Does 20 Hz Transcranial Alternating Current Stimulation over the Human Primary Motor Cortex Modulate Beta Rebound Following Voluntary Movement?

Beta frequency oscillations originating from the primary motor cortex increase in amplitude following the initiation of voluntary movement, a process termed beta rebound. The strength of beta rebound has been reported to predict the recovery of motor function following stroke, suggesting therapeutic applications of beta rebound modulation. The present study examined the effect of 20 Hz transcranial alternating current stimulation (tACS) on the beta rebound induced by self-paced voluntary movement. Electroencephalograms (EEGs) and electromyograms (EMGs) were recorded from 16 healthy adults during voluntary movements performed before and after active or sham tACS. There was no significant change in average beta rebound after active tACS. However, the beta rebound amplitude was significantly enhanced in a subset of participants, and the magnitude of the increase across all participants was negatively correlated with the difference between individual peak beta frequency and tACS frequency. Thus, matching the stimulus frequency of tACS with individual beta frequency may facilitate therapeutic enhancement for motor rehabilitation.

Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial

BACKGROUND

Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001).

INTERPRETATION

Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor.

FUNDING

Boehringer Ingelheim and Eli Lilly.

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND

The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1).

INTERPRETATION

In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease.

FUNDING

Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.

Event-Related Brain Potentials N140 and P300 during Somatosensory Go/NoGo Tasks Are Modulated by Movement Preparation

The Go/NoGo task requires attention and sensory processing to distinguish a motor action cue or 'Go stimulus' from a 'NoGo stimulus' requiring no action, as well as motor preparation for a rapid Go stimulus response. The neural activity mediating these response phases can be examined non-invasively by measuring specific event-related brain potentials (ERPs) using electroencephalography. However, it is critical to determine how different task conditions, such as the relationship between attention site and movement site, influence ERPs and task performance. In this study, we compared attention-associated ERP components N140 and P300, the performance metrics reaction time (RT) and accuracy (%Error) and movement-related cortical potentials (MRCPs) between Go/NoGo task trials in which attention target and movement site were the same (right index finger movement in response to right index finger stimulation) or different (right index finger movement in response to fifth finger stimulation). In other Count trials, participants kept a running count of target stimuli presented but did not initiate a motor response. The N140 amplitudes at electrode site Cz were significantly larger in Movement trials than in Count trials regardless of the stimulation site-movement site condition. In contrast, the P300 amplitude at Cz was significantly smaller in Movement trials than in Count trials. The temporal windows of N140 and P300 overlapped with the MRCP. This superposition may influence N140 and P300 through summation, possibly independent of changes in attentional allocation.

Movement of the stimulated finger in a Go/NoGo task enhances attention directed to that finger as evidenced by P300 amplitude modulation

Somatosensory cues and the optimal allocation of attentional resources are critical for motor performance, but it is uncertain how movement of a body part modulates directed attention and the processing of somatosensory signals originating from that same body part. The current study measured motor reaction time (RT) and the P300 event-related potential during a required movement response to stimulation of the same body part in a Go/NoGo task under multiple response. In the Movement Condition, participants were instructed to extend their right index finger in response to mild electrical stimulation of the same finger (Go signal) or remain still when receiving electrical stimulation to the fifth right finger (NoGo signal). Movement RTs and P300 amplitudes and latencies were measured under varying Go signal 50% probabilities. In other trial blocks, participants were required to count Go signals but not respond with movement or to ignore all signals while engaged in an unrelated task. Mean RT in the Movement Condition was 234.5 ms. P300 response amplitudes at midline electrodes (Fz, Cz, Pz) were the largest in the Movement Condition. The P300 amplitude at parietal electrode site Pz was significantly greater during Movement Condition trials than during Count Condition trials. The increase in P300 amplitude during trials requiring movement of the same body part receiving somatosensory stimulation suggests that movement itself modulates the attentional resources allocated to that body part.

Antiferromagnetic topological insulator with selectively gapped Dirac cones

Antiferromagnetic (AF) topological materials offer a fertile ground to explore a variety of quantum phenomena such as axion magnetoelectric dynamics and chiral Majorana fermions. To realize such intriguing states, it is essential to establish a direct link between electronic states and topology in the AF phase, whereas this has been challenging because of the lack of a suitable materials platform. Here we report the experimental realization of the AF topological-insulator phase in NdBi. By using micro-focused angle-resolved photoemission spectroscopy, we discovered contrasting surface electronic states for two types of AF domains; the surface having the out-of-plane component in the AF-ordering vector displays Dirac-cone states with a gigantic energy gap, whereas the surface parallel to the AF-ordering vector hosts gapless Dirac states despite the time-reversal-symmetry breaking. The present results establish an essential role of combined symmetry to protect massless Dirac fermions under the presence of AF order and widen opportunities to realize exotic phenomena utilizing AF topological materials.

Case report: Self-restraint in a patient with alien hand syndrome following cerebral infarction involving the anterior cerebral artery territory

Frontal alien hand syndrome (AHS) presents as impulsive grasping and groping and compulsive manipulation of environmental objects that can affect the dominant or nondominant hand. A few reports have shown improvements in neuropsychological scores over time when self-restraint of the right hand AHS was enforced. A 72-year-old woman presented with right-handed involuntary instinctive grasping reactions and compulsive manipulation of tools after an infarction of the frontal lobe and corpus callosum (CC). She was diagnosed with cerebral infarction involving the anterior cerebral artery territory and a frontal variant of AHS. At AHS onset, the patient was unaware that her right hand was moving against her will; she was only aware that her right hand was moving when the therapist pointed it out to her. Later, she began to recognize that her right hand was involuntarily moving, and she could restrain the movement of her right hand with her left hand. Approximately 5 months following AHS onset, the patient could voluntarily restrain her AHS symptoms by telling her right hand not to move against her will in her head. Most neuropsychological scores improved by 5 months following AHS onset. However, the patient showed disruptions in the genu and midbody of the left cingulate cortex, as shown via diffusion tensor imaging (DTI), and the sensation of the "right hand moving by itself" remained even 5 months after AHS onset. Although damage to the CC fibers was evident on DTI at 5 months following onset, the patient exhibited no sensory deficits and demonstrated good hand ownership as well as early improvement in attention and cognitive dysfunction. Therefore, the patient recognized her AHS symptoms, which included her hand moving against her will, and was able to consciously restrain her hand movement.

Effects of repetitive practice of motor tasks on somatosensory gating

Introduction

During voluntary muscle contraction, the amplitude of the somatosensory evoked potential (SEP) is reduced by inhibiting sensory information from a peripheral nerve supplying the contracted muscle. This phenomenon is called “gating.” We reported that participants with good motor skills indicated strong suppression of somatosensory information. The present study investigated the effects of motor performance improvement following repetitive practice on the SEP amplitude.

Methods

The ball rotation task (BR task) was practiced by 15 healthy participants repetitively. SEPs were recorded before (pre) and after (post) repetitive practice.

Results

The BR task performance was significantly improved and the required muscle activation to perform the task was significantly reduced after the repetitive practice. The degree of gating was not significant between pre and post- for the SEP amplitude. A significant correlation was found between changes in SEP amplitude from pre to post and performance improvement.

Discussion

After repetitive practice, the degree of gating did not change, but the performance of the BR task improved, and the muscle activity required for the BR task decreased. These results suggest that repetitive practice does not change the degree of gating but changes the mechanism of gating. Furthermore, they indicate that suppression of the somatosensory area may play a role in improving task performance.

Transcranial direct current stimulation to the left dorsolateral prefrontal cortex enhances early dexterity skills with the left non-dominant hand: a randomized controlled trial

BACKGROUND

The left dorsolateral prefrontal cortex (DLPFC) is involved in early-phase manual dexterity skill acquisition when cognitive control processes, such as integration and complexity demands, are required. However, the effectiveness of left DLPFC transcranial direct current stimulation (tDCS) on early-phase motor learning and whether its effectiveness depends on the cognitive demand of the target task are unclear. This study aimed to investigate whether tDCS over the left DLPFC improves non-dominant hand dexterity performance and determine if its efficacy depends on the cognitive demand of the target task.

METHODS

In this randomized, double-blind, sham-controlled trial, 70 healthy, right-handed, young adult participants were recruited. They were randomly allocated to the active tDCS (2 mA for 20 min) or sham groups and repeatedly performed the Purdue Pegboard Test (PPT) left-handed peg task and left-handed assembly task three times: pre-tDCS, during tDCS, and post tDCS.

RESULTS

The final sample comprised 66 healthy young adults (mean age, 22.73 ± 1.57 years). There were significant interactions between group and time in both PPT tasks, indicating significantly higher performance of those in the active tDCS group than those in the sham group post tDCS (p < 0.001). Moreover, a greater benefit was observed in the left-handed assembly task performance than in the peg task performance (p < 0.001). No significant correlation between baseline performance and benefits from tDCS was observed in either task.

CONCLUSIONS

These results demonstrated that prefrontal tDCS significantly improved early-phase manual dexterity skill acquisition, and its benefits were greater for the task with high cognitive demands. These findings contribute to a deeper understanding of the underlying neurophysiological mechanisms of the left DLPFC in the modulation of early-phase dexterity skill acquisition.

TRIAL REGISTRATION

This study was registered in the University Hospital Medical Information Network Clinical Trial Registry in Japan (UMIN000046868), Registered February 8, 2022 https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000053467.

The impact of visual cross-modal conflict with semantic and nonsemantic distractors on working memory task: A functional near-infrared spectroscopy study

Cross-modal conflicts arise when information from multisensory modalities is incongruent. Most previous studies investigating audiovisual cross-modal conflicts have focused on visual targets with auditory distractors, and only a few studies have focused on auditory targets with visual distractors. Moreover, no study has investigated the differences in the impact of visual cross-modal conflict with semantic and nonsemantic competition and its neural basis. This cross-sectional study aimed to characterize the impact of 2 types of visual cross-modal conflicts with semantic and nonsemantic distractors through a working memory task and associated brain activities. The participants were 33 healthy, right-handed, young male adults. The paced auditory serial addition test was performed under 3 conditions: no-distractor and 2 types of visual distractor conditions (nonsemantic and semantic distractor conditions). Symbols and numbers were used as nonsemantic and semantic distractors, respectively. The oxygenated hemoglobin (Oxy-Hb) concentration in the frontoparietal regions, bilateral ventrolateral prefrontal cortex (VLPFC), dorsolateral prefrontal cortex, and inferior parietal cortex (IPC) were measured during the task under each condition. The results showed significantly lower paced auditory serial addition test performances in both distractor conditions than in the no-distractor condition, but no significant difference between the 2 distractor conditions. For brain activity, a significantly increased Oxy-Hb concentration in the right VLPFC was only observed in the nonsemantic distractor condition (corrected P = .015; Cohen d = .46). The changes in Oxy-Hb in the bilateral IPC were positively correlated with changes in task performance for both types of visual cross-modal distractor conditions. Visual cross-modal conflict significantly impairs auditory working memory task performance, regardless of the presence of semantic or nonsemantic distractors. The right VLPFC may be a crucial region to inhibit visual nonsemantic information in cross-modal conflict situations, and bilateral IPC may be closely linked with the inhibition of visual cross-modal distractor, regardless of the presence of semantic or nonsemantic distractors.

The relationships between motor behavior and sensory gating in the ball rotation task

During voluntary muscle contraction, sensory information induced by electrostimulation of the nerves supplying the contracting muscle is inhibited and the amplitude of the corresponding somatosensory evoked potential (SEP) decreases. This phenomenon is called "gating." The reduction of the SEP amplitude is reportedly significantly larger when task performance is high. However, the relationship between dexterous movement skills and gating remains unclear. In this study, we investigated through a ball rotation (BR) task how dexterous movement skills affect the SEP amplitudes. Thirty healthy subjects performed the BR task comprising the rotation of two wooden balls as quickly as possible. We estimated the median number of ball rotations for each participant and classified the participants into two (fast and slow) groups based on the results. Moreover, we recorded SEPs, while the subjects performed BR tasks or rested. SEP amplitude reduction (P45) was significantly larger in the fast than in the slow group. We also observed that the P45 amplitude during the BR task was attenuated even more so in the case of the participants with better dexterous movement skills. Our results suggest that the participants with better dexterous movement skills might display stronger somatosensory information suppression because of increasing the motor cortex activity and the afferent input during the BR task.

The Effect of Pedaling at Different Cadence on Attentional Resources

We investigated the relationship between attentional resources and pedaling cadence using electroencephalography (EEG) to measure P300 amplitudes and latencies. Twenty-five healthy volunteers performed the oddball task while pedaling on a stationary bike or relaxing (i.e., no pedaling). We set them four conditions, namely, (1) performing only the oddball task (i.e., control), (2) performing the oddball task while pedaling at optimal cadence (i.e., optimal), (3) performing the oddball task while pedaling faster than optimal cadence (i.e., fast), and (4) performing the oddball task while pedaling slower than optimal cadence (i.e., slow). P300 amplitudes at Cz and Pz electrodes under optimal, fast, and slow conditions were significantly lower than those under control conditions. P300 amplitudes at Pz under fast and slow conditions were significantly lower than those under the optimal condition. No significant changes in P300 latency at any electrode were observed under any condition. Our findings revealed that pedaling at non-optimal cadence results in less attention being paid to external stimuli compared with pedaling at optimal cadence.

Validation of Potential Reference Measure for Indoor Walking Distance to Evaluate Wearable Sensing Devices. Annu Int Conf IEEE Eng Med Biol Soc 2021;2021:7178-7181. [PMID: 34892756 DOI: 10.1109/embc46164.2021.9629854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

The walking distance estimated from the coordinate position information of the center of mass obtained via Xsens MTw Awinda were validated from 5 adult volunteers and the accuracy was shown significantly high. (Average absolute error of -1.22% with a standard deviation of 2.26%).

Accuracy of Posture Estimation by ActiGraph and Development of Posture Prediction Model from Raw Acceleration Data

Full body motion tracking system was used to obtain accurate posture information under free-living condition and the accuracy of posture prediction by ActiGraph was verified. ActiGraph tends to detect people as standing when they are actually sitting. By combining a prediction model that detects posture change, lying posture, and walking from raw acceleration data obtained by ActiGraph, we were able to predict posture information with higher accuracy.Clinical Relevance- By combining model for predicting posture changes, lying posture, and walking from raw acceleration data obtained by ActiGraph, it is possible to obtain more accurate posture information.

Impact of the Pressure-Free Yutori Education Program on Myopia in Japan

This study aimed to investigate the influence of educational pressure on myopia. A less-intense school curriculum was introduced nationally in Japan beginning in 2012 based on a pressure-free education policy. In this retrospective observational study, a total of 1025 Japanese medical students of Asahikawa Medical University underwent measurements of the cycloplegic refractive error and axial length (AL), from 2011 to 2020. The spherical equivalent (SE) and AL were correlated significantly with the fiscal year of births (p = 0.004 and p = 0.034, respectively) only during enforcement of the system of high-pressure education. The SE and AL regression rates during the two educational approaches differed significantly (p = 0.004 and p = 0.037, respectively). The prevalence of high myopia was correlated significantly (p < 0.001) only during the system of high-pressure education. The regression of the prevalence rate of high myopia during the two education approaches differed significantly (p = 0.010). The progression rates of myopia and increased prevalence of high myopia were observed only during high-pressure education, suggesting that not only ophthalmologists but also educators and the government should work on together to control the progression of myopia.

Altered somatosensory evoked potentials associated with improved reaction time in a simple sensorimotor response task following repetitive practice

INTRODUCTION

Repetitive practice of sensorimotor tasks is widely used for neurorehabilitation; however, it is unknown how practice alters sensory processing (e.g., recognition, discrimination, and attentional allocation) and associated cognitive processing, such as decision-making. The purpose of this study was to investigate whether long-latency somatosensory evoked potentials (SEPs) reflecting sensory processing, attention, and decision-making are altered by sensorimotor learning.

METHODS

Fifteen participants performed a simple sensorimotor response task (thumb opposition in response to surface electrical stimulation), with experimental recording sessions before and after three days of practice. We then compared multiple SEP waveforms and reaction times (RTs) between pre- and postpractice trials.

RESULTS

The RT was reduced after practice of three days, and we found a significant positive correlation between ΔRT and ΔN140_lat at F3, Cz, and C3', ΔRT and ΔN250_lat at F3, and there was a significant negative correlation between ΔRT and ΔP300_amp at C3'.

CONCLUSION

The present study suggests that motor learning improves somatosensory processing and attentional allocation via neuroplasticity and that these alterations are reflected by specific SEP changes.

Comparison of the sacral table angles by progression stage of lumbar spondylolysis

STUDY DESIGN

Retrospective study.

OBJECTIVES

The purpose of this study was to investigate sacral table angle (STA) values in early-stage spondylolysis. Several studies suggested that the STA of patients with L5 spondylolysis or spondylolisthesis was significantly lower than that of healthy controls. Separation of the pars interarticularis creates shear stress between the upper sacral end plate and L5 vertebra. This was considered the cause of low STA in patients with spondylolysis or spondylolisthesis. However, if a low STA value is obtained in the early stage of L5 spondylolysis, it suggests that low STA does not result in the remodeling of the sacral end plate.

METHODS

Patients with L5 spondylolysis and those with low back pain without pars defect were retrospectively identified from a hospital database in 2014-2016. Pars defect of the spondylolysis was classified into three categories based on CT and MRI results: early, progressive, or terminal stage. The STA difference between groups was calculated using one-way analysis of variance and Scheffe F test, which were used for post hoc testing.

RESULTS

A total of 84 cases of L5 spondylolysis and 70 cases of low back pain were identified. No significant difference was found between the STAs of the early- or progressive-stage spondylolysis and the terminal-stage L5 spondylolysis and low back pain patients. The STA of the terminal-stage L5 spondylolysis was significantly lower than that of low back pain patients.

CONCLUSIONS

In conclusion, patients with early- or progressive-stage spondylolysis do not have low STA. Low STA is seen only in patients with terminal-stage spondylolysis, suggesting that low STA is associated with remodeling changes in response to shear force after onset of spondylolysis. STA value might not important as a prognostic parameter about development of the spondylolysis.

LEVEL OF EVIDENCE

Level IV.

Conversion of a conventional superconductor into a topological superconductor by topological proximity effect

Realization of topological superconductors (TSCs) hosting Majorana fermions is a central challenge in condensed-matter physics. One approach is to use the superconducting proximity effect (SPE) in heterostructures, where a topological insulator contacted with a superconductor hosts an effective p-wave pairing by the penetration of Cooper pairs across the interface. However, this approach suffers a difficulty in accessing the topological interface buried deep beneath the surface. Here, we propose an alternative approach to realize topological superconductivity without SPE. In a Pb(111) thin film grown on TlBiSe₂, we discover that the Dirac-cone state of substrate TlBiSe₂ migrates to the top surface of Pb film and obtains an energy gap below the superconducting transition temperature of Pb. This suggests that a Bardeen-Cooper-Schrieffer superconductor is converted into a TSC by the topological proximity effect. Our discovery opens a route to manipulate topological superconducting properties of materials.

Realizing topological superconductivity is essential for applicable fault-tolerant quantum computation. Here, Trang et al. report migration of Dirac-cone from TlBiSe₂ substrate to top surface of superconducting Pb film due to topological proximity effect, suggesting realization of topological superconductivity.

Association of preoperative inflammation-based prognostic score with survival in patients undergoing salvage esophagectomy

Salvage esophagectomy (SALV) is potentially beneficial for patients with residual or relapsed esophageal carcinoma after definitive chemoradiotherapy (dCRT), although preoperatively identifying good candidates for SALV remains difficult. We investigated the prognostic impacts of inflammatory and nutritional status in patients undergoing SALV after dCRT. Forty-seven SALV patients were retrospectively reviewed, of whom 46 (98%) had squamous cell carcinoma and 1 (2%) adenocarcinoma. Possible prognostic factors included patients' demographic data, physical status, blood chemistry profiles, and clinical/pathological tumor features. The Glasgow prognostic score (GPS) was derived from preoperative C-reactive protein (CRP) and albumin values. Thirty (64%), 11 (23%), and 6 (13%) patients were classified into the GPS 0, 1, and 2, respectively, groups. None of the possible prognostic factors showed significant correlations with GPS. Patients with GPS 0 had better outcomes than those with GPS 1 or GPS 2 (Median survivals: 37.8, 15.9, and 5.1 months, respectively, P < 0.001). In the multivariable Cox proportional hazards model, GPS 1 (HR 5.62, 95% CI 1.94-16.4, P = 0.002), GPS 2 (HR 9.10, 95% CI 2.60-31.8, P < 0.001), R1/2 resection (HR 16.3, 95% CI 3.62-86.7, P < 0.001) and incomplete response to dCRT (HR 3.53, 95% CI 1.12-12.5, P = 0.03) were all independent risk factors for a poor outcome. Preoperative GPS is potentially useful for predicting outcomes in esophageal cancer patients undergoing SALV.

Segmental Lordosis of the Spondylolytic Vertebrae in Adolescent Lumbar Spondylolysis: Differences between Bilateral L5 and L4 Spondylolysis

Study Design

Retrospective study.

Purpose

This study aimed to investigate whether segmental lumbar hyperlordosis of the affected vertebra in patients with spondylolysis occurs only at L5 or also occurs at L4.

Overview of Literature

To the best of our knowledge, increase in segmental lordosis of the spondylolytic vertebrae has only been investigated in bilateral L5 spondylolysis; it has not been examined at different levels of bilateral spondylolysis. According to the characteristics of segmental lordosis in bilateral L5 spondylolysis, patients with bilateral L4 spondylolysis may also have increased segmental lordosis of the L4 vertebra.

Methods

Patients with bilateral spondylolysis of the L5 or L4 vertebra in 2013–2015 were retrospectively identified from the hospital database. Standing lateral lumbar radiographs were assessed for the angle of segmental lordosis of the L5 and L4 vertebra, sacral slope, and lumbar lordosis. The differences in segmental lordosis of the L5 and L4 vertebra, sacral slope, and lumbar lordosis were determined using non-paired Student t-test.

Results

Overall, 15 cases of bilateral L4 spondylolysis and 41 cases of bilateral L5 spondylolysis satisfied the inclusion and exclusion criteria. Lordosis of the L4 vertebra was significantly greater in the bilateral L4 spondylolysis group (24.2°±7.0°) than that in the L5 spondylolysis group (20.3°±6.1°, p=0.047). Lordosis of the L5 vertebra was significantly lower in the L4 spondylolysis group (27.7°±8.2°) than that in the L5 spondylolysis group (32.5°±7.3°, p=0.040). The sacral slope and lumbar lordosis did not significantly differ between the groups.

Conclusions

Adolescent patients with bilateral spondylolysis have segmental hyperlordosis of the affected vertebra not only at the L5 level but also at the L4 level.

Weak localization in bilayer graphene with Li-intercalation/desorption

We performed in-situ electrical transport measurements for bilayer graphene grown on SiC(0 0 0 1) substrate, Li-intercalated bilayer graphene, and after that desorbing Li atoms by heating. Bilayer graphene after desorbing intercalated Li atoms showed a higher resistivity and different behavior in magnetoconductance compared to pristine bilayer graphene. We observed the weak localization of carriers at low temperatures in all the three samples and analyzed the experimental results with the extended Hikami-Larkin-Nagaoka equation to investigate the transport properties. The result shows that the magnetoconductance of pristine bilayer graphene is described by the AB stacking structure model and the phase breaking scattering is dominated by the electron-electron scattering. The intra-valley scattering occurs most frequently probably due to dopants in SiC substrate. However, in Li-desorbed graphene, the magnetoconductance can be described by neither AB nor AA-stacking model, suggesting the coexistence of domains with several different stacking structures.

Cortical Oxyhemoglobin Elevation Persists After Moderate-Intensity Cycling Exercise: A Near-Infrared Spectroscopy Study

Near-infrared spectroscopy (NIRS) can measure cortical activity during gross motor tasks based on the cerebral hemodynamic response. Although some reports suggest that cycling exercise improves cortical oxygenation, its after-effects are unknown. We examined the after-effects of low- and moderate-intensity cycling exercise on cortical oxygenation. Ten healthy volunteers (mean age 21.3 ± 0.7 years; 4 women) underwent cycle ergometer exercise at 30% or 50% of VO₂peak for 20 min, followed by an 8-min post-exercise rest (PER). O₂Hb levels of the supplementary motor area (SMA) and sensorimotor cortex (SMC) were recorded using a near-infrared spectroscopy system. Skin blood flow (SBF) and mean arterial pressure (MAP) were continuously measured. The peak values of O₂Hb between exercise and PER were compared. The O₂Hb, SBF, and MAP increased in the exercise phase. SBF degraded over time, and MAP decreased immediately after exercise. The O₂Hb decreased immediately and increased again in the PER. There were no significant differences between exercise and PER in the SMC in the 30% VO₂peak experiment or in the SMA and SMC in the 50% VO₂peak experiment. The O₂Hb in the motor-related area was elevated during both exercise and PER especially in the 50% VO₂peak experiment.

Electrical Stimulation of Denervated Rat Skeletal Muscle Ameliorates Bone Fragility and Muscle Loss in Early-Stage Disuse Musculoskeletal Atrophy

We tested whether daily muscle electrical stimulation (ES) can ameliorate the decrease in cortical bone strength as well as muscle and bone geometric and material properties in the early stages of disuse musculoskeletal atrophy. 7-week-old male F344 rats were randomly divided into three groups: age-matched control group (Cont); a sciatic denervation group (DN); and a DN + direct electrical stimulation group (DN + ES). Denervated tibialis anterior (TA) muscle in the DN + ES group received ES with 16 mA at 10 Hz for 30 min/day, 6 days/week. Micro CT, the three-point bending test, and immunohistochemistry were used to characterize cortical bone mechanical, structural, and material properties of tibiae. TA muscle in the DN + ES group showed significant improvement in muscle mass and myofiber cross-sectional area relative to the DN group. Maximal load and stiffness of tibiae, bone mineral density estimated by micro CT, and immunoreactivity of DMP1 in the cortical bone tissue were also significantly greater in the DN + ES group than in the DN group. These results suggest that daily ES-induced muscle contraction treatment reduced the decrease in muscle mass and cortical bone strength in early-stage disuse musculoskeletal atrophy and is associated with a beneficial effect on material properties such as mineralization of cortical bone tissue.

Inhibitory effect of intensity and interstimulus interval of conditioning stimuli on somatosensory evoked magnetic fields

Magnetoencephalography (MEG) recordings were performed to investigate the inhibitory effects of conditioning stimuli with various types of interstimulus intervals (ISIs) or intensities on somatosensory evoked magnetic fields (SEFs) using a 306-ch whole-head MEG system. Twenty-three healthy volunteers participated in this study. Electrical stimuli were applied to the right median nerve at the wrist. Six pulse trains with ISIs of 500 ms were presented in Experiment 1. A paired-pulse paradigm with three kinds of conditioning stimulus (CON) intensities, 500 ms before the test stimulus (TS), was applied in Experiment 2. Finally, three CONs 500 or 1000 ms before TS were presented in Experiment 3. Three main SEF deflections (N20m, P35m, and P60m) were observed, and the source activities of P35m and P60m significantly decreased after the 2nd pulse of a six pulse trains. These source activities also significantly decreased with increasing intensity of CON. In addition, these attenuations of source activities were affected by CON-CON or CON-TS intervals. These results indicated that the source activities were modulated by the intensity and ISIs of CONs. Furthermore, P35m after the stimulation were very sensitive to CONs; however, the attenuation of P60m after the stimulation lasted for a longer period than that of P35m. Our findings suggest that the conditioning stimulation had inhibitory effects on subsequent evoked cortical responses for more than 500 ms. Our results also provide important clues about the nature of short-latency somatosensory responses in human studies.

Enhancement of electron-phonon coupling in Cs-overlayered intercalated bilayer graphene

We have performed high-resolution angle-resolved photoemission spectroscopy (ARPES) on cesium (Cs) intercalated bilayer graphene with a Cs overlayer (Cs-C8CsC8). Low-energy electron diffraction shows a (2  ×  2) pattern consistent with intercalation of a Cs layer similar to bulk C8Cs, in addition to the signature of a nearly commensurate superstructure created by the Cs overlayer. ARPES results reveal folding of the π bands due to the periodic (2  ×  2) potential of the intercalated Cs atoms, together with a free-electron-like state at the [Formula: see text] point. Significant mass renormalization is observed in the band dispersion near the Fermi level, indicative of strong electron-phonon coupling. Based on analysis of the self-energy, we find anisotropic electron-phonon coupling with an estimated strength of [Formula: see text]  ±  0.02 in the K-[Formula: see text] direction, and [Formula: see text] in the K-M direction. This coupling is much larger than that of other doped graphenes, and comparable to superconducting bulk GICs. We attribute this large electron-phonon coupling constant to the presence of the Cs overlayer, which highly dopes [Formula: see text] bands, and creates a structure similar to stage-I graphite intercalation compounds.

Effect of Transcranial Direct Current Stimulation over the Primary Motor Cortex on Cerebral Blood Flow: A Time Course Study Using Near-infrared Spectroscopy

Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that is applied during stroke rehabilitation. The purpose of this study was to examine diachronic intracranial hemodynamic changes using near-infrared spectroscopy (NIRS) during tDCS applied to the primary motor cortex (M1). Seven healthy volunteers were tested during real stimulation (anodal and cathodal) and during sham stimulation. Stimulation lasted 20 min and NIRS data were collected for about 23 min including the baseline. NIRS probe holders were positioned over the entire contralateral sensory motor area. Compared to the sham condition, both anodal and cathodal stimulation resulted in significantly lower oxyhemoglobin (O2Hb) concentrations in the contralateral premotor cortex (PMC), supplementary motor area (SMA), and M1 (p<0.01). Particularly in the SMA, the O2Hb concentration during anodal stimulation was significantly lower than that during the sham condition (p<0.01), while the O2Hb concentration during cathodal stimulation was lower than that during anodal stimulation (p<0.01). In addition, in the primary sensory cortex, the O2Hb concentration during anodal stimulation was significantly higher than the concentrations during both cathodal stimulation and the sham condition (p<0.05). The factor of time did not demonstrate significant differences. These results suggest that both anodal and cathodal tDCS cause widespread changes in cerebral blood flow, not only in the area immediately under the electrode, but also in other areas of the cortex.

Correlation Between the Cerebral Oxyhaemoglobin Signal and Physiological Signals During Cycling Exercise: A Near-Infrared Spectroscopy Study

Near-infrared spectroscopy (NIRS) is a widely used noninvasive method for measuring human brain activation based on the cerebral haemodynamic response. However, systemic changes can influence the signal's parameters. Our study aimed to investigate the relationships between NIRS signals and skin blood flow (SBF) or blood pressure during dynamic movement. Nine healthy volunteers (mean age, 21.3 ± 0.7 years; 6 women) participated in this study. The oxyhaemoglobin (O2Hb) signal, SBF, and mean arterial pressure (MAP) were measured while the volunteers performed multi-step incremental exercise on a bicycle ergometer, at workloads corresponding to 30, 50, and 70 % of peak oxygen consumption (VO2peak) for 5 min. The Pearson's correlation coefficients for the O2Hb signal and SBF at 50 and 70 % VO2peak were 0.877 (P < 0.01) and -0.707 (P < 0.01), respectively. The correlation coefficients for O2Hb and MAP during warm-up, 30 % VO2peak, and 50 % VO2peak were 0.725 (P < 0.01), 0.472 (P < 0.01), and 0.939 (P < 0.01), respectively. Changes in the state of the cardiovascular system influenced O2Hb signals positively during low and moderate-intensity exercise, whereas a negative relationship was observed during high-intensity exercise. These results suggest that the relationship between the O2Hb signal and systemic changes is affected by exercise intensity.

Switching of Dirac-Fermion Mass at the Interface of Ultrathin Ferromagnet and Rashba Metal

We have performed spin- and angle-resolved photoemission spectroscopy on tungsten (110) interfaced with an ultrathin iron (Fe) layer to study an influence of ferromagnetism on the Dirac-cone-like surface-interface states. We found an unexpectedly large energy gap of 340 meV at the Dirac point, and have succeeded in switching the Dirac-fermion mass by controlling the direction of Fe spins (in plane or out of plane) through tuning the thickness of the Fe overlayer or adsorbing oxygen on it. Such a manipulation of Dirac-fermion mass via the magnetic proximity effect opens a promising platform for realizing new spintronic devices utilizing a combination of exchange and Rashba-spin-orbit interactions.

Regional Changes in Cerebral Oxygenation During Repeated Passive Movement Measured by Functional Near-infrared Spectroscopy

The aim of this study is to investigate the influence of passive movement repetition frequency at 1.5-Hz and 1-Hz on changes in cerebral oxygenation and assess the temporal properties of these changes using functional near-infrared spectroscopy (fNIRS). No significant differences in systemic hemodynamics were observed between resting and passive movement phases for either 1.5-Hz or 1-Hz trial. Changes in cortical oxygenation as measured by fNIRS in bilateral supplementary motor cortex (SMC), left primary motor cortex (M1), left primary somatosensory cortex (S1), and left posterior association area (PAA) during passive movement of the right index finger revealed greater cortical activity at only 1.5-Hz movement frequency. However, there were no significant differences in the time for peak oxyhemoglobin (oxyHb) among regions (bilateral SMC, 206.4 ± 14.4 s; left M1, 199.1 ± 14.8 s; left S1, 207.3 ± 9.4 s; left PAA, 219.1 ± 10.2 s). Therefore, our results that passive movement above a specific frequency may be required to elicit a changed in cerebral oxygenation, and the times of peak ΔoxyHb did not differ significantly among measured regions.

Skill-Specific Changes in Somatosensory Nogo Potentials in Baseball Players

Athletic training is known to induce neuroplastic alterations in specific somatosensory circuits, which are reflected by changes in somatosensory evoked potentials and event-related potentials. The aim of this study was to clarify whether specific athletic training also affects somatosensory Nogo potentials related to the inhibition of movements. The Nogo potentials were recorded at nine cortical electrode positions (Fz, Cz, Pz, F3, F4, C3, C4, P3 and P4) in 12 baseball players (baseball group) and in 12 athletes in sports, such as track and field events and swimming, that do not require response inhibition, such as batting for training or performance (sports group). The Nogo potentials and Go/Nogo reaction times (Go/Nogo RTs) were measured under a somatosensory Go/Nogo paradigm in which subjects were instructed to rapidly push a button in response to stimulus presentation. The Nogo potentials were obtained by subtracting the Go trial from the Nogo trial. The peak Nogo-N2 was significantly shorter in the baseball group than that in the sports group. In addition, the amplitude of Nogo-N2 in the frontal area was significantly larger in the baseball group than that in the sports group. There was a significant positive correlation between the latency of Nogo-N2 and Go/Nogo RT. Moreover, there were significant correlations between the Go/Nogo RT and both the amplitude of Nogo-N2 and Nogo-P3 (i.e., amplitude of the Nogo-potentials increases with shorter RT). Specific athletic training regimens may induce neuroplastic alterations in sensorimotor inhibitory processes.

Changes of epidural blood flow after epidural administration of epinephrine in young rats

PURPOSE

For caudal epidural analgesia, the needle is inserted at a site where vessels are abundant. To avoid complications related to intravascular administration of the local anesthetic, epinephrine is usually added, but there is no evidence about the safety of epidural administration of epinephrine in pediatric patients. The objective of this study was to assess the changes in epidural blood flow after epidural injection of epinephrine in young rats.

METHODS

With approval of the local ethics committee, four young Sprague-Dawley rats weighing 110-120 g were investigated. The rats were anesthetized with isoflurane via a mask. After there was no escape reaction to pain, an arterial catheter, epidural blood flow monitor (Laser Doppler blood flow ALF 21; ADVANCE Corp.), and caudal epidural catheter were inserted while the rats remained under general anesthesia. Exactly, 10 μl of 1 : 1000 epinephrine was then infused, followed by measurement of the blood pressure and epidural blood flow. After the recovery of the blood pressure and epidural blood flow to baseline, 10 μl of saline was infused through the epidural catheter. The blood pressure and epidural blood flow were then measured again.

RESULTS

One rat was excluded because epinephrine was inadvertently injected into the epidural vessels. Therefore, three rats were investigated in this experiment. Blood flow in the epidural space showed no change after the injection of saline. When epinephrine was administered into the epidural space, epidural blood flow decreased immediately and low flow persisted for 6-15 min. The reduction of blood flow was not very great, being only 8-14%, so there was no risk of spinal ischemia which would require 60-80% reduction.

CONCLUSION

Administration of epinephrine into the epidural space was safe in young rats. While reduction of epidural blood flow was observed, there was no spinal ischemia.

Effect of electrical stimulation-induced muscle force and streptomycin treatment on muscle and trabecular bone mass in early-stage disuse musculoskeletal atrophy

OBJECTIVES

The aim was to determine whether daily muscle electrical stimulation (ES) and streptomycin treatment would have positive or negative effects on trabecular bone mass in disuse rats.

METHODS

Seven-week-old male F344 rats were randomly divided into five groups of eight animals each: an age-matched control group (CON); a sciatic denervation group (DN); a DN + direct electrical stimulation group (DN+ES); a DN + streptomycin treatment group (DN+SM); and a DN+ES+SM group. The tibialis anterior (TA) muscles in all ES groups were stimulated with 16mA at 10Hz for 30 min/day, six days/week, for one week. Bone volume and structure were evaluated using micro-CT, and histological examinations of the tibiae were performed.

RESULTS

Direct ES significantly reduced the disuse-induced trabecular bone loss. Osteoid thickness were also significantly greater in the ES groups than in the DN group. Micro CT and histomorphological parameters were significantly lower in the DN+ES+SM group than in the DN+ES group, while there were no significant differences between the DN and DN+SM groups.

CONCLUSIONS

These results suggest that ES-induced muscle force reduced trabecular bone loss, and streptomycin treatment did not induce bone loss, but attenuated the effects of ES-induced muscle force on reducing the loss of disused bone.

High-temperature superconductivity in potassium-coated multilayer FeSe thin films

The recent discovery of possible high-temperature (T(c)) superconductivity over 65 K in a monolayer FeSe film on SrTiO3 (refs 1-6) triggered a fierce debate on how superconductivity evolves from bulk to film, because bulk FeSe crystal exhibits a T(c) of no higher than 10 K (ref. 7). However, the difficulty in controlling the carrier density and the number of FeSe layers has hindered elucidation of this problem. Here, we demonstrate that deposition of potassium onto FeSe films markedly expands the accessible doping range towards the heavily electron-doped region. Intriguingly, we have succeeded in converting non-superconducting films with various thicknesses into superconductors with T(c) as high as 48 K. We also found a marked increase in the magnitude of the superconducting gap on decreasing the FeSe film thickness, indicating that the interface plays a crucial role in realizing the high-temperature superconductivity. The results presented provide a new strategy to enhance and optimize T(c) in ultrathin films of iron-based superconductors.

Depression of corticomotor excitability after muscle fatigue induced by electrical stimulation and voluntary contraction

In this study, we examined the effect of muscle fatigue induced by tetanic electrical stimulation (ES) and submaximal isometric contraction on corticomotor excitability. Experiments were performed in a cross-over design. Motor-evoked potentials (MEPs) were elicited by transcranial magnetic stimulation (TMS). Corticomotor excitability was recorded before and after thumb opposition muscle fatigue tasks, in which 10% of the maximal tension intensity was induced by tetanic ES or voluntary contraction (VC). The participants were 10 healthy individuals who performed each task for 10 min. Surface electrodes placed over the abductor pollicis brevis (APB) muscle recorded MEPs. F- and M-waves were elicited from APB by supramaximal ES of the median nerve. After the tetanic ES- and VC tasks, MEP amplitudes were significantly lower than before the task. However, F- and M-wave amplitudes remained unchanged. These findings suggest that corticospinal excitability is reduced by muscle fatigue as a result of intracortical inhibitory mechanisms. Our results also suggest that corticomotor excitability is reduced by muscle fatigue caused by both VC and tetanic ES.

Maximum Power During Vertical Jump and Isometric Knee Extension Torque Alter Mobility Performance: A Cross-Sectional Study of Healthy Individuals

OBJECTIVE

To provide reference values of muscle function (MF) and mobility performance (MP) and to clarify the effects of MF on MP.

DESIGN

A normative cross-sectional study.

SETTING

An urban area of Niigata, Japan.

PARTICIPANTS

A total of 401 individuals (210 men and 191 women) with a mean age of 41.8 years (range, 7-79 years) who lived in the community and did not have impairments in activities of daily living.

METHODS

Grip strength, isometric knee extension torque (IKET), and maximum ground reaction force (Fmax) and maximum power (Pmax) during a vertical jump were used as measurements of MF. The chair-rise test (CRT) and the timed "Up and Go" test (TUG) were used to assess MP.

MAIN OUTCOME MEASUREMENTS

Mean values of GS, IKET, CRT, TUG, Fmax, and Pmax were calculated according to age and gender. A stepwise multiple regression analysis was used to identify MF factors with an effect on CRT and TUG in participants ≥20 years of age.

RESULTS

Our results showed that all MF parameters were decreased in individuals ≥20 years of age compared to those <20 years old. Moreover, all of the MP parameters increasingly deteriorated with increasing age. CRT and TUG were affected by Pmax and IKET in men and by IKET in women according to logistic regression analysis.

CONCLUSION

The study findings suggest that muscle power affects MP more than the muscle strength in persons aged ≥20 years.