Reflex Activity Research Articles

Correlation of Pupil Cycle Time and Postural Hypotension as a Marker for Diabetic Neuropathy

Introduction: Diabetic Neuropathy (DN) can involve autonomic nervous system like cardiovascular system and pupillary reflex. Cardiovascular DN can be measured by estimating the change in Blood Pressure (BP) based on position. Ocular DN can be evaluated by using Pupil Cycle Time (PCT), which is an early diagnostic tool to estimate ocular DN. It is a simple way to measure autonomic reflex activity and is a specific test to study parasympathetic function. Aim: To assess the correlation of effects of postural hypotension and PCT on persistent diabetes. Materials and Methods: The prospective cross-sectional study was conducted in Ophthalmology Out Patient Department (OPD) at KS Hegde Medical Academy, Mangalore, Karnataka, India, from January 1st 2019 to December 31st 2019. The study included 60 male patients between the age group of 40-60 years which were divided into two groups of 30 diabetics (Random Blood Sugar (RBS) >200 mg/dL, Fasting Blood Sugar (FBS) >126 mg/dL and Glycated Haemoglobin (HbA1c) >6.5%) and 30 non diabetics. The blood pressure of all the patients were recorded using a sphygmomanometer in sitting and standing positions. PCT was measured in both eyes using Haggstreittype of slit lamp after the subject was seated in a dimly lit room after dark adaptation for 15 minutes. Results: The mean age of patients in the diabetic group was 54±3.2 years and the non diabetic group was 52±2.7 years. The mean HbA1c of diabetics was 6.9±0.8%. The mean BP among diabetics in standing position was 133.86±29.34 mmHg systolic and 87.4±16.72 mmHg diastolic whereas in sitting position, it was 141.66±28.17 mmHg systolic and 85.26±13.39 mmHg diastolic. The mean BP among non diabetics in standing position was 129.46±24.84 mmHg systolic and 83.46±13.52 mmHg diastolic whereas in sitting position, it was 132.06±26.48 mmHg systolic and 81.26±11.45 mmHg diastolic. The mean PCT-I and PCT-II in diabetics was 1000.52±187.73 and 1006.09±199.45, respectively. The systolic and diastolic BP, both during sitting and standing postures, in diabetic patients were high. The mean PCT-I and PCT-II in non diabetics was 853.23±181.54 and 880.17±192.72, respectively. The PCT-I and PCT-II were found to be significantly high in diabetic patients as compared to controls. The PCT-I and PCT-II negatively correlated with both diastolic and systolic blood pressure in sitting and standing postures. Conclusion: Prolongation of PCT in diabetics correlates significantly with evidence of autonomic neuropathy obtained from testing of postural BP variations. Patients whose cardiovascular reflexes are very abnormal tend to have pupils which cycle slowly.

INTELLECTUAL ARCHITECTONICS OF REGIONAL INFORMATION AND EDUCATION SPACES IN THE NEW REALIA OF PROFESSIONAL POTENTIAL DEVELOPMENT

This study is a continuation of longitudinal research in the problem area of humanistic activities of the regional information and education environment, which is currently undergoing significant changes due to the actual value aspects of the polyphony of innovative theoretical research and pedagogical findings. The authors see the mission and goals of this article in presenting some novel results of the investigation of regional peculiarities in the aspect of integrated modeling and design. Based on theoretical, methodological and practical search of modern realities the article focuses on the environmental and cultural approaches as the leading ones. The latter helps to formulate the following methodological message: the constructive self-development of the region professional potential is possible if focused on leadership and communicative strategic guidelines. Modeling and designing of the humanitarian trends of the regional information and educational spaces are to develop the research array in terms of the use of systemic humanistic, humanitarian and communicative strategies. It means the reflexive activity on cultural self-determination of a personality who turns/goes professional, and then is in need of the basic intellectual skill set as a priority. As a result of developing the axiology context of the current target study, this project reflects the innovative dominant value trends integrated into the sociocultural and professional system of the region within the threefold intellectual architectonics covering the findings for professional potential development in terms of a) psychological balance; b) the intellectual component of a goer professional c) the communication management of professionals. In conclusion, the authors state the significance of the target goals and devices to systematically develop, test and implement optimal models of communication models for the existence of the participants of a secure information and communication environment, taking into account regional specifics.

The neurophysiology aspect of congenital craniofacial deformities in children

Congenital craniofacial deformities in children are conditions with varying degrees of severity between minor and severe, they can be present at birth, but they can also be detected during the child's development. Material and methods. In the period 2014-2021, 57 children (29 boys and 28 girls), average age 9,1 ± 2,4 months, with craniofacial deformities from different medical centers in the Republic of Moldova were examined polysystemically. In this sense, we evaluated the state of the masseter, temporal and tongue muscles by electromyography with surface electrodes to determine the quality of their muscle activity. Recordings of the bioelectrical activity of muscle activity during exercise were performed using a Nihon Kohden portable electromyograph (Japan). Results. The balance dysfunction of the neuromuscular system in these children, as a neuro-physiological sign of pathological muscular weakness in the sucking reflex activity, is highlighted in 87.7% of cases by a marked asymmetry (p<0.001) of the tongue and masseter muscles activity and, respectively less highlighted (p<0.05) of the anterior temporal. Discussion. Thus, the EMG pattern evaluation highlights a decrease in the average amplitude of the action potentials (mV) mainly for the tongue, mm. masseters and temporalis on the left side, associated with an increase in the potential (ms) average duration from both the affected and the contralateral muscles, thus reflecting the reduction in their contraction capacity and the quality decrease in the act of sucking and mastication, predominantly on the left, in the child with congenital craniofacial deformities and disorders of the sucking reflex in infants. Conclusions. The neurophysiological examination highlights various forms of muscle function abnormalities in children with craniofacial deformities, which require multifunctional and multidisciplinary recovery.

Motoric Automatisms of the Maxillofacial Region: a Lecture

INTRODUCTION. Effective kinesitherapy of peripheral and central paralysis of the mimic, masticatory, lingual and pharyngeal muscles requires in-depth study of the features of the cooperative work of these muscles in the norm and in pathology. AIM. To acquaint rehabilitation specialists with motor automatisms of the brachiofacial area and show the principles of their practical use. MATERIAL AND METHODS. We studied more than 70 literature sources on involuntary activity of the maxillofacial region and adjacent regions muscles as well as we summarized our own experience in rehabilitation of patients with peripheral facial neuropathies and with bulbar and pseudobulbar syndromes RESULTS AND DISCUSSION. The study showed that the face, neck, and arm are involved in various mesencephalic-bulbar automatisms, both normal (ontogenetic and psychosomatic synkinesia, postural-ocular and postural-mandibular reflexes) and pathological (trunk eye-facial synkinesia, oral automatic reflexes), much more closely than other body parts. All of them, with the exception of facial hyperkinesias, may serve as a basis for optimizing kinesitherapy methods for movement disorders of the brachiofacial region. CONCLUSION. The face, neck, and hand are closely involved in a variety of stem and subcortical automatisms. The better the physical therapist is familiar with the features of the existing or potentially available to the patient reflex activity in the part of the body being rehabilitated, the more effective the rehabilitation treatment will be. The face, neck and arm are closely involved in a variety of stem and subcortical automorphisms. The better a doctor or an instructor in exercise therapy is acquainted with the reflex activity present or potentially available in the part of the body to be rehabilitated, the more effective the rehabilitation treatment will be.

THE USE OF RUQYAH QUR’ANIYAH THERAPY ON THE EFFECT OF BRAIN WAVES HEALING TOURETTE SYNDROME PATIENTS

Ruqyah is a prayer therapy used for specific treatments, which consists of a particular series of readings from the sources of the verses of the Qur’an and the hadith of the Prophet Muhamad SAW. Imam Qurtubi believed that ‘ruqyah quraniyah’ therapy could contribute to healing physical and spiritual ailments. The resonance effect on the ruqyah therapy of the verses of the Qur’an has a tremendous impact on each reading that is heard (voiced) for various objects. The Research question in this research is how the effectiveness of using ruqyah quraniyah on the effect of brain waves on the healing of Tourette syndrome patients at dr.Sardjito Yogyakarta? This study uses a qualitative method with an experimental phenomenological approach. The experimental stage stimulated it with a variant of the codification of the ruqyah verses in the form of ‘Hizb Bahr,’ which was tested on pediatric neurology patients for eight weeks so that the patient’s brain memory records resulted in refraction and habits. This result indicates that patients with TS change to improve along with psychological conditions that can be calmed by listening to the beauty of the ‘Hizb Bahr’ in daily life for eight consecutive weeks. The state of listening to the beauty of reading the Qur’an in this ‘ruqyah quraniyah’ codification model essentially conditions the patient’s brain waves at the alpha level. No frontal beta makes the patient perform reflex activities as long as his psychological state is calm and controlled.

Quadriceps Weakness is Associated with Neuroplastic Changes Within Specific Corticospinal Pathways and Brain Areas After Anterior Cruciate Ligament Reconstruction: Theoretical Utility of Motor Imagery-Based Brain-Computer Interface Technology for Rehabilitation

Persistent quadriceps weakness is a problematic sequela of anterior cruciate ligament reconstruction (ACLR). The purposes of this review are to summarize neuroplastic changes after ACL reconstruction; provide an overview of a promising interventions, motor imagery (MI), and its utility in muscle activation; and propose a framework using a brain-computer interface (BCI) to augment quadriceps activation. A literature review of neuroplastic changes, MI training, and BCI-MI technology in postoperative neuromuscular rehabilitation was conducted in PubMed, Embase, and Scopus. Combinations of the following search terms were used to identify articles: “quadriceps muscle,” “neurofeedback,” “biofeedback,” “muscle activation,” “motor learning,” “anterior cruciate ligament,” and “cortical plasticity.” We found that ACLR disrupts sensory input from the quadriceps, which results in reduced sensitivity to electrochemical neuronal signals, an increase in central inhibition of neurons regulating quadriceps control and dampening of reflexive motor activity. MI training consists of visualizing an action, without physically engaging in muscle activity. Imagined motor output during MI training increases the sensitivity and conductivity of corticospinal tracts emerging from the primary motor cortex, which helps “exercise” the connections between the brain and target muscle tissues. Motor rehabilitation studies using BCI-MI technology have demonstrated increased excitability of the motor cortex, corticospinal tract, spinal motor neurons, and disinhibition of inhibitory interneurons. This technology has been validated and successfully applied in the recovery of atrophied neuromuscular pathways in stroke patients but has yet to be investigated in peripheral neuromuscular insults, such as ACL injury and reconstruction. Well-designed clinical studies may assess the impact of BCI on clinical outcomes and recovery time. Quadriceps weakness is associated with neuroplastic changes within specific corticospinal pathways and brain areas. BCI-MI shows strong potential for facilitating recovery of atrophied neuromuscular pathways after ACLR and may offer an innovative, multidisciplinary approach to orthopaedic care. Level of EvidenceV, expert opinion.

Pedagogical conditions for the formation of the reflexive component of the professional and pedagogical culture of students-teachers

Introduction. This article presents reflection as a personal resource that allows a teacher to determine their own professional development pathway, taking into account the dynamic conditions of professional reality. Purpose setting. The aim of the study is to identify pedagogical conditions for the formation of the reflexive component of the professional and pedagogical culture of the students-teachers.Methodology and methods of the study. The article presents the results of the analysis of scientific literature on the problem of development of professional and pedagogical culture of a teacher, and the reflexive component of this culture; and also, the results of modeling the educational process and experimental work to identify the effectiveness of the model.Results. The article reveals the pedagogical conditions for the formation of the reflexive component of the culture at issue among student-teachers. A set of methodological, methodical, personal conditions presupposes to organize educational process on the basis of activity-based, axiological and personal approaches in pedagogy. The implementation of these approaches should be carried out taking into account: a systemically differentiated approach to the interpretation of the term «reflectionˮ; activation of students’ reflexive activity, and creation of emotionally safe conditions for its implementation; application of heuristic teaching methods; actualization of the personal significance of the subject matter for students. The article presents a model for implementation of the considered pedagogical conditions in the educational process of a pedagogical university. The model includes conceptual, target, organizational, reflexive-effective components and an assessment instrument for diagnosing the level of formation of the reflexive component of the student-teachers’ professional and pedagogical culture. The article provides a description of the experimental work to verify the effectiveness of this model and the productivity of the considered pedagogical conditions.Conclusions. The research materials open up new sides in the study of problems related to the development of a teacher’s professional and pedagogical culture and offer a systematic solution to the problem of forming a reflexive component of the culture at issue of pedagogical university students.

The Role of The Hippocampus in Conditionally Reflective Activity and The Formation of The Functional State of The Crust of The Large Hemisphere

The studies were carried out on dogs, which were stereotactically implanted with depth electrodes in the ventral and dorsal parts of the hippocampus. We studied the effect of stimulation of these structures with an electric current of high (60 pulses/sec) and low (4 pulses/sec) frequencies on conditional reflex activity and the formation of the functional state of the cerebral cortex. It was revealed that stimulation of different structures of the hippocampus has a different effect on the tone of cortex cells. The nature of this influence depends on the frequency of the electric current, which was used to stimulate. Formulation of the problem. Analysis of recent research and publications. There are a number of scientific papers devoted to the study of the role of the hippocampus in the regulation of various body functions (Giuliana, Caronia, Jennifer, Wilcoxon, et all., 2010; Purvis, EM, O'Donnelly, JC et all, 2020). Some authors believe that the hippocampus is a poly-functional structure: the center of visceral functions and sense of smell, memory, and learning, the regulator of emotions and motivations, it is used for orientation reflexes and attention, sensory analysis (Chaychenko, G.M., 1984; Wiskott L, Rasch MJ, Kempermann G. Wiskott L, Rasch MJ, Kempermann G. et all. 2006). But today there is not enough reliable data on the role of this structure in conditioned reflex activity under conditions of electrical stimulation of various structures of the hippocampus. It was found that when the hippocampus is stimulated by a weak electric current during the formation of conditioned reflexes, the fixation time of the reflex is significantly reduced, ie the processes of memorization and learning are accelerated (Gray, J.A., 1983; Diana, X Yu, Maria, C Marchetto, Fred, H Gage, 2014; Nader, K, Krysiak A, Beroun, A, et all., 2019; Whitfield, JF, Chakravarthy, BR., 2009). The mechanism of temporal connections has been shown to play an important role in regulating cortical tone. If the question of the formation of the functional state of the cortex of the large hemispheres during the formation of conditioned reflexes is more or less studied, then the question of the dependence of this phenomenon on the properties of the inhibitory process is insufficiently studied (William, D Jones, Sarah, M Guadiana, Elizabeth, A Grove, 2019). In addition, the role of various subcortical structures and, in particular, the hippocampus in the regulation of the tone of the cortex of the large hemispheres has not been clarified to date. The purpose to establish features of the formation of a functional condition of the bark of large hemispheres in the conditions of electric stimulation of various structures of a hippocampus

Redox intensity and psychoemotional status of rats in burn skin injury

Relevance. Currently, the problem of regeneration of damaged skin, including of a burn nature, remains relevant. The work describes the results of the study of the redox intensity and of the psychoemotional status of rats in thermal skin injury. The aim of the study is an experimental study of the redox intensity and of the psychoemotional status of rats in burn skin injury. Materials and Methods. The study was conducted on nonlinear male rats of average weight 250 grams for 6-8 months. To assess psychoemotional status, studies were carried out using standard psychophysiological methods: «Open Field», «Elevated cruciform maze», «Suok Test» and «Porsolt.» The intensity of redox processes in the hypothalamic and prefrontal regions of the brain was assessed by determining the intensity of lipid peroxidation and catalase activity. The activity of lipid peroxidation was determined by the initial content of malonic dialdehyde, as well as by the rate of spontaneous and ascorbic peroxidation of lipids. Results and Discussion. During the study, it was found that burn damage to the skin was accompanied by an increase in the concentration of TBC-active products of lipid peroxidation in the hypothalamic and prefrontal regions of the brain of rats, which resulted in the development of oxidative stress. Burn injury initiated peroxidation processes in the studied areas of the brain, the most pronounced in the early period of the burn process (on days 2-4), with varying degrees decreasing in the following periods (on days 7, 10). The results of the assessment of the psychoemotional status of animals in burn skin injury in standard behavioral tests confirm the involvement of the nervous system in response to stress, the reflex activity of which under stressful conditions manifests itself in a change in behavioral reactions. In the conditions of burn damage to the skin, signs of an alarming-depressive state, in particular disorientation in space, suppression of the psychoemotional state, and a change in the nature of behavioral reactions were noted. Conclusion. Thus, the revealed changes in the intensity of redox processes and the peculiarities of the psychoemotional status of rats in burn skin damage are the result of biochemical and functional disorders of the brain, activated during protective and adaptation reactions in burn injury.

Mathematical description of proprioception through muscle activation signal generation in core musculoskeletal system

ObjectiveCentral Pattern Generators (CPGs) produce the majority of muscle activation signals during gait whereas, reflexive signals from proprioception deal with perturbations. The reflexive neuromuscular signals are rather difficult to measure directly. The objective of this study is to mathematically estimate the reflexive neuromuscular signals of the core muscles during a movement similar to a normal gait. Methods1-Musculoskeletal model: a 2-D musculoskeletal model is designed for the upper body. 2-Neuromuscular model: mathematical models for neuromuscular reflexes are derived based on their physiological function descriptions. 3-Simulation: mathematical equations are extracted from the model and solved using numerical methods. Kinematics, muscle forces, and activation signals are obtained from the simulation. 4-Verification: verification of the model is conducted through a sample study. Five IMU sensors and four surface EMG electrodes are utilized to gather data from the experiment. ResultsUpper body kinematics, core muscle forces, and activation signals of the subject are estimated through model simulation for the intended movement. The verification process indicates similarity between simulation outcomes and test results. ConclusionThe proposed mathematical description of proprioception can successfully simulate and estimate reflexive activation signals of core muscles. The estimated activation signals can be employed in conjunction with a musculoskeletal model to predict body kinematics. SignificanceReflexive signal estimation of core muscles can further enhance studies concerning body stability control. Such predictive models have also the aptitude to be employed as an auxiliary clinical tool to help the therapist choose appropriate treatment protocols.

The Latest Pedagogical Ideas for Development of Creative Abilities in Preschool Children

The article attempts an author's technology to develop the creative abilities of preschool children in drawing classes. The authors have reviewed the latest neurophysiological aspects of creativity and have taken them into account in modeling the framework model of the development of creative abilities of preschool children in drawing classes. The aim of the article is to pursue two successive theoretical and methodological steps: a natural neurophysiological justification of the educational law of forming the visual development of elementary school children valid for teachers' understanding and use and a framework morphed structuring of reflexive, cognitive, and reflective activity of schoolchildren. It is possible with synergetic and, in fact, parallel realization of sensitivity, figurative assimilation of signals of the surrounding world, acquisition of experience and (as a cumulative result) - spontaneous, but framed by facilitative intervention, creative realization of the child's deep needs. The main result of the article was that we realized: a training module can be represented as a synergy of educational-neurophysiological correlations. That is, training modules consist, on the one hand, of target, content, technological and productive settings and expectations, and on the other hand, these settings are inseparable from associative, sensual-aesthetic, activity and motivational (cognition - satisfaction) manifestations of children's psyche. The international significance of the article lies in the reception of the latest pedagogical and neurophysiological ideas for development of creative abilities in preschool children for development of the author’s technology. This can be used by practicing teachers as a model for implementation of pedagogical style in the cultural, social and educational conditions of the Eastern European region.

18F-FDG and 18F-FLT Uptake Profiles for Breast Cancer Cell Lines Treated with Targeted PI3K/Akt/mTOR Therapies.

Background: To evaluate 18F-fluoro-2-deoxy-glucose (18F-FDG) and 18F-fluorothymidine (18F-FLT) as early-response biomarkers for phosphoinositide-3-kinase/Akt/mammalian-target-of-rapamycin (PI3K/Akt/mTOR) inhibition in breast cancer (BC) models. Materials and Methods: Two human epidermal growth factor receptor 2 (HER2)-positive (trastuzumab-sensitive SKBR3; trastuzumab-resistant JIMT1) and one triple-negative BC cell line (MDA-MB-231, trastuzumab, and everolimus resistant) were treated with trastuzumab (HER2 antagonist), PIK90 (PI3K inhibitor), or everolimus (mTOR inhibitor). Radiotracer uptake was measured before, 24, and 72 h after drug exposure and correlated with changes in cell number, glucose transporter 1 (GLUT1), cell cycle phase, and downstream signaling activation. Results: In responsive cells, cell number correlated with 18F-FLT at 24 h and 18F-FDG at 72 h of drug exposure, except in JIMT1 treated with everolimus, where both radiotracers failed to detect response owing to a temporary increase in tracer uptake. This flare can be caused by reflex activation of Akt combined with a hyperactive insulin-like growth factor I receptor (IGF-1R) signaling, resulting in increased trafficking of GLUTs to the cell membrane (18F-FDG) and enhanced DNA repair (18F-FLT). In resistant cells, no major changes were observed, although a nonsignificant flair for both tracers was observed in JIMT1 treated with trastuzumab. Conclusion: 18F-FLT positron emission tomography (PET) detects response to PI3K-targeting therapy earlier than 18F-FDG PET in BC cells. However, therapy response can be underestimated after trastuzumab and everolimus owing to negative feedback loop and crosstalk between pathways.

Hierarchical Properties and Functional Staging of the Fugl-Meyer Assessment Lower Extremity Scale

<h3>Research Objectives</h3> This study aimed (1) to investigate the hierarchical properties of FMA-LE and Brunnstrom stages, and (2) to develop a functional staging, a graphical plot, of FMA-LE and its relationships to low (0–21), high (22–34) FMA-LE cut-off scores. <h3>Design</h3> Secondary analysis of cross-sectional data. <h3>Setting</h3> Outpatient rehabilitation settings. <h3>Participants</h3> The Locomotor Experience Applied Post-stroke (LEAPS) trial data included 408 patients with stroke with a mean age of 62 years old (SD = 12.7, range = 25 to 98). The mean onset of stroke was 64 days (SD = 8.5, range = 43 to 112). About 55% of the sample were male. The majority (80%) of the sample had an ischemic stroke. Approximately half of the sample had brain lesions in the right hemisphere, followed by the left hemisphere (35%), brainstem (15%), and bilateral (2%). <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> The 17-item FMA-LE assesses lower extremity motor function including reflex activity, movement within and outside synergy patterns, and speed/coordination. It has two subscales: Lower Extremity and Speed/Coordination, which are scored on a 3-level ordinal scale (0 = none; 1 = partial; 2 = full). The total summed score of 34 points indicates normal function. <h3>Results</h3> Overall, the item difficulty hierarchical order of the FMA-LE reflected the Brunnstrom stages. The items from easy to difficult were reflex activity items, followed by items assessing flexor and extensor synergy, and movement with little/no synergies. The ‘normal reflex activity', ‘knee flexion to 90° (hip at 0°)', ‘coordination/speed' items represented the most difficult items. The two-level functional staging was judged to be clinically logical and to provide insight for clinical interpretation of patient progress. We further provided the functional staging for the clinical interpretation across all FMA-LE scores. <h3>Conclusions</h3> Our findings suggest that the FMA-LE items reflect the lower extremity motor recovery stage. This study demonstrates how functional staging can be used to translate a standardized assessment into a useful, evidence-based tool for making clinical practice decisions. <h3>Author(s) Disclosures</h3> The authors declare that there is no conflict of interest.

Hierarchical Properties of the Fugl-Meyer Assessment Upper Extremity Scale for People After Stroke

<h3>Research Objectives</h3> This study aimed (1) to investigate the hierarchical properties of FMA-UE and Brunnstrom stages, and (2) to develop a functional staging, a graphical plot, of FMA-UE and its relationships to severe (0–28), moderate (29–42), and mild (43–66) FMA-UE cut-off scores. <h3>Design</h3> Secondary analysis of cross-sectional data. <h3>Setting</h3> Outpatient rehabilitation settings. <h3>Participants</h3> The Locomotor Experience Applied Post-stroke (LEAPS) trial data included 408 patients with stroke with a mean age of 62 years old (SD = 12.7, range = 25 to 98). The mean onset of stroke was 64 days (SD = 8.5, range = 43 to 112). About 55% of the sample were male. The majority (80%) of the sample had an ischemic stroke. Approximately half of the sample had brain lesions in the right hemisphere, followed by the left hemisphere (35%), brainstem (15%), and bilateral (2%). Although most of the sample was White (58%), other racial groups were represented: Black (22%), Asian (13%), Native Hawaiian or other Pacific Islander (5%), and American Indian/Alaska Native (1%). <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> The 33-item FMA-UE has four subsections: (1) shoulder-arm, (2) wrist, (3) hand, and (4) coordination and speed designed to measure impairment from proximal to distal, reflexive to voluntary, and synergistic to isolated voluntary movement. <h3>Results</h3> Overall, the item difficulty hierarchical order of the FMA-UE reflected the Brunnstrom stages. The items from easy to difficult were reflex activity items, followed by items assessing flexor and extensor synergy, movement combining synergies, and movement out of synergy. The ‘normal reflex activity', ‘shoulder flexion 90-180°', ‘coordination/speed' items represented the most difficult items. The three-level functional staging was judged to be clinically logical and to provide insight for clinical interpretation of patient progress. <h3>Conclusions</h3> Our findings suggest that the FMA-UE items reflect the upper extremity motor recovery stage. This study demonstrates how functional staging can be used to translate a standardized assessment into a useful, evidence-based tool for making clinical practice decisions. <h3>Author(s) Disclosures</h3> The authors declare that there is no conflict of interest.

Unobtrusive Cardio-Respiratory Assessment for Different Indoor Environmental Conditions

The achievement of a healthy indoor environ- ment—an indispensable requirement for human well-being—relies on the establishment of good air quality conditions and thermal comfort levels. This study addresses the development of a healthcare-focused Internet-of-Things (IoT) system for the cardiac assessment using photoplethysmography (PPG) and ballistocardiography (BCG) that can be applied in any indoor environment. Results from its experimental application include the analysis of heart rate variability (HRV) and respiratory status from a group of young adults under different thermal conditions and relative humidity (RH) levels. The final goal was to investigate the effects of short-term exposure to different air temperature and humidity conditions on human thermal comfort based on the analysis of the autonomic nervous system (ANS) activity. The experiment took place in a regular and nonisothermal office environment. Simulations based on computational fluid dynamics (CFD) were conducted to estimate heat distribution and select the optimal locations for the environmental sensor nodes’ placement. Results indicated that activation of the parasympathetic system was more notable in short-term exposures to environments with different air temperatures (24 °C–30 °C) than with different levels of RH (50%–70%). Changes in ambient air temperature led to the activation of thermal regulatory reflexes and thermal discomfort, perceived by an increase in the ratio of low frequency to high frequency (LF/HF) at higher air temperature exposures. In addition, HRV parameters were used to train machine learning models on predicting if the user is in a thermally comfortable environment or a discomfortable environment (hot or humid), having achieved an 87% average accuracy.

Proprioceptive Cervicogenic Dizziness: A Narrative Review of Pathogenesis, Diagnosis, and Treatment.

Basic science and clinical evidence suggest that cervical spine disorders can lead to dizziness. The cervical spine has highly developed proprioceptive receptors, whose input information is integrated with the visual and vestibular systems in the central nervous system, acting on the neck and eye muscles to maintain the coordinative motion of the head, eyes, neck, and body through various reflex activities. When the cervical proprioceptive input changes due to the mismatch or conflict between vestibular, visual, and proprioceptive inputs, cervicogenic dizziness may occur. The diagnosis of cervicogenic dizziness can be determined based on clinical features, diagnostic tests, and the exclusion of other possible sources of dizziness. The cervical torsion test appears to be the best diagnostic method for cervicogenic dizziness. Based on the available evidence, we first developed the diagnostic criteria for cervicogenic dizziness. Treatment for cervicogenic dizziness is similar to that for neck pain, and manual therapy is most widely recommended.

Narratives in the educational process of critical thinking

In modern higher education, the number of educational programs aimed at improving the quality of thinking, reasoning abilities, and creativity is growing. The campus course «Logic and Critical Thinking» is aimed at improving the intellectual dispositions of students involved in the professional and personal sphere. Narrative in the educational process is considered as a didactic technique in teaching logic and critical thinking. The purpose of the article is to analyze the narrative as a supporting construct of the emerging discursive model, to study the possibility of the narrative as a role model in the process of forming their own mental practice of the project participants. The flexible narrative model used for interpretation is designed to awaken the deep curiosity of the student, the subjective need to solve logical problems and form the skill to think critically. The author studies the experience of narrative in the concept of an oral narrative of such a form of education as a seminar lesson. The trigger mechanism of students’ reflexive activity is a narrative text, the value of the narrative is shown in the recognition of qualitative questions, their clear formulation and the direction of their own research. It is concluded that an effective pedagogical narrative is content-variable and subject-oriented. Narrativization of the educational process is important not only for the development of critical thinking of students, but also for the teacher who reflects on the issues of building a more effective educational strategy.

Cough: some aspects of pathogenesis and therapeutic approaches

This article is a literature review on the management of patients with acute cough. The classification of cough, the main causes of acute and subacute cough, the current view on the etiology and pathogenesis of chronic cough are presented. Cough is an important protective mechanism, but in acute and chronic diseases of the bronchopulmonary system cough significantly reduces the quality of life and causes numerous complications. The most common cause of acute and subacute cough is respiratory viruses. Chronic cough is currently explained by the theory of cough hypersensitivity, according to which chronic refractory cough is the result of hypersensitivity of the cough receptors. Before the cause of chronic cough is identified, and when treating patients with acute and subacute cough, symptomatic therapy with cough suppressants that eliminate increased cough reflex activity to normal levels regardless of cough etiology, although not affecting the pathophysiological mechanisms of cough, or with combined drugs with suppressant and expectorant effects, is often required. Peripheral suppressants reduce the activity of peripheral cough receptors of the upper airway mucosa by softening, moistening and enveloping. Central cough suppressants include butamirate. Central non-narcotic cough suppressants in various combinations with muco- and bronchodilators and antihistamines form part of many anti-cough medicines. Butamirate has a non-specific anticholinergic and therefore bronchodilator effect. This article presents a review of clinical studies on the efficacy of butamirate.

A fibrous neuromorphic device for multi-level nerve pathways implementing knee jerk reflex and cognitive activities

Here, we present fibrous neuromorphic devices (FNDs) that serves as multi-level nerve pathways to implement a biomimetic knee-jerk reflex and cognitive activities. By the tunable charge-carrier polarity of the fibrous electrolyte, FNDs successfully simulate the competition between glutamate and γ-aminobutyric acid (GABA) in a multiplexed transmission process in the human nervous system. To emulate action signals that respond to environmental stimuli in a low-level nerve pathway, a fiber-level neurologically integrated muscular system was constructed by cascading with FNDs and artificial muscle fibers; the system realized unconditioned reflex, even under loads of several Newtons. To emulate the high-level nerve pathway, multiple conductive states of FNDs were used to construct flexible neuromorphic networks; the recognition accuracy for the Fashion MNIST dataset was > 83%, with < 0.1% loss of accuracy even after 100 bending cycles, which represents the most stable recognition result for flexible neuromorphic electronics so far. The presented FNDs provide an excellent basis for the development of human-compatible artificial neurological systems.

Carotid body stimulation as a potential intervention in sudden death in epilepsy

ObjectiveTo investigate carotid body (CB) mechanisms related to sudden death during seizure. Ictal activation of oxygen-conserving reflexes (OCRs) can trigger fatal cardiorespiratory collapse in seizing rats, which presents like human sudden unexpected death in epilepsy (SUDEP). The CB is strongly implicated in OCR pathways; we hypothesize that modulating CB activity will provide insight into these mechanisms of death. MethodsLong-Evans rats were anesthetized with urethane. Recordings included: electrocorticography, electrocardiography, respiration via nasal thermocouple, and blood pressure (BP). The mammalian diving reflex (MDR) was activated by cold water delivered through a nasal cannula. Reflex and stimulation trials were repeated up to 16 times (4 pre-intervention, 12 post-intervention) or until death. In some animals, one or both carotid bodies were denervated. In some animals, the CB was electrically stimulated, both with and without MDR. Seizures were induced with kainic acid (KA). ResultsAnimals without seizure and with no CB modulation survived all reflexes. Non-seizing animals with CB denervation survived 7.1 ± 5.4 reflexes before death, and only 1 of 7 survived past the 12-trial threshold. Electrical CB stimulation without seizure and without reflex caused significant tachypnea and hypotension. Electrical CB stimulation with seizure and without reflex required higher amplitudes to replicate the physiological responses seen outside seizure. Seizing animals without CB intervention survived 3.2 ± 3.6 trials (per-reflex survival rate 42.0% ± 44.4%), and 0 of 7 survived past the 12-trial threshold. Seizing animals with electrical CB stimulation survived 10.5 ± 4.7 ictal trials (per-reflex survival rate 86.3% ± 35.0%), and 6 of 8 survived past the 12-trial threshold. SignificanceThese results suggest that, during seizure, the ability of the CB to stimulate a restart of respiration is impaired. The CB and its afferents may be relevant to fatal ictal apnea and SUDEP in humans, and CB stimulation may be a relevant intervention technique in these deaths.