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At least 649 records · Page 36Linked to original sources
PubMed2006

Influence of menstrual cycle phase on pulmonary function in asthmatic athletes.

The main aim of this study was to investigate whether there is a relationship between menstrual cycle phase and exercise-induced bronchoconstriction (EIB) in female athletes with mild atopic asthma. Seven eumenorrheic subjects with regular 28-day menstrual cycles were exercised to volitional exhaustion on day 5 [mid-follicular (FOL)] and day 21 [mid-luteal (LUT)] of their menstrual cycle. Pulmonary function tests were conducted pre- and post-exercise. The maximal percentage decline in post-exercise forced expiratory volume in 1 s (FEV(1)) and forced expiratory flow from 25 to 75% of forced vital capacity (FEF(25-75%)) was significantly greater (P<0.05) on day 21 (mid-LUT phase) (-17.35+/-2.32 and -26.28+/-6.04%, respectively), when salivary progesterone concentration was highest, compared to day 5 (mid-FOL phase) (-12.81+/-3.35 and -17.23+/-8.20%, respectively), when salivary progesterone concentration was lowest. The deterioration in the severity of EIB during the mid-LUT phase was accompanied by worsening asthma symptoms and increased bronchodilator use. There was a negative correlation between the percent change in pre- to post-exercise FEV(1) and salivary progesterone concentration. However, no such correlation was found between salivary estradiol and the percentage change in pre- to post-exercise FEV(1). This study has shown for the first time that menstrual cycle phase is an important determinant of the severity of EIB in female athletes with mild atopic asthma. Female asthmatic athletes may need to adjust their training and competition schedules to their menstrual cycle and to consider the potential negative effects of the LUT phase of the menstrual cycle on exercise performance.

Asthma↗
PubMed2006

Influence of the menstrual cycle on proenkephalin peptide F responses to maximal cycle exercise.

Proenkephalin peptide F [107-140] is an enkephalin-containing peptide found predominantly within the adrenal medulla and is co-packaged with epinephrine within adrenal medullary chromaffin granules. Peptide F has been shown to have the classic opioid analgesia effects along with immune cell interactions. This is only the second peptide F study in women, and in it we compare the responses of peptide F to a maximal cycle exercise test and recovery values over the follicular and luteal phases of the menstrual cycle. Eight untrained (directly documented in this study) women who were eumenorrheic performed a progressive maximal exercise test to volitional exhaustion on a cycle ergometer, once during the follicular phase, and once during the luteal phases of the menstrual cycle. Blood was obtained pre-exercise, immediately post-exercise and at 0, 15, and 30 min into recovery. Typical exercise changes in response to the cycle tests were observed with blood lactate increases that remained elevated 30 min into recovery. No significant exercise-induced elevations were observed for peptide F concentrations with exercise nor were any differences observed between the two menstrual phases. Thus, the effects of the menstrual cycle on peptide F concentrations appear to be minimal under the conditions of this investigation. With high concentrations of peptide F observed at rest (approx. 0.2-0.3 pmol ml(-1)) pre-exercise arousal mechanisms may have obviated any exercise-induced response. In addition, inhibition via elevated epinephrine may have inhibited any post-exercise increases and finally adrenal medullary capacity for circulatory concentrations of peptide F may have been reached in such untrained women. Pre-exercise arousal mechanisms potentially related to analgesia may also be involved to prepare untrained women for the stress of maximal exercise.

Adolescent↗
PubMed2006

The effects of intensive, moderate and downhill treadmill running on human blood lymphocytes expressing the adhesion/activation molecules CD54 (ICAM-1), CD18 (beta2 integrin) and CD53.

This study examined the effects of intensive, moderate and downhill treadmill running on blood lymphocyte expression of adhesion/activation (AA) molecules. Trained subjects completed three treadmill-running protocols of identical duration: (1) an intensive protocol at 80% VO2max to volitional exhaustion, (2) a moderate protocol at 60% VO2max and (3) a -10% downhill (eccentric) protocol at 80% VO2max. Blood samples were taken before, immediately after, 1 and 24 h after exercise. Isolated lymphocytes were assessed for expression of the AA molecules CD54, CD18 and CD53 by flow cytometry. Lymphocyte counts increased immediately after all running protocols. Lymphocytopenia was observed 1 h after the intensive and eccentric protocols only. Plasma creatine kinase increased 24 h after the downhill protocol only. Increases in the number and percentage of CD54+, CD18bright and CD53bright lymphocytes were observed immediately after the intensive and eccentric protocols, with the numbers falling below pre-exercise values at 1 h post-exercise for all protocols. No differences were found between the intensive protocol and the eccentric protocol at the same relative intensity. Analysis of lymphocyte subsets showed that the total number of CD3+, CD4+, CD8+ and CD56+ lymphocytes increased after the intensive protocol before falling below pre-exercise values at 1 h post-exercise. A relatively greater mobilisation of CD56+ and CD8+ cells accounts for the changes in CD54+, CD18bright and CD53bright cell populations. Lymphocytes that enter and exit the circulation following exercise express high levels of AA molecules, which may mediate extravasation and post-exercise lymphocytopenia. This effect appears to be influenced by exercise intensity and not muscle damage.

Adult↗
PubMed2006

The validity of predicting maximal oxygen uptake from perceptually regulated graded exercise tests of different durations.

The purpose of this study was to assess the validity of predicting maximal oxygen uptake [V(.-)((O)(2)(max))] from sub-maximal V(.-)((O)(2)) values elicited during perceptually regulated exercise tests of 2- and 4-min duration. Nineteen physically active men and women (age range 19-23 years) volunteered to participate in two graded exercise tests to volitional exhaustion to measure V(.-)((O)(2)(max)) [V(.-)((O)(2)(max))(GXT)], at the beginning and end of a 2-week period, and four incremental, perceptually regulated tests to predict [V(.-)((O)(2)(max))] in the intervening period. Effort production tests comprised 2 x 2-min and 2 x 4-min bouts on a cycle ergometer, perceptually regulated at intensities of 9, 11, 13, 15 and 17 on the Borg 6-20 rating of perceived (RPE) scale, in that order. Individual linear relationships between RPE and V(.-)((O)(2) for RPE ranges of 9-17, 11-17 and 9-15 were extrapolated to RPE 20 to predict [V(.-)((O)(2)(max))]. The prediction of [V(.-)((O)(2)(max))] was not moderated by gender. Although, [V(.-)((O)(2)(max))] estimated from RPE 9-17 of trial 1 of the 2-min protocol was significantly lower (P < 0.05) than [V(.-)((O)(2)(max))(GXT)], and V(.-)((O)(2)(max)) predicted from the 4-min trials, the V(.-)((O)(2)(max)) predicted from trial 2 of the 2-min protocol was a more accurate prediction of [V(.-)((O)(2)(max))(GXT)], across all trials. The intraclass correlation coefficient (R) was also higher between [V(.-)((O)(2)(max))(GXT)], and [V(.-)((O)(2)(max))] predicted from trial 2 of the 2-min protocol compared to both trials in the 4-min protocol (R = 0.95, 0.88 and 0.79, respectively). Similar results were observed for RPE ranges 9-15 and 11-17. Results suggest that a sub-maximal, perceptually guided, graded exercise protocol, particularly of a 2-min duration, provides acceptable estimates of maximal aerobic power, which are not moderated by gender.

Adult↗
PubMed1997

Monitoring high-intensity endurance training using neuromuscular excitability to recognize overtraining.

The minimal rectangular current pulse that produces a single contraction of reference muscles at different pulse durations has been recommended as a marker of the neuromuscular excitability (NME) of skeletal muscles. NME is improved in well-trained, non-fatigued endurance athletes and deteriorates after prolonged heavy exercise and high-volume overtraining. The hypothesis was tested that a deterioration in NME also indicates an early stage in the overtraining process during high-intensity endurance training. Six subjects participated for 40-60 min per day in a 6-week, 6-days-per-week, intensive, steady-state and interval training program using a cycle ergometer. Training was stopped each day on volitional exhaustion. On day 7 of each week training was of low intensity for about 30-40 min. Submaximum and maximum power output were significantly increased after 3 weeks, but there was no further improvement, rather a deterioration after week 6 compared to week 3. Even after 2 weeks of regeneration no supercompensation was evident, rather a decrease in maximum power output. NME was slightly improved after 3 weeks, but deteriorated after 6 weeks, and was again normalized after 2 weeks of regeneration. The discrepancy between normalization of NME and still-deteriorated performance ability after 2 weeks of regeneration reflects additional significant, and probably central mechanisms that explain persistent performance incompetence. Deterioration in NME may indicate an early stage in the overtraining process during high-volume as well as high-intensity endurance overtraining, but normalization does not necessarily indicate sufficient regeneration.

Adult↗
PubMed1997

Mechanomyography of the human quadriceps muscle during incremental cycle ergometry.

The mechanical activity of the human quadriceps muscle during maximal incremental cycle ergometry was investigated by mechanomyography (MMG). MMG and surface electromyography (EMG) recordings of vastus lateralis muscle activity were obtained from nine males. Cycle ergometry was performed at 60 rev/ min and work load was incremented step wise by 20 W (3.2 Nm) every minute until volitional fatigue. The mean amplitudes of MMG (mMMG) and EMG (mEMG) during the contraction phase were calculated from the last six contractions in each load. The duration, load and work rate of exercise at exhaustion were 13.3 (1.6) min, 44.1 (5.5) Nm, 276.7 (34.7) W, respectively. A linear relationship between mMMG and load was evident in each subject (r = 0.868-0.995), while mEMG seemed to dissociate as the load became greater. In the grouped mean data, mMMG was linearly related to load whether aligned to the absolute (r = 0.995) or maximal (r = 0.995) load. Involvement of the noise component was further investigated by studying passive cycling by four subjects. Pedals were rotated passively for the first half of each stage (PAS) and the subject then pushed the pedals for the second half (ACT). In the lighter load region, the mMMG of ACT was as small as that of PAS. However, the change in the mMMG of PAS was very small compared with that of ACT. In conclusion, this study demonstrates a linear relationship between the mMMG of the quadriceps muscle and work load during maximal incremental cycle ergometry. The effect of movement noise was thought to be small and stable.

Adult↗
PubMed1998

Gender comparison of peak oxygen uptake: repetitive box lifting versus treadmill running.

The gender differences in peak oxygen uptake (VO2peak) for various modes of exercise have been examined previously; however, no direct gender comparisons have been made during repetitive lifting (RL). In the present study the VO2peak between RL and treadmill running (TR) was compared between 20 men [mean (SD) age, height, body mass and body fat: 21 (3) years, 1.79 (0.06) m, 81 (9) kg, 19 (6)%, respectively] and 20 women [mean (SD) age, height, body mass and body fat: 21 (3) years, 1.63 (0.05) m, 60 (7) kg, 27 (6)%, respectively]. VO2peak (l x min[-1]), defined as the highest value obtained during exercise to volitional fatigue, was determined using discontinuous protocols with treadmill grade or box mass incremented to increase exercise intensity. For RL VO2peak, a pneumatically driven shelf was used to lower a loaded box to the floor, and subjects then lifted the box, at a rate of 15 lifts x min(-1). VO2peak (l x min(-1) and ml x kg(-1) x min[-1]) and minute ventilation (VE, l x min[-1]) were determined using an on-line gas analysis system. A two-way repeated measures analysis of variance revealed significant gender effects, with men having higher values for VO2peak (l x min(-1) and ml x kg(-1) x min[-1]) and VE, but women having higher values of the ventilatory equivalent for oxygen (VE/VO2). There were also mode of exercise effects, with TR values being higher for VO2peak (l x min(-1) and ml x kg(-1) x min[-1]) and VE and an interaction effect for VO2peak (l x min(-1) and ml x kg(-1) x min[-1]) and VE/VO2. The women obtained a greater percentage (approximately 84%) of their TR VO2peak during RL than did the men (approximately 79%). There was a marginal tendency for women to decrease and men to increase their VE/VO2 when comparing TR with RL. The magnitude of the gender differences between the two exercise modalities appeared to be similar for heart rate, VE and R, but differed for VO2peak (l x min(-1) and ml x kg(-1) x min[-1]). Lifting to an absolute height (1.32 m for the RL protocol) may present a different physical challenge to men and women with respect to the degree of involvement of the muscle groups used during lifting and ventilation.

Adult↗
PubMed1999

Physiological factors in stretcher carriage performance.

In this study we examined the anthropometric and physiological factors that may account for the ability to carry a casualty on a stretcher. Eleven young soldiers were pretested to obtain their anthropometry, body composition, physical fitness, and muscle cross-sectional areas. They then performed a two-person manual carry of a stretcher containing an 82-kg manikin while walking on a treadmill at a speed of 4.8 km/h. Subjects walked until volitional fatigue, as indicated by slippage of the stretcher from their hands. Average (SD) carriage time was 2.7(1.4) min with a range of 1.4-6.4 min. A stepwise multiple linear regression revealed that forearm bone-plus-muscle cross-sectional area, thigh muscle cross-sectional area, and push-up performance accounted for most of the variance in hand carriage time (r2 = 0.99, P < 0.001). These data suggest that muscle cross-sectional area and upper-body muscular endurance are important physiological factors in the ability to carry a loaded stretcher by hand.

Adult↗
PubMed2001

Localization of diaphragm motor cortical representation and determination of corticodiaphragmatic latencies by using magnetic stimulation in normal adult human subjects.

The aims of this study were to identify the motor cortical representation of the diaphragm and to assess the corticodiaphragmatic pathway from both hemispheres. Specially designed bipolar surface electrodes were used to record the ipsilateral and contralateral compound motor evoked potentials (CMEPs) of the diaphragm after transcranial magnetic stimulation (TMS) of the motor cortex. In addition, the response to cervical magnetic stimulation of the phrenic nerve roots, effected using a figure-of-eight magnetic coil, was also recorded. The study involved 30 normal adult male volunteers. The average point of optimal excitability (POE) was determined to be 3.7 cm lateral to the mid-sagittal plane and 0.89 cm anterior to the preauricular plane. The largest response was obtained at a stimulus coil orientation of 0-90 degrees. The TMS of either hemisphere produced CMEPs in the contralateral and ipsilateral diaphragm muscles. TMS of either hemisphere elicited CMEPs that had significantly greater amplitudes and shorter latencies from the contralateral muscles compared with the ipsilateral response (P<0.0001). The central motor conduction time of the crossed tract (8.8 ms) was significantly shorter than that of the uncrossed tract (12.2 ms). No significant interhemispheric differences were recorded. The recorded CMEPs recorded in response to TMS were facilitated during volitional inspiration. Phrenic nerve latency was 5.7 ms and 5.6 ms for the right and left phrenic nerves, respectively, with no significant difference between these values. Both bilateral crossed and uncrossed corticospinal connections to the diaphragm were usually present, with the crossed tract predominating. The technique used in this study may be useful for investigations into the function and integrity of central and peripheral pathway of the diaphragm muscles in various neurological disorders.

Adolescent↗
PubMed2006

Head tilt-translation combinations distinguished at the level of neurons.

Angular and linear accelerations of the head occur throughout everyday life, whether from external forces such as in a vehicle or from volitional head movements. The relative timing of the angular and linear components of motion differs depending on the movement. The inner ear detects the angular and linear components with its semicircular canals and otolith organs, respectively, and secondary neurons in the vestibular nuclei receive input from these vestibular organs. Many secondary neurons receive both angular and linear input. Linear information alone does not distinguish between translational linear acceleration and angular tilt, with its gravity-induced change in the linear acceleration vector. Instead, motions are thought to be distinguished by use of both angular and linear information. However, for combined motions, composed of angular tilt and linear translation, the infinite range of possible relative timing of the angular and linear components gives an infinite set of motions among which to distinguish the various types of movement. The present research focuses on motions consisting of angular tilt and horizontal translation, both sinusoidal, where the relative timing, i.e. phase, of the tilt and translation can take any value in the range -180 degrees to 180 degrees . The results show how hypothetical neurons receiving convergent input can distinguish tilt from translation, and that each of these neurons has a preferred combined motion, to which the neuron responds maximally. Also shown are the values of angular and linear response amplitudes and phases that can cause a neuron to be tilt-only or translation-only. Such neurons turn out to be sufficient for distinguishing between combined motions, with all of the possible relative angular-linear phases. Combinations of other neurons, as well, are shown to distinguish motions. Relative response phases and in-phase firing-rate modulation are the key to identifying specific motions from within this infinite set of combined motions.

Cybernetics↗
PubMed1997

Neural control of interlimb oscillations. I. Human bimanual coordination.

How do humans and other animals accomplish coordinated movements? How are novel combinations of limb joints rapidly assembled into new behavioral units that move together in in-phase or anti-phase movement patterns during complex movement tasks? A neural central pattern generator (CPG) model simulates data from human bimanual coordination tasks. As in the data, anti-phase oscillations at low frequencies switch to in-phase oscillations at high frequencies, in-phase oscillations occur at both low and high frequencies, phase fluctuations occur at the anti-phase in-phase transition, a "seagull effect" of larger errors occurs at intermediate phases, and oscillations slip toward in-phase and anti-phase when driven at intermediate phases. These oscillations and bifurcations are emergent properties of the CPG model in response to volitional inputs. The CPG model is a version of the Ellias-Grossberg oscillator. Its neurons obey Hodgkin-Huxley type equations whose excitatory signals operate on a faster time scale than their inhibitory signals in a recurrent on-center off-surround anatomy. When an equal command or GO signal activates both model channels, the model CPG can generate both in-phase and anti-phase oscillations at different GO amplitudes. Phase transitions from either in-phase to anti-phase oscillations, or from anti-phase to in-phase oscillations, can occur in different parameter ranges, as the GO signal increases.

Extremities↗
PubMed1999

Identification of head motions by central vestibular neurons receiving linear and angular input.

Most naturally occurring displacements of the head in space, due to either an external perturbation of the body or a self-generated, volitional head movement, apply both linear and angular forces to the head. The vestibular system detects linear and angular accelerations of the head separately, but the succeeding control of gaze and posture often relies upon the combined processing of linear and angular motion information. Thus, the output of a secondary neuron may reflect the linear, the angular, or both components of the head motion. Although the vestibular system is typically studied in terms of separate responses to linear and angular acceleration of the head, many secondary and higher-order neurons in the vestibular system do, in fact, receive information from both sets of motion sensors. The present paper develops methods to analyze responses of neurons that receive both types of information, and focuses on responses to sinusoidal motions composed of a linear and an angular component. We show that each neuron has a preferred motion, but a single neuron cannot code for a single motion. However, a pair of neurons can code for a motion by the relative phases of firing-rate modulation. In this way, information about motion is enhanced by neurons combining information about linear and angular motion.

Animals↗
PubMed1996

Influence of cold and hot conditions on postactivation in human skeletal muscles.

The influence of cold (+5 degrees C), room temperature (+22 degrees C) and hot (+75 degrees C) air exposures on postactivation effects (PAE) in brachial biceps (BBs) and triceps (TBs) muscles were investigated bilaterally in six male subjects. PAE were evoked by 1 min volitional isometric contraction (VIC) at submaximal level in BBs by holding an inertial weight by palms, with right-angled elbows. At room temperature, average EMG during PAE (PAEav) usually was 2-4% and the integral of EMG (PAEint) was 3-7% of that of VIC respectively. PEA duration was 1-6 min. Cold exposure evoked an approximately two-fold increase of PAEint (P < 0.01). Hot exposure decreased PAEint (P < 0.01) and shortened PAE duration by approximately 50% (P < 0.01). In two subjects, long- term modulation of EMG intensity during PAE was observed. Cold increased the frequency and amplitude of these waves, while heat decreased them. In two subjects, alternation of BBs and TBs in EMG activity during PAE was observed. The data obtained suggest that postactivation of muscles strongly depends on the environmental temperature.

Adult↗
PubMed2006

Using dual-process theory and analogical transfer to explain facilitation on a hypothetico-deductive reasoning task.

Using the analogical transfer paradigm, the present study investigated the competing explanations of Girotto and Legrenzi (Psychological Research 51: 129-135, 1993) and Griggs, Platt, Newstead, and Jackson (Thinking and Reasoning 4: 1-14, 1998) for facilitation on the SARS version of the THOG problem, a hypothetico-deductive reasoning task. Girotto and Legrenzi argue that facilitation is based on logical analysis of the task [System 2 reasoning in Evans's (Trends in Cognitive Sciences 7: 454-459, 2003) dual-process account of reasoning] while Griggs et al. maintain that facilitation is due to an attentional heuristic produced by the wording of the problem (System 1 reasoning). If Girotto and Legrenzi are correct, then System 2 reasoning, which is volitional and responsible for deductive reasoning, should be elicited, and participants should comprehend the solution principle of the THOG task and exhibit analogical transfer. However, if Griggs et al. are correct, then System 1 reasoning, which is responsible for heuristic problem solving strategies such as an attentional heuristic, should occur, and participants should not abstract the solution principle and transfer should not occur. Significant facilitation (68 and 82% correct) was only observed for the two SARS source problems, but significant analogical transfer did not occur. This lack of transfer suggests that System 1 reasoning was responsible for the facilitation observed in the SARS problem, supporting Griggs et al.'s attentional heuristic explanation. The present results also underscore the explanatory value of using analogical transfer rather than facilitation as the criterion for problem understanding.

Adult↗
PubMed2002

Aspiration risk after acute stroke: comparison of clinical examination and fiberoptic endoscopic evaluation of swallowing.

Aspiration is an important variable related to increased morbidity, mortality, and cost of care for acute stroke patients. This prospective systematic replication study compared a clinical swallowing examination consisting of six clinical identifiers of aspiration risk, i.e., dysphonia, dysarthria, abnormal gag reflex, abnormal volitional cough, cough after swallow, and voice change after swallow, with an instrumental fiberoptic endoscopic evaluation of swallowing (FEES) to determine reliability in identifying aspiration risk following acute stroke. A referred consecutive sample of 49 first-time stroke patients was evaluated within 24 hours poststroke, first with the clinical examination followed immediately by FEES. The endoscopist was blinded to results of clinical testing. The clinical examination correctly identified 19 subjects with aspiration risk, when compared with the criterion standard FEES, but incorrectly identified 3 patients as having no aspiration risk when they did. The clinical examination incorrectly identified 19 subjects with aspiration risk but determined correctly no aspiration risk in 8 patients who did not exhibit aspiration risk on FEES. Clinical examination sensitivity = 86%; specificity = 30%; false negative rate = 14%; false positive rate = 70%; positive predictive value = 50%; and negative predictive value = 73%. It was concluded that the clinical examination, when compared with FEES, underestimated aspiration risk in patients with aspiration risk and overestimated aspiration risk in patients who did not exhibit aspiration risk. Careful consideration of the limitations of clinical testing leads us to believe that a reliable, timely, and cost-effective instrumental swallow evaluation should be available for the majority of patients following acute stroke.

Aged↗
PubMed2003

Principles of medical ethics in supportive care: a reflection.

The possibility of medical-moral controversy in contemporary health care delivery is occasioned by the interfacing of expanding technology with both professional and personal value systems, frequent and significant knowledge deficits on the part of health care consumers, and increased circumspection of and economic constraints experienced by health care providers. Particularly in an era of increasing regulatory mandates and the frequent and lamentable decrease in the availability of human, natural, and institutional resources, an understanding of the function of ethical analysis is indigenous to care, which is simultaneously medically appropriate and morally indicated. But while a familiarity with and an appreciation of the potential contribution of ethical reasoning is essential in all health care delivery, it assumes critical importance in supportive care. In that venue, where the rigors and demands of aggressively therapeutic interventions have ceased and the goal and the demeanor of care have shifted to the palliative mode, heightened attention to the principles of medical ethics is necessary for the balancing of rights and responsibilities for health care consumers and providers alike. This issue ultimately can be singularly salient in providing care that is patient centered and directed. Individuals acting as moral agents, suggesting what "ought" to be done in a given situation, either for themselves or as they are involved in rendering or supporting decisions proffered for or by other moral agents, particularly those in extremis, those in the throes of terminal illness following the collapse of the curative mode, need recourse to principles to facilitate their reasoning. Although the employment of each principle of medical ethics offers guidelines for reflection on the most comprehensive and appropriate care, it is attention to autonomy, informed consent, and beneficence that promotes the most effective supportive care. For even as the question of medical viability is settled in favor of palliation over aggression, there remain the entanglements of psychological stability, conflicting value systems, and the impact of the social milieu as well as the issues of economic responsibility and resource accountability. It is in the attention to the medical ethical principles of autonomy and informed consent, especially as amplified by the creation of and respect for advance directives, that the most holistic and productive supportive care can be offered. It is also in this posture that appeal to the principle of beneficence is made. Just as the progress of disease and, therefore, the realistic goals of care change, so too can an individual's considered opinion with regard to end-of-life decisions. Preserving the integrity of patients and caregivers alike and engaging in fruitful and informative dialog prior to seeking volitional authorization or operationalizing a supportive approach demonstrates renewed concern for both patient autonomy and professional accountability in the provision of a comprehensive end-of-life care plan. Discussions will not be avoided until they can no longer effectively take place, salient questions will not go unanswered, and decisions around end-of-life questions, in the mode of supportive care, will not be absent where care was exercised to engage patients in significant dialog earlier rather than later in their disease processes.

Ethics, Clinical↗
PubMed2006

Neuromuscular electrical stimulation for a patient with metastatic lung cancer--a case report.

A 47-year-old female patient suffering from advanced lung cancer with metastatic bone and brain disease participated in a passive exercise program, consisting of neuromuscular electrical stimulation (NMES) five times a week, carried out for 4 weeks. After the training period, the results of the 6-min walk (420 m before and 603 m after the training period) have improved by 44%, which demonstrates the increase of physical performance (mobility, endurance capacity). The results of the "Timed up and go" indicate an improvement of mobility and functional health of skeletal muscles. Furthermore, the quality of life (QOL)-scales (assessed by using the SF-36 health survey) "Physical functioning", "Role-physical", "Mental health", "Role-emotional", "Vitality", "Bodily pain", and "General health" showed improvements after the intervention period. Feasibility, safety, and beneficial effects of the NMES program were proven for the patient in this case study. These findings indicate that NMES, initiated and executed with appropriate care, may serve as a useful supportive means of palliative treatment in some patients with advanced cancer and metastatic disease, especially in cases of metastatic involvement of the brain and of the skeletal system with the risk of seizures and pathological fractures where volitional training is not allowed.

Bone Neoplasms↗
PubMed2006

Neuroimaging and pain: a window on the autonomic nervous system.

Pain is one of the most common experiences of humans. Neuroimaging techniques can visualize the main brain areas involved in pain modulation, the pain matrix. It is noteworthy that many of the brain areas forming the pain matrix are also involved in modulating autonomic nervous system (ANS) activity that in turn plays a major role in determining the best adaptive response to the pain experience. The tight connection between the pain system and ANS is also evident from neuroanatomical studies indicating that the lamina 1 neurons receive both painful and visceral stimuli from all visceral organs giving rise to the spinothalamocortical pathway concerned with conveying interoceptive information to central structures. The resulting interoceptive stream projects to the viscerosensory cortex in the mid-insula and onto the right anterior insula and orbitofrontal cortices. Right anterior insula activation is involved in the sympathetic arousal associated with mental tasks. This brain region receives numerous other inputs including pain and painful stimuli are conveyed somatotopically to both insulae. A similar somatotopic organization of painful stimuli has also been shown in the basal ganglia involved in cognitive, affective, motor and autonomic states. This highly specialized organization of nociceptive information in these brain areas may subserve a number of functions, particularly of coupling pain with the most appropriate autonomic states and affective/emotional states. The anterior cingulated cortex, another brain area playing a crucial role in nociception, is also directly involved in the control of autonomic functions such as arousal during volitional behaviour, including effortful cognitive processing. It is evident that the nociceptive system and ANS closely interact in many processes involved in maintaining internal homeostatis and in order to give the most appropriate biological substrate for cognitive, affective and emotional states.

Autonomic Nervous System↗