Differences in intracortical responses following non-noxious and noxious stimulation in anaesthetized rats.

Cortical responses have been proposed as a source for the extraction of unique and non-subjective sensory information. The present study aimed to investigate if it is possible to distinguish between non-noxious and noxious cortical responses with two different types of anesthesia. Sixteen rats were randomly allocated to receive either Hypnorm/Dormicum (HD) or isoflurane (ISO) anesthesia. Each animal had a custom-made microelectrode array implanted in the primary somatosensory cortex to record the local field potentials and a cuff electrode implanted around the sciatic nerve to deliver electrical stimulations. Three stimulation intensities were applied: 1x movement threshold (MT) (i.e., non-noxious activation), 5x MT (low intensity noxious activation), and 10x MT (high intensity noxious activation). The evoked potentials were assessed by extracting three features: 1) the negative peak (NP), 2) the positive peak (PP), and 3) the peak-to-peak (PtP) amplitudes. Our results showed that it was possible to distinguish between three levels of stimulation intensities based on the NP, PP, and PtP features for the HD group, whereas it was only possible to make the same differentiation with the use of PP and PtP when applying ISO. This work is believed to contribute to a basic understanding of how the cortical responses change in the hyperacute phase of pain and which cortical features may be suitable as objective measures of nociception.

Comprehensive assessments and related interventions to enhance the long-term outcomes of child, adolescent and young adult cancer survivors - presentation of the CARE for CAYA-Program study protocol and associated literature review.

BACKGROUND: Improved, multimodal treatment strategies have been shown to increase cure rates in cancer patients. Those who survive cancer as a child, adolescent or young adult (CAYA), are at a higher risk for therapy-, or disease-related, late or long-term effects. The CARE for CAYA-Program has been developed to comprehensively assess any potential future problems, to offer need-based preventative interventions and thus to improve long-term outcomes in this particularly vulnerable population. METHODS: The trial is designed as an adaptive trial with an annual comprehensive assessment followed by needs stratified, modular interventions, currently including physical activity, nutrition and psycho-oncology, all aimed at improving the lifestyle and/or the psychosocial situation of the patients. Patients, aged 15-39 years old, with a prior cancer diagnosis, who have completed tumour therapy and are in follow-up care, and who are tumour free, will be included. At baseline (and subsequently on an annual basis) the current medical and psychosocial situation and lifestyle of the participants will be assessed using a survey compiled of various validated questionnaires (e.g. EORTC QLQ C30, NCCN distress thermometer, PHQ-4, BSA, nutrition protocol) and objective parameters (e.g. BMI, WHR, co-morbidities like hyperlipidaemia, hypertension, diabetes), followed by basic care (psychological and lifestyle consultation). Depending on their needs, CAYAs will be allocated to preventative interventions in the above-mentioned modules over a 12-month period. After 1 year, the assessment will be repeated, and further interventions may be applied as needed. During the initial trial phase, the efficacy of this approach will be compared to standard care (waiting list with intervention in the following year) in a randomized study. During this phase, 530 CAYAs will be included and 320 eligible CAYAs who are willing to participate in the interventions will be randomly allocated to an intervention. Overall, 1500 CAYAs will be included and assessed. The programme is financed by the innovation fund of the German Federal Joint Committee and will be conducted at 14 German sites. Recruitment began in January 2018. DISCUSSION: CAYAs are at high risk for long-term sequelae. Providing structured interventions to improve lifestyle and psychological situation may counteract against these risk factors. The programme serves to establish uniform regular comprehensive assessments and need-based interventions to improve long-term outcome in CAYA survivors. TRIAL REGISTRATION: Registered at the German Clinical Trial Register (ID: DRKS00012504, registration date: 19th January 2018).

Central nervous system lymphoma presenting as trigeminal neuralgia: A diagnostic challenge.

We describe an atypical man with diffuse large B cell lymphoma localized to the sphenoid wing and adjacent cavernous sinus, initially presenting with isolated ipsilateral facial pain mimicking trigeminal neuralgia due to invasion of Meckel's cave but subsequently progressing to intra-axial extension and having synchronous features of systemic lymphoma. Primary central nervous system lymphoma is uncommon, accounting for approximately 2% of all primary intracranial tumors, but its incidence has been steadily increasing in some groups [1]. It usually arises in the periventricular cerebral white matter, and reports of lymphoma in extra-axial regions are rare [2]. This man highlights the importance of maintaining lymphoma in the differential diagnosis of tumors of the skull base presenting with trigeminal neuralgia-like symptoms.

Development of an implantable transverse intrafascicular multichannel electrode (TIME) system for relieving phantom limb pain.

Phantom limb pain frequently follows amputation. Currently there is no fully effective treatment available. Our aim is to develop an innovative Human Machine Interface (HMI) where we apply multi-channel microstimulation to the nerve stump of an amputee subject to manipulate the phantom limb sensations and explore the possibility of using microstimulation as a treatment for phantom limb pain.

Antibodies against Crandell Rees feline kidney (CRFK) cell line antigens, alpha-enolase, and annexin A2 in vaccinated and CRFK hyperinoculated cats.

BACKGROUND: Cats inoculated with feline herpesvirus 1, calicivirus, and panleukopenia (FVRCP) vaccines grown on the Crandell Rees feline kidney (CRFK) cell line have been shown to develop anti-CRFK antibodies. The identities of common CRFK antigens are unknown. HYPOTHESIS: Cats inoculated with CRFK lysates and FVRCP vaccines will develop autoantibodies measurable by Western blot immunoassay. Antigens associated with these antibodies can be isolated for further study. ANIMALS: One CRFK hyperinoculated rabbit, 44 age-matched unvaccinated kittens purchased from a commercial vendor. METHODS: Commonly recognized CRFK antigens were identified by comparison of Western blot immunoassays using sera from a hyperinoculated rabbit and kittens inoculated with CRFK lysate or 1 of 4 commercially available FVRCP vaccines. Antigens were purified from CRFK lysates and sequenced. Antigen recognition was confirmed by Western blot immunoassay and indirect ELISA for 2 proteins using sera from CRFK and FVRCP inoculated kittens. RESULTS: CRFK antigens 47, 40, and 38 kD in size were identified. Protein isolation and sequencing identified 3 CRFK proteins as alpha-enolase, annexin A2, and macrophage capping protein (MCP). Sera from FVRCP and CRFK inoculated cats were confirmed to recognize annexin A2 and alpha-enolase by Western blot immunoassay and indirect ELISA. CONCLUSIONS AND CLINICAL RELEVANCE: This study validated the use of Western blot immunoassay for detection of antibodies against CRFK proteins and identified 3 CRFK antigens. In humans, alpha-enolase antibodies are nephritogenic; alpha-enolase and annexin A2 antibodies have been associated with autoimmune diseases. Further research will be necessary to determine the clinical relevance of these findings.

Caso clínico: aspergilosis pulmonar invasiva tratada con Voriconazol en paciente con Síndrome de Inmunodeficiencia Adquirida / Clinical case: invasive pulmonary aspergillosis treated with Voriconazol in an AIDS patient

Se reporta un caso clínico de aspergilosis pulmonar invasiva en un paciente de 29 años VIH(+) en etapa SIDA, sin antecedentes mórbidos conocidos, con diagnóstico inicial de neumonía por Pneumocystis jirovecii. Fue tratado con éxito, pero sin asistir a controles posterior a su alta . Tres meses después ingresa al servicio de Urgencias del Hospital Gustavo Fricke con tos productiva mucopurulenta, disnea progresiva, fiebre intermitente y compromiso del estado general. La radiografía de tórax sugirió neumonía atípica, detectándose en los exámenes Pneumocystis jirovecii y Enterobacter aerógenes , por lo que se inicia tratamiento con Cotrimoxazol y Ertapenem. En los cultivos en agar Sabouraud se detectó abundante desarrollo de Aspergillus fumigatus , por lo que se empieza tratamiento con anfotericina B en dosis crecientes hasta alcanzar 50 mg/día, sin embargo, por reacciones adversas severas se decidió tratamiento con Voriconazol intravenoso y luego oral, con buena respuesta clínica, radiológica y de laboratorio. Es dado de alta con tratamiento con Voriconazol oral, además de profilaxis secundaria para P. jirovecii y Mycobaterium avium.

A clinical case of an invasive pulmonary aspergillosis in a 29 aged VIH (+) patient, at an AIDS stage, lacking any known morbid data, and bearing an initial diagnosis of pneumonia by Pneumocystis jirovecii is herein described. Was successfully treated even though he failed to attend subsequent health controls. Three months later he is admitted in the Hospital Gustavo Fricke, showing productive mucupurulent cough, progressive disnea, intermittent fever and his overall health condition resulting deeply compromised. Thorax X-ray revealed an atypical pneumonia together with the presence of P. jirovecii and Enterobacter aerogenes, and decided to treat him with Cotrimoxazol and Ertapenem. Meanwhile in agar cultures a heavy development of Aspergillus fumigatus was detected, thus the patient was given Anfotericina B in increasing doses up to reach 50mg/day; however due to some severe adverse reactions, the treatment with intravenous and later oral Voriconazol, which rendered satisfactory clinical, radiological and laboratory responses was ultimately preferred. The patient is discharged from the hospital and advised to continue with oral Voriconazol besides undergoing secondary profilaxis for P. jirovecii and Mycobaterium avium.

Acute peripheral nerve recording characteristics of polymer-based longitudinal intrafascicular electrodes.

We examined the recording characteristics of two different types of polymer-based longitudinal intrafascicular electrodes (LIFEs) in peripheral nerve: single-stranded (s-polyLIFEs) and multistranded (m-polyLIFEs). Recordings were also made from Pt-Ir wire-based electrodes (PtIrLIFEs) as a control. The electrodes were implanted in either tibial or medial gastrocnemius branches of the rabbit sciatic nerve, and in the sciatic nerve of rats. Recorded neural activity induced by manually elicited afferent neural activity showed that both polyLIFE versions performed comparably to PtIrLIFEs.

Encoding of self-paced, repetitive forelimb movements in rat primary motor cortex.

Multi-unit, intra-cortical recordings from the primary motor cortex have been shown to provide information about functional movement of the body, and thus, have been used as command signals for control of an external robotic arm in rat and monkey. However, study of the M1 responses has shown that movement encoding may be dependent on both the functional and behavioral context of the intended motion. The main objective of the present work was to determine if self-paced, repetitive forelimb movements are effectively encoded in multiple-unit recordings from the primary motor cortex (M1) in freely moving, non-constrained rats. Four rats were chronically implanted with 7-channel, 50 microm tungsten micro-wire arrays. Standard psychophysical techniques were first used to train the rats to depress a response paddle in return for a food reward. We computed peri-event time histograms and found both statistically significant excitatory (24/49) and inhibitory (9/49) pre-paddle activity up to 200 ms before a paddle hit. On average, responses from 161+/-37 individual paddle hits were necessary in order to detect statistically significant (> 95%), excitatory pre-paddle action. Thus, while it is possible to detect self-paced, forelimb movements in multi-unit recordings of M1, the high number of repetitions required would limit the efficacy of a real-time cortical neuroprosthesis.

Use of a PCR assay to assess the prevalence and risk factors for Mycoplasma haemofelis and 'Candidatus Mycoplasma haemominutum' in cats in the United Kingdom.

Blood samples from 426 healthy and sick cats in the UK were tested in a PCR assay for 'Candidatus Mycoplasma haemominutum' and Mycoplasma haemofelis (basonym Haemobartonella felis). Seventy-two of the cats (16.9 per cent) were positive for 'Candidatus M. haemominutum' alone, six (1.4 per cent) were positive for M. haemofelis alone and one (0.2 per cent) was positive for both. Logistic regression analysis indicated that older male cats were significantly more likely to be infected with 'Candidatus M. haemominutum', but there was no significant association between it and any of the haematological variables measured. M. haemofelis infection was uncommon in the anaemic cats sampled, and there were too few positive cases for multivariable analysis to be performed for M. haemofelis-positive status.

FcgammaRIIB-mediated inhibition of T-cell receptor signal transduction involves the phosphorylation of SH2-containing inositol 5-phosphatase (SHIP), dephosphorylation of the linker of activated T-cells (LAT) and inhibition of calcium mobilization.

The low-affinity receptor for immunoglobulin G, FcgammaRIIB, is expressed on most B-cells and on immature and activated mature T-cells. Co-aggregation of FcgammaRIIB with the B-cell antigen receptor (BCR) leads to attenuation of BCR-induced blastogenesis and cell proliferation via inhibition of p21(ras), phosphatidylinositol 3-kinase (PI3-K) and phospholipase Cgamma (PLCgamma) activation. These effects are mediated, at least in part, by the recruitment of SH2-containing protein tyrosine phosphatase-1 (SHP-1) and -2 (SHP-2) and SH2-containing inositol 5-phosphatase (SHIP). In this report, we demonstrate that FcgammaRIIB co-aggregation with the T-cell antigen receptor (TCR), which may occur when T-cells recognize antibody-coated target cells, leads to inhibition of TCR-induced phosphorylation of the linker of activated T-cells (LAT). When phosphorylated, LAT functions as an adapter molecule and recruits PI3-K. Additionally, we demonstrate that PI3-K is required for TCR-induced Ca(2+) mobilization. Together, these data suggest that FcgammaRIIB may inhibit TCR-mediated Ca(2+) mobilization, in part via inhibition of LAT phosphorylation and subsequent inhibition of PI3-K activation. A similar mechanism has been described in B-cells, where FcgammaRIIB co-aggregation with the BCR leads to inhibition of PI3-K activity via dephosphorylation of CD19. It is likely that, in both cell types, levels of PtdIns(3,4,5)P(3) are additionally modulated via the enzymic activity of SHIP.

Utility of fiberoptic bronchoscopy before bronchial artery embolization for massive hemoptysis.

OBJECTIVE: We wanted to investigate the utility of performing fiberoptic bronchoscopy before bronchial artery embolization in patients with massive hemoptysis. MATERIALS AND METHODS: We retrospectively reviewed the cases of all patients with hemoptysis who had presented at either of two local hospitals, one county hospital and one community hospital, between 1988 and 2000 and who had undergone fiberoptic bronchoscopy before bronchial arteriography. All data were abstracted using a standardized coding form, and radiographs were independently reviewed by two of the authors. RESULTS: Twenty-nine patients meeting the inclusion criteria were identified; one patient was excluded because of missing radiographs. The remaining 28 patients consisted of 19 men and nine women, with an average age of 54.6 years (age range, 16-91 years). The clinically determined diagnoses of their symptoms were tuberculous bronchiectasis (n = 14; 50.0%); bronchogenic carcinoma (n = 4; 14.3%); active tuberculosis (n = 2; 7.1%); nontuberculous bronchiectasis (n = 2; 7.1%); active coccidioidomycosis, pancreaticobronchial fistula, arteriovenous malformation, and tetralogy of fallot (n =1 each; 3.6% each); and unknown cause (n = 2; 7.1%). The bleeding site determined through bronchoscopy was consistent with that determined through radiographs in 23 patients (82.1%); all had either unilateral disease (n = 15), bilateral disease with unilateral cavities (n = 5), or a preponderance of disease on one side (n = 3). Bronchoscopy was an essential tool in determining the bleeding site in only three patients (10.7%), all of whom had bronchiectasis without localizing features visible on chest radiographs. In the remaining two patients (7.1%), bronchoscopic findings were indeterminate, but radiographs were helpful. CONCLUSION: Fiberoptic bronchoscopy before bronchial artery embolization is unnecessary in patients with hemoptysis of known causation if the site of bleeding can be determined from radiographs and no bronchoscopic airways management is needed.

Effect of initial joint position on nerve-cuff recordings of muscle afferents in rabbits.

The objective was to characterize nerve-cuff recordings of muscle afferents to joint rotation over a large part of the physiological joint range. This information is needed to develop control strategies for functional electrical stimulation (FES) systems using muscle afferent signals for sensory feedback. Five acute rabbit experiments were performed. Tripolar cuff electrodes were implanted around the tibial and peroneal divisions of the sciatic nerve in the rabbit's left leg. The electroneurograms (ENG) were recorded during passive ankle rotation, using a ramp-and-hold profile starting at seven different joint positions (excursion = 5 degrees, velocity = 10 degrees/s, initial positions 60 degrees, 70 degrees, 80 degrees, 90 degrees, 100%, 110 , and 120 ). The amplitude of the afferent activity was dependent on the initial joint position. The steady-state sensitivity of both nerve responses increased with increasing joint flexion, whereas the dynamic sensitivity increased initially but then decreased. The results indicate that recordings of the muscle afferents may provide reliable information over only a part of the physiological joint range. Despite this limitation, muscle afferent activity may be useful for motion feedback if the movement to be controlled is within a narrow joint range such as postural sway.

Neuro-fuzzy extraction of angular information from muscle afferents for ankle control during standing in paraplegic subjects: an animal model.

This paper is part of a project whose aim is the implementation of closed-loop control of ankle angular position during functional electrical stimulation (FES) assisted standing in paraplegic subjects using natural sensory information. In this paper, a neural fuzzy (NF) model is implemented to extract angular position information from the electroneurographic signals recorded from muscle afferents using cuff electrodes in an animal model. The NF model, named dynamic nonsingleton fuzzy logic system is a Mamdani-like fuzzy system, implemented in the framework of recurrent neural networks. The fuzzification procedure implemented was the nonsingleton technique which has been shown in previous works to be able to take into account the uncertainty in the data. The proposed algorithm was tested in different situations and was able to predict reasonably well the ankle angular trajectories especially for small excursions (as during standing) and when the stimulation sites are far from the registration sites. This suggests it may be possible to use activity from muscle afferents recorded with cuff electrodes for FES closed-loop control of ankle position during quite standing.

An unusual complication during central venous catheter placement.

A 31-year-old man with disseminated Coccidioides imitis infection required central catheter placement for access. The patient had an inferior vena cava (IVC) filter placed as a result of previous deep venous thrombosis of the left lower extremity. The guidewire could not be removed following placement of the right internal jugular catheter by the Seldinger technique. Fluoroscopic examination revealed entanglement of the J-tip guidewire in the apex of the IVC filter. The catheter was successfully removed by interventional radiologists using a snare tip catheter through the left femoral vein.

Quantitative shedding of two genotypes of Cryptosporidium parvum in California ground squirrels (Spermophilus beecheyi).

Sixteen percent of California ground squirrels (Spermophilus beecheyi) were found to be shedding an average of 53,875 Cryptosporidium parvum oocysts/g of feces. Male squirrels had a higher prevalence and higher intensity of shedding than did female squirrels. The majority of C. parvum isolates matched a bovine-murine genotype, with a few isolates resembling a porcine genotype. Higher intensities of shedding by males may enhance dissemination and genotypic mixing of this protozoa given males' proclivity to disperse to nonnatal colonies.

Inoculation of two genotypes of Hemobartonella felis (California and Ohio variants) to induce infection in cats and the response to treatment with azithromycin.

OBJECTIVES: To describe clinical and laboratory findings associated with cats experimentally infected by inoculation with the 2 recognized genotypes of Hemobartonella felis (small variant, Hfsm; large variant, Hflg) and to determine the response of cats to treatment with azithromycin. ANIMALS: 18 young adult domestic shorthair cats of both sexes. PROCEDURES: Cats were inoculated with H felis and monitored weekly, using CBC counts and a polymerase chain reaction (PCR) designed to detect both genetic variants of H felis. Beginning 26 days after inoculation, 11 cats were administered azithromycin (15 mg/kg of body weight, PO, q 12 h, for 7 days). RESULTS: Inoculation resulted in coinfection with Hflg and Hfsm, and both variants were detected by PCR. Clinical abnormalities and anemia were most severe in Hflg- and dual-infected cats. Results of PCR and CBC were positive for H felis in 112/112 (100%) and 42/112 (37.5%), respectively, samples collected after inoculation. Administration of azithromycin had little effect on clinical variables, including anemia. All cats, regardless of treatment with azithromycin, had positive results for the PCR at the end of the study period. CONCLUSIONS AND CLINICAL RELEVANCE: In these cats, Hflg was more pathogenic than Hfsm, and coinfection with both variants was detected. Results of the PCR were superior to results of CBC for detecting infection with H felis. Azithromycin administered at the dose and duration reported here was not efficacious for the treatment of cats with hemobartonellosis.

Use of a polymerase chain reaction assay to detect and differentiate two strains of Haemobartonella felis in naturally infected cats.

OBJECTIVE: To develop a polymerase chain reaction (PCR) assay that detects and differentiates the Ohio strain of Haemobartonella felis (H. felis-OH) and the California strain of H. felis (H. felis-CA) and to apply the assay to blood samples from cats with and without suspected haemobartonellosis (suspect and control cats, respectively). SAMPLE POPULATION: 220 blood samples were examined; 82 were from suspect cats, and 138 were from control cats. PROCEDURE: A PCR assay was designed to detect and differentiate H. felis-OH and H. felis-CA. RESULTS: On the basis of PCR assay results, the overall prevalence of H. felis infection was 19.5% (43/220). Suspect cats (28.0%; 23/82) were significantly more likely than control cats (14.5%; 20/138) to be H. felis infected. Significantly greater numbers of suspect cats were H. felis-OH infected (12.2%, 9/82) or H. felis-OH and H. felis-CA infected (4.9%, 4/82) than control cats (0% [0/138] and 0.7% [1/138], respectively). Significantly more anemic cats were H. felis-OH infected (14.3%; 4/28) or H. felis-OH and H. felis-CA infected (7.1%; 2/28) than nonanemic cats (2.3% [3/128] and 0.8% [1/128], respectively). The PCR assay was more accurate than cytologic examination for detection of H. felis. CONCLUSIONS AND CLINICAL RELEVANCE: Haemobartonella felis infections are more common in cats than previously recognized. Haemobartonella felis-OH is apparently more pathogenic than H. felis-CA. The PCR assay is more accurate than cytologic examination for detection of H. felis infection and is an effective clinical tool for the detection and differentiation of both H. felis strains known to infect cats.

Hospital care by hospital-based and clinic-based faculty: a prospective, controlled trial.

BACKGROUND: The hospital length of stay decreases and clinical outcomes are maintained when teaching hospitals involve hospital-based attending physicians in comparison with traditional attending physicians. The attending physician's time commitment, including the number of hours per day and months per year, required to achieve this result is unknown. This study compared the clinical outcomes and cost of care for patients treated by hospital-based and clinic-based attending physicians devoting dramatically different amounts of time to supervising residents on the medical wards of a suburban county hospital. METHODS: Patients were alternately admitted to 2 groups of ward teams. Faculty who attended 10 months of the year supervised one group. The comparison group's attending physicians were on service for 2 months or less and maintained clinic responsibilities while on service. The cost of patient care was compared by means of the length of stay, total hospital costs, and costs for ancillary services. Hospital mortality and readmission rates compared clinical outcomes. RESULTS: There were 4456 patients hospitalized on the medical wards of a teaching service. No differences were detected in the length of stay (4.37 +/- 0.1 days for hospital-based and 4.39 +/- 0.1 days for clinic-based attending physicians). Hospital cost was observed to be similar (average cost, $5989 and $5977 per patient, respectively). The clinical outcomes were equivalent, with adjusted mortality rates for hospital-based attending physicians of 3.2% vs 3.9% for clinic-based attending physicians (P =.28). CONCLUSION: An increase of faculty time and involvement for supervision of resident-managed hospital care did not improve clinical outcomes or decrease costs during the 1-year study period.

Effect of agonist-antagonist electrical stimulation on muscle afferent recordings in anesthetized rabbits.

Objective. Sensory feedback extracted from muscle afferents is an approach to achieve closed-loop control of paralyzed muscles using functional electrical stimulation (FES). The objective of the present study was to characterize the effect of agonist-antagonist electrical stimulation on nerve cuff recordings of muscle afferent activity. Methods. Cuff electrodes were implanted around the tibial and peroneal nerve branches in five acute rabbit experiments. Two wires were implanted in each of the tibialis anterior (TA) and the lateral gastrocnemius (LG) muscles to obtain bipolar, intramuscular stimulation. Electroneurograms (ENG) were recorded during trapezoidal rotations of the ankle joint and compared during periods (25%, 50% and 100% of maximal force) with and without electrical stimulation of the muscle. Results. The activity from a stretched and electrically stimulated muscle showed the same pattern as the recordings from a matched nonstimulated muscle. The background afferent activity increased with increasing level of muscle stimulation. The static and dynamic sensitivities were not found to be different, except in one case (peroneal nerve at 100% TA recruitment). Discussion. The main contribution to the tibial activity was believed to originate from muscle afferents in nonstimulated, synergist muscles. The main contribution to the peroneal activity was believed to be from muscle afferents within the muscle being stimulated. It was suggested that the increased background activity could be attributed to the increased activity of the Golgi tendon organs. Conclusions. Sensory information about joint flexion and joint extension are preserved in muscle afferent recordings from electrically activated muscles at low and intermediate stimulation levels, but it still has to be shown whether muscle afferent information can be useful as sensory feedback in FES control.