The fall and rise of corticomotor excitability with cancellation and reinitiation of prepared action

The sudden cancellation of a motor action, known as response inhibition (RI), is fundamental to human motor behavior. The behavioral selectivity of RI can be studied by cueing cancellation of only a subset of a planned response, which markedly delays the remaining executed components. The present study examined neurophysiological mechanisms that may contribute to these delays. In two experiments, human participants received single- and paired-pulse transcranial magnetic stimulation while performing a bimanual anticipatory response task. Participants performed most trials bimanually (Go trials) and were sometimes cued to cancel the response with one hand while responding with the other (Partial trials). Motor evoked potentials were recorded from left first dorsal interosseous (FDI) as a measure of corticomotor excitability (CME) during Go and Partial trials. CME was temporally modulated during Partial trials in a manner that reflected anticipation, suppression, and subsequent initiation of a reprogrammed response. There was an initial increase in CME, followed by suppression 175 ms after the stop signal, even though the left hand was not cued to stop. A second increase in excitability occurred prior to the (delayed) response. We propose an activation threshold model to account for nonselective RI. To investigate the inhibitory component of our model, we investigated short-latency intracortical inhibition (sICI), but results indicated that sICI cannot fully explain the observed temporal modulation of CME. These neurophysiological and behavioural results indicate that the default mode for reactive partial cancellation is suppression of a unitary response, followed by response reinitiation with an inevitable time delay.

Splenic abscess caused by Blastomyces dermatitidis in association with peritoneal involvement: case report and review

We report a rare case of a patient with blastomycosis who presented with splenic abscess and peritoneal involvement. This case is unique in that no historical or radiographic evidence of antecedent pulmonary infection was apparent and therapy with orally administered ketoconazole was effective. We reviewed the English-language literature on blastomycotic splenic abscess and compared findings from other cases with findings from the current case.

The bookend nasal septal splint

A malleable nasal septal splint is presented. Its purpose is to hold the septum in the midline, and to depress the floor of the inlet over the premaxillary wings. Blunting of the nasal valves is avoided. This appliance can be both firmly seated and well tolerated, since its pedestals can be curved up laterally within the lateral crura. Additional splints can be threaded onto the first one to reach high posterior synechiae. A useful modification is provided to support nasal bones when nasal packing must be avoided.