bioavailability data of codeine were 59% and 63%, respectively.