Citations

PurposeCorticomuscular electroencephalographic-electromyographic (EEG-EMG) coherence elicited by speech and nonspeech oromotor tasks in healthy participants and those with Parkinson’s disease (PD) was examined. Hypotheses were the following: (a) corticomuscular coherence is demonstrable between orbicularis oris (OO) muscles' EMG and scalp EEG recording; (b) the presence, location, and magnitude of coherence is task specific; (c) differences in corticomuscular coherence patterns exist between healthy and PD participants; and (d) differences will manifest as either increased or decreased coherence values in certain frequency bands, with EEG localization at primary sensorimotor cortex and/or supplementary motor area (SMA).MethodSimultaneous EEG, EMG (OO), and speech samples were recorded on 20 healthy and 20 PD participants during speech and nonspeech tasks. Fast Fourier transform and coherence analysis was performed with Neuroscan software on 1,000 randomly generated epochs per task per group. Corticomuscular coherence was analyzed between each EEG electrode and right and left superior and inferior OO muscles up to 200 Hz. Significant coherence peaks exceeded 95% confidence limits (.003).ResultsCorticomuscular coherence existed for both groups and for all tasks, but to varying degrees in primary sensorimotor cortex and SMA.ConclusionsResults support task specificity for both groups and, in PD, a diminished modulation flexibility linked to the sensorimotor area and reduced corticomuscular coherence at the SMA.

Individual psychological responses to heights vary on a continuum from acrophobia to height intolerance, height tolerance, and height enjoyment. This paper reviews the English literature and summarizes the physiologic and psychological factors that generate different responses to heights while standing still in a static or motionless environment. Perceptual cues to height arise from vision. Normal postural sway of 2 cm for peripheral objects within 3 m increases as eye-object distance increases. Postural sway >10 cm can result in a fall. A minimum of 20 minutes of peripheral retinal arc is required to detect motion. Trigonometry dictates that a 20-minute peripheral retinal arch can no longer be achieved in a standing position at an eye-object distance of >20 m. At this distance, visual cues conflict with somatosensory and vestibular inputs, resulting in variable degrees of imbalance. Co-occurring deficits in the visual, vestibular, and somatosensory systems can significantly increase height imbalance. An individual's psychological makeup, influenced by learned and genetic factors, can influence reactions to height imbalance. Enhancing peripheral vision and vestibular, proprioceptive, and haptic functions may improve height imbalance. Psychotherapy may improve the troubling subjective sensations to heights.

Abstract Therapy-related myelodysplastic syndromes (t-MDSs) and acute myeloid leukemia (t-AML) have a poor prognosis with conventional therapy. Encouraging results are reported after allogeneic transplantation. We analyzed outcomes in 868 persons with t-AML (n = 545) or t-MDS (n = 323) receiving allogeneic transplants from 1990 to 2004. A myeloablative regimen was used for conditioning in 77%. Treatment-related mortality (TRM) and relapse were 41% (95% confidence interval [CI], 38-44) and 27% (24-30) at 1 year and 48% (44-51) and 31% (28-34) at 5 years, respectively. Disease-free (DFS) and overall survival (OS) were 32% (95% CI, 29-36) and 37% (34-41) at 1 year and 21% (18-24) and 22% (19-26) at 5 years, respectively. In multivariate analysis, 4 risk factors had adverse impacts on DFS and OS: (1) age older than 35 years; (2) poor-risk cytogenetics; (3) t-AML not in remission or advanced t-MDS; and (4) donor other than an HLA-identical sibling or a partially or well-matched unrelated donor. Five-year survival for subjects with none, 1, 2, 3, or 4 of these risk factors was 50% (95% CI, 38-61), 26% (20-31), 21% (16-26), 10% (5-15), and 4% (0-16), respectively (P < .001). These data permit a more precise prediction of outcome and identify subjects most likely to benefit from allogeneic transplantation.

Although attention-dividing dual tasks hinder gait performance in older persons, gender differences in gait have not been examined. The purpose of this study was to examine whether gait performance differs between older men and women during dual task walking. A total of 44 healthy adults (20 men and 24 women) aged 65 years or older participated in the study. Participants walked under normal and dual task (backward spelling) conditions at self-selected speeds. Mean gait speed and stride-to-stride variability in gait speed were quantified with GAITRite ® instrumentation. Whereas gait speed decreased and variability in gait speed increased in both groups during dual task walking, men walked with greater variability during dual task walking than did women. The magnitude of the increase in variability in gait speed observed in men indicates that stride-to-stride variability in gait speed during dual task walking requires more investigation as a potential risk factor for falls in older men.

Abstract Heart failure with preserved ejection fraction (HFpEF) is a common but under-recognized cause of pulmonary hypertension (PH), particularly among the elderly. While elevated pulmonary artery pressures are clearly associated with increased mortality in HFpEF, it remains unknown whether or how pulmonary vascular disease in HFpEF should be treated. This case emphasizes the importance of maintaining a high index of suspicion for HFpEF in elderly patients presenting with PH and illustrates potential hazards associated with selective pulmonary vasodilation in this growing population.

AbstractThe objective of this case-control study was to compare the efficacy and toxicity of lenalidomide plus dexamethasone (len/dex) versus thalidomide plus dexamethasone (thal/dex) as initial therapy for newly diagnosed myeloma. We retrospectively studied 411 newly diagnosed patients treated with len/dex (228) or thal/dex (183) at the Mayo Clinic. The differences were similar in a matched-pair analysis that adjusted for age, sex, transplantation status, and dexamethasone dose. The proportions of patients achieving at least a partial response to len/dex and thal/dex were 80.3% versus 61.2%, respectively (P < .001); very good partial response rates were 34.2% and 12.0%, respectively (P < .001). Patients receiving len/dex had longer time to progression (median, 27.4 vs 17.2 months; P = .019), progression-free survival (median, 26.7 vs 17.1 months; P = .036), and overall survival (median not reached vs 57.2 months; P = .018). A similar proportion of patients in the 2 groups experienced at least one grade 3 or 4 adverse event (57.5% vs 54.6%, P = .568). Main grade 3 or 4 toxicities of len/dex were hematologic, mainly neutropenia (14.6% vs 0.6%, P < .001); the most common toxicities in thal/dex were venous thromboembolism (15.3% vs 9.2%, P = .058) and peripheral neuropathy (10.4% vs 0.9%, P < .001). Len/dex appears well-tolerated and more effective than thal/dex. Randomized trials are needed to confirm these results.