Targeted verbal cues can immediately alter gait following stroke.

BACKGROUND: Physical therapists use verbal cueing extensively during gait rehabilitation. Nevertheless, little is known about the ability of individuals post-stroke to make immediate changes to targeted spatiotemporal gait parameters from verbal commands. Additionally, adequate muscle strength may be necessary to promote positive alterations in gait. OBJECTIVES: To determine the influence of targeted verbal cues on spatiotemporal gait parameters for individuals with chronic stroke. Further, we assessed the potential of a relationship between cue-induced gait modifications and paretic lower limb strength. METHODS: Using a within-subjects design, twenty-seven adults with chronic stroke walked over a pressure mat with verbal cues to walk at (1) comfortable and (2) fast speeds, with increased (3) arm swing, (4) foot height, (5) step length, (6) push off, and (7) cadence. We also assessed lower extremity strength using a hand-held dynamometer. We measured gait speed, step length, stance time, and cadence for comparisons between conditions and performed correlational analyses to assess the influence of strength on gait alterations. RESULTS: Specific cues elicited increased walking speed, cadence, step lengths and paretic limb stance time. Only greater paretic hip and knee flexion strength was related to the ability to increase cadence when cued to do so (r > 0.41). CONCLUSION: With targeted verbal cueing, clinicians can improve step length, gait speed, stance time and cadence for individuals with chronic stroke. Lower extremity strength does not appear to be related to the ability to alter gait with verbal cueing in individuals with chronic stroke.

Evaluation of the combined glucose-insulin and intravenous glucose tolerance tests for insulin dysregulation diagnosis in donkeys.

BACKGROUND: Insulin dysregulation (ID) and donkey metabolic syndrome (DMS) are common in this species. Contrary to horses, diagnostic guidelines compiling insulin cut-offs values and dynamic testing interpretations have not been reported for this species. OBJECTIVES: To evaluate resting serum insulin concentrations, the combined glucose-insulin test (CGIT) and the glucose intravenous tolerance test (IVGTT) for the diagnosis of DMS with ID suspicion. STUDY DESIGN: Diagnostic test comparison. METHODS: Six of 80 mix-breed adult donkeys fulfilled the inclusion criteria for DMS based on history or clinical evidence of recurrent laminitis, body condition >6 and neck score >2 or baseline insulin and leptin concentrations >20 µIU/mL and >12 ng/mL respectively. CGIT and IVGTT were performed in all donkeys within a week and interpreted following guidelines reported for equine metabolic syndrome (EMS). Insulin and glucose curves were analysed, proxies calculated and correlations and multivariate analysis assessed. RESULTS: Following EMS guidelines, CGIT classified 2 (using glucose-positive phase duration) or 3 (using insulin concentration) and IVGTT classified 5 donkeys as ID. ID donkeys showed a lower glucose/insulin ratio, QUICKI and RISQI, and a higher insulin/glucose ratio, MIRG and HOMA-B%. MAIN LIMITATIONS: Comparison of these tests with additional dynamic testing including a larger number of ID donkeys is necessary. CONCLUSIONS: This is the first study evaluating dynamic tests to assess ID/DMS in DMS-suspected donkeys. IVGTT detected more ID donkeys than CGIT. EMS recommendations could also be used for DMS diagnosis, although a baseline insulin cut-off value is needed.

Empirical evidence for cognitive subgroups in body dysmorphic disorder.

OBJECTIVE: Current understanding of cognitive functioning in body dysmorphic disorder is limited, owing to few studies, small sample sizes and assessment across only limited cognitive domains. Existing research has also shown inconsistent findings, with both intact and impaired cognition reported in body dysmorphic disorder, which might point towards cognitive heterogeneity in the disorder. This study aimed to examine the cognitive profile of body dysmorphic disorder in a large sample across eight cognitive domains, and to explore whether cognitive subgroups might be identified within body dysmorphic disorder. METHOD: Cognitive domains of inhibition/flexibility, working memory, speed of processing, reasoning and problem-solving, visual and verbal learning, attention/vigilance and social cognition were assessed and compared between 65 body dysmorphic disorder patients and 70 healthy controls. Then, hierarchical clustering analysis was conducted on the body dysmorphic disorder group's cognitive data. RESULTS: Group-average comparisons demonstrated significantly poorer cognitive functioning in body dysmorphic disorder than healthy controls in all domains except for attention/vigilance and social cognition. Cluster analysis identified two divergent cognitive subgroups within our body dysmorphic disorder cohort characterised by (1) broadly intact cognitive function with mild selective impairments (72.3%), and (2) broadly impaired cognitive function (27.7%). However, the clusters did not significantly differ on clinical parameters or most sociodemographic characteristics. CONCLUSION: Our findings demonstrate considerable cognitive heterogeneity among persons with body dysmorphic disorder, rather than uniform deficits. Poor performances in the broadly impaired subgroup may have driven group-level differences. However, our findings also suggest a dissociation between cognitive functioning and clinical characteristics in body dysmorphic disorder that has implications for current aetiological models. Additional research is needed to clarify why some people with body dysmorphic disorder demonstrate cognitive deficits while others do not.

Systemic Toxoplasmosis in a Horse.

An adult American Quarter Horse gelding with a history of weight loss presented with an acute onset of colic, fever, soft faeces and elevated liver enzymes. At necropsy, there were gastric mucosal masses and evidence of caecal necrosis. Histologically, the masses were lymph nodes with granulomatous inflammation and areas of liquefactive necrosis. Within and surrounding necrotic areas were free and intrahistiocytic clusters of protozoal tachyzoites. Similar but milder inflammation was evident in the spleen, lungs and liver. Necrotizing typhlitis was also evident. Immunolabelling for Toxoplasma gondii was positive and the ultrastructural morphology of the protozoa was compatible with T. gondii. Although studies have shown seropositivity to T. gondii in horses throughout the world, this is the first report of clinical toxoplasmosis in this species.

Impaired Recognition of Negative Facial Emotions in Body Dysmorphic Disorder.

OBJECTIVES: Patients with body dysmorphic disorder (BDD) have difficulty in recognising facial emotions, and there is evidence to suggest that there is a specific deficit in identifying negative facial emotions, such as sadness and anger. METHODS: This study investigated facial emotion recognition in 19 individuals with BDD compared with 21 healthy control participants who completed a facial emotion recognition task, in which they were asked to identify emotional expressions portrayed in neutral, happy, sad, fearful, or angry faces. RESULTS: Compared to the healthy control participants, the BDD patients were generally less accurate in identifying all facial emotions but showed specific deficits for negative emotions. The BDD group made significantly more errors when identifying neutral, angry, and sad faces than healthy controls; and were significantly slower at identifying neutral, angry, and happy faces. CONCLUSIONS: These findings add to previous face-processing literature in BDD, suggesting deficits in identifying negative facial emotions. There are treatment implications as future interventions would do well to target such deficits.

Insight in body dysmorphic disorder (BDD) relative to obsessive-compulsive disorder (OCD) and psychotic disorders: Revisiting this issue in light of DSM-5.

INTRODUCTION: In DSM-5, body dysmorphic disorder (BDD) was reclassified under the obsessive-compulsive and related disorders (OCRDs), but little is known about the nature of BDD beliefs. This study aimed to compare level of insight in BDD and consider related implications for DSM-5 classification. METHOD: Participants were 27 BDD, 19 obsessive-compulsive disorder (OCD), and 20 psychosis (SZ) participants as well as 42 non-clinical controls (NC), who completed the Brown Assessment of Beliefs Scale (BABS) and Peters Delusions Inventory (PDI). RESULTS: For total (and most individual) BABS items, BDD and SZ participants scored significantly higher than OCD and NC participants. On the PDI, there were significant group differences in number of questions endorsed, with clinical groups scoring significantly higher than the NC group on dimensions of distress and preoccupation, but not conviction. CONCLUSION: These findings suggest appearance-related concerns in BDD somewhat resemble delusions seen in psychosis (and not OCD), and convey important nosological and therapeutic implications.

Susceptibility of Trichopyton mentagrophytes to Visible Light Wavelengths.

OBJECTIVE: To determine whether a blue light (405 nm) could inhibit the growth of Trichopyton mentagrophytes without using a photosensitizing material as part of the treatment protocol. DESIGN: Basic physiologic randomized trial using laboratory specimens (T mentagrophytes). INTERVENTIONS/METHODS: Plated on a growth medium, T mentagrophytes were exposed to 3 to 5 administrations of blue light at 20 J/cm over 28 hours. Following 7 days of incubation, colony-forming units were counted and compared with nonirradiated controls. RESULTS: The study found 3, 4, and 5 administrations of blue light produced significant inhibition of T mentagrophytes (P < .05); 4 and 5 applications produced the greatest inhibition of growth (84.7% and 93.6% kill rates, respectively). CONCLUSIONS: The application of 405-nm light at a dose of 20 J/cm is an effective in vitro inhibitor of T mentagrophytes. To give results similar to those seen when a photosensitizing material is included, 3 to 5 applications of this wavelength and dose condition delivered over 28 hours is likely needed.

Reduced cortical thickness in body dysmorphic disorder.

Recent neuroimaging studies in body dysmorphic disorder (BDD) have implicated abnormal structure and function of occipito-temporal and fronto-limbic regions in the potential pathophysiology of the disorder. To date, morphometric investigations have yielded inconsistent results, and have suggested that clinical symptoms may mediate structural brain abnormalities in BDD. We measured Grey Matter (GM) cortical thickness in 20 participants with BDD and 20 healthy control participants matched on age, gender, estimated IQ and handedness. We observed cortical thinning in BDD patients compared with healthy control participants within the left middle temporal and left inferior parietal gyrus. No significant relationships between cortical thickness and BDD symptom severity, insight, social anxiety and depression were observed within the BDD group. Thinning within left temporal and left inferior parietal regions supports the involvement of these regions in the pathophysiology of BDD.

The clinical value of whole blood point-of-care biomarkers in large animal emergency and critical care medicine.

OBJECTIVE: To summarize the current medical literature and provide a clinical perspective of whole blood point-of-care (POC) biomarkers in large animal emergency and critical care practice. DATA SOURCES: Original studies, reviews, and textbook chapters in the human and veterinary medical fields. SUMMARY: POC biomarkers are tests used to monitor normal or disease processes at or near the patient. In both human and veterinary medicine these tools are playing an increasingly important role in the management of critical diseases. The most important whole blood POC biomarkers available for veterinary practitioners include l-lactate, cardiac troponin I, serum amyloid A, triglyceride, creatinine, and glucose, although many other tests are available or on the horizon. CONCLUSION: Whole blood POC biomarkers enable clinicians to provide improved management of critical diseases in large animals. These tools are especially useful for establishing a diagnosis, guiding therapy, and estimating disease risk and prognosis.

Regional brain volumes in body dysmorphic disorder compared to controls.

OBJECTIVES: Body dysmorphic disorder (BDD) is characterized by a preoccupation with a misperceived flaw in appearance, causing significant distress and disability. Neuropsychological research has revealed deficits in executive function and inhibitory control of emotional responses. The few previous structural neuroimaging studies have had inconclusive findings and we aimed to take this field of research forward by contributing high quality structural data. METHODS: To investigate regional brain volumes we compared 20 BDD participants and 20 matched controls using high-resolution structural T1-weighted magnetic resonance imaging (MRI). The MRI data was subjected to cortical reconstruction and volumetric segmentation using Freesurfer software. RESULTS: Results showed the right orbitofrontal cortex, bilateral thalamus, left anterior cingulate cortex, hippocampus and amygdala were significantly smaller in the BDD sample compared to controls. The most pronounced differences were in the right orbitofrontal cortex and left anterior cingulate cortex, as these areas were smaller in BDD participants independent of reduced global brain volumes. Duration of illness significantly negatively correlated with right orbitofrontal cortex volumes. CONCLUSIONS: This is the largest volumetric neuroimaging study in BDD to date and provides important data on volumetric differences that implicate fronto-limbic circuits.

Proliferative pododermatitis (canker) with intralesional spirochetes in three horses.

Spirochetes were identified histologically in canker (proliferative pododermatitis) in 3 horses. The data suggest that spirochetes may contribute to the pathology of equine chronic foot diseases similar to the manner in which they contribute to the pathology of bovine papillomatous digital dermatitis and contagious ovine digital dermatitis.