Sunnybrook Research Articles

Fine grained automatic left ventricle segmentation via ROI based Tri-Convolutional neural networks.

The left ventricle segmentation (LVS) is crucial to the assessment of cardiac function. Globally, cardiovascular disease accounts for the majority of deaths, posing a significant health threat. In recent years, LVS has gained important attention due to its ability to measure vital parameters such as myocardial mass, end-diastolic volume, and ejection fraction. Medical professionals realize that manually segmenting data to evaluate these processes takes a lot of time, effort when diagnosing heart diseases. Yet, manually segmenting these images is labour-intensive and may reduce diagnostic accuracy. This paper, propose a combination of different deep neural networks for semantic segmentation of the left ventricle based on Tri-Convolutional Networks (Tri-ConvNets) to obtain highly accurate segmentation. CMRI images are initially pre-processed to remove noise artefacts and enhance image quality, then ROI-based extraction is done in three stages to accurately identify the LV. The extracted features are given as input to three different deep learning structures for segmenting the LV in an efficient way. The contour edges are processed in the standard ConvNet, the contour points are processed using Fully ConvNet and finally the noise free images are converted into patches to perform pixel-wise operations in ConvNets. The proposed Tri-ConvNets model achieves the Jaccard indices of 0.9491 ± 0.0188 for the sunny brook dataset and 0.9497 ± 0.0237 for the York dataset, and the dice index of 0.9419 ± 0.0178 for the ACDC dataset and 0.9414 ± 0.0247 for LVSC dataset respectively. The experimental results also reveal that the proposed Tri-ConvNets model is faster and requires minimal resources compared to state-of-the-art models.

Comparison of laser therapy and galvanic stimulation on facial appearance and function in Bell’s palsy among south Indian population

Introduction and Aim: Bell’s palsy is an instantaneous lower motor neurons injury of 7th cranial nerve associated with infection and swelling. It produces unexpected unilateral weakness of facial muscles, progresses rapidly and attains peak symptoms within a week. The most common age of incidence is between 20 to 40 years. Although facial paralysis in Bell’s palsy is self-limited, only 80% of the patients make a full recovery. There are studies stating that both galvanic electrical stimulation and laser therapy speed up the recovery of facial paralysis, but the extent of complete recovery is unknown. Hence, this study is an attempt to understand and compare how laser therapy and galvanic electrical stimulation affect facial appearance and facial muscle functions in Bell's palsy. Materials and Methods: This study included thirty subjects with acute onset of Bell’s palsy aged between 20-40 years. They were randomly grouped into A and B. Galvanic electrical stimulation and low-level laser therapy were given to group A and group B respectively for 6 weeks (3 sessions/week) along with facial exercises. Facial disability index scale was used to measure facial muscle function and Sunny brook scale was used to measure facial symmetry in pre- and post-treatment periods. Results: When comparing the pre- and post-mean values of groups A and B on the Sunny Brook facial grading and the facial disability index (physical, social), group B (with low level laser therapy) showed a highly significant difference in mean values at p 0.001. Conclusion: Low-level laser therapy can be used as an adjective in treating the patients with Bell’s palsy.

IS PHYSICAL THERAPY SESSION DURATION EFFECTIVE ON FUNCTIONALITY IN REHABILITATION OF BELL’S PALSY (IDIOPATHIC FACIAL PARALYSIS)?

Abstract
 Purpose: The aim of the study is to evaluate the effect of the changing number of physical therapy sessions on the functionality level of the in patients with Bell Palsy.
 Method: In this retrospective study, the data of patients who were diagnosed with Bell's Palsy (BP) and applied a physical therapy program consisting of electrotherapy, infrared and mimic exercises were examined. The data of 21 patients who were rehabilitated with the diagnosis of BP and received 15 sessions of treatment and 21 patients who received 30 sessions of treatment were analyzed. Age, gender and comorbidities of the patients were recorded. Functionality of the patients was evaluated with Facial Disability Index (FDI), House Brackmann System (HBS) and Sunny Brook Grading System (SBGS) before and after treatment.
 Results: In all intragroup clinical and functionality evaluations of the patients, significant improvement was observed in both groups both after 15 sessions and after 30 sessions (p

Making Semi-Automatic Segmentation Method to be Automatic Using Deep Learning for Biventricular Segmentation

Ventricular Segmentation or Delineation of Cardiac Magnetic Resonance Imaging (CMRI) is significant in obtaining the cardiac contractile function, which in turn is taken as input for diagnosing Cardio Vascular Diseases (CVD). Many automatic and semi-automatic methods were evolved to meet the constraints of diagnosing CVDs. Among these, semi-automatic methods require user intervention for delineation of ventricles, which consumes time and leads to intra and inter-observability, as with manual delineation. Thus, the automatic method is suggested by most of the researchers to address the above-stated problem. We proposed Saliency-based Active contour U-Net (SACU-Net) for automatic bi-ventricular segmentation which is found to surpass the existing highest developed methods regarding closeness to the gold standard. Three schemes are used by our proposed algorithm, namely 1. Saliency Detection Scheme for Region of Interest (ROI) Localization to concentrate only on Object of Interest, 2. Drop-out embedded U-net for Initial Contour evolution that performs initial segmentation and 3. Local-Global-based Regional active Contour (LGRAC) to fine-tune and avoid leaking, merging of ventricles during Delineation. We used three datasets namely Automatic Cardiac Diagnosing Challenge (ACDC) of MICCAI 2017, Right Ventricular Segmentation Challenge (RVSC) of MICCAI 2012, and Sunny Brook (SB) of MICCAI 2009 dataset to test the adaptability nature of our algorithm over different scanner resolutions and protocols. 100 and 50 CMRI Images of ACDC were used for training and testing respectively which obtained average Dice Coefficient (DC) metric of 0.963, 0.934, and 0.948 for Left Ventricular Cavity (LVC), Left Ventricular Myocardium (LVM), and Right Ventricular Cavity (RVC) respectively. 32 and 16 CMRI Images of RVSC are used for preparing and experimenting respectively, which obtained an average DC metric of 0.95 for RVC.30 and 15 CMRI Images of SB are used for preparing and experimenting respectively, which obtained average DC metric of 0.96 and 0.97 for LVC and LVM, respectively. Hausdorff Distance (HD) Metrics are also calculated to learn the distance of proposed delineated ventricles to reach the gold standard. The above resultant metrics show the robustness of our proposed SACU-Net in the segmentation of ventricles of CMRI than previous methods.

Kinesitherapy for idiopathic facial palsy: A protocol of systematic review and meta-analysis.

Background:Idiopathic facial nerve palsy (Bells palsy) is the most common acute mono-neuropathy which lack of effective treatments. Kinesitherapy as an alternative therapeutic approach was widely used in clinical. But the effects on Bells palsy outcome are still debated.Methods:The aim of this study is to systematically review the therapeutic efficacy of kinesitherapy for Bells palsy. Database including PubMed, EMBASE, Cochrane Library, Chinese Biomedical database (CBM), Chinese National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical database (VIP) and WangFang database will be searched to collect randomized controlled trails (RCTs) on kinesitherapy for Bells palsy from inception to Nov 2020. The therapeutic effects based on recovery rate, House-Brackmann (H-B) facial classification system, Sunny brook face grading system and adverse events after the treatment will be marked as the primary outcomes. RevMan V.5.3 software will be used to calculate the data synthesis as well as to perform meta-analysis if the results are appropriate.Results:The literature will provide a high-quality synthesis of current evidence of kinesitherapy for Bells palsy from various comprehensive assessment, including the recovery rate, H-B facial classification, Sunny brook face scores, adverse events rate, Facial disability index (FDI), residual symptoms 6 months after onset, incomplete recovery rate after 1 year.Conclusion:The systematic review will provide up-to-date evidence to assess kinesitherapy for Bells palsy.PROSPERO registration number:PROSPERO CRD42020215109.

KABAT INTERVENTIONS INTEGRATED WITH FACIAL EXPRESSIVE AND FUNCTIONAL EXERCISES FOR BETTER AND SPEEDY RECOVERY IN BELL’S PALSY; A PRE-POST DESIGN

Background: Bell’s palsy (BP) is an acute and idiopathic paralysis of the seventh cranial nerve, which has higher incidence rate in Asian countries compared to the western world. Different contemporary physiotherapy interventions have been used in treatment of impairments and functional limitations caused due to the BP. However, traditional usual care is still in practice in context like Nepal, which has to be shifted to evidence-based treatment. Therefore, pres­ent study investigated effectiveness of Kabat intervention integrated with facial expressive and functional exercises in Bell’s palsy. Methods: This pre-post comparative study recruited eight participants of age 22 to 52 years with acute and sub-acute, unilateral, idiopathic BP by purposive sampling. A physiotherapist admin­istered the Kabat intervention integrated with facial expressive and functional exercises for four weeks. Another physiotherapists assessed before as well as after two and four weeks of the treat­ment using Sunny Brook Facial Grading, House-Brackmann grading, lip-length measurement, facial disability and patients’ satisfaction measures. One-way ANOVA with repeated measures was used to analyze data across three points of time. Results: Eight participants with mean age 41.38 years (10.66) completed the study. Significant improvement with high effect sizes (0.82 – 0.95) was found on both outcome measures across the time. There was significant improvement on lip measurement as well. The participants’ satisfaction level was 8.5 (±1.20)/10 with the intervention. Conclusions: The Kabat intervention integrated with facial expressive and functional exercises demonstrated significant improvement in impairments and functional level. Large effect sizes and high level of participants’ satisfaction indicated clinical relevance of the intervention.

Automatic Facial Recognition System Assisted-facial Asymmetry Scale Using Facial Landmarks

This study aimed to demonstrate the application of our automated facial recognition system to measure facial nerve function and compare its effectiveness with other conventional systems and provide a preliminary evaluation of deep learning-facial grading systems. Retrospective, observational. Tertiary referral center, hospital. Facial photos taken from 128 patients with facial paralysis and two persons with no history of facial palsy were analyzed. Diagnostic. Correlation with Sunnybrook (SB) and House-Brackmann (HB) grading scales. Our results had good reliability and correlation with other grading systems (r = 0.905 and 0.783 for Sunnybrook and HB grading scales, respectively), while being less time-consuming than Sunnybrook grading scale. Our objective method shows good correlation with both Sunnybrook and HB grading systems. Furthermore, this system could be developed into an application for use with a variety of electronic devices, including smartphones and tablets.

The Efficacy of Acupuncture in the Treatment of Bell's Palsy Sequelae

This study was planned to evaluate the effectiveness of acupuncture treatment for the treatment Bell’s palsy sequelae. In this study, forty patients with Bell’s palsy sequelae were randomly allocated to either the acupuncture or the control group. The clinical outcomes before and after treatment were assessed using the following assays: the facial nerve compound motor action potential and HouseeBrackmann (HB) and Sunnybrook (SB) grading scales. Agreement analysis was performed between the SB and HB grading scales. There was significant difference between pretreatment and posttreatment compound motor action potential values of the patients within the acupuncture group (p = 0.036). In pretreatment and posttreatment SB and HB scores, significant differences within the two groups were observed. However, the significance level in the improvement rate in the acupuncture group was higher than that of the control group. General agreement between the SB and HB scores of groups was an acceptable value, and weighted agreement between the scales was a moderate agreement. In this study, we found that acupuncture treatment is effective in improving Bell’s palsy sequelae. Acupuncture can be used as a safe method in the treatment of Bell’s palsy sequelae.

MULTIPLE APPROACHES IN MANAGEMENT OF BELL’S PALSY- A CASE STUDY

Bell’s palsy is a prevalent type of Facial nerve Palsy, estimated up to 75% of the cases. A 58 year old male patient presented with right sided Bell’s palsy. Thorough examination revealed the weakness of facial musculature and synkinesis associated with drooping and asymmetry. Reportedly, he had difficulty in eye closure, chewing and drinking. Assessment was conducted using Sunny Brook Facial Grading Scale. After assessment a comprehensive strategy combining of different modalities including electrical stimulation with Russian Current, gentle soft tissue mobilization, resistance exercises and taping. Symptomatically, after 3 weeks there was a significant improvement in the facial symmetry, strength and function of facial musculature as well as score of Sunny Brook Facial Grading Scale. Experimentally, this indicates effectiveness of this treatment regime, however; further randomized control trials should be conducted to further investigate efficacy and validity of this combination approach.

Automatic segmentation of the left ventricle in a cardiac MR short axis image using blind morphological operation

Conventionally, cardiac MR image analysis is done manually. Automatic examination for analyzing images can replace the monotonous tasks of massive amounts of data to analyze the global and regional functions of the cardiac left ventricle (LV). This task is performed using MR images to calculate the analytic cardiac parameter like end-systolic volume, end-diastolic volume, ejection fraction, and myocardial mass, respectively. These analytic parameters depend upon genuine delineation of epicardial, endocardial, papillary muscle, and trabeculations contours. In this paper, we propose an automatic segmentation method using the sum of absolute differences technique to localize the left ventricle. Blind morphological operations are proposed to segment and detect the LV contours of the epicardium and endocardium, automatically. We test the benchmark Sunny Brook dataset for evaluation of the proposed work. Contours of epicardium and endocardium are compared quantitatively to determine contour’s accuracy and observe high matching values. Similarity or overlapping of an automatic examination to the given ground truth analysis by an expert are observed with high accuracy as with an index value of 91.30% . The proposed method for automatic segmentation gives better performance relative to existing techniques in terms of accuracy.

Individualized management of facial synkinesis based on facial function

Objectives: The researchers analyzed facial patterns in subjects with facial synkinesis after facial paralysis and evaluated the involved muscles to aid in the development of effective treatments for facial synkinesis.Methods: A total of 142 subjects were included in the study, the primary measure for synkinesis was determined by video analysis involving the strongest combination of two muscle groups that contributed to facial expression. The secondary measure of synkinesis was the analysis of its severity using the SB grading system, while observing the number of facial synkinetic movements.Results: The most common type of facial synkinesis was oral–ocular synkinesis (n = 137). Other synkinesis such as ocular–oral, ocular–nasal, ocular–chin, ocular–stapedial, chin–ocular and chin–oral synkinesis continued to coexist together with oral–ocular synkinesis. The results of BTX-A treatment are assessed based on the number of facial synkinetic movements observed and the evaluation of initial facial function.Conclusion: The effectiveness of botulinum toxin A (BTX-A) treatment should be considered on an individual basis, according to the initial state of facial function. A patient with mild facial synkinesis restricted to the oral–ocular area and with a high score on the Sunnybrook (SB) facial nerve grading system would be the best candidate for BTX-A treatment.

Comparison between Proprioceptive Neuromuscular Facilitation and Neuromuscular Re-Education for Reducing Facial Disability and Synkinesis in Patients with Bell’s palsy: A Randomized Clinical Trial

Purpose To evaluate the comparative effectiveness of neuromuscular re-education technique and proprioceptive neuromuscular facilitation technique on improving facial disability and synkinesis in rehabilitation of bell's palsy. Methodology: It was a randomized clinical trial consisting 40 participants (males and females) 20 in each group, with Bell’s palsy of non-traumatic origin. Group A received proprioceptive neuromuscular technique (PNF) with conventional PT treatment and Group B received facial neuromuscular re-education technique (NMR) combined with conventional PT treatment for 6 days a week for 4 weeks. Results: The result suggest that Group A had significant higher score at Sunny brook facial grading scale (SFGS) whereas in Facial Disability Index (FDI) Group A had significant difference at total score but there was no significant difference over individual component (social and physical function). Group B had significant better improvement over Synkinesis Assessment Questionnaire (SAQ). Conclusions: Both PNF group and NMR showed significant results and displayed efficient improvement in facial symmetry after 4 weeks of treatment. PNF with conventional PT is more effective in improving facial function and reducing facial disability whereas NMR with conventional PT is better in reducing synkinesis in Bell’s palsy rehabilitation.

Half-mirror biofeedback exercise in combination with three botulinum toxin A injections for long-lasting treatment of facial sequelae after facial paralysis

The present study was conducted to develop a new method for maintaining the effect of botulinum toxin treatment for facial sequelae. We used a combination strategy including the administration of botulinum toxin three times at 6-8-month intervals followed by daily newly developed half-mirror biofeedback rehabilitation for about 2 years from the first injection. This was a prospective study. Seventeen patients with unilateral facial palsy for >1 year were included in the study. The amount injected per site varied from 1.5 to 3U. The purpose of the first injection was to reduce the most inconvenient facial problem such as facial synkinesis or hyperkinetic movement at the points of the periocular area and the zygomaticus major and minor muscles with an average dosage of 17.4±13.9U. The second injection was to enhance facial symmetry at prominent hypertrophic areas on the contralateral side with 36.5±15.4U, and the third injection was to add cosmetic configuration at the points of deep furrows and creases caused by facial muscular hyperkinesis or atrophy with 15.6±8.4U. After three injections of botulinum toxin A and 2 years of half-mirror biofeedback exercises, all patients showed marked relief of facial synkinesis and facial asymmetry. Before treatment, the mean±standard deviation (SD) Sunnybrook (SB) score was 36.8±8.76. After the first injection, the score increased by 11.4. After the second injection, the score increased by 14.6; it further increased by 15.6 after the third injection. This facial rehabilitation strategy, consisting of three injections of botulinum toxin and half-mirror biofeedback exercises, proceeds over the course of 2 years and offers a long-lasting cure for facial synkinesis and facial symmetry as well as improved facial aesthetics.

Botulinum toxin injection of both sides of the face to treat post-paralytic facial synkinesis

An attempt has been made to produce a new 'balance' in facial dynamics between a paralysed and a non-paralysed face with reduction of synkinesis, by concomitant injection of botulinum toxin A (BTX-A) on both sides in patients with long-lasting facial sequelae. Prospective clinical study. University hospital. Forty-two consecutive patients who recovered partially from facial nerve paralysis were enrolled for this study. The amount injected per site of the paralysed side with synkinesis varied from 1.5 to 2.5 U, and the total dose used per patient was 10-26 U (mean 17.12±5.3 U). That of the non-paralysed side with muscular hypertrophy varied from 2.5 to 5 U, and the total dose used per patient was 35-72 U (mean 52.6±9.7 U). All patients had been evaluated by the Sunnybrook (SB) facial nerve grading systems and developed dynamic facial asymmetry ratio. After administration of injection of BTX-A on both sides of the face, relief of facial synkinesis and enhancement of facial symmetry were observed in all patients. Before the injection, the patients showed an SB score of 38.8±10.68. After the injection, changes of synkinesis and symmetry score were 7.9±1.81 and 8.4±3.25, respectively, resulting in a 58.4±12.46 score at the last evaluation. Before the administration, the mean±standard deviation (SD) value of dynamic facial asymmetry was 0.83±0.06 and it was increased significantly to 0.90±0.05 1 month after administration. After BTX-A injection on both sides for synkinesis and contralateral hypertrophy, the patients showed significant suppression of the synkinesis and improvement of facial symmetry with resulting elevated quality of life, social interaction, personal appearance and food intake.

Abstract A11: Recruitment Monitoring Report of a Pan-Canadian Multi-center Study, the COOLS Trial.

Abstract Screening logs are used for clinical trials to maintain the representativeness and validity of patient recruitment. It is especially critical in the active enrolment phase of a trial. The objectives of this study are: 1) To update the screening and recruitment status and 2) To discuss the challenges in patient recruitment and benefit in using screening log in a multi-centre trial. Methods: Using Microsoft Office Excel (2007), the Central Management Team (CMT) designed a screening log template with fields based on the 2010 Consolidated Standards of Reporting Trials (CONSORT). Data were collected with respect to patient information (Screening Date, Last Initial, First Initial, Referral Sources), lesion information (Anatomical Site, Diagnosis), recruitment (Recruitment Status - eligible, ineligible, refusal or not approached; Reasons to each unsuccessful recruitment status), Consent Date, and Baseline CT neck/chest (CT Date, CT Results). Built-in features such as customized dropdown lists with predetermined values were designed to maintain data consistency and text fields were used for detail explanations of scenario encountered. For patient confidentiality, the screening log was anonymous and without any patient identifiers. Screening logs were introduced, distributed, and explained to each Site Coordinator (SC) via Cisco WebEx teleconferencing tool, and were reviewed weekly by the CMT. Descriptive analysis was used for patient recruitment status. Results: From September 2010 to July 2012, six COOLS study sites (Vancouver, London, Toronto (Sunny Brook Hospital), Calgary, Halifax, Winnipeg) have been actively using the screening log. A total of 420 patients are screened with 167 (40%) were identified as ineligible according to the enrollment criteria, including anatomic site, the visibility of the margin of lesions, diagnosis, and tumor size. Among 253 eligible patients, 175 (69%) were consented, 59 (23%) refused to participate, and 19 (8%) are not approached. The main reasons for patient refusal were compliance for scheduled follow-up visits (29, 49%) and unwillingness to fill study forms (8, 14%). The main reasons for patients not been approached were history of not compliance from previous study participation (7, 37%) and scheduling conflict and failure in study referral (4, 21%). Eight consented patients failed to receive assigned treatment due to unavailability of the FV specialists. Issues are identified and communicated with PI and SC in a timely fashion for better solutions. Conclusions: The COOLS trial screening log is implemented to help monitor recruitment activity and quality of the subject screening. It is also a source to examine patient acceptance to the trial and new technology. The tool can be used as a communication channel to bridge a strong network between the CMT and SCs and to understand the strength and weakness of site referral and recruitment. Through early identification of recruitment issues, site-specific strategies can be developed and recruitment goal can be reached. (Supported by the Terry Fox Research Institute (2009-24) and the Canadian Cancer Society Research Institute (CCS-20336). Citation Format: Yi Ping Kelly Liu, Shane X. Duan, Alisa Kami, Sylvia F. Lam, Catherine F. Poh. Recruitment monitoring report of a pan-Canadian multicenter study, the COOLS Trial. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr A11.

Inflammation and memory deficits: a role for extrasynaptic GABAA receptors

Event Abstract Back to Event Inflammation and memory deficits: a role for extrasynaptic GABAA receptors Dian-Shi Wang1* and Beverley Orser1, 2 1 University of Toronto, Departments of Physiology and Anesthesia, Canada 2 Sunny brook Health Sciences Centre, Canada γ-Aminobutyric acid type A receptors (GABAARs) are the main inhibitory receptors in the central nervous system. Two forms of GABAAR-mediated inhibition exist: phasic inhibition which is mediated by synaptic GABAARs clustered at postsynaptic terminals, and tonic inhibition which is generated by high-affinity, slowly desensitizing extrasynaptic GABAARs that are activated by low ambient concentrations of GABA. Cognitive deficits and memory impairment occur in a variety of inflammatory disorders in which proinflammatory cytokines such as IL-1β and TNF-α are produced in the brain. Proinflammatory cytokines have been shown to interfere with cognitive function. Here we test the hypothesis that the prototypic proinflammatory cytokine, IL-1β enhances the tonic conductance and thereby impair memory during brain inflammation. The effects of IL-1β on phasic GABAAR function were also tested. We also sought to determine the signaling pathways involved in IL-1&beta's effects. Whole-cell voltage clamp techniques were used to record tonic, synaptic and GABA-evoked currents in cultured murine hippocampal neurons. Pretreatment of neurons with IL-1β (20 ng/ml, ≈ 1.18 nM) for 20 min increased the tonic current density (≈ 44.3%, n = 22, P < 0.05) in comparison with that of vehicle control. Acute perfusion of IL-1β (20 ng/ml) for 2 min also caused an increase in the tonic current (36.2 ± 2.5%, mean ± SEM; n = 6, P < 0.05). In contrast, both the amplitude and frequency of mIPSCs were suppressed by IL-1β. IL-1β also inhibited currents activated by GABA at concentrations above 1 µM. In addition, IL-1 receptor antagonist can block both the enhancing effect on tonic conductance and the inhibitory effect on GABA evoked currents of IL-1β suggesting that type I IL-1 receptor mediates the effects of IL-1β. Furthermore, P38 MAPK inhibitor SB203580 (20 µM) could block the enhancing effect of IL-1β on tonic conductance, whereas the inhibitory effect of IL-1β on GABA-evoked currents could not be blocked by SB203580, but PI3k inhibitor LY294002 (20 µM) and Wortmanin (0.1 µM) could abolish the inhibitory effect of IL-1β. Our results show that IL-1β acts on type 1 IL-1 receptor to enhance the tonic conductance through P38 MAPK pathway, whereas to inhibit the synaptic conductance via PI3k pathway. The enhancing effect of IL-1β on tonic conductance may impair memory in inflammatory disorders. Future study will decipher the mechanisms underlying the signaling pathways that differentially modulate IL-1β on tonic and synaptic GABAAR function in hippocampal neurons and whether such changes influence memory behavior. Conference: B.R.A.I.N. platform in Physiology poster day 2009, Toronto, ON, Canada, 16 Dec - 16 Dec, 2009. Presentation Type: Poster Presentation Topic: Poster presentations Citation: Wang D and Orser B (2009). Inflammation and memory deficits: a role for extrasynaptic GABAA receptors. Front. Neurosci. Conference Abstract: B.R.A.I.N. platform in Physiology poster day 2009. doi: 10.3389/conf.neuro.03.2009.17.047 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 18 Dec 2009; Published Online: 18 Dec 2009. * Correspondence: Dian-Shi Wang, University of Toronto, Departments of Physiology and Anesthesia, Toronto, Canada, dianshi.wang@utoronto.ca Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Dian-Shi Wang Beverley Orser Google Dian-Shi Wang Beverley Orser Google Scholar Dian-Shi Wang Beverley Orser PubMed Dian-Shi Wang Beverley Orser Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Physical Therapy (93)

Intertester reliability of the McKenzie evaluation in assessing patients with mechanical low back pain. (Sunny Brook &amp; Women's College Health Sciences Centre, Toronto, Ontario, Canada) J Orthop Sports Phys Ther 2000;30:368–389.In this study, patients were assessed simultaneously by 2 physical therapists trained in the McKenzie evaluation system. The therapists were randomly assigned as examiner and observer. Agreement was estimated by Kappa statistics. Forty‐five subjects (47 ± 14 years), composed of 25 women and 20 men with acute, subacute, or chronic low back pain were examined. The agreement between raters for selection of the McKenzie syndromes was K = 0.70, and for the derangement subsyndromes was K = 0.96. Interrater agreement for the presence of lateral shift, relevance of lateral shift, relevance of lateral component, and deformity in the sagittal plane was K = 0.52, 0.85, 0.95, and 1.00, respectively. Intertester agreement on syndrome categories in 17 patients under 55 years of age was excellent with K = 1.00. Conclude that a form of low back evaluation, using patterns of pain response to repeated end range spinal test movements, was highly reliable when performed by 2 properly trained physical therapists. Comment by Karen Crawford, RPT.This article intends to address the ability for therapists to agree on a low back pain diagnosis using the McKenzie technique of classification. It is important for this study to select a clear clinical diagnosis in order to establish rationale for patient management and determine a prognosis. Another purpose for this study was to agree on the relevance of sagittal and frontal plane deformities using McKenzie methods in assessing patients with back pain. The subjects included adult patients with a history of acute, subacute, or chronic low back pain. Patients were referred by general practitioners or specialists for treatment at an outpatient department where the study was conducted. The examination consisted of taking a history, observational evaluation of the range of motion, and completion of a specified tests movements in the sagittal, frontal, and combined planes. Subjects were allowed to communicate only with the assessor. A total of 46 patients with a history of low back pain agreed to complete the assessment. Patients were divided into 2 groups, those 55 years of age and older and those younger than 55. McKenzie identifies only 3 mechanical syndromes: 1. Postural, 2. Dysfunction, 3. Derangement. Each of these syndromes were divided into separate subsyndromes according to location of the pain and presence or absence of spinal deformities. The study concluded that therapists trained in use of the McKenzie evaluation system can be highly reliable in reaching the same conclusion in respect to classifying patients into diagnostic syndromes and subsyndromes, especially in patients under the age of 55. In contrast to other published studies, the importance of advanced training for interpretation of symptom behavior definitely leads to selection of the correct diagnosis.