The rising role of cognitive reserve and associated compensatory brain networks in spinocerebellar ataxia type 2.

Pre-existing or enhanced cognitive abilities influence symptom onset and severity in neurodegenerative diseases, which improve an individual's ability to deal with neurodegeneration. This process is named cognitive reserve (CR), and it has acquired high visibility in the field of neurodegeneration. However, the investigation of CR has been neglected in the context of cerebellar neurodegenerative disorders. The present study assessed CR and its impact on cognitive abilities in spinocerebellar ataxia type 2 (SCA2), which is a rare cerebellar neurodegenerative disease. We investigated the existence of CR networks in terms of compensatory mechanisms and neural reserve driven by increased cerebello-cerebral functional connectivity. The CR of 12 SCA2 patients was assessed using the Cognitive Reserve Index Questionnaire (CRIq), which was developed for appraising life-span CR. Patients underwent several neuropsychological tests to evaluate cognitive functioning and a functional MRI examination. Network based statistics analysis was used to assess functional brain networks. The results revealed significant correlations of CRIq measures with cognitive domains and patterns of increased connectivity in specific cerebellar and cerebral regions, which likely indicated CR networks. This study showed that CR may influence disease-related cognitive deficits, and it was related to the effective use of specific cerebello-cerebral networks that reflect a CR biomarker.

"Mens Sana in Corpore Sano": The Emerging Link of Motor Reserve with Motor and Cognitive Abilities and Compensatory Brain Networks in SCA2 Patients.

The ability to resiliently cope with neuropathological lesions is a key scientific concern. Accordingly, this study aims to investigate whether motor reserve (MR), likely to be boosted by exercise engagement in a lifetime, affects motor symptom severity, cognitive functioning, and functional brain networks in spinocerebellar ataxia type 2 (SCA2)-a cerebellar neurodegenerative disease. The MR of 12 SCA2 patients was assessed using the Motor Reserve Index Questionnaire (MRIq), developed ad hoc for estimating lifespan MR. The International Cooperative Ataxia Rating Scale was used to assess clinical motor features, and neuropsychological tests were used to evaluate cognitive functioning. Patients underwent an MRI examination, and network-based statistics (NBS) analysis was carried out to detect patterns of functional connectivity (FC). Significant correlations were found between MRIq measures and the severity of motor symptoms, educational and intellectual levels, executive function, and processing speed. NBS analysis revealed a higher FC within subnetworks consisting of specific cerebellar and cerebral areas. FC patterns were positively correlated with MRIq measures, likely indicating the identification of an MR network. The identified network might reflect a biomarker likely to underlie MR, influenced by education and cognitive functioning, and impacting the severity of motor symptoms.

COVID-19's Negative Impacts on Clinical Learning and Proposed Compensation Mechanisms Among Undergraduate Midwifery and Nursing Students of Jimma University.

BACKGROUND: Even though lockdown measures contributed to reducing the rate of COVID-19 transmission, it resulted in great distraction in clinical learning. Thus, the aim of this study was to assess COVID-19's negative impacts on clinical learning, and proposed compensation mechanisms among midwifery and nursing undergraduate students of Jimma University, southwest Ethiopia. METHODS: This study was conducted among 147 midwifery and nursing students of Jimma University in March 2021 using cross-sectional study design. The respondents were selected by simple random sampling method. Data were collected by using a self-administered questionnaire and analyzed descriptively by SPSS v.23. The results were presented in tables, and narrated. RESULTS: Three fifths (88 (59.9%)) of the study participants perceived high negative impacts of COVID-19 on their recent clinical learning. The proposed compensation mechanisms to be implemented before and during the next clinical practice include: using teacher-facilitated skill demonstration laboratory, case scenarios, clinical teaching videos, and clinical conferences. Students' effort to understand the objectives of their clinical learning and using multi-media to achieve it was another proposed compensation mechanism. Also, providing pre-placement training and in-service training with priority for students graduating during COVID-19 pandemic were proposed compensation mechanisms. CONCLUSION: COVID-19's negative impacts on clinical learning were great among the participants of this study. The proposed compensation mechanisms should be applied by all concerned bodies with great emphasis to end the long-term negative impact of the pandemic, thereby ensuring the production of competent midwives and nurses.

Static and dynamic sagittal lumbar apex: a new concept for the assessment of lumbar lordosis distribution in spinal deformity.

PURPOSE: Sagittal lumbar apex has been demonstrated to be a key parameter in sagittal plane morphology. Our aim was to understand its behavior with postural changes, analyzing two different concepts of lumbar apex. MATERIALS AND METHODS: Prospective observational study with a cohort of patients presenting sagittal malalignment identified from a monocenter database of adult spinal deformities (ASD). Inclusion criteria were age > 30 years, SVA > 40 mm, and/or PT > 20. All patients had full-spine EOS radiographs in 2 different positions: (P1: natural position) and position 2 (P2: compensated position). Sagittal alignment, spinopelvic values, and two different methods of assessing lordosis apex location were analyzed in both P1 and P2 positions. Changes between P1 and P2 were compared using a paired t test with a significance level at p < 0.05. RESULTS: Twenty-five patients were recruited (21 women and 4 men). The mean age was 64.8 years (range 21-79). The patient's main compensation was based on an increase in the femoral shaft angle, and pelvic retroversion, with a subsequent decrease in sacral slope, and therefore of the lower lumbar arc. When the lumbar apex was calculated as the most anterior point touching the vertical line in a lateral radiograph, postural compensation changes modified its location usually shifting it to a more caudal position. When the lumbar apex was assessed as the most distant point of the global lumbar lordosis, its position remained stable regardless of compensation. CONCLUSIONS: Postural changes can modify the location of the lumbar apex when understanding its location as the cornerstone of sagittal plane harmonic distribution. This concept can be useful as an additional sign to assess compensation. However, if the lumbar apex was calculated as the angular point of the global lordosis, its position remained stable regardless of postural changes. This concept can help to mold lumbar lordosis in ASD surgery. LEVEL OF EVIDENCE IV: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

Pelvic motion the key to understanding spine-hip interaction.

Pelvic motion acting as a hinge between the spine and hips is essential to maintain proper balance during bipedalism. Pelvic rotation is recruited as a compensation mechanism when spinal malalignment occurs.This pelvic rotation can affect functional acetabular orientation, and consequently functional cup positioning if a total hip arthroplasty (THA) is needed. Pelvic retroversion, frequently associated with degenerative spinal changes, implies an increase of acetabular version.Patients with flexible lumbar spines (spine users) protect the hip joint. Patients with stiff, degenerated or fused lumbar spines (hip users) demand higher hip mobility, placing the THA at risk.Pelvises in retroversion place the THA at risk for anterior dislocation when standing. In contrast, pelvises in anteversion or with low pelvic incidence (PI) can place THA at risk for posterior dislocation when sitting.Try to set the cup in an anatomic position. However, bear in mind that low PI pelvises may need more acetabular ante-inclination, and high PI pelvises more acetabular retroversion.If surgery is needed, start first by addressing the hip, except in patients with compensation (high pelvic retroversion), who may need spine surgery first to place the pelvis, and consequently the acetabulum, in a proper position. Cite this article: EFORT Open Rev 2020;5:522-533. DOI: 10.1302/2058-5241.5.200032.

Expression Evolution of Ancestral XY Gametologs across All Major Groups of Placental Mammals.

Placental mammals present 180 million-year-old Y chromosomes that have retained a handful of dosage-sensitive genes. However, the expression evolution of Y-linked genes across placental groups has remained largely unexplored. Here, we expanded the number of Y gametolog sequences by analyzing ten additional species from previously unexplored groups. We detected seven remarkably conserved genes across 25 placental species with known Y repertoires. We then used RNA-seq data from 17 placental mammals to unveil the expression evolution of XY gametologs. We found that Y gametologs followed, on average, a 3-fold expression loss and that X gametologs also experienced some expression reduction, particularly in primates. Y gametologs gained testis specificity through an accelerated expression decay in somatic tissues. Moreover, despite the substantial expression decay of Y genes, the combined expression of XY gametologs in males is higher than that of both X gametologs in females. Finally, our work describes several features of the Y chromosome in the last common mammalian ancestor.

[How badly is the coronavirus pandemic affecting orthopaedic and trauma surgery clinics? : An analysis of the first 5 weeks]. / Wie stark trifft die Corona-Pandemie die Kliniken für Orthopädie und Unfallchirurgie? : Eine Analyse der ersten 5 Wochen.

BACKGROUND: The corona pandemic poses enormous financial challenges for hospitals. Using the example of a clinic for orthopaedics and trauma surgery, the performance development of the first 5 weeks in comparison to last year and an evaluation of the compensation measures laid down by law will be evaluated. METHODOLOGY: Based on the performance figures, a comparison is made between the period 16.03 to 17.04.2019 and the same period in 2020. Changes in the number of cases, case mix, case-mix index and day-mix index, as well as the occupancy days are recorded. The monetary measures from the COVID-19 Hospital Relief Act are applied to these changes, and the adequacy is evaluated. RESULTS: Compared to last year, there was a decrease in inpatient admissions of n = 307 patients in the observation period. As a result, there was a decrease of 595 points in case mix and 2320 days of occupancy. This results in a decrease in revenue of approximately EUR 1.9 million. The flat rate for empty beds represents the largest monetary compensation for the loss of revenue. It amounts to approximately EUR 1.3 million. Taking into account further support and an adjustment for variable costs, a deficit of EUR 382,069 remains for 5 weeks. DISCUSSION: The measures taken by the Government are an important pillar for the economic security of German hospitals. The lack of differentiation of measures by specialty leads to insufficient compensation for orthopaedics and trauma surgery.

Dry Fasting Physiology: Responses to Hypovolemia and Hypertonicity.

OBJECTIVE: The aim of this study was to provide a deeper insight into dry fasting (DF) physiology. DESIGN: Ten participants performed DF for 5 consecutive days. METHODS: The following parameters were monitored daily: cortisol, aldosterone, high-sensitivity C-reactive protein (CRP), erythropoietin, albumin, uric acid, and vitamin C in serum; vasopressin (ADH), adrenocorticotropic hormone (ACTH), renin, angiotensin II, and total antioxidant capacity (TAC) in plasma; hematocrit and erythrocytes in whole blood; osmolality, noradrenaline, dopamine, adrenaline, Na+, and K+ in 24-h urine; waist circumference and body, urine, and stool weight. RESULTS: The following parameters increased: ADH (60 ± 11%), ACTH (176 ± 34%), cortisol (495 ± 75%), urine osmolality (20 ± 4%), CRP (167 ± 77%), renin (315 ± 63%), angiotensin II (74 ± 21%), aldosterone (61 ± 21%), TAC (80.4 ± 17%), uric acid (103 ± 19%), albumin (18.4 ± 2.4%), erythrocytes (13.4 ± 2.2%), hematocrit (11 ± 1.8%), and the excretion of noradrenaline (40.3 ± 10%) and dopamine (17 ± 5%). The following parameters decreased: waist circumference (8.20 ± 0.61 cm), body weight (7.010 ± 0.3 kg), erythropoietin (65 ± 18%), and the excretion of adrenaline (38 ± 4%) and Na+ (60 ± 16%). The excretion of K+ remained unchanged. Vitamin C decreased, showing a half-life of 4.8 ± 0.7 days. The percent ratios of lost weight components were: urine (52.2 ± 3.7%), insensible water loss (32.2 ± 1.4%), stool (5 ± 0.3%), and respiratory gases, i.e., expired CO2 - incorporated O2 (10.6 ± 5.4%). CONCLUSION: The mechanisms underlying the hypertonicity and hypovolemia compensation and the ratio analysis of lost weight components were presented. DF demonstrated short-term antioxidant, anti-ischemic, immune-stimulating, anti-edematous, and anti-inflammatory effects. The results may have an impact on developing new concepts for the treatment of edema, obesity, and inflammatory and ischemic diseases.

Study on compensation mechanism reform of primary healthcare institutions in Zhejiang province / 中华医院管理杂志

Objective@#To evaluate the new compensation mechanism for primary healthcare institutions in Zhejiang province, in terms of fairness, performance, incentive mechanism and sustainability in pilot areas.@*Methods@#Evaluation indicators were constructed based on stakeholder theory, fairness theory, expectation theory and sustainable development theory.Focus group interviews were conducted with stakeholders and quantitative data were collected through questionnaires. Meanwhile, the financial compensation, income and expenditure and work equivalent data were collected from such institutions of the four pilot areas, with quantitative data subject to descriptive analysis.@*Results@#This study found the reform used reasonable proportion of funds allocated(the proportion of basic salary for employees was lower than 50%)and adjustment factors(1.0-1.8)of different primary healthcare institutions to guarantee the fairness of the reform; the increase of work equivalents(the per capita work equivalents of medical staff in pilot counties had increased from 38.435 million in the previous year to 42.590 million work equivalents)reflected the performance outcomes of the reform. The incentive and sustainability of the reforms were the weak parts. These were mainly due to the fact that the internal distribution system of primary healthcare institutions failed to make corresponding reforms.@*Conclusions@#The reform of the compensation mechanism based on the equivalent method has changed medical staff′s perception of the distribution of funds. The principle of" more pay for more work" and the use of information technology to capture work equivalents have improved the enthusiasm of primary medical staff and the operational efficiency of these institutions, thus, making reform generally scientific and reasonable.

What is the price for the Duchenne gait pattern in patients with cerebral palsy?

Duchenne gait is characterized by trunk lean towards the affected stance limb with the pelvis stable or elevated on the swinging limb side during single limb stance phase. We assessed the relationship between hip abduction moments and trunk kinetics in patients with cerebral palsy showing excessive lateral trunk motion. Data of 18 subjects with bilateral spastic cerebral palsy (CP) and 20 aged matched typically developing subjects (TD) were collected retrospectively. Criteria for patient selection were barefoot walking without aid presenting with excessive lateral trunk motion. Subjects had been monitored by conventional 3D gait analysis of the lower extremity including four markers for monitoring trunk motion. Post-hoc, a generic musculoskeletal full body model (OpenSim 3.3) assuming a rigid trunk articulated to the pelvis by a single ball joint was applied for analyzing joint kinematics and kinetics of the lower limb joints including this spine joint. Joint angle ranges of motion, maximum joint moments and powers in the frontal plane as well as mechanical work were calculated and averaged within groups showing prominent differences between groups in all parameters. To the best of our knowledge, this is the first work explicitly looking into the kinetics of Duchenne gait in patients with CP, clinically known as compensation for unloading hip abductor muscles. The results show that excessive lateral trunk motion may indeed be an extremely effective compensation mechanism to unload the hip abductors in single limb stance but for the price of a drastic increase in demand on trunk muscle effort and work.

Changes of EEG Spectra and Functional Connectivity during an Object-Location Memory Task in Alzheimer's Disease.

Object-location memory is particularly fragile and specifically impaired in Alzheimer's disease (AD) patients. Electroencephalogram (EEG) was utilized to objectively measure memory impairment for memory formation correlates of EEG oscillatory activities. We aimed to construct an object-location memory paradigm and explore EEG signs of it. Two groups of 20 probable mild AD patients and 19 healthy older adults were included in a cross-sectional analysis. All subjects took an object-location memory task. EEG recordings performed during object-location memory tasks were compared between the two groups in the two EEG parameters (spectral parameters and phase synchronization). The memory performance of AD patients was worse than that of healthy elderly adults The power of object-location memory of the AD group was significantly higher than the NC group (healthy elderly adults) in the alpha band in the encoding session, and alpha and theta bands in the retrieval session. The channels-pairs the phase lag index value of object-location memory in the AD group was clearly higher than the NC group in the delta, theta, and alpha bands in encoding sessions and delta and theta bands in retrieval sessions. The results provide support for the hypothesis that the AD patients may use compensation mechanisms to remember the items and episode.

On the tragedy of the commons: When predation and livestock loss may improve the economic lot of herders.

This paper studies the practice of semi-domestic reindeer (Rangifer t. tarandus) herding in Finnmark county in northern Norway. In this area, the Saami reindeer herders compete for space and grazing areas and keep large herds, while at the same time, the reindeer population is heavily exposed to carnivore predation by the lynx (Lynx lynx), the wolverine (Gulo gulo), and the golden eagle (Aquila chrysaetos). It is demonstrated that predation actually may improve the economic lot of livestock holders in this unmanaged local common setting. There are ecological as well as economic reasons as to why this happens. The ecological reason is that predation compensates for natural mortality; that is, increased predation reduces natural mortality, indicating that the net loss due to predation actually may be quite small. When predation reduces livestock density, the feeding conditions of the animals will improve, resulting in increased livestock weight and higher per animal slaughter value. At the same time, a smaller stock reduces the operating costs of the herders.

Compensating for thalamocortical synaptic loss in Alzheimer's disease.

The study presents a thalamocortical network model which oscillates within the alpha frequency band (8-13 Hz) as recorded in the wakeful relaxed state with closed eyes to study the neural causes of abnormal oscillatory activity in Alzheimer's disease (AD). Incorporated within the model are various types of cortical excitatory and inhibitory neurons, recurrently connected to thalamic and reticular thalamic regions with the ratios and distances derived from the mammalian thalamocortical system. The model is utilized to study the impacts of four types of connectivity loss on the model's spectral dynamics. The study focuses on investigating degeneration of corticocortical, thalamocortical, corticothalamic, and corticoreticular couplings, with an emphasis on the influence of each modeled case on the spectral output of the model. Synaptic compensation has been included in each model to examine the interplay between synaptic deletion and compensation mechanisms, and the oscillatory activity of the network. The results of power spectra and event related desynchronization/synchronization (ERD/S) analyses show that the dynamics of the thalamic and cortical oscillations are significantly influenced by corticocortical synaptic loss. Interestingly, the patterns of changes in thalamic spectral activity are correlated with those in the cortical model. Similarly, the thalamic oscillatory activity is diminished after partial corticothalamic denervation. The results suggest that thalamic atrophy is a secondary pathology to cortical shrinkage in Alzheimer's disease. In addition, this study finds that the inhibition from neurons in the thalamic reticular nucleus (RTN) to thalamic relay (TCR) neurons plays a key role in regulating thalamic oscillations; disinhibition disrupts thalamic oscillatory activity even though TCR neurons are more depolarized after being released from RTN inhibition. This study provides information that can be explored experimentally to further our understanding on the neurodegeneration associated with AD pathology.

Interaction between Vestibular Compensation Mechanisms and Vestibular Rehabilitation Therapy: 10 Recommendations for Optimal Functional Recovery.

This review questions the relationships between the plastic events responsible for the recovery of vestibular function after a unilateral vestibular loss (vestibular compensation), which has been well described in animal models in the last decades, and the vestibular rehabilitation (VR) therapy elaborated on a more empirical basis for vestibular loss patients. The main objective is not to propose a catalog of results but to provide clinicians with an understandable view on when and how to perform VR therapy, and why VR may benefit from basic knowledge and may influence the recovery process. With this perspective, 10 major recommendations are proposed as ways to identify an optimal functional recovery. Among them are the crucial role of active and early VR therapy, coincidental with a post-lesion sensitive period for neuronal network remodeling, the instructive role that VR therapy may play in this functional reorganization, the need for progression in the VR therapy protocol, which is based mainly on adaptation processes, the necessity to take into account the sensorimotor, cognitive, and emotional profile of the patient to propose individual or "à la carte" VR therapies, and the importance of motivational and ecologic contexts. More than 10 general principles are very likely, but these principles seem crucial for the fast recovery of vestibular loss patients to ensure good quality of life.

Desfolha em diferentes estádios fenológicos sobre características agronômicas em trigo / Defoliation at different growth stages on agronomic characteristics wheat

O trabalho teve o objetivo de avaliar a interferência da desfolha sobre caracteres de interesse agronômico na cultura do trigo. Foi utilizada a cultivar de trigo Mirante. Os níveis de desfolhamento iniciaram a partir da emissão da terceira folha até a folha bandeira, totalizando seis níveis de desfolha. Foram analisadas as seguintes variáveis: número de afilhos, número de afilhos férteis, altura de inserção de espigas, tamanho de espiga do afilho principal, número de grãos por espiga do afilho principal, massa de grãos por espiga do afilho principal, número de grãos por espiga dos afilhos, massa de grãos por espiga dos afilhos, peso hectolítrico, massa de mil grãos e rendimento. A análise de variância relevou efeitos significativos para interação entre tratamentos e anos de cultivo para as variáveis massa de mil grãos e altura da inserção da espiga. A desfolha na cultura do trigo influenciou negativamente a massa de mil grãos, o número de afilhos férteis, massa de grãos do afilho principal, peso hectolitrico e o rendimento.

The work aimed to evaluate the influence of defoliation on agronomically important traits in wheat. Was used to cultivate wheat Mirante. Defoliation levels started from the issuance of the third leaf to flag leaf, totaling six levels of defoliation. We analyzed the following variables: number of tillers, number of fertile tillers, ear insertion height, size of main tiller spike, number of grains per ear of the main tiller, grain weight per ear of the main tiller, number of grains per spike of ear, grain weight per ear of tillers, test weight, thousand grain weight and yield. The analysis of variance relented significant effects for interaction between treatments and years of cultivation to the variables thousand grain weight and height of the ear insertion. Defoliation in wheat influenced negatively the thousand grain weight, number of fertile tillers, grain weight of main tiller, test weight and yield in the evaluation of both years.

Compensation mechanisms for lost productivity: a comparison between four European countries.

OBJECTIVE: Productivity costs are usually estimated by multiplying the wage with the period absent. This can lead to an overestimation if compensation mechanisms occur. Until now only Dutch data are available on the influence of compensation mechanisms on lost productivity, but between-country differences in frequency and type of compensation mechanisms can be expected. The objective of this study was to understand whether compensation mechanisms for days absent from paid work differ in type and frequency across countries and to explore whether this would result in between-country differences in relevant lost productivity. METHODS: Data from a cross-sectional survey among respondents with rheumatic disorders from four countries were the basis for this study. Analyses focused on respondents with paid employment who reported absence in the last 3 months. The different compensation mechanisms are described and the resulting lost productivity in terms of days absent was calculated with and without taking compensation mechanisms into account. Logistic regression analyses were performed to examine which variables influence compensation mechanisms leading to relevant lost productivity. RESULTS: The results indicate that compensation mechanisms occur and are relevant in all four countries. Between-country differences in the type and frequency of compensation mechanisms and relevant lost productivity were observed. The logistic regression analyses indicate that, correcting for other variables, this is also the case for the use of compensation mechanisms leading to relevant lost productivity. CONCLUSIONS: Between-country differences in compensation mechanisms in case of absenteeism exist and could vary to such an extent that foreign relevant lost productivity data should be used with caution.