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Biomedical subjects

D Wilson

Publications and source records attributed to D Wilson.

At least 109 records · Page 6Linked to original sources

Prognostic value of magnetic resonance imaging in the management of fistula-in-ano.

PURPOSE: Magnetic resonance imaging of fistula-in-ano has been shown to predict surgical anatomy accurately and identify complex features. In addition, fistula complexity has been correlated with poor outcome after surgical intervention. We investigated whether preoperative magnetic resonance imaging could predict clinical outcome after surgery for fistulous disease better than clinical examination under anesthetic. METHODS: Seventy patients with clinically suspected fistula-in-ano underwent preoperative dynamic contrast-enhanced magnetic resonance imaging before surgical exploration. Outcome was assessed at a minimum of one year after surgical exploration and correlated in a blinded fashion with the surgical and magnetic resonance grading of the severity of the fistulous disease. RESULTS: Of 70 patients, 12 were not operated on and 6 were lost to follow-up, making 52 patients eligible for analysis. Assessment by dynamic contrast-enhanced magnetic resonance imaging more accurately predicted outcome than the findings at initial surgical exploration. Dynamic contrast-enhanced magnetic resonance imaging had a sensitivity of 81 percent, specificity of 73 percent, and positive predictive value of 75 percent; surgery had a sensitivity of 77 percent, specificity of 46 percent, and positive predictive value of 59 percent. Surgical assessment of apparent disease severity bore no relation to final outcome. Dynamic contrast-enhanced magnetic resonance imaging could accurately predict whether patients were likely to have a satisfactory or unsatisfactory outcome after surgery. CONCLUSION: Dynamic contrast-enhanced magnetic resonance imaging better predicts clinical outcome of patients with fistula-in-ano than initial surgical exploration.

Adult↗

Conformational transitions in model silk peptides.

Protein structural transitions and beta-sheet formation are a common problem both in vivo and in vitro and are of critical relevance in disparate areas such as protein processing and beta-amyloid and prion behavior. Silks provide a "databank" of well-characterized polymorphic sequences, acting as a window onto structural transitions. Peptides with conformationally polymorphic silk-like sequences, expected to exhibit an intractable beta-sheet form, were characterized using Fourier transform infrared spectroscopy, circular dichroism, and electron diffraction. Polymorphs resembling the silk I, silk II (beta-sheet), and silk III (threefold polyglycine II-like helix) crystal structures were identified for the peptide fibroin C (GAGAGS repetitive sequence). Two peptides based on silk amorphous sequences, fibroin A (GAGAGY) and fibroin V (GDVGGAGATGGS), crystallized as silk I under most conditions. Methanol treatment of fibroin A resulted in a gradual transition from silk I to silk II, with an intermediate state involving a high proportion of beta-turns. Attenuated total reflectance Fourier transform infrared spectroscopy has been used to observe conformational changes as the peptides adsorb from solution onto a hydrophobic surface. Fibroin C has a beta-strand structure in solution but adopts a silk I-like structure upon adsorption, which when dried on the ZnSe crystal contains silk III crystallites.

Amino Acid Sequence↗

The price of peace: the personal and financial cost of paramilitary punishments in Northern Ireland.

The aim of this study was to compare the injuries sustained during paramilitary punishments both before and after the onset of "peace" in Northern Ireland. A retrospective chart review was performed looking at age, injuries, treatments instituted, theatre time, length of hospital stay and overall cost of care. In the 10-month period before the ceasefire, 31 patients were treated after sustaining paramilitary punishment shootings. Mean age was 25.2 years. All patients had small entrance and exit wounds with minimal soft tissue disruption. A total of 18 fractures were recorded in 15 patients and 14 arteries required repair. Mean operative time was 2.6 h, mean hospital stay 7.61 days and mean cost per patient 3102 Pounds. In the following 10-month period 28 patients were admitted after punishments, only one of whom had been shot, all others had been beaten with sticks and clubs. Mean age was 27.4 years. In 52 limbs, 64 fractures were recorded and 44% of these were open; 15 of the fractures were Gustilo and Anderson Grade III or greater and 11 of the fractures were intra-articular. There were no arterial injuries. Mean operative time was 2.6 h, mean hospital stay 12.4 h and mean cost per patient 3849 Pounds.

Cost of Illness↗

MRI of liver: a comparison of CNR enhancement using high dose and low dose ferumoxide infusion in patients with colorectal liver metastases.

The purpose of this study was to compare the effects of high dose (HD) and low dose (LD) ferumoxides infusions on lesion-to-liver contrast-to-noise ratio (CNR) using four different T(2)-weighted MR sequences. Seventy-three patients with known colorectal liver metastases underwent T(2)-weighted fast spin echo (FSE) imaging before and after ferumoxides. After ferumoxides, T(2)-weighted dual echo (DE) and T(2)-weighted GRE FLASH images were also obtained. To evaluate the relationship between TE length and lesion-to-liver CNR, the same FLASH sequence was repeated in 18 LD patients after lengthening the TE. Ferumoxides was administered at a dose of 15 micromol/kg (HD) and 7.5 micromol/kg (LD) in 45 and 28 patients, respectively. The effects of HD and LD ferumoxides infusions were measured as the percentage signal intensity change (PSIC) in the liver and lesions, lesion-to-liver CNR and the change in lesion-to-liver CNR (DeltaCNR). In both LD and HD groups, all CNR values obtained after SPIO were significantly greater than those observed with unenhanced FSE (p < 0.01). There was no significant difference between the mean CNR values obtained with either dose for any sequence. With the FLASH sequence, CNR increased progressively with longer TE. At the longest TE of 26 ms, mean CNR was higher than that recorded with any of the other sequences. Although mean liver PSIC was significantly greater in the HD group than in the LD group (p < 0.01) because the mean lesion PSIC was also greater in the HD group, the mean DeltaCNR after ferumoxides was not significantly different in the two groups. LD SPIO enhanced MR significantly increases lesion-to-liver CNR compared with unenhanced images. At 1. 0 T, HD and LD ferumoxides infusions produce comparable lesion-to-liver CNR. Our results suggest that at 1.0 T ferumoxides may be administered at a dose of 7.5 micromol/kg without loss of image quality.

Aged↗

Reduction-oxidation control of beta-sheet assembly in genetically engineered silk.

Genetically engineered spider dragline silk protein was modified to incorporate methionines flanking the beta-sheet forming polyalanine regions. The methionines could be selectively chemically oxidized and reduced. This chemical change altered the bulkiness and charge of the sulfhydryl groups, and in turn, the beta-sheet forming tendencies of the polyalanine domains and solubility of the protein. The genes encoding these redesigned proteins were constructed, cloned and expressed in Escherichia coli. In the reduced state (beta-mercaptoethanol) the approximately 25 kDa protein behaved similarly to native spider dragline silk, crystallizing into beta-sheets based on diffraction analysis and appearing fibrous by TEM. The addition of the methionines into the consensus dragline silk sequence did not disrupt the normal macromolecular assembly behavior of the protein. In the oxidized state (phenacyl bromide) the protein did not form beta-sheet crystals and appeared morphologically featureless based on TEM. A reduction in beta-strand content was also observed upon oxidation based on FTIR and TEM analysis and confirmed by X-ray diffraction analysis. To further confirm changes in assembly behavior observed for the recombinant protein containing the methionines, a model peptide with the same repeat amino acid sequence was synthesized and characterized. Shifts in molecular weight, observed by MALDI, along with corresponding changes in crystallinity, by electron diffraction, agreed with the changes expected on activation and deactivation of the redox trigger. These results support the use of a redox trigger as a useful feature with which to control the assembly of beta-sheet forming proteins.

Amino Acid Sequence↗

A prospective economic evaluation of basiliximab (Simulect) therapy following renal transplantation.

BACKGROUND: Immunoprophylaxis with basiliximab (Simulect), an anti-interleukin-2-receptor (anti-IL-2R; CD25) chimeric monoclonal antibody, has been demonstrated to significantly reduce the incidence of acute cellular rejection in adult renal allograft recipients (32% vs. placebo, p < 0.01). METHODS: An economic evaluation was conducted as part of a U.S. multi-center, randomized, double-blind, placebo-controlled clinical trial comparing basiliximab plus dual immunosuppressive therapy (cyclosporine modified [Neoral] and corticosteroids) to dual therapy alone. Healthcare resources utilized by the 346 subjects in the 'intent-to-treat' population were prospectively collected over the 1-yr study period. Direct medical costs were determined for all hospitalizations, outpatient provider visits, procedures (excluding the initial transplant procedure), laboratory and diagnostic tests, and immunosuppressants, including basiliximab when administered. RESULTS: Total first-year medical costs were lower for the basiliximab group than for the placebo group ($28 927 vs. $32 300, difference = $3373). although this difference was not statistically significant. First-year hospital costs for treating acute rejection were also lower for the basiliximab group ($9328 vs. $10761, difference = $1433); however, this difference did not achieve statistical significance. Importantly, the efficacy analysis demonstrated a significant reduction in the incidence of acute rejection (38 vs. 55%, p < 0.01) in the basiliximab arm, and this was accomplished without increasing the overall cost of care. Fewer basiliximab-treated patients (8 vs. 15%,, p = 0.03) were hospitalized. This observation suggested less serious illness and reduced treatment costs among basiliximab-treated patients, because the overall incidence of infection was similar between the groups. The adverse event profile of patients receiving basiliximab was clinically and economically indistinguishable from that of those treated with placebo. CONCLUSION: Induction immunosuppression with basiliximab, combined with cyclosporine modified and corticosteroids, was therapeutically beneficial and contained medical costs during the initial post-transplant year.

Adrenal Cortex Hormones↗

Mutations in a new gene in Ellis-van Creveld syndrome and Weyers acrodental dysostosis.

Ellis-van Creveld syndrome (EvC, MIM 225500) is an autosomal recessive skeletal dysplasia characterized by short limbs, short ribs, postaxial polydactyly and dysplastic nails and teeth. Congenital cardiac defects, most commonly a defect of primary atrial septation producing a common atrium, occur in 60% of affected individuals. The disease was mapped to chromosome 4p16 in nine Amish subpedigrees and single pedigrees from Mexico, Ecuador and Brazil. Weyers acrodental dysostosis (MIM 193530), an autosomal dominant disorder with a similar but milder phenotype, has been mapped in a single pedigree to an area including the EvC critical region. We have identified a new gene (EVC), encoding a 992-amino-acid protein, that is mutated in individuals with EvC. We identified a splice-donor change in an Amish pedigree and six truncating mutations and a single amino acid deletion in seven pedigrees. The heterozygous carriers of these mutations did not manifest features of EvC. We found two heterozygous missense mutations associated with a phenotype, one in a man with Weyers acrodental dysostosis and another in a father and his daughter, who both have the heart defect characteristic of EvC and polydactyly, but not short stature. We suggest that EvC and Weyers acrodental dysostosis are allelic conditions.

Alternative Splicing↗

Suicidal ideation in a random community sample: attributable risk due to depression and psychosocial and traumatic events.

OBJECTIVE: To determine the attributable risk for suicidal ideation of depression and psychosocial and traumatic events in a random and representative population. METHOD: Data were gathered from a random and representative sample of 2501 South Australians. Suicidal ideation and clinical depression were determined by the general health questionnaire (GHQ-28) and the short-form health survey (SF-12) respectively, and information regarding psychosocial stressors and traumatic events was collated. These data were subjected to univariate and multivariate analyses to determine the population-attributable risks for suicidal ideation. RESULTS: Overall, 5.6% of men and 5.3% of women had suicidal ideation. Univariate analyses demonstrated a significant attributable risk for suicidal ideation for depression and the majority of the psychosocial and traumatic events. Multivariate analysis demonstrated that clinical depression remained significantly associated with suicidal ideation, with a population-attributable risk of 46.9%. Because of the small number of people in the population who experience both suicidal ideation and specific events, multivariate analysis could not be applied to individual events. However, even when the psychosocial events were summed, they no longer remained significantly associated with suicidal ideation, whereas the summation of traumatic events remained significant, with a population-attributable risk of 38.0%. CONCLUSIONS: These results confirm the importance of traumatic events as significant factors in contributing to suicidal ideation. However, of even greater importance is that they indicate, unequivocally, the magnitude of the contribution of clinical depression to suicidal ideation, with the population-attributable risk of depression indicating that elimination of mood disorders would reduce suicidal ideation by up to 46.9%.

Adolescent↗

Participation in clinical studies among patients infected with HIV-1 in a single treatment centre over 12 years.

OBJECTIVE: To examine a complete population of clinic attenders in order to compare the demographics of patients who participated in a clinical study with those who had not. These were subdivided into trials of antivirals, trials for drugs used in opportunistic infections or symptomatic HIV and epidemiological studies. The setting was an established London teaching hospital. All patients diagnosed HIV-positive and attending between July 1983 and 1 January 1999 with one measured CD4 count and at least one follow-up visit were included. METHODS: The demographics of those participating in a clinical study were compared to those not enrolling using chi2 tests and Wilcoxon tests. Cox models were used to determine factors related to participation in clinical studies. RESULTS: Data from 2703 patients representing 5342.7 person-years' follow-up were assessed. Median time of follow-up was 23.6 months. Six hundred and eighty-seven (33%) patients had ever participated in a clinical study. After adjustment for demographic factors in multivariate analysis using Cox models, homosexuals were more likely to participate compared with heterosexuals or injecting drug users (IDU) (P = 0.0035 and P = 0.0001, respectively). Women were more likely to enter a study (P = 0.02) and there was no difference between Caucasians and black Africans (P = 0.35). Between the three types of studies few differences were seen. CONCLUSION: High rates of participation in clinical trials and epidemiological studies were seen in this cohort. In keeping with other studies, homosexual men were well represented but IDU were under-represented. However, women and black African patients showed good uptake of all clinical studies. Hence in this population there is some success in targeting representative groups to participate in clinical studies, but more effort needs to be made with IDU.

AIDS-Related Opportunistic Infections↗

Results of HCV screening of volunteer blood donors with a chemiluminescent immunoassay and a second- or third-generation EIA: overlap of false-positive reactivity and its impact on donor management.

BACKGROUND: This study reports the results of adopting a strategy of anti-HCV testing of volunteer blood donors that uses a primary screening assay, two secondary EIAs (Anti-HCV Version III, Murex; Monolisa Anti-HCV New Antigens, Sanofi Pasteur), and a confirmatory immunoblot (HCV WB, Murex). STUDY DESIGN AND METHODS: A comparison was made of HCV test results from volunteer donors tested in two periods when different primary HCV screening assays were in use. The same two secondary screening assays and the same confirmatory test were used for the whole study. The two different primary assays were semi-automated second- or third-generation HCV EIA (Abbott Diagnostics) and an HCV chemiluminescent immunoassay (ChLIA), performed on a fully automated analyzer (PRISM, Abbott). RESULTS: During the period of use of the EIAs as primary screening assays, there were 60 donors per year who were confirmed as anti-HCV-positive, 29 who were classed as having indeterminate HCV serologic results, and 236 who were assessed as having biologically false-positive anti-HCV results. These numbers compared with 57, 52, and 320 such donors, respectively, in the first year of routine use of the ChLIA. The significant increase (p<0.05) in the number of anti-HCV-indeterminate donors after the introduction of the ChLIA was primarily due to an increase in donors who reacted on Monolisa HCV, but not an HCV Murex (expected 18/year vs. the observed 31/year, p<0.01). CONCLUSIONS: Compared to the second- or third-generation HCV EIA, the HCV ChLIA has a significantly greater overlap of false reactivity with the Monolisa HCV assay. This finding has implications for the selection of primary and secondary assays for anti-HCV screening of blood donors.

Blood Donors↗

I.v. regional diamorphine for analgesia after foot surgery.

Opioids administered to peripheral tissues can have significant analgesic effects in doses which would not be effective centrally. We have assessed the effects of regional diamorphine 2.5 mg i.v. in 14 patients undergoing surgical correction of bilateral arthritic foot deformities in a prospective, randomized, double-blind study. Patients acted as their own controls as only one foot received the active drug. Visual analogue scale (VAS) pain scores and wound tenderness were measured over 72 h. Diamorphine did not improve median VAS area under the curve pain scores during the first 6 h after surgery (33 (95% confidence intervals (CI) 25-46) vs 24 (17-35)). It also did not effect wound hypersensitivity when tested at 72 h after surgery (95 (47-125) vs 90 (50-125) g). There were no significant adverse effects.

Adolescent↗

Prevalence of herpes simplex virus in malignant laryngeal lesions.

OBJECTIVE: To determine the prevalence of herpes simplex virus (HSV) in malignant laryngeal lesions. STUDY DESIGN: Retrospective review. MATERIALS AND METHODS: Paraffin-embedded, histologically confirmed specimens containing benign laryngeal lesions, squamous cell carcinoma of the larynx, and squamous cell carcinoma of the oral cavity were identified from archived surgical specimens. Biopsies of normal-appearing oral cavity tissue were also obtained from fresh-frozen cadavers. These tissues were analyzed for the presence of HSV DNA using polymerase chain reaction techniques. Patient charts were reviewed for patient demographics, risk factors, stage, clinical course, treatment, and outcome. RESULTS: HSV was detected in nine laryngeal squamous cell carcinomas (75%) and in none of the benign laryngeal lesions (P = .0001). HSV was also found in three oral cavity squamous cell carcinomas (25%) and in none of the controls (P = .049). CONCLUSION: HSV is more prevalent in squamous cell carcinoma of the larynx and oral cavity than in their respective control groups, suggesting a role for carcinogenesis. HSV is more prevalent in squamous cell carcinoma of the larynx than of the oral cavity. Further studies to determine the role of HSV as a cocarcinogen and its interrelationship with other environmental factors in laryngeal cancer are warranted.

Aged↗

The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery.

OBJECTIVE: To define the prevalence of pelvic floor disorders in a non-institutionalised community and to determine the relationship to gender, age, parity and mode of delivery. DESIGN: A representative population survey using the 1998 South Australian Health Omnibus Survey. SAMPLE: Random selection of 4400 households; 3010 interviews were conducted in the respondents' homes by trained female interviewers. This cross sectional survey included men and women aged 15-97 years. RESULTS: The prevalence of all types of self-reported urinary incontinence in men was 4.4% and in women was 35.3% (P<0.001). Urinary incontinence was more commonly reported in nulliparous women than men and increased after pregnancy according to parity and age. The highest prevalence (51.9%) was reported in women aged 70-74 years. The prevalence of flatus and faecal incontinence was 6.8% and 2.3% in men and 10.9% and 3.5% in women, respectively. Pregnancy (> 20 weeks), regardless of the mode of delivery, greatly increased the prevalence of major pelvic floor dysfunction, defined as any type of incontinence, symptoms of prolapse or previous pelvic floor surgery. Multivariate logistic regression showed that, compared with nulliparity, pelvic floor dysfunction was significantly associated with caesarean section (OR 2.5, 95% CI 1.5-4.3), spontaneous vaginal delivery (OR 3.4, 95% CI 2.4-4.9) and at least one instrumental delivery (OR 4.3, 95% CI 2.8-6.6). The difference between caesarean and instrumental delivery was significant (P<0.03) but was not for caesarean and spontaneous delivery. Other associations with pelvic floor morbidity were age, body mass index, coughing, osteoporosis, arthritis and reduced quality of life scores. Symptoms of haemorrhoids also increased with age and parity and were reported in 19.9% of men and 30.2% of women. CONCLUSION: Pelvic floor disorders are very common and are strongly associated with female gender, ageing, pregnancy, parity and instrumental delivery. Caesarean delivery is not associated with a significant reduction in long term pelvic floor morbidity compared with spontaneous vaginal delivery.

Adolescent↗

Hepatic lesion detection after superparamagnetic iron oxide enhancement: comparison of five T2-weighted sequences at 1.0 T by using alternative-free response receiver operating characteristic analysis.

PURPOSE: To compare the accuracy of five T2-weighted sequences in the detection of liver lesion at magnetic resonance (MR) imaging after superparamagnetic iron oxide (SPIO) enhancement. MATERIALS AND METHODS: Forty-nine candidates for hepatic resection with known coloretal metastases were examined. Before SPIO enhancement, fast spin-echo (SE) images were obtained. After enhancement, the same fast SE sequence and long; TR/short TE, short TE, long TR/TE, and T2-weighted fast low-angle shot (FLASH) sequences were used. All images were viewed independently by four observers who were blinded to the results of the other imaging sequences, the results of the other observers, and the findings at surgery and histopathologic examination. Four weeks after the initial reading, the combined long TR/short TE and long TR/TE dual-echo images were also viewed as an additional set. The alternative free response receiver operating characteristic (ROC) method was used to analyze the results, which were correlated with findings at surgery, intraoperative ultrasonography, and histopathologic examination. RESULTS: Irrespective of lesion size, the accuracy of all sequences after enhancement was significantly greater than that of the nonenhanced fast SE sequence (P < .01). Dual-echo and FLASH sequences were significantly more accurate than the enhanced fast SE sequence (P < .03 or P < .02, respectively). For all lesions, lesions smaller than 1 cm, and lesions 1 cm or larger, mean accuracies were as follows: dual-echo, 0.75, 0.54, and 0.93; FLASH, 0.75, 0.54, and 0.95; and enhanced fast SE, 0.72, 0.49, and 0.92. CONCLUSION: At 1.0 T, dual-echo and FLASH sequences are the most accurate pulse sequences after SPIO enhancement.

Aged↗

Hepatocellular carcinoma in the cirrhotic liver: double-contrast MR imaging for diagnosis.

PURPOSE: To measure the sensitivity and accuracy of double-contrast magnetic resonance (MR) imaging for the diagnosis of hepatocellular carcinoma (HCC) in the cirrhotic liver. MATERIALS AND METHODS: Twenty-seven patients with MR features of dysplastic nodules and/or HCC were examined. T2-weighted spin-echo and T1-weighted gradient-echo imaging was performed before and after superparamagnetic iron oxide (SPIO) administration and immediately followed by T1-weighted gradient-echo imaging at 10, 40, and 120 seconds after bolus injection of a gadolinium-based contrast material. Nonenhanced, nonenhanced plus SPIO-enhanced, and nonenhanced plus SPIO-enhanced plus gadolinium-enhanced images were reviewed. Alternative-free response receiver operating characteristic (ROC) methodology was used to analyze the results, which were correlated with histopathologic findings after transplantation in 15 patients and at biopsy in 12. Lesions visualized with all three techniques were characterized as a dysplastic nodule or HCC, and ROC analysis was performed. RESULTS: For all observers, SPIO-enhanced MR imaging (mean accuracy, 0.76) was more accurate than nonenhanced MR imaging (mean accuracy, 0.64) (P <.04), and double-contrast MR imaging (mean accuracy, 0.86) was more accurate than SPIO-enhanced imaging (P <.05). Both types of lesions were correctly characterized with all three techniques, although observer confidence for lesion characterization was greatest with double-contrast MR imaging. CONCLUSION: Double-contrast MR imaging significantly improves the diagnosis of HCC compared with SPIO-enhanced and nonenhanced imaging (P <.01).

Adult↗

Neuromuscular correlates to the evolution of flapping flight in birds.

The neuromotor pattern (i.e. the onset/offset of muscle contraction within the locomotor cycle) is conserved for some homologous muscles of the tetrapod shoulder but not others in the transition from terrestrial locomotion to flight. Here we test for three shoulder muscles of the European starling (Sturnus vulgaris) to determine whether retention of, or deviation from, a conserved neuromotor pattern can be predicted on the basis of the location of the muscle's motor nucleus within the motor column and the histochemical profile of its constituent muscle fibers. The M. supracoracoideus, the major wing elevator, illustrates a neuromotor pattern that has shifted in its timing within the limb movement cycle. Of the two heads of the triceps, the electrical activity pattern of M. humerotriceps is conserved during the transition, whereas that of the M. scapulotriceps is not. We reacted serial sections of each muscle for myosin adenosine triphosphotase (ATPase), nicotinamide adenine dinucleotide diaphorase (NADH-D), and alpha-glycerophosphate dehydrogenase (alpha-GPD) to characterize all muscles into two fiber types: fast glycolytic (FG) and fast oxidative glycolytic (FOG). We used retrograde axonal tracers to determine the longitudinal distribution and topographical organization of the motoneurons within the motor column in the spinal cord. The histochemical profile of each muscle studied is unique and is statistically different from its homologue in non-avian tetrapods. Compared to non-avian tetrapods, the spatial location of the motor nucleus of the supracoracoideus is conserved. The topology of the two heads of the triceps is fundamentally conserved relative to the other test muscles, but relative to one another there is some spatial segregation which might reflect their respective functional specializations. These data indicate that an evolutionary change in neuromotor pattern can occur without a corresponding topological reorganization of a muscle's motor nucleus within the motor column. Nor can the histochemical profile of homologous muscles be used to predict their neuromotor pattern in the transition from terrestrial locomotion to flight. These findings suggest that evolutionary change in neuromotor outflow relates to altered synaptic input from supraspinal or segmental sources or by alteration of factors intrinsic to individual motoneurons.

Animals↗