Статті в журналах: "Afferent limb failure"

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Sundararajan, Krishnaswamy, Alice O’Connell, Arthas Flabouris, and Campbell Thompson. "Responding to clinical deterioration: Diurnal variation in afferent limb failure." Resuscitation 160 (March 2021): 14–15. http://dx.doi.org/10.1016/j.resuscitation.2020.12.025.

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Trinkle, Rebecca M., and Arthas Flabouris. "Documenting Rapid Response System afferent limb failure and associated patient outcomes." Resuscitation 82, no. 7 (July 2011): 810–14. http://dx.doi.org/10.1016/j.resuscitation.2011.03.019.

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Sandroni, Claudio, and Fabio Cavallaro. "Failure of the afferent limb: A persistent problem in rapid response systems." Resuscitation 82, no. 7 (July 2011): 797–98. http://dx.doi.org/10.1016/j.resuscitation.2011.04.012.

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DiBona, G. F., and L. L. Sawin. "Reflex regulation of renal nerve activity in cardiac failure." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 266, no. 1 (January 1, 1994): R27—R39. http://dx.doi.org/10.1152/ajpregu.1994.266.1.r27.

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Efferent renal sympathetic nerve activity (ERSNA) is increased in the rat with low-cardiac-output congestive heart failure (CHF; myocardial infarction). Arterial and cardiopulmonary baroreflex control of ERSNA in CHF and control rats was examined. Cardiac index and arterial pressure were lower and total peripheral resistance index, left ventricular end-diastolic pressure, and heart-to-body weight ratio were higher in CHF than in control rats. Increases in left ventricular end diastolic pressure produced by intravenous volume loading failed to increase cardiac index in CHF rats as it did in control rats. Single-unit analysis of aortic baroreceptor nerve activity showed that CHF rats had higher pressure threshold, lower frequency at pressure threshold, and lower gain than control rats. Arterial baroreflex control of ERSNA was attenuated; this was due to diminished gain of the afferent limb while the gain of the central portion of the reflex was normal. Single-unit analysis of vagal nerve activity showed that CHF rats had higher pressure threshold, lower frequency at saturation, and lower gain than control rats. Cardiopulmonary baroreflex control of ERSNA was attenuated; this was due to diminished gain of the afferent limb while the gain of the central portion of the reflex was normal. In the CHF rat, arterial and cardiopulmonary baroreflex control of ERSNA is markedly attenuated because of abnormalities in the periphery at the level of the aortic and cardiopulmonary receptors, respectively, and not in the central nervous system.

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DiBona, G. F., and L. L. Sawin. "Increased renal nerve activity in cardiac failure: arterial vs. cardiac baroreflex impairment." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 268, no. 1 (January 1, 1995): R112—R116. http://dx.doi.org/10.1152/ajpregu.1995.268.1.r112.

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Cardiac failure is characterized by increased renal sympathetic nerve activity that is associated with an impairment of both arterial and cardiac baroreceptor reflex function. These reflex dysfunctions are in the afferent limb at the level of the peripheral baroreceptors. This study sought to define the relative quantitative magnitude of the defects in arterial and cardiac baroreceptor function in cardiac failure. Renal sympathetic nerve activity was measured in anesthetized normal control rats and rats with cardiac failure (left coronary ligation) during sequential random order sinoaortic denervation and vagotomy to interrupt afferent input from the arterial and cardiac baroreceptors, respectively. Increases in renal sympathetic nerve activity after individual or combined sinoaortic denervation and vagotomy were less (P < 0.05 for both) in cardiac failure than in normal control rats in both order sequences (42 +/- 5 vs. 87 +/- 8%; 44 +/- 5 vs. 108 +/- 7%). In cardiac failure rats, vagotomy produced lesser increases (P < 0.05 for both) in renal sympathetic nerve activity than sinoaortic denervation in both order sequences (10 +/- 4 vs. 32 +/- 5%; 13 +/- 2 vs. 30 +/- 5%). The relative magnitude of impaired cardiac baroreceptor reflex function that is associated with the increased renal sympathetic nerve activity of cardiac failure is greater than that of impaired arterial baroreceptor reflex function.

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Tirkkonen, Joonas, Markus B. Skrifvars, Tero Tamminen, Michael J. A. Parr, Ken Hillman, Ilmar Efendijev, and Anders Aneman. "Afferent limb failure revisited – A retrospective, international, multicentre, cohort study of delayed rapid response team calls." Resuscitation 156 (November 2020): 6–14. http://dx.doi.org/10.1016/j.resuscitation.2020.08.117.

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Lamotte, Guillaume, Elizabeth A. Coon, Mariana D. Suarez, Paola Sandroni, Eduardo Benarroch, Jeremy K. Cutsforth-Gregory, Michelle L. Mauermann, et al. "Standardized Autonomic Testing in Patients With Probable Radiation-Induced Afferent Baroreflex Failure." Hypertension 79, no. 1 (January 2022): 50–56. http://dx.doi.org/10.1161/hypertensionaha.121.17805.

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Injury of the afferent limb of the baroreflex from neck radiation causes radiation-induced afferent baroreflex failure (R-ABF). Identification and management of R-ABF is challenging. We aimed to investigate the pattern of autonomic dysfunction on standardized autonomic testing in patients with probable R-ABF. We retrospectively analyzed all autonomic reflex screens performed at Mayo Clinic in Rochester, MN, between 2000 and 2020 in patients with probable R-ABF. Additional tests reviewed included ambulatory blood pressure monitoring, plasma norepinephrine, and thermoregulatory sweat test. We identified 90 patients with probable R-ABF. Median total composite autonomic severity score (range, 0–10) was 7 (interquartile range, 6–7). Cardiovascular adrenergic impairment was seen in 85 patients (94.4%), increased blood pressure recovery time after Valsalva maneuver in 71 patients (78.9%; median 17.4 seconds), and orthostatic hypotension in 68 patients (75.6%). Cardiovagal impairment was demonstrated by abnormal heart rate responses to deep breathing (79.5%), Valsalva ratio (87.2%), and vagal baroreflex sensitivity (57.9%). Plasma norepinephrine was elevated and rose appropriately upon standing (722–1207 pg/mL). Ambulatory blood pressure monitoring revealed hypertension, postural hypotension, hypertensive surges, tachycardia, and absence of nocturnal dipping. Blood pressure lability correlated with impaired vagal baroreflex function. Postganglionic sympathetic sudomotor function was normal in most cases; the most frequent thermoregulatory sweat test finding was focal neck anhidrosis (78.9%). Standardized autonomic testing in R-ABF demonstrates cardiovascular adrenergic impairment with orthostatic hypotension, blood pressure lability, and elevated plasma norepinephrine. Cardiovagal impairment is common, while sudomotor deficits are limited to direct radiation effects.

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Rostand, S. G., J. D. Brunzell, R. O. Cannon, and R. G. Victor. "Cardiovascular complications in renal failure." Journal of the American Society of Nephrology 2, no. 6 (December 1991): 1053–62. http://dx.doi.org/10.1681/asn.v261053.

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Cardiovascular diseases are a leading cause of death in end-stage renal disease (ESRD) largely as a result of the progressively increasing age of ESRD patients and the broad constellation of uremia-associated factors that can adversely affect cardiac function. Hypertension, one of the leading causes of renal failure, is a major culprit in this process, causing left ventricular hypertrophy, cardiac chamber dilation, increased left ventricular wall stress, redistribution of coronary blood flow, reduced coronary artery vasodilator reserve, ischemia, myocardial fibrosis, heart failure, and arrhythmias. In addition to impairing the coronary microcirculation, hypertension may contribute to the development of atherosclerotic coronary artery disease, particularly in the presence of the many lipid abnormalities observed in ESRD. These patients have reduced high-density lipoprotein cholesterol and increased plasma triglyceride concentrations, and there is a defect in cholesterol transport. Other abnormalities that may contribute to atherosclerotic coronary artery disease in ESRD are reduced high-density lipoprotein cholesterol synthesis and reduced activity of the reverse cholesterol pathway. Treatment with fibric acids, nicotinic acids, and lovastatin may be useful in lowering cholesterol and triglyceride concentrations in some of these patients. The incidence of coronary artery disease in ESRD populations is difficult to determine. About 25 to 30% of ESRD patients with angina have no evidence of significant coronary artery disease, and an undetermined number have silent coronary disease. The presence of resting electrocardiographic abnormalities caused by hypertension or conduction defects makes it difficult to accurately diagnosis coronary artery disease in ESRD populations by noninvasive methods, including exercise testing and thallium scintigraphy with or without the use of dipyridamole. Hypotension is a frequent complication of the dialytic process. Many factors have been implicated, including autonomic neuropathy. There is no consensus on the function of the efferent limb of the sympathetic nervous system. The afferent limb (arterial baroreflex function) is felt to be impaired. Further, there may be defects in the ability of the cardiovascular system to respond to sympathetic nerve activity. Most studies of autonomic function have used indirect measurements. Studies are underway that use techniques to assess sympathetic function directly. Such experiments with microneuropathy suggest greater skeletal sympathetic muscle discharge in uremic patients than in normal patients.

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Van Iterson, Erik H., Bruce D. Johnson, Michael J. Joyner, Timothy B. Curry, and Thomas P. Olson. "V̇o2 kinetics associated with moderate-intensity exercise in heart failure: impact of intrathecal fentanyl inhibition of group III/IV locomotor muscle afferents." American Journal of Physiology-Heart and Circulatory Physiology 313, no. 1 (July 1, 2017): H114—H124. http://dx.doi.org/10.1152/ajpheart.00014.2017.

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Heart failure (HF) patients demonstrate impaired pulmonary, circulatory, and nervous system responses to exercise. While HF demonstrates prolonged [time constant (τ)] pulmonary O2 uptake (V̇o2) on-kinetics, contributing to exercise intolerance, it is unknown whether abnormal V̇o2 kinetics couple with ventilatory and circulatory dysfunction secondary to impaired group III/IV afferents in HF. Because lower lumbar intrathecal fentanyl inhibits locomotor muscle afferents, resulting in improved exercise ventilation and hemodynamics, we tested these hypotheses: HF will demonstrate 1) rapid V̇o2 on-kinetics and 2) attenuated steady-state V̇o2 amplitude and O2 deficit (O2def) during exercise with fentanyl versus placebo. On separate visits (randomized), breath-by-breath V̇o2 was measured in HF (ejection fraction: 27 ± 6%, New York Heart Association class I–III) and age- and sex-matched controls (both n = 9, ages: 60 ± 6 vs. 63 ± 8 yr, P = 0.37) during cycling transitions at 65% peak workload (78 ± 24 vs. 115 ± 39 W, P < 0.01) with intrathecal fentanyl or placebo. Regardless of group or condition, optimal phase II (primary component) curve fits reflected a phase I period equal to 35 s (limb-to-lung timing) via single-exponential functions. Condition did not affect steady-state V̇o2, the phase II τ of V̇o2, or O2def within controls ( P > 0.05). Without differences in steady-state V̇o2, reduced O2def in fentanyl versus placebo within HF (13 ± 4 vs. 22 ± 15 ml/W, P = 0.04) was accounted for by a rapid phase II τ of V̇o2 in fentanyl versus placebo within HF (45 ± 11 vs. 57 ± 14 s, P = 0.04), respectively. In an integrative manner, these data demonstrate important effects of abnormal locomotor muscle afferents coupled to pulmonary and circulatory dysfunction in determining impaired exercise V̇o2 in HF. Effects of abnormal muscle afferents on impaired exercise V̇o2 and hence exercise intolerance may not be discernable by independently assessing steady-state V̇o2 in HF. NEW & NOTEWORTHY Inhibition of locomotor muscle afferents results in rapid primary-component O2 uptake (V̇o2) on-kinetics accounting for the decreased O2 deficit in heart failure (HF). This study revealed that abnormal musculoskeletal–neural afferents couple with pulmonary and circulatory dysfunction to provoke impaired exercise V̇o2 in HF. Steady-state V̇o2 cannot properly phenotype abnormal muscle afferent contributions to impaired exercise V̇o2 in HF.

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Shemtov, Ron, Phil Fleshner, and Gaurav Syal. "P120 PRE-POUCH ILEITIS IS A RISK FACTOR FOR DEVELOPMENT OF CROHN’S DISEASE-LIKE COMPLICATIONS, NEED FOR BIOLOGIC THERAPY AND POUCH FAILURE." Inflammatory Bowel Diseases 26, Supplement_1 (January 2020): S44. http://dx.doi.org/10.1093/ibd/zaa010.115.

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Abstract Introduction Pre-pouch ileitis or afferent limb inflammation is generally considered to be suggestive of de novo Crohn’s disease in patients with ileal pouch. However, the data on whether these patients progress to develop CD-like complications is limited. We aim to study the evolution of pre-pouch ileitis in this study. Methods All patients who underwent an IPAA surgery by an expert surgeon between 1990 and 2018 for diagnosis of ulcerative colitis (UC) or inflammatory bowel disease-unclassified (IBD-U) at our institution and later went to develop pre-pouch ileitis were included. Patient charts were reviewed were reviewed subsequent to the diagnosis of pre-pouch ileitis to assess development of CD-like complications (non-anastomotic strictures and fistulae developing >6 months after ileostomy closure) or requirement of J-pouch surgery or ileostomy. Pre-pouch ileitis was defined by presence of erosions or ulcers in the afferent limb. Results 58 patients with J-pouch developed pre-pouch ileitis at a median of 21 months (range 1–216 months) from ileostomy closure. Baseline characteristics are shown in table 1. Median follow up duration after the diagnosis of pre-pouch ileitis was 48 months (range 2–204 months). 54/58 (93%) patients had concomitant pouchitis with pre-pouch ileitis. 36/58 (62%) patients were initiated on biologic therapy during their follow up course and 3/58 (5%) were treated with an immunomodulator. 20/58 (35%) patients developed Crohn’s disease-like complications (10 developed non-anastomotic strictures and 10 developed perianal complications) at a median follow up of 17 months (range 2–85 months) from the diagnosis of pre-pouch ileitis. 5/58 (8.6%) needed endoscopic stricture dilation and 6/58 (10%) needed perianal surgery for fistula or abscess. Pouch failure occurred in 5/58 (9%) of patients (3 with pouch resection, 1 with pouch revision and 1 with permanent ileostomy), while 3/58 (5%) patients required temporary ileostomy. Conclusions Patients who develop pre-pouch ileitis are at high risk of developing CD-like complications (non-anastomotic strictures and perianal complications). The risk of pouch failure and requirement for endoscopic procedures or surgery in this cohort also appears to higher than traditionally reported in patients with pouchitis. Hence, pre-pouch ileitis should be considered suggestive of Crohn’s disease and treated aggressively.

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Jaggy, A., Y. Malik, J. Howard, S. Rüfenacht, D. Spreng, and F. Forterre. "Non-selective cutaneous sensory neurectomy as an alternative treatment for auto-mutilation lesion following arthrodesis in three dogs." Veterinary and Comparative Orthopaedics and Traumatology 22, no. 03 (2009): 233–37. http://dx.doi.org/10.3415/vcot-08-09-0091.

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Summary Objective: To describe an alternative method for the treatment of non-responsive self-mutilation injuries in three dogs after carpal/tarsal arthrodesis. Study design: Case series Animals: Two dogs with carpal injury and one dog with tarsal injury treated by arthrodesis Methods: All dogs developed self-mutilation injuries due to licking and/or chewing of the toes within 21–52 days of surgery. Clinical signs did not resolve within one week after conservative treatment with wound debridement and protective bandages. Following general anaesthesia, a deep horseshoe-shaped skin incision, including the subdermal tissue, was performed proximal to the selfmutilation injury transecting the sensory cutaneous afferent nerves. The skin incision was closed with simple interrupted sutures. Results: All wounds healed without complication. Self-mutilation resolved completely within 24 hours after surgery in all dogs. No recurrence was observed (5 months to 3 years). Conclusion: Non-selective cutaneous sensory neurectomy may lead to resolution of self-mutilation following arthrodesis in dogs. Clinical relevance: Failure of conservative treatment in self-mutilation injuries often leads to toe or limb amputation as a last resort. The technique described in this case series is a simple procedure that should be considered prior to amputation. The outcome of this procedure in dogs self-multilating due to neurological or behavioral disturbances unrelated to carpal or tarsal arthrodesis is not known.

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Ollech, J., S. Harel, K. Yadgar, N. Asayag, A. Cahan, N. Lederman, E. Matz, et al. "P206 Demographic data and therapy before proctocolectomy with ileal pouch-anal anastomosis are associated with long-term pouch outcomes: A report from the epi-IIRN." Journal of Crohn's and Colitis 14, Supplement_1 (January 2020): S241. http://dx.doi.org/10.1093/ecco-jcc/jjz203.335.

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Abstract Background Up to 25% of patients with ulcerative colitis (UC) may undergo restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). Pouchitis may occur in 50–70% of patients, and ~30% may develop chronic pouchitis (CP) or Crohn’s-like disease of the pouch (CLDP). We aimed to identify predictors for the development of CP or CLDP during a long follow-up period. Methods Patients followed prospectively at the pouch clinic at Rabin Medical Center, were cross-referenced with data from the validated epiIIRN cohort which includes all IBD patients in Israel (n = 45 074). All patients had at least one year of follow-up since ileal continuity (i.e., ileostomy closure after pouch formation). CP was defined as an active flare of pouchitis for >4 weeks and being treated with antibiotics or anti-inflammatory therapy, or >4 episodes of acute pouchitis/year. CLDP was defined as having one or more of the following: pouch-related fistula (>1 year after ileostomy closure), inflammation of the afferent limb, or fibrostenotic disease of the pouch. For the analysis, the cohort was further categorised into favourable pouch outcomes (sustained normal pouch, acute pouchitis) vs. unfavourable pouch outcomes (CP, CLDP or pouch failure). Logistic regression included gender, age, previous therapies, disease duration before pouch surgery, surgical technique and number of previous non-IBD related abdominal operations. Results We included 182 patients (55% females; median age at IPAA: 32 years (IQR 23–45); median disease duration until pouch surgery 6 years (3–11); two-staged surgery 69%). The median follow up time was 14 years (IQR 7–22). Before surgery, 37% of patients had been exposed to immunomodulators (either thiopurines or methotrexate), 24% were exposed to anti-TNF therapy and 5% were previously treated with vedolizumab. An unfavourable pouch phenotype was noted in 48% of patients. On multivariate logistic regression, anti-TNF therapy and older age at pouch surgery were associated with decreased odds of an unfavourable pouch outcome (OR 0.3 95% CI 0.11–0.69, p = 0.007 and OR 0.96 95% CI 0.93–0.98, p = 0.005, respectively). Conclusion Therapy of UC with an anti-TNF and older age were associated with a favourable pouch outcome. These may be surrogates for patients with longer follow up as well as indication for IPAA. Such factors should be taken into consideration in clinical decision making.

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Amann, Markus, Massimo Venturelli, Stephen J. Ives, David E. Morgan, Benjamin Gmelch, Melissa A. H. Witman, H. Jonathan Groot, D. Walter Wray, Josef Stehlik, and Russell S. Richardson. "Group III/IV muscle afferents impair limb blood in patients with chronic heart failure." International Journal of Cardiology 174, no. 2 (June 2014): 368–75. http://dx.doi.org/10.1016/j.ijcard.2014.04.157.

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Amann, Markus. "Group III/IV muscle afferents impair limb blood flow in patients with chronic heart failure." Autonomic Neuroscience 192 (November 2015): 27. http://dx.doi.org/10.1016/j.autneu.2015.07.333.

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SCOTT, Adam C., L. Ceri DAVIES, Andrew J. S. COATS, and Massimo PIEPOLI. "Relationship of skeletal muscle metaboreceptors in the upper and lower limbs with the respiratory control in patients with heart failure." Clinical Science 102, no. 1 (December 3, 2001): 23–30. http://dx.doi.org/10.1042/cs1020023.

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Increased activity of muscle metaboreceptors (afferents sensitive to muscle contraction that are responsible for the ventilatory responses to exercise) has been proposed in patients with chronic heart failure (CHF) to constitute a missing link between muscle metabolic abnormalities and exercise overventilation. We looked at this reflex overactivation to determine if it is systemic or limited to a single muscle region in the same human subject. This was done by comparing the metaboreflex response of ventilatory control in the lower and upper limbs in CHF patients and healthy controls. Groups of 15 stable CHF patients (63.7±2.7 years) and eight control subjects (69.8±1.8 years) performed both leg and arm metaboreflex tests. These metaboreflex tests involved two 5min episodes of bicycle or handgrip exercise: on one occasion after the exercise the subjects recovered normally, while on the other occasion tourniquet cuffs were inflated around the exercising limb to supra-systolic pressure at the onset of recovery to obtain a regional circulatory occlusion, which isolates and maintains the stimulation of the metaboreflex after exercise. The contribution of the metaboreflex to exercise ventilation was computed as the absolute increment of peak ventilation that was maintained by regional circulatory occlusion. The metaboreceptor contribution to the ventilatory response to both leg exercise (patients, 5.3±1.6litres/min; controls, 0.2±0.7litres/min) and arm exercise (patients, 3.7±1.0litres/min; controls, 0.02±0.4litres/min) was significantly higher in CHF patients (P < 0.05). A significant correlation was present between metaboreflex responses to arm and leg exercises (r = 0.4, P < 0.05). Metaboreflex responses during both types of exercise were inversely correlated with peak oxygen uptake (leg, r =-0.43, P < 0.05; arm, r =-0.633, P = 0.0009), but only the reflex during arm exercise was correlated with the E (ventilation)/co2 (CO2 production) slope (r = 0.576, P < 0.005). Thus the metaboreflex system is systemically overactive and may potentially contribute to exercise intolerance during both lower- and upper-limb efforts in CHF. This suggests a unique mechanism responsible for overactivation of this system in the skeletal muscle of heart failure patients.

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Vila-Chã, Carolina, Deborah Falla, Miguel Velhote Correia, and Dario Farina. "Changes in H reflex and V wave following short-term endurance and strength training." Journal of Applied Physiology 112, no. 1 (January 1, 2012): 54–63. http://dx.doi.org/10.1152/japplphysiol.00802.2011.

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This study examined the effects of 3 wk of either endurance or strength training on plasticity of the neural mechanisms involved in the soleus H reflex and V wave. Twenty-five sedentary healthy subjects were randomized into an endurance group ( n = 13) or strength group ( n = 12). Evoked V-wave, H-reflex, and M-wave recruitment curves, maximal voluntary contraction (MVC), and time-to-task-failure (isometric contraction at 40% MVC) of the plantar flexors were recorded before and after training. Following strength training, MVC of the plantar flexors increased by 14.4 ± 5.2% in the strength group ( P < 0.001), whereas time-to-task-failure was prolonged in the endurance group (22.7 ± 17.1%; P < 0.05). The V wave-to-maximal M wave (V/Mmax) ratio increased significantly (55.1 ± 28.3%; P < 0.001) following strength training, but the maximal H wave-to-maximal M wave (Hmax/Mmax) ratio remained unchanged. Conversely, in the endurance group the V/Mmax ratio was not altered, whereas the Hmax/Mmax ratio increased by 30.8 ± 21.7% ( P < 0.05). The endurance training group also displayed a reduction in the H-reflex excitability threshold while the H-reflex amplitude on the ascending limb of the recruitment curve increased. Strength training only elicited a significant decrease in H-reflex excitability threshold, while H-reflex amplitudes over the ascending limb remained unchanged. These observations indicate that the H-reflex pathway is strongly involved in the enhanced endurance resistance that occurs following endurance training. On the contrary, the improvements in MVC following strength training are likely attributed to increased descending drive and/or modulation in afferents other than Ia afferents.

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Ives, Stephen, Markus Amann, Massimo Venturelli, H. Jonathan Groot, Melissa A. H. Witman, David E. Morgan, D. Walter Wray, and Russell S. Richardson. "Limb Movement‐Induced Central and Peripheral Hemodynamics in Heart Failure: The Role of Afferent Feedback." FASEB Journal 27, S1 (April 2013). http://dx.doi.org/10.1096/fasebj.27.1_supplement.943.21.

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Zbinden, Jan, and Max Ortiz-Catalan. "The rubber hand illusion is a fallible method to study ownership of prosthetic limbs." Scientific Reports 11, no. 1 (February 24, 2021). http://dx.doi.org/10.1038/s41598-021-83789-7.

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AbstractEnabling sensory feedback in limb prostheses can reverse a damaged body image caused by amputation. The rubber hand illusion (RHI) is a popular paradigm to study ownership of artificial limbs and potentially useful to assess sensory feedback strategies. We investigated the RHI as means to induce ownership of a prosthetic hand by providing congruent visual and tactile stimuli. We elicited tactile sensations via electric stimulation of severed afferent nerve fibres in four participants with transhumeral amputation. Contrary to our expectations, they failed to experience the RHI. The sensations we elicited via nerve stimulation resemble tapping as opposed to stroking, as in the original RHI. We therefore investigated the effect of tapping versus stroking in 30 able-bodied subjects. We found that either tactile modality equally induced ownership in two-thirds of the subjects. Failure to induce the RHI in the intact hand of our participants with amputation later confirmed that they form part of the RHI-immune population. Conversely, these participants use neuromusculoskeletal prostheses with neural sensory feedback in their daily lives and reported said prostheses as part of their body. Our findings suggest that people immune to the RHI can nevertheless experience ownership over prosthetic limbs when used in daily life and accentuates a significant limitation of the RHI paradigm.

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Julnes, Signe Gunn, Laila Solli Reitan, Tove Myrvang, Gry Rønning, and Solfrid Vatne. "Use of rapid response system afferent limb to recognize and respond to deteriorating patients: An action research study." Nordic Journal of Nursing Research, October 3, 2022, 205715852211243. http://dx.doi.org/10.1177/20571585221124376.

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Failure to recognize the deterioration of hospital patients has led to the implementation of a system known as the Rapid Response System. The aim was to explore nurses’ use of the afferent limb of the Rapid Response System to recognize and respond to deteriorating patients. Data were collected via video recordings with observations of 20 registered nurses (RNs) from general wards performing scenarios in a simulation laboratory with focus group interviews. Data were analyzed using systematic text condensation. COREQ were followed. In the first scenario, nurses did not apply ABCDE or ISBAR, and the use of NEWS was insufficient. Completing an education program led to evident improvement in the use of the tools during the second scenario. Nurses initially viewed their new competency as useful, but it was not sustained a year later. Customized education programs and fidelity-scale simulations are suited but not sufficient to change clinical competency without management anchoring.

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Berry, Debra, Maryann Street, Kylie Hall, Stephanie K. Sprogis, and Julie Considine. "Recognizing and responding to clinical deterioration in adult patients in isolation precautions for infection control: a retrospective cohort study." International Journal for Quality in Health Care 34, no. 2 (January 1, 2022). http://dx.doi.org/10.1093/intqhc/mzac020.

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Abstract Background Patient isolation is widely used as a strategy for prevention and control of infection but may have unintended consequences for patients. Early recognition and response to acute deterioration is an essential component of safe, quality patient care and has not been explored for patients in isolation. Objective The primary aims of this study were to (i) describe the timing, frequency and nature of clinical deterioration during hospital admission for patients with isolation precautions for infection control and (ii) compare the characteristics of patients who did and did not deteriorate during their initial period of isolation precautions for infection control. Methods This retrospective cohort study was conducted across three sites of a large Australian health service. The study sample were adult patients (≥18 years) admitted into isolation precautions within 24 h of admission from 1 July 2019 to 31 December 2019. Results There were 634 patients who fulfilled the study inclusion criteria. One in eight patients experienced at least one episode of clinical deterioration during their time in isolation with most episodes of deterioration occurring within the first 2 days of admission. Timely Medical Emergency Team calls occurred in almost half the episodes of deterioration; however, the same proportion (47.2%) of deterioration episodes resulted in no Medical Emergency Team activation (afferent limb failure). In the 24 h preceding each episode of clinical deterioration (n = 180), 81.6% (n = 147) of episodes were preceded by vital signs fulfilling pre-Medical Emergency Team criteria. Patients who deteriorated during isolation for infection control were older (median age 74.0 vs 71.0 years, P = 0.042); more likely to live in a residential care facility (21.0% vs 7.2%, P = 0.006); had a longer initial period of isolation (4.0 vs 2.9 days, P = < 000.1) and hospital length-of-stay (median 4.9 vs 3.2 days, P = < 0.001) and were more likely to die in hospital (12.3% vs 4.3%, P < 0.001). Conclusion Patients in isolation precautions experienced high Medical Emergency Team afferent limb failure and most fulfilled pre-Medical Emergency Team criteria in the 24 h preceding episodes of deterioration. Timely recognition and response to clinical deterioration continue to be essential in providing safe, quality patient care regardless of the hospital-care environment.

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Considine, Julie, Debra Berry, Andrea Doric, Joanna Simpson, Alison Dwyer, Steven Hirth, and Evan Newnham. "Frequency and nature of medical emergency team afferent limb failure in patients with documented vital sign abnormalities: A retrospective point prevalence study." Australian Critical Care, July 2022. http://dx.doi.org/10.1016/j.aucc.2022.05.005.

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Amann, Markus, Massimo Venturelli, Steve Ives, David Morgan, Benjamin Gmelch, Melissa Witman, Jon Groot, David Walter Wray, Josef Stehlik, and Russell Richardson. "Group III/IV muscle afferents impair limb blood flow during exercise in patients with heart failure." FASEB Journal 27, S1 (April 2013). http://dx.doi.org/10.1096/fasebj.27.1_supplement.699.4.

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Jenkinson, Paul M., Cristina Papadaki, Sahba Besharati, Valentina Moro, Valeria Gobbetto, Laura Crucianelli, Louise P. Kirsch, Renato Avesani, Nick S. Ward, and Aikaterini Fotopoulou. "Welcoming back my arm: affective touch increases body ownership following right-hemisphere stroke." Brain Communications 2, no. 1 (January 1, 2020). http://dx.doi.org/10.1093/braincomms/fcaa034.

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Abstract Right-hemisphere stroke can impair the ability to recognize one’s contralesional body parts as belonging to one’s self. The study of this so-called ‘disturbed sense of limb ownership’ can provide unique insights into the neurocognitive mechanisms of body ownership. In this study, we address a hypothesis built upon experimental studies on body ownership in healthy volunteers. These studies have shown that affective (pleasant) touch, an interoceptive modality associated with unmyelinated, slow-conducting C-tactile afferents, has a unique role in the sense of body ownership. In this study, we systematically investigated whether affective touch stimulation could increase body ownership in patients with a disturbed sense of limb ownership following right-hemisphere stroke. An initial feasibility study in 16 adult patients with acute stroke enabled us to optimize and calibrate an affective touch protocol to be administered by the bedside. The main experiment, conducted with a different sample of 26 right hemisphere patients, assessed changes in limb ownership elicited following self- (patient) versus other- (experimenter) generated tactile stimulation, using a velocity known to optimally activate C-tactile fibres (i.e. 3 cm/s), and a second velocity that is suboptimal for C-tactile activation (i.e. 18 cm/s). We further examined the specificity and mechanism of observed changes in limb ownership in secondary analyses looking at (i) the influence of perceived intensity and pleasantness of touch, (ii) touch laterality and (iii) level of disturbed sense of limb ownership on ownership change and (iv) changes in unilateral neglect arising from touch. Findings indicated a significant increase in limb ownership following experimenter-administered, C-tactile-optimal touch. Voxel-based lesion-symptom mapping identified damage to the right insula and, more substantially, the right corpus callosum, associated with a failure to increase body ownership following experimenter-administered, affective touch. Our findings suggest that affective touch can increase the sense of body-part ownership following right-hemisphere stroke, potentially due to its unique role in the multisensory integration processes that underlie the sense of body ownership.

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Pereira, Hugo M., Felipe F. de Lima, Bruno M. Silva, and André F. Kohn. "Sex differences in fatigability after ischemic preconditioning of non-exercising limbs." Biology of Sex Differences 11, no. 1 (October 27, 2020). http://dx.doi.org/10.1186/s13293-020-00338-z.

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Abstract Background Ischemic preconditioning (IPC) is suggested to decrease fatigability in some individuals but not others. Sex differences in response to IPC may account for this variability and few studies systematically investigated the effects of IPC in men and women. The goal of this study was to determine if time to task failure, perception of pain, and neuromuscular mechanisms of fatigability were altered by IPC in men and women. Methods Ten women (29 ± 5 years old) and 10 men (28 ± 6 years old) performed isometric contractions with the plantar flexor muscles of the dominant leg at 20% of maximal voluntary contraction until task failure. We used a repeated measures design where each individual performed 3 randomized and counterbalanced test sessions: (A) IPC session, cuff inflation and deflation (5 min each repeated 3 times) performed before the exercise by inflating cuffs to the non-dominant leg and arm; (B) sham session, cuffs were inflated for a short period (1 min); and (C) control session, no cuffs were involved. Results Compared with control, IPC increased time to task failure in men (mean difference, 5 min; confidence interval (CI) of mean difference, 2.2; 7.8 min; P = 0.01) but not women (mean difference, − 0.6 min; CI of mean difference, − 3.5; 2.4 min; P = 0.51). In men, but not women, the IPC-induced increase in time to task failure was associated with lower response to pressure pain (r = − 0.79). IPC further exposed sex differences in arterial pressure during fatiguing contractions (session × sex: P < 0.05). Voluntary activation, estimated with the twitch interpolation technique, and presynaptic inhibition of leg Ia afferents were not altered after IPC for men and women. The tested variables were not altered with sham. Conclusions The ergogenic effect of IPC on time to task failure was observed only in men and it was associated with reductions in the perception of pain. This pilot data suggest the previously reported inter-individual variability in exercise-induced fatigability after IPC could be a consequence of the sex and individual response to pain.

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Atwan, Eman Fawzy, Ahmad Sayed Awad, Safaa M. Abdelrahman, Samuel Helmy Makar, and Mohammed Hamadna Allah El Ghobashy. "Surveillance and monitoring of early failing arteriovenous fistula using Doppler assessment in children on regular hemodialysis." Egyptian Journal of Radiology and Nuclear Medicine 53, no. 1 (October 31, 2022). http://dx.doi.org/10.1186/s43055-022-00912-y.

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Abstract Background A well-functioning vascular access is a mainstay to perform an efficient hemodialysis procedure. Limited lifespan of arteriovenous accesses is one of the major challenges of the current long-term hemodialysis therapy. Vascular access-related morbidity accounts for up to 50% of total dialysis patient’s costs. The pediatric vascular access clinical guidelines published by the National Kidney Foundation Kidney Disease Outcome Quality Initiative recommend establishing a surveillance strategy to detect access stenosis and direct patients for early intervention. The aim of this study was to test the role of using the color Doppler ultrasonography (CDU) as a surveillance method for arteriovenous fistulae in children on regular hemodialysis and its value for detecting the early vascular access failure or dysfunction to avoid access loss. Results During 10-month duration, we prospectively conducted surveillance for 30 patients on regular hemodialysis through arteriovenous fistulae (AVF) as a vascular access, clinical assessment of AVF and radiological examination using CDU of the upper limbs. Their ages were ranging from 2 to 18 years with 1:1 male: female ratio. Doppler indices were measured in the afferent arteries, at the site of anastomosis, and the draining veins. AVF stenosis was the highest among all the detected complications (n = 9, 30%), aneurysm and pseudoaneurysmal formation (n = 8, 26%) anastomoses diameter reduction in 16.6%, and it was correlated with the dialysis adequacy measured through the Kt/v. Other complications were thrombosis (n = 2, 6.7%), central venous stenosis (n = 2, 6.7%), steal syndrome (n = 1, 3.3%) and calcifications in (n = 1, 3.3%). In total, 26% of the patients have more than one malfunction. Only one case has access failure a month after CDU examination. Conclusion In conclusion, among pediatric patients CDU can detect early stenosis of AVF in children, which can affect the dialysis adequacy.

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