Do patients with congenital hemiparesis and ipsilateral corticospinal projections respond differently to constraint-induced movement therapy?

This study investigates whether the type of corticospinal reorganization (identified by transcranial magnetic stimulation) influences the efficacy of constraint-induced movement therapy (CIMT). Nine patients (five males, four females; mean age 16y [SD 6y 5mo], range 11-30y) controlling their paretic hand via ipsilateral corticospinal projections from the contralesional hemisphere and seven patients (three males, four females; mean age 17y [SD 7y], range 10-30y) with preserved crossed corticospinal projections from the affected hemisphere to the paretic hand underwent 12 consecutive days of CIMT. A Wolf motor function test applied before and after CIMT revealed a significant improvement in the quality of upper extremity movements in both groups. Only in patients with preserved crossed projections, however, was this amelioration accompanied by a significant gain in speed, whereas patients with ipsilateral projections tended to show speed reduction. These data, although preliminary, suggest that patients with congenital hemiparesis and ipsilateral corticospinal projections respond differently to CIMT.

What does it take to control malaria?

More than 125 years after the discovery of the causative parasites, human malaria remains a major global-health problem. Despite many important discoveries in the epidemiology and pathogenesis of the disease, and the availability of effective treatment and control measures, there was no decline in global malarial mortality from 1954 to 1997. The economic prospects of the countries in which malaria is endemic are closely related to the burden of the disease, a situation that calls for an enhanced, concerted effort from the global community in the fight against the disease. This review explains the effects and limitations of the available control tools, summarises the extent to which they are currently employed, describes how their use could be improved, and discusses the particular importance of a vaccine in controlling the disease.

Multiple test procedures using an upper bound of the number of true hypotheses and their use for evaluating high-dimensional EEG data

Frequency analyses of EEG data yield large data sets, which are high-dimensional and have to be evaluated statistically without a large number of false positive statements. There exist several methods to deal with this problem in multiple comparisons. Knowing the number of true hypotheses increases the power of some multiple test procedures, however the number of true hypotheses is unknown, in general, and must be estimated. In this paper, we derive two new multiple test procedures by using an upper bound for the number of true hypotheses. Our first procedure controls the generalized family-wise error rate, and thus is an improvement of the step-down procedure of Hommel and Hoffmann [Hommel G., Hoffmann T. Controlled uncertainty. In: Bauer P. Hommel G. Sonnemann E., editors. Multiple Hypotheses Testing, Heidelberg: Springer 1987;ISBN 3540505598:p. 154-61]. The second new procedure controls the false discovery proportion and improves upon the approach of Lehmann and Romano [Lehmann E.L., Romano J.P. Generalizations of the familywise error rate. Ann. Stat. 2005;33:1138-54]. By Monte-Carlo simulations, we show how the gain in power depends upon the accuracy of the estimate of the number of true hypotheses. The gain in power of our procedures is demonstrated in an example using EEG data on the processing of memorized lexical items.

Cortical neuromodulation by constraint-induced movement therapy in congenital hemiparesis: an FMRI study

OBJECTIVE

The aim of this study was to assess neuromodulative effects of CIMT in congenital hemiparesis.

PATIENTS AND METHODS

Ten patients (age range: 10-30 years) with congenital hemiparesis due to unilateral cortico-subcortical infarctions in the middle cerebral artery territory, and with preserved cortico-spinal projections from the affected hemisphere to the paretic hand, were included. After a twelve-day period of constraint-induced movement therapy (CIMT), all showed a significant improvement of paretic hand function. Immediately before and after therapy, functional MRI during active and passive hand movements was performed to monitor cortical activation.

RESULTS

Four patients showed consistent increases in cortical activation during movements of the paretic hand in the primary sensorimotor cortex of the affected hemisphere. Of the remaining six patients, three showed similar changes, but these results were potentially contaminated by an improved task performance after therapy. No significant alteration in activation was observed in two patients, and one showed movement artifacts.

CONCLUSIONS

Even a short period of CIMT can induce changes of cortical activation in congenital hemiparesis. In our sample, increases in fMRI activation were consistently observed in the primary sensorimotor cortex of the affected hemisphere. Thus, the potential for neuromodulation is preserved in the affected hemisphere after early brain lesions.

[Possibilities for process optimization in orthopedic surgery]

It is mandatory to include all professions involved in the operating room (OR) in any attempt to improve the process. Early and detailed planning, short interruptions to change OR patients and a variable end of the day combined with transparent decision hierarchies help to ensure that things run smoothly. Parallel processes are essential for accelerating the change of patients. The different duties and responsibilities have to be documented. This can be done either in the records of quality management or in a special OR statutes. The evaluation and analysis of process critical parameters, including surgery as well as anesthesiology, are essential for maintaining the continuous process of improvement.

A DNA prime-modified vaccinia virus ankara boost vaccine encoding thrombospondin-related adhesion protein but not circumsporozoite protein partially protects healthy malaria-naive adults against Plasmodium falciparum sporozoite challenge

The safety, immunogenicity, and efficacy of DNA and modified vaccinia virus Ankara (MVA) prime-boost regimes were assessed by using either thrombospondin-related adhesion protein (TRAP) with a multiple-epitope string ME (ME-TRAP) or the circumsporozoite protein (CS) of Plasmodium falciparum. Sixteen healthy subjects who never had malaria (malaria-naive subjects) received two priming vaccinations with DNA, followed by one boosting immunization with MVA, with either ME-TRAP or CS as the antigen. Immunogenicity was assessed by ex vivo gamma interferon (IFN-gamma) enzyme-linked immunospot assay (ELISPOT) and antibody assay. Two weeks after the final vaccination, the subjects underwent P. falciparum sporozoite challenge, with six unvaccinated controls. The vaccines were well tolerated and immunogenic, with the DDM-ME TRAP regimen producing stronger ex vivo IFN-gamma ELISPOT responses than DDM-CS. One of eight subjects receiving the DDM-ME TRAP regimen was completely protected against malaria challenge, with this group as a whole showing significant delay to parasitemia compared to controls (P = 0.045). The peak ex vivo IFN-gamma ELISPOT response in this group correlated strongly with the number of days to parasitemia (P = 0.033). No protection was observed in the DDM-CS group. Prime-boost vaccination with DNA and MVA encoding ME-TRAP but not CS resulted in partial protection against P. falciparum sporozoite challenge in the present study.

[Grading of the functional sport shoe parameter "cushioning" and "forefoot flexibility" on running shoes]

On nearly every running event a heterogeneous structure of participants regarding body height and body weight can be observed. This study should figure out whether the running shoe manufacturers will consider this anthropometric variability. Moreover it should be investigated the runners needs based on different anthropometrics regarding preferred cushioning and forefoot flexibility properties. In order to check whether the running shoe manufacturers will apply a grading pattern, a dynamic material study with conventional running shoes in different sizes was conducted. In a second step a field study in Middle Europe and North America with 244 female and 227 male runners was organized. Every subject had to run and evaluate 7 different shoe modifications. Based on the material study it is to state, that the running shoe manufacturers currently do not consider a systematic grading of cushioning and forefoot flexibility properties. In contrast to this, the field study reveals the necessity to grade these properties. A shoe size dependent and a geographic grading concept are suggested. It is supposed, that the application of these grading concepts do not only provide a comfort improvement, but they also contribute to a reduction of joint loads of the lower extremities and consequently to a prevention of overuse injuries.

Safety of recombinant fowlpox strain FP9 and modified vaccinia virus Ankara vaccines against liver-stage P. falciparum malaria in non-immune volunteers

The ability to generate potent antigen-specific T cell responses by vaccination has been a major hurdle in vaccinology. Vaccinia virus and avipox viruses have been shown to be capable of expressing antigens in mammalian cells and can induce a protective immune response against several mammalian pathogens. We report on two such vaccine constructs, modified vaccinia virus Ankara and FP9 (an attenuated fowlpox virus) both expressing the pre-erythrocytic malaria antigen thrombospondin-related adhesion protein and a string of CD8+ epitopes (ME-TRAP). In prime-boost combinations in a mouse model MVA and FP9 are highly immunogenic and induce substantial protective efficacy. A series of human clinical trials using the recombinant MVA and FP9 malaria vaccines encoding ME-TRAP, both independently and in prime-boost combinations with or without the DNA vaccine DNA ME-TRAP, has shown them to be both immunogenic for CD8+ T cells and capable of inducing protective efficacy. We report here a detailed analysis of the safety profiles of these viral vectors and show that anti-vector antibody responses induced by the vectors are generally low to moderate. We conclude that these vectors are safe and show acceptable side effect profiles for prophylactic vaccination.

[Injuries and response to overload stress in running as a sport]

Running is rarely associated with acute injuries (muscle injuries, ankle sprain, ruptures of the Achilles tendon). More than 80% of the complaints are due to overuse injuries, mainly concerning knee, foot and Achilles tendon. Risk factors are high-performance sports, high training quantity, rapid increase of training intensity, previous injuries, and skeletal axis malalignment. Running is not suitable for severely overweight people and those with significant skeletal malalignment, dysplastic hips, spondylolisthesis, or cartilage damage.