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There is increasing evidence of central hyperexcitability in chronic whiplash-associated disorders (cWAD). However, little is known about how an apparently simple cervical spine injury can induce changes in cerebral processes. The present study was designed (1) to validate previous results showing alterations of regional cerebral blood flow (rCBF) in cWAD, (2) to test if central hyperexcitability reflects changes in rCBF upon non-painful stimulation of the neck, and (3) to verify our hypothesis that the missing link in understanding the underlying pathophysiology could be the close interaction between the neck and midbrain structures. For this purpose, alterations of rCBF were explored in a case-control study using H215O positron emission tomography, where each group was exposed to four different conditions, including rest and different levels of non-painful electrical stimulation of the neck. rCBF was found to be elevated in patients with cWAD in the posterior cingulate and precuneus, and decreased in the superior temporal, parahippocampal, and inferior frontal gyri, the thalamus and the insular cortex when compared with rCBF in healthy controls. No differences in rCBF were observed between different levels of electrical stimulation. The alterations in regions directly involved with pain perception and interoceptive processing indicate that cWAD symptoms might be the consequence of a mismatch during the integration of information in brain regions involved in pain processing.
Chronic insomnia is defined by difficulties in falling asleep, maintaining sleep, and early morning awakening, and is coupled with daytime consequences such as fatigue, attention deficits, and mood instability. These symptoms persist over a period of at least 3 months (Diagnostic and Statistical Manual 5 criteria). Chronic insomnia can be a symptom of many medical, neurological, and mental disorders. As a disorder, it incurs substantial health-care and occupational costs, and poses substantial risks for the development of cardiovascular and mental disorders, including cognitive deficits. Family and twin studies confirm that chronic insomnia can have a genetic component (heritability coefficients between 42% and 57%), whereas the investigation of autonomous and central nervous system parameters has identified hyperarousal as a final common pathway of the pathophysiology, implicating an imbalance of sleep–wake regulation consisting of either overactivity of the arousal systems, hypoactivity of the sleep-inducing systems, or both. Insomnia treatments include benzodiazepines, benzodiazepine-receptor agonists, and cognitive behavioural therapy. Treatments currently under investigation include transcranial magnetic or electrical brain stimulation, and novel methods to deliver psychological interventions.
Routine nuclear cardiology examinations indicate heart rate, cardiac rhythm, the height of cardiac pulse and respiration rhythm. It would be of interest to study whether these data, especially if the same tests are repeated, can indicate patients’ well being in the future and perhaps patients’ life span, other factors being equal. Related old theories and suggestions are mentioned. Furthermore, some drugs like I-f channel antagonists and stress tests testing cardiac reserves could support such a study.
All you need is sleep
(2016)
In 21st century, the century when the humanity hopes to embark on interplanetary travel, we are yet to fully reach an understanding of our very own idiosyncratic terra incognita – the human sleep. Sleep is a highly conserved evolutionary process that constitutes approximately one third of our life, and the lack or inadequate sleep may lead to impairment across multiple cognitive domains (Tononi and Cirelli, 2014; Lim and Dinges, 2010). Sleep deprivation also leads to aberrant brain functioning, immunological and metabolic collapse, and if it is sufficiently prolonged it will ultimately lead to death (Tononi and Cirelli, 2014).
Knight Götz von Berlichingen (1480–1562) lost his right hand distal to the wrist due to a cannon ball splinter injury in 1504 in the Landshut War of Succession at the age of 24. Early on, Götz commissioned a gunsmith to build the first “Iron Hand,” in which the artificial thumb and two finger blocks could be moved in their basic joints by a spring mechanism and released by a push button. Some years later, probably around 1530, a second “Iron Hand” was built, in which the fingers could be moved passively in all joints. In this review, the 3D computer-aided design (CAD) reconstructions and 3D multi-material polymer replica printings of the first “Iron hand“, which were developed in the last few years at Offenburg University, are presented. Even by today’s standards, the first “Iron Hand”—as could be shown in the replicas—demonstrates sophisticated mechanics and well thought-out functionality and still offers inspiration and food for discussion when it comes to the question of an artificial prosthetic replacement for a hand. It is also outlined how some of the ideas of this mechanical passive prosthesis can be translated into a modern motorized active prosthetic hand by using simple, commercially available electronic components.
In this editorial, a topic for general discussion in the field of neuroprosthetics of the upper limb is addressed: which way—invasive or non-invasive—is the right one for the future in the development of neuroprosthetic concepts. At present, two groups of research priorities (namely the invasive versus the non-invasive approach) seem to be emerging, without taking a closer look at the wishes but also the concerns of the patients. This piece is intended to stimulate the discussion on this.
Note: In lieu of an abstract, this is an excerpt from the first page.
Recently, we reported the three-dimensional computer-aided design (3D-CAD) reconstruction of the first “Iron Hand” of the famous Franconian knight, Götz von Berlichingen (1480–1562), who lost his right hand by a cannon ball splinter injury in 1504 in the War of the Succession of Landshut [...]
This is a commentary note on the situation of functional neuroimaging in psychiatry. With this we would like to encourage psychiatrists and the journal editors of psychiatric and related journals to at least rethink the role of functional neuroimaging in this discipline and use these imaging techniques in their various aspects of clinical diagnosis and therapy regimens,respectively.
In this paper pathophysiological interrelated deactivation/activation phenomena are set out in the example of whiplash injury. These phenomena could have been underestimated in previous positron emission tomography studies as their focus was on hypoperfusion rather than hyperperfusion. In addition, statistical parametric mapping analysis of cerebral studies is normally not fine-tuned to special interesting areas rather than to obvious clusters of difference.