Programming and execution of movement in Parkinson's disease

Programming and execution of arm movements in Parkinson's disease were investigated in choice and simple reaction time (RT) situations in which subjects made aimed movements at a target. A no-aiming condition was also studied. Reaction time was fractionated using surface EMG recording into premotor (central) and motor (peripheral) components. Premotor RT was found to be greater for parkinsonian patients than normal age-matched controls in the simple RT condition, but not in the choice condition. This effect did not depend on the parameters of the impending movement. Thus, paradoxically, parkinsonian patients were not inherently slower at initiating aiming movements from the starting position, but seemed unable to use advance information concerning motor task demands to speed up movement initiation. For both groups, low velocity movements took longer to initiate than high velocity ones. In the no-aiming condition parkinsonian RTs were markedly shorter than when aiming, but were still significantly longer than control RTs. Motor RT was constant across all conditions and was not different for patient and control subjects. In all conditions, parkinsonian movements were around 37% slower than control movements, and their movement times were more variable, the differences showing up early on in the movement, that is, during the initial ballistic phase. The within-subject variability of movement endpoints was also greater in patients. The motor dysfunction displayed in Parkinson's disease involves a number of components: (1) a basic central problem with simply initiating movements, even when minimal programming is required (no-aiming condition); (2) difficulty in maintaining computed forces for motor programs over time (simple RT condition); (3) a basic slowness of movement (bradykinesia) in all conditions; and (4) increased variability of movement in both time and space, presumably caused by inherent variability in force production.

Inverse association of esophageal eosinophilia with Helicobacter pylori based on analysis of a US pathology database

BACKGROUND & AIMS

Eosinophilic esophagitis (EoE) is of increasing prevalence and believed to result from allergic processes. Helicobacter pylori has been inversely associated with allergic diseases, but there is no known relationship between H pylori, EoE, and esophageal eosinophilia. We investigated the association between esophageal eosinophilia and H pylori infection.

METHODS

We performed a cross-sectional study of data, collected from a US pathology database, on 165,017 patients in the United States who underwent esophageal and gastric biopsies from 2008 through 2010. Patients with and without H pylori on gastric biopsy were compared, and odds of esophageal eosinophilia were determined.

RESULTS

From the data analyzed, 56,301 (34.1%) had normal esophageal biopsy specimens, 5767 (3.5%) had esophageal eosinophilia, and 11,170 (6.8%) had H pylori infection. Esophageal eosinophilia was inversely associated with H pylori (odds ratio [OR], 0.77; 95% confidence interval [CI], 0.69-0.87). Compared with patients with normal esophageal biopsy specimens, odds of H pylori were reduced among patients with ≥ 15 eosinophils per high-power field (eos/hpf) (OR, 0.79; 95% CI, 0.70-0.88), ≥ 45 eos/hpf (OR, 0.75; 95% CI, 0.61-0.93), ≥ 75 eos/hpf (OR, 0.72; 95% CI, 0.50-1.03), and ≥ 90 eos/hpf (OR, 0.52; 95% CI, 0.31-0.87) (P for trend <.001). A similar dose-response trend was observed for increasing clinical suspicion for EoE and decreasing prevalence of H pylori. Additionally, severity of histologic effects of H pylori was inversely associated with esophageal eosinophilia. All trends held in multivariate analysis.

CONCLUSIONS

In a large cross-sectional analysis, H pylori infection was inversely associated with esophageal eosinophilia. This relationship could have implications for the pathogenesis and epidemiology of EoE.

Evaluation of symptom surveys for occupational musculoskeletal disorders

Symptom surveys have been used extensively as part of workplace ergonomic screening programs and epidemiologic assessments of musculoskeletal disorders in groups of workers. This paper examines the reliability and validity of two musculoskeletal symptom surveys, the Nordic Musculoskeletal Questionnaire (NMQ) and a survey used in conjunction with epidemiologic assessments by the National Institute for Occupational Safety and Health (NIOSH). Journal articles assessing the validity and reliability of the NMQ were reviewed. A retrospective assessment combining two NIOSH cohorts with a total of 852 workers assessed the reliability and validity of that survey. Reliability was assessed through test-retest methods and interitem correlations between similar questions. Validity was assessed by comparison with results from physical examination assessments of workers and self-reports of workers seeking medical care. Both reliability and validity were found to be acceptable for the purposes of workplace ergonomics programs. Implications for use of these surveys for prevention and treatment outcomes research are discussed.

Prevalence of esophageal eosinophilia varies by climate zone in the United States

OBJECTIVES

The epidemiology of eosinophilic esophagitis (EoE) is rapidly evolving, and differences in climate could impact the prevalence of EoE. We aimed to examine the association between esophageal eosinophilia and climate zones in the United States.

METHODS

This was a cross-sectional study of esophageal biopsies from 2008 to 2010 in a large US pathology database. Cases were patients with esophageal eosinophilia; controls had normal esophageal biopsies. A Köppen-Geiger (K-G) climate class was assigned to each patient, and the association between case-control status and the main K-G climate type (tropical, arid, temperate, or cold) was assessed.

RESULTS

A total of 233,649 patients were included, 71,948 (30.8%) with normal esophageal biopsies and 9,995 (4.3%) with esophageal eosinophilia. Using the temperate zone as the referent and after multivariable analysis, the odds of esophageal eosinophilia were highest in the cold climate zone (odds ratio (OR)=1.39, 95% confidence interval (CI): 1.34-1.47), compared with the tropical zone (OR=0.87; 95% CI: 0.71-10.8) and the arid zone (OR=1.27; 95% CI: 1.19-1.36). Increased likelihood of EoE was also associated with increasing odds of being in the cold climate zone. Compared with patients with normal esophageal biopsies, patients with dysphagia, a clinical suspicion of EoE, no reflux or Barrett's esophagus, esophageal eosinophilia, and eosinophilic microabscesses had the highest adjusted odds of being in a cold climate zone (OR 2.02; 1.78-2.28).

CONCLUSIONS

Esophageal eosinophilia differs significantly between K-G climate zones, with the highest prevalence in the cold and arid zones. Geographical and climate patterns may help identify candidate antigens characteristic to high-prevalence areas to be targeted for future investigation.

Histopathologic diagnosis of eosinophilic conditions in the gastrointestinal tract

Eosinophils, a constitutive component of the columnar-lined gastrointestinal tract, play an essential role in allergic responses and parasitic infections. The tissue density of these cells also increases in a variety of conditions of uncertain etiology. With the exception of the esophageal squamous epithelium, in which no eosinophils are normally present, the population of normal eosinophils in the remainder of the luminal gut is poorly defined. Therefore, histopathologists must rely on their subjective judgment to determine when a diagnosis of eosinophilic gastritis, enteritis, or colitis should be rendered. Eosinophilic esophagitis is currently the best defined and most studied eosinophilic condition of the digestive tract; therefore, the confidence in accurate diagnosis is increasing. In contrast, the characteristic clinicopathologic features of eosinophilic conditions affecting other parts of the digestive tract remain somewhat elusive. This review was designed to present pathologists with simple and practical information for the biopsy-based histopathologic diagnosis of eosinophilic esophagitis, gastritis, enteritis, and colitis. It was prepared by critically reviewing more than 200 articles on the topic, along with incorporating evidence accumulated through our own collective experience. We anticipate that by increasing pathologists' confidence in reporting these abnormal but often nameless eosinophilic infiltrates, we can help better define and characterize their significance.

Further observations on the problem of isolating Mycoplasma suipneumoniae from field cases of enzootic pneumonia in pigs

In previous work in this laboratory, Mycoplasma suipneumoniae was recovered in liquid medium from 13% of individual cases and 18% of outbreaks of enzootic pneumonia in pigs. In the work now described, however, these recovery rates, when judged by the same criteria, were 45 and 75%, respectively. As there was evidence to suggest that this second series of pneumonic cases was less suitable for cultural examination than the first series, some of the other factors that might have improved the recovery rate were investigated.Some improvement was probably achieved by inoculating the liquid medium with three or four different dilutions of pneumonic tissue, each dilution always being in duplicate, and by incubating the inoculated tubes for over 3 weeks before discarding them.A second advantage could have derived from the fact that all batches of liquid medium were tested for their ability to support the growth of M. suipneumoniae before being used to culture field material.THE EFFECT OF VARYING ONE CONSTITUENT AT A TIME WAS OBSERVED IN CONTROLLED EXPERIMENTS: different batches of pig sera had a marked, variable effect on the growth of both M. suipneumoniae and Mycoplasma hyorhinis; medium made with purchased Hartley's broth was found to be superior to medium incorporating broth made in this laboratory, more so for the growth of M. suipneumoniae than M. hyorhinis; the incorporation of yeast extract made in this laboratory gave a marginal advantage for the growth of M. hyorhinis; and both mycoplasmas grew equally well in medium containing or lacking thallium acetate.Some batches of medium were, by chance, markedly selective for the growth of M. suipneumoniae compared with M. hyorhinis. As the full reasons for this were not known, attempts were made to develop selective media in a more direct way. One such medium contained 5% pig serum and 15% horse serum, and a second was of similar composition, except that the pig serum used inhibited preferentially the growth of M. hyorhinis compared with M. suipneumoniae. Both media markedly favoured the growth of M. suipneumoniae when tested separately with cultures of M. suipneumoniae and M. hyorhinis. The second medium yielded M. suipneumoniae when inoculated with a 10(-1) dilution of a culture of M. suipneumoniae and a 10(-2) dilution of a culture of M. hyorhinis, whereas a standard batch of liquid medium, similarly inoculated with M. suipneumoniae did not yield this mycoplasma until the M. hyorhinis culture included in the inoculum was diluted to 10(-6).Both selective media, when tested on a small number of field cases, gave improved isolations of M. suipneumoniae compared with the routine batches of liquid medium used initially.Considerable difficulty was experienced in producing a sufficiently high level of antibodies to M. hyorhinis in pig sera and to M. suipneumoniae in rabbit sera. This exacerbated the problem of isolating and identifying M. suipneumoniae from field cases of enzootic pneumonia by this cultural method.

Duodenal adenomas coincide with colorectal neoplasia

BACKGROUND AND AIM

Small case series have alluded to an association between sporadic duodenal adenomas and colorectal neoplasia. The strength of the association remains uncertain. This case-control study was designed to test this association in a large national pathology database.

METHODS

This study, performed at Miraca Life Sciences, a specialized pathology laboratory that receives gastrointestinal biopsy specimens from outpatient centers throughout the US, included all subjects who underwent a bidirectional endoscopy with biopsy results from both procedures between January 2008 and December 2011. The association between duodenal and colonic neoplasms was investigated using odds ratios (OR) and their 95 % confidence intervals (CIs) derived from univariate and multivariate analyses.

RESULTS

There were 203,277 patients who underwent bidirectional procedures within the study period (mean age 58 years, 58 % females). Duodenal adenomas were present in 537 patients (median age 65 years, 51 % females; OR for male sex 1.34, 95 % CI 1.13-1.59). Hyperplastic colon polyps were present in 30,205 and colon adenomas in 85,801 patients. Hyperplastic polyps were more common in patients with duodenal adenomas (1.45, 1.07-1.95). Patients with duodenal adenomas also had a significantly greater prevalence of all types of colonic adenomas (2.65, 2.16-3.25), particularly of advanced adenomas (4.30, 3.24-5.70) and colorectal cancer (3.13, 1.38-7.12). Duodenal adenomas were associated with an equally increased risk for left and right colon adenomas.

CONCLUSIONS

Patients with duodenal adenomas harbor an increased risk for any type of colonic neoplasm. This association may provide new insights into the general mechanisms underlying mucosal proliferation in the gastrointestinal tract.

Clinical spinal instability: 10 years since the derivation of a clinical prediction rule. A narrative literature review

BACKGROUND

Between 2005 and 2015 significant changes in the clinical decision making paradigm for the treatment of spinal instability occurred. This was largely motivated by a clinical prediction rule (CPR) derivation study that was developed to specifically identify patients with low back pain who are more likely to respond positively to lumbar stabilization exercises.

OBJECTIVE

This is a narrative literature review on the recent advances physiotherapy has made in the treatment of clinical spinal instability.

METHODS

Literature discussing the conservative treatment of lumbar spinal instability published from 2005-2015 was identified with electronic searches of PubMed (MEDLINE) Advanced search, Web of Science, BIOSIS Previews, MEDLINE (EBSCO), SportDISCUS (EBSCO), CINAHL (EBSCO), PEDro, Scopus and Cochrane and reviewed.

RESULTS

Five systematic reviews, 2 with meta-analyses, and 1 systematic review on the quality of systematic reviews were found. There seems to be some benefit from specific stabilization exercise programs in regards to pain reduction, but they might not be more effective than other forms of exercise. The currently existing CPR for stabilization exercises is not far enough developed to use in clinical practice and is not validated as of yet.

CONCLUSION

Stabilization exercises seem to decrease chronic low back pain, although it is not clear that this pain has to be caused by clinical spinal instability. Caution should be exercised when using CPRs in the clinic; they are not meant to be strict treatment guidelines, but rather a tool that helps facilitate clinical decision-making.