Evaluation of the Effect of Morphological Structure on Dilatational Tracheostomy Interference Location and Complications with Ultrasonography and Fiberoptic Bronchoscopy.

Background: Percutaneous dilatational tracheostomy (PDT) is the most commonly performed minimally invasive intensive care unit procedure worldwide. Methods: This study evaluated the percentage of consistency between the entry site observed with fiberoptic bronchoscopy (FOB) and the prediction for the PDT level based on pre-procedural ultrasonography (USG) in PDT procedures performed using the forceps dilatation method. The effect of morphological features on intervention sites was also investigated. Complications that occurred during and after the procedure, as well as the duration, site, and quantity of the procedures, were recorded. Results: Data obtained from a total of 91 patients were analyzed. In 57 patients (62.6%), the USG-estimated tracheal puncture level was consistent with the intercartilaginous space observed by FOB, while in 34 patients (37.4%), there was a discrepancy between these two methods. According to Bland Altman, the agreement between the tracheal spaces determined by USG and FOB was close. Regression formulas for PDT procedures defining the intercartilaginous puncture level based on morphologic measurements of the patients were created. The most common complication related to PDT was cartilage fracture (17.6%), which was proven to be predicted with maximum relevance by punctured tracheal level, neck extension limitation, and procedure duration. Conclusions: In PDT procedures using the forceps dilatation method, the prediction of the PDT intervention level based on pre-procedural USG was considerably in accordance with the entry site observed by FOB. The intercartilaginous puncture level could be estimated based on morphological measurements.

Evaluation of Executive Functions With Functional Near-Infrared Spectroscopy in Euthymic Bipolar and Borderline Personality Disorders.

Introduction: Bipolar disorder (BD) and borderline personality disorder (BPD) are often indistinguishable, given both the key features of impulsivity and emotional dysregulation. This indicates widespread comorbidity and potential misdiagnosis in both groups. Therefore, this study aimed to differentiate BD and BPD by using alterations of brain hemodynamics under the influence of executive tests. Methods: Twenty patients with the euthymic phase of BD and 20 patients with BPD, and 20 healthy control subjects were included in this study. The prefrontal cortex (PFC) hemodynamic responses were evaluated using functional near-infrared spectroscopy (fNIRS) during the Stroop Test and Wisconsin Card Sorting Test (WCST). Results: Left dorsolateral prefrontal cortex (DLPFC) activation was significantly decreased in BPD during both tests. On the other hand, the BD group showed medial PFC hypoactivation during both tests, and this finding is distinct from BPD (p<0.05). Conclusion: Our results indicate that brain hemodynamics during the executive test can highlight differences between BP and BPD. While medial PFC hypoactivation was more prominent in the BP group, DLPFC hypoactivation was more pronounced in the BPD group.

Application of diffuse optical back reflection spectroscopy for determining articular cartilage thickness in a clinical setting.

PURPOSE: Develop a spectroscopic method to assess cartilage thickness during the arthroscopic examination. METHODS: Currently, arthroscopy assesses cartilage damage visually; outcomes are based on the surgeon's subjective experience. Light reflection spectroscopy is a promising method for measuring cartilage thickness based on the absorption of light by the subchondral bone. In the presented study, in vivo diffuse optical back reflection spectroscopic measurements were acquired by gently placing an optical fibre probe on different locations of the articular cartilage of 50 patients during complete knee replacement surgery. The optical fibre probe consists of two optical fibers with a diameter of 1 mm to deliver the light and detect back-reflected light from the cartilage. Centre to centre distance between the source and the detector fibers was 2.4 mm. Actual thicknesses of the articular cartilage samples were measured under microscopy using histopathological staining. RESULTS: Using half of the samples in the patient data, a linear regression model was formed to estimate cartilage thicknesses from the spectroscopic measurements. The regression model was then used to predict the cartilage thickness in the second half of the data. The cartilage thickness was predicted with a mean error of 8.7% if the actual thickness was less than 2.5 mm (R2 = 0.97). CONCLUSION: The outer diameter of the optical fibre probe was 3 mm, which can fit into the arthroscopy channel and can be used to measure the cartilage thickness in real-time during the arthroscopic examination of the articular cartilage.

The effect of the horizontal vs. vertical PAPE protocol on the swim start performance in adolescent male.

Post-activation performance enhancement (PAPE) is referred to enhancement in muscular performance due to high-intensity voluntary contractions. This study aimed to examine the effect of the horizontal vs. vertical PAPE protocol on the start performance in swimming. Sixteen swimmers (age: 13.71 ± 0.95 years; height: 169.43 ± 9.68 cm; body mass: 58.47 ± 7.64 kg) performed three warm-up protocols: (i) a swim-specific warm-up (SWU); (ii) back squat (BS) followed SWU (SWUB); (iii) barbell hip thrust (BHT) followed SWU (SWUH) which consisted of 1 set of 3 reps at 80% 1RM. Rest times are evaluated individually. The findings of this study indicate that SWUB has no beneficial effect on any phase in all examined parameters, while SWUH has a slight improvement only in the take-off phase compared to SWUB (p < 0.05). BHT is better compared to BS as a PAPE stimulus for swimming, but there is no positive effect on 50 m swimming time compared to SWU (p > 0.05). In conclusion, to the best of our knowledge, the effect of BHT as a PAPE stimulus was investigated for swimming for the first time, but results show that neither BS nor BHT has a positive effect on 50 m swimming performance.

External Focus Reduces Accuracy and Increases Antagonist Muscle Activation in Novice Adolescent Soccer Players.

Instep kick is one of the most effective kicking techniques in soccer. Lower extremity muscles and joints play a crucial role during instep kick. However, external (EF) and internal focus and their effect on the muscles are still ambiguous. In this study, 13 male adolescent soccer players were included and aimed to hit the targets in internal and EF conditions. Lower extremity muscle activations were measured with surface electromyography, and kinematics were measured with a high-speed video camera. Muscle activations and movement latencies were analyzed in four different phases (backswing, leg cocking, acceleration, and follow-through) of kicking. While 10 out of 13 participants kicked accurately in internal focus, only five out of 13 in EF kicked accurately. Gastrocnemius muscle activations increased significantly in EF in all phases except acceleration. Movement latencies were found 0.07 ± 0.002 s for accurate and 0.05 ± 0.004 s for inaccurate kicks in EF. A correlation has been found between accuracy and movement latency in EF (R = .67). Our results suggest that novices cannot yet coordinate their muscles in EF, cocontraction ratio increases. Therefore, training strategies that aim to reduce the cocontraction ratio can help the athlete increase performance through better motor coordination. Moreover, better motor coordination may be beneficial in preventing injuries (joint stiffness, etc.) caused by increased cocontraction ratio.

Electrophysiological and kinesiological analysis of deep tendon reflex responses, importance of angular velocity.

Deep tendon reflexes are one of the main parameters of the neurological examination in many diseases. Reflex responses increase in upper motor neuron diseases due to a lack of suprasegmental control such as spasticity and rigidity. This information provided by the reflex response makes it an indispensable element of neurological examination. However, an important limitation is that this assessment is subjective. In this study, EMG and kinesiology measurements were recorded together during the assessment of the patellar T reflex in healthy control, spasticity, and Parkinson's disease groups. Nine kinesiologic and three electrophysiologic features were extracted. We validated the proposed method with three healthy participants by ten repeated measurements on 6 different days and we observed that angular velocity is the most stable parameter. Clustering of different groups determined with K-clustering and artificial neural network used for classification with kinesiological and EMG inputs. Our findings show that reflex grade can be determined with high accuracy (Acc = 98.6) in a large population for both pathological and healthy groups and angular velocity is sufficient for reflex grading. Therefore, we think that our study will contribute to the literature by providing an approach with high reliability and reproducibility in the quantitative assessment of reflexes.

Rosuvastatin Reduces L-Type Ca2+ Current and Alters Contractile Function in Cardiac Myocytes via Modulation of ß-Adrenergic Receptor Signaling.

Rosuvastatin is one of the most used statins to lower plasma cholesterol levels. Although previous studies have reported remarkable cardiovascular effects of rosuvastatin (RSV), the mechanisms of these effects are largely unknown. In this study, we investigated the acute effects of RSV on L-type Ca2+ currents and contractile function of ventricular myocytes under basal conditions and during ß-adrenergic stimulation. The effects of RSV were investigated in freshly isolated adult rat ventricular myocytes. L-type Ca+2 currents and myocyte contractility were recorded using patch-clamp amplifier and sarcomere length detection system. All experimental recordings were performed at 36 ± 1 °C. L-type Ca+2 currents were significantly reduced with the administration of 1 µM RSV (~ 24%) and this reduction in Ca2+ currents was observed at almost all potential ranges applied. Suppression of L-type Ca2+ current by RSV was prevented by adenylyl cyclase (AC) and protein kinase A (PKA) inhibitors SQ 22536 and KT5720, respectively. However, inhibition of Rho-associated kinases (ROCKs) by Y-27632 or nitric oxide synthase (NOS) by L-NAME failed to circumvent the inhibitory effect of RSV. Finally, we examined the effect of RSV during ß-adrenergic receptor stimulation by isoproterenol and observed that RSV significantly suppresses the ß-adrenergic responses in both L-type Ca2+ currents and contraction parameters. In conclusion, RSV modulates the ß-adrenergic signaling cascade and thereby mimics the impact of ß-adrenergic receptor blockers in adult ventricular myocytes through modulation of the AC-cAMP-PKA pathway.

Diabetes-induced changes in cardiac voltage-gated ion channels.

Diabetes mellitus affects the heart through various mechanisms such as microvascular defects, metabolic abnormalities, autonomic dysfunction and incompatible immune response. Furthermore, it can also cause functional and structural changes in the myocardium by a disease known as diabetic cardiomyopathy (DCM) in the absence of coronary artery disease. As DCM progresses it causes electrical remodeling of the heart, left ventricular dysfunction and heart failure. Electrophysiological changes in the diabetic heart contribute significantly to the incidence of arrhythmias and sudden cardiac death in diabetes mellitus patients. In recent studies, significant changes in repolarizing K+ currents, Na+ currents and L-type Ca2+ currents along with impaired Ca2+ homeostasis and defective contractile function have been identified in the diabetic heart. In addition, insulin levels and other trophic factors change significantly to maintain the ionic channel expression in diabetic patients. There are many diagnostic tools and management options for DCM, but it is difficult to detect its development and to effectively prevent its progress. In this review, diabetes-associated alterations in voltage-sensitive cardiac ion channels are comprehensively assessed to understand their potential role in the pathophysiology and pathogenesis of DCM.

Amplitude and velocity dependence of patellar pendulum triggered by T reflex in Parkinson's rigidity.

OBJECTIVES: The relation between increase of tonus and joint movement velocity is controversial in Parkinson's rigidity. It is accepted that the increase of tonus in rigidity is constant during joint movement, and does not change within all limits of movement. However, there is thoughtful evidence that the change in tonus in rigidity has a correlation with joint movement velocity and amplitude of movement. The pendulum movement that is formed by triggering of the patellar T reflex allows the examination of phasic stretching reflexes and physiological changes of passive stretching. Therefore, the velocity and amplitude properties of tonus in Parkinson's rigidity can be scanned together. MATERIALS AND METHODS: Patellar T reflex-triggered patellar pendulum was recorded in 40 Parkinson's patients. The velocity and amplitude changes in the pendulum were observed according to the rigidity scale. Muscle action potentials were recorded from the rectus femoris muscle and biceps femoris muscles simultaneously via superficial recording electrodes. Knee joint angle changes were recorded with a goniometer. The kinesiological and electromyographic features were compared with those of the control subjects. RESULTS: The number of pendulums decreased significantly, the angle of joint movement decreased, the peak time decreased and the angular velocity slowed down significantly in the Parkinson's group. While the latency of the patellar T reflex did not change significantly, its amplitude decreased, and the onset time of joint movement measured by accelerometer was prolonged. CONCLUSIONS: Parkinson's rigidity has a velocity-dependent component, and this correlates negatively with the rigidity scale.

Mathematical model of patella T-reflex and clinical evaluation with Ashworth scales.

Spasticity is one of the major problems that arise in different neurological diseases and seriously affect the quality of human life. Research on the understanding of mechanism of spasticity remains as important as the studies on the spasticity therapy and rehabilitation. In this study, the spasticity mechanism which develops concerning the upper motor neuron lesions is investigated by modelling "Patella tendon reflex triggered patella pendulum". The mathematical model based on the pendulum phenomenon is developed by solving the curve-fitting problem as finding the curve that best fits a set of data points. Electrophysiological and dynamic measurement data were taken from 76 spastic subjects and 20 healthy participants. The mathematical model is determined by the morphological properties of the goniometric variations. The results denote that the mathematical model containing two clinically relevant parameters -frequency component of the damped oscillatory motion defined as "f 0 " with the maximum angle of the reflex defined as "a 0 " ensures to distinguish spasticity from healthy subjects.

Modified motor unit number index (MUNIX) algorithm for assessing excitability of alpha motor neuron in spasticity.

OBJECTIVE: The understanding of the spasticity mechanism is still a problem in the literature, as its definition can be made on the basis of more than one parameter. Therefore, we studied alpha motor neuron excitability, dynamic changes based on force production, and patellar tendon (T) reflex in spasticity and healthy control groups. METHODS: Alpha motor neuron excitability, force production, and patellar T reflex were evaluated through three different test protocols. Motor Unit Number Index (MUNIX) measurement was applied for understanding motor neuron pool properties in the first protocol. Voluntary force production and patellar T reflex parameters were evaluated by voluntary force production and triggering patellar T reflex. Twenty spasticity and 20 healthy volunteers participated in the study. RESULTS: In the spasticity group, both MUNIX numbers and Motor Unit Size Index (MUSIX) numbers were lower than those in the control group. The results for the Ideal Case Motor Unit Count (ICMUC) parameter show that there is no significant difference between spasticity and healthy individuals for low-level contractions, whereas there is a significant difference for high-level contractions (p < 0.05). In the spasticity group, an increase was observed in the ratio of maximal voluntary force to the T reflex triggered force production (Tf/Vf). CONCLUSION: Spasticity and healthy subjects can be distinguished easily and clearly by evaluating the changes in both kinesiological and electrophysiological findings and the decreasing threshold in the alpha motor neuron pool. SIGNIFICANCE: This study shows that such combined methods, which allow the evaluation of the alpha motor neuron pool, as well as kinesiological and electrophysiological parameters, are tools that cannot be overlooked in understanding spasticity.