A gravitational contribution to perceived body weight

The weightlessness experienced by astronauts has fascinated scientists and the public. On Earth, body weight is given by Newton’s laws as mass times gravitational acceleration. That is, an object’s weight is determined by the pull of gravity on it. We hypothesised that perceived body weight is – like actual weight – dependent on the strength of gravity. If so, changes in the experienced strength of gravity should alter the experience of one’s own body weight. We asked participants to estimate the weight of two body parts, their hand or their head, both in normal terrestrial gravity (1 g) and during exposure to experimentally altered gravitational fields, 0 g and +1.8 g during parabolic flight and +1 g using a short arm human centrifuge. For both body parts, there was an increase in perceived weight during the experience of hypergravity, and a decrease during the experience of microgravity. Our results show that experimental alterations of gravity produce rapid changes in the perceived weight of specific individual body parts. Traditionally, research has focused on the social factors for weight perception, as in the putative role of mass media in eating disorders. Our results, in contrast, emphasize that the perception of body weight is highly malleable, and shaped by immediate sensory signals.

Are You Suggesting That's My Hand? The Relation Between Hypnotic Suggestibility and the Rubber Hand Illusion

Hypnotic suggestibility (HS) is the ability to respond automatically to suggestions and to experience alterations in perception and behavior. Hypnotically suggestible participants are also better able to focus and sustain their attention on an experimental stimulus. The present study explores the relation between HS and susceptibility to the rubber hand illusion (RHI). Based on previous research with visual illusions, it was predicted that higher HS would lead to a stronger RHI. Two behavioral output measures of the RHI, an implicit (proprioceptive drift) and an explicit (RHI questionnaire) measure, were correlated against HS scores. Hypnotic suggestibility correlated positively with the implicit RHI measure contributing to 30% of the variation. However, there was no relation between HS and the explicit RHI questionnaire measure, or with compliance control items. High hypnotic suggestibility may facilitate, via attentional mechanisms, the multisensory integration of visuoproprioceptive inputs that leads to greater perceptual mislocalization of a participant's hand. These results may provide insight into the multisensory brain mechanisms involved in our sense of embodiment.

Neural Mechanisms of Body Awareness in Infants

The ability to differentiate one's body from others is a fundamental aspect of social perception and has been shown to involve the integration of sense modalities attributable to the self. Though behavioral studies in infancy have investigated infants' discrimination of body-related multisensory stimuli, whether they attribute this information as belonging to the self is still unknown. In human adults, neuroimaging studies have demonstrated the recruitment of a specific set of brain regions in response to body-related multisensory integration. To test whether the infant brain integrates this information similarly to adults, in a first functional near-infrared spectroscopy study we investigated the role of visual–proprioceptive feedback when temporal cues are manipulated by showing 5-month-old infants an online video of their own face while the infant was performing movements. To explore the role of body-related contingency further, in a second study we investigated whether cortical activation in response to self-initiated movements and external tactile stimulation was similar to that found in the first study. Our results indicate that infants' specialized cortical activation in response to body-related contingencies is similar to brain activation seen in response to body awareness in adults.

Impact of rhinovirus nasopharyngeal viral load and viremia on severity of respiratory infections in children

There are few and partially discordant data regarding nasopharyngeal rhinovirus (RV) load and viremia, and none of the published studies evaluated the two variables together. The aim of this study was to provide new information concerning the clinical relevance of determining nasopharyngeal viral load and viremia when characterising RV infection. Nasopharyngeal swabs were obtained from 251 children upon their admission to hospital because of fever and signs and symptoms of acute respiratory infection in order to identify the virus and determine its nasopharyngeal load, and a venous blood sample was taken in order to evaluate viremia. Fifty children (19.9 %) had RV-positive nasopharyngeal swabs, six (12 %) of whom also had RV viremia: RV-C in four cases (66.6 %), and RV-A and RV-B in one case each. The RV nasopharyngeal load was significantly higher in the children with RV viremia (p < 0.001), who also had a higher respiratory rate (p = 0.02), white blood cell counts (p = 0.008) and C-reactive protein levels (p = 0.006), lower blood O2 saturation levels (P = 0.005), and more often required O2 therapy (p = 0.009). The presence of RV viremia is associated with a significantly higher nasopharyngeal viral load and more severe disease, which suggests that a high nasopharyngeal viral load is a prerequisite for viremia, and that viremia is associated with considerable clinical involvement.

Otorrhea in Kawasaki disease diagnosis complicated by an EBV infection: coincidental disease or a true association

The Authors report on two children affected by Kawasaki disease (KD). The diagnosis of KD was made after exclusion of conditions with similar presentation. At admission these children (cases 1 and 2) presented fever, purulent caseous pharyngotonsillitis, and cervical bilateral lymphadenopathy, as well as an erythematous non-vesicular rash over the face and trunk, and a mild bilateral non-exudative conjunctivitis in case 1. After respectively three and two days corticosteroid therapy was started without any significant improvement of the general condition and any diminutions of the fever. Two days later in case 1 the child presented a clear otorrhea, a cutaneous non vesicular rash, and soon after all the remaining signs of Kawasaki disease, in case 2 otorrhea was found after 4 days and then the other signs of the KD. These patients were treated with intravenous immunoglobulin (2 g/kg day), with an improvement of their general condition. To our knowledge we report the first cases of otorrhea in the setting of Kawasaki disease. We cannot exclude that the presence of Kawasaki disease in the context of otorrhea in children positive for Epstein-Barr virus (EBV) is merely coincidental. Besides, recent acquisitions show that KD is due to a new virus that could cross-react with the EBV. The Authors conclude that the presence of EBV infection or similar condition in a febrile child may not exclude Kawasaki disease and a differential diagnosis has to be performed for a timely commencement of intravenous immunoglobulin therapy.  

Tracheostomy in childhood: new causes for an old strategy

INTRODUCTION

A review of the available literature has shown that the indications, epidemiology, and complications for tracheostomies are changing, and that no definite guidelines have been established. In the 1970s, the most common indication for tracheostomies in children was acute inflammatory airway obstruction. Modern neonatal intensive care units (ICU) have turned long-term intubation into an alternative to a tracheostomy. Currently, long-term intubation has become the most important indication for tracheostomies in children.

PATIENTS AND METHODS

We present our series involving tracheostomies performed in paediatric patients between 2004 and 2008 at our hospital. Sixteen patients underwent tracheostomies for respiratory failure and upper airway obstruction.

RESULTS

The total complications rate was 37.5%. In children < 1 year of age, the complications rate was 25%, while in children > 1 year of age, the complications rate was 12.5%.

CONCLUSIONS

Long-term intubation and its sequelae have now become one of the most important indications for tracheostomies in the paediatric age group.

Increased plasticity of the bodily self in eating disorders

BACKGROUND

The rubber hand illusion (RHI) has been widely used to investigate the bodily self in healthy individuals. The aim of the present study was to extend the use of the RHI to examine the bodily self in eating disorders (EDs).

METHOD

The RHI and self-report measures of ED psychopathology [the Eating Disorder Inventory - 3 (EDI-3) subscales of Drive for Thinness, Bulimia, Body Dissatisfaction, Interoceptive Deficits, and Emotional Dysregulation; the 21-item Depression, Anxiety and Stress Scale (DASS-21); and the Self-Objectification Questionnaire (SOQ)] were administered to 78 individuals with an ED and 61 healthy controls.

RESULTS

Individuals with an ED experienced the RHI significantly more strongly than healthy controls on both perceptual (i.e. proprioceptive drift) and subjective (i.e. self-report questionnaire) measures. Furthermore, both the subjective experience of the RHI and associated proprioceptive biases were correlated with ED psychopathology. Approximately 23% of the variance for embodiment of the fake hand was accounted for by ED psychopathology, with interoceptive deficits and self-objectification significant predictors of embodiment.

CONCLUSIONS

These results indicate that the bodily self is more plastic in people with an ED. These findings may shed light on both aetiological and maintenance factors involved in EDs, particularly visual processing of the body, interoceptive deficits, and self-objectification.

Acute asthma in children: treatment in emergency

BACKGROUND AND OBJECTIVE

Asthma is one of the most common chronic diseases, leading to an increased rate of hospitalization.

MATERIAL AND METHODS

The aim of this report is to review the current concepts and treatment of asthmatic children, focusing our attention on the treatment of children in a Department of Pediatric Emergency.

DISCUSSION

Frequent respiratory infections, personal or familial allergy, disease severity and young age are important factors leading to hospitalization. However, regular clinical follow-up and use of inhaled corticosteroids, the IgE levels and O2 saturation may reduce the probability of hospitalization during asthma attacks. The diagnosis of asthma in children is based on recognizing a characteristic pattern of episodic respiratory symptoms and signs, in the absence of an alternative explanation for them. The presence of these factors increases the probability that a child with respiratory symptoms will have asthma. These factors include age at presentation; sex; severity and frequency of previous wheezing episodes; coexistence of atopic disease; family history of atopy; and abnormal lung function.

CONCLUSION

Asthma is a chronic condition that often remains uncontrolled for reasons that may be related to the disease process itself, the management decisions of clinicians, the patient's perceptions of disease control or self-management behaviors, the cost of medications, or a combination of all of these factors. To this end, patients with asthma should be educated not to accept a certain level of symptoms or activity limitations as an inevitable consequence of asthma. Both the levels of current impairment and the future risks (of asthma exacerbations or adverse medication effects) should be used to inform decisions about appropriate levels of asthma therapy, and physicians should be aware of the new medication recommendations.

Upper extremity prone position exercise as aerobic capacity indicator

Peak oxygen uptake of prone upper extremity exercise (VO2peak arm) compared with maximal oxygen uptake of upright lower extremity cycling (VO2max leg) was examined in an unselected young healthy male population (n = 21). The large standard deviation of the mean value of VO2peak arm expressed as a percentage of VO2max leg (60.48% +/- 11.84%) discourages use of a maximal upper extremity exercise test to predict total body aerobic capacity (r = 0.595 p = 0.002). However, the relationship between VO2peak arm and VO2max leg was influenced by the individual's cardiorespiratory fitness and capacity to perform either arm or leg work. When the population was divided into subgroups according to cardiorespiratory fitness or when subjects previously trained for either arm or leg work were excluded from analysis, the predictive power of VO2peak arm improved. (r = 0.946 p less than 0.001). Study results suggest that with careful analysis of subjects' fitness prior to upper extremity exercise testing, such exercise in a prone position can indicate aerobic capacity and may be used for fitness training when lower limb disabilities exist.

The electrocardiographic response to maximal treadmill exercise of asymptomatic men with left bundle branch block

This study presents the results of maximal treadmill testing and coronary angiography in 31 asymptomatic USAF aircrewmen with acquired left bundle branch block. There were two subgroups: 26 men with normal coronary angiography and five men with significant angiographic coronary angiography and five men with significant angiographic coronary artery disease. The mean amount of maximal ST-segment depression induced by treadmill exercise was --0.5 mv. for both groups and the range in the normal subgroup was --0.3 to --1.0 mv. No significant differences were found between the groups. We concluded that apparently healthy, asymptomatic men with acquired left bundle branch block can have considerable ST-segment depression in response to maximal treadmill testing and that their ST-segment response cannot be used to make diagnostic decisions about them.

The electrocardiographic response to maximal treadmill exercise of asymptomatic men with right bundle branch block

This study presents the results of maximal treadmill testing and cardiac catheterization in 40 asymptomatic and apparently healthy men with acquired right bundle-branch block. Eight of the men had significant angiographic coronary artery disease, and six of the eight only had single-vessel disease. The 40 men had normal maximal oxygen consumptions, normal maximal heart rates, and normal maximal blood pressure responses; none of the men had abnormal ST-segment changes in response to maximal treadmill testing. Thus, the sensitivity of exercise testing for coronary artery disease in men with right bundle branch block is uncertain. However, the apparently high specificity of exercise testing demonstrated by this study necessitates further evaluation for coronary artery disease in men with right bundle branch block who develop abnormal ST-segment depression in response to exercise testing.

Angiographic findings in asymptomatic aircrewmen with electrocardiographic abnormalities

Cardiac catheterization was used to evaluate 298 asymptomatic, apparently healthy aircrewmen with electrocardiographic abnormalities. These men were identified from annual electrocardiograms and exercise tests used to screen for latent heart disease. Data from 27 additional symptomatic aircrewmen who underwent cardiac catheterization because of mild probable angina pectoris are also included. The men were grouped according to major reason for cardiac catheterization. The order of groups by increasing prevalence of coronary artery disease was as follows: abnormal treadmill test (labile lead only), supraventricular tachycardia, right bundle branch block, left bundle branch block, abnormal treadmill test, ventricular irritability, probable infarct and angina. Approximately 60 percent of the men were completely free of angiographic coronary artery disease. Risk factors and other possible causes for the electrocardiographic abnormalities are discussed. The electrocardiographic abnormalities studied have a poorer predictive value for coronary artery disease in asymptomatic apparently healthy men than in a hospital or clinic population.

A comparison of two bipolar exercise electrocardiographic leads to lead V5

ST-segment depression and slope were compared in three lead systems (V5, CC5, and CM5) and in two groups of patients using both visual analysis of electrocardiographic paper and computerized techniques. Bipolar lead CC5 was found to be comparable to lead V5 when visual analysis of electrocardiographic recordings was utilized. Bipolar lead CM5 was found not to be comparable to lead V5 and to be less sensitive if classic criteria for slope were used. The technique of computerized analysis mad measurements of slope and amplitude to a reproducible level not possible with the standard technique. Statistically significant differences were found between the exercise electrocardiographic leads utilizing computerized electrocardiographic analysis . We conclude that computerized techniques of electrocardiographic analysis require new criteria for defining an abnormal repolarization response. The criteria must be specific for different electrocardiographic leads if the repolarization changes in these leads are to have comparable diagnostic significance.

Care of patients after cardiac catheterization

In an effort to provide more definitive diagnosis for Air Force flyers referred to the USAF School of Aerospace Medicine, cardiac catherization has been performed, as indicated, on over 425 flyers since 1971. Since they are an apparently healthy and asymptomatic population, their recovery after cardiac catheterization is usually uneventful. However, the nurse must be able to recognize and interpret significant potential and/or existing post-catheterization complications. Nursing care of the patient after this procedure is essential to the successful completion of the test. Since any invasive procedure can lead to complications, quick and accurate nursing assessment and action are essential. The possible complications of cardiac catheterization which the nurse may encounter have been divided into possible causes, and a suggested plan of action. Reference tables are provided for each of the two main classifications, in an effort to provide quick guidance for the nurse responsible for care of the patients after catheterization.

Value of exercise testing for screening asymptomatic men for latent coronary artery disease

Treadmill exercise testing identifies a group of men at high risk for coronary atherosclerotic heart disease. However, the predictive value and sensitivity limitations are obvious. An abnormal electrocardiographic response does not absolutely predict the presence of coronary atherosclerotic heart disease, and a normal response does not rule out this possibility. Thus in appropriate instances when the minimal risk of coronary angiography is justified this procedure can be used to determine the anatomic correlation of exercise-induced functional ST-segment changes.

Normal values and commonly used echocardiographic formulae for adults

Echocardiography is a valuable and widespread clinical and research tool. The normal parameters and formulae for adults are widely dispersed throughout the medical literature. The purpose of this paper is to present, in a single source, the already acquired normal values and formulae used in the field.

Normal coronary angiography in an aircrewman with serial exercise test changes

A 45-year-old asymptomatic aircrewman is presented who developed an abnormal ST segment response to maximal treadmill testing after normal responses for 3 previous years. Coronary angiography performed after his abnormal stress test reveled no change from a previously normal study. It has been demostrated that serially performing exercise tests can increase the sensitivity of detecting latent coronary artery disease. The importance of the case report is to demonstrate that the change from a normal exercise test to an abnormal one does not absolutely indicate that an individual has a coronary artery disease and that it is mandatory to search for other possible causes. Further studies will be required to determine the significance of such serial changes.