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Minimal enteral feeding induces maturation of intestinal motor function but not mucosal growth in neonatal dogs.

Providing small enteral feedings for parenterally fed preterm infants during the first few weeks of life improves feeding tolerance. However, it is not known whether these feedings achieve this result via stimulation of gut growth and/or maturation of function. The minimal level needed to attain these responses is also critical to identify, because neonatologists often limit feeding volumes to minimize the risk of necrotizing enterocolitis. Thus, we determined the dose-response relationships between enteral feeding volume and gastrointestinal growth and small intestine motor function. Newborn canine pups (n = 51) received 0, 2.5, 5.0, 7.5, 10, 30 or 100% of their daily fluid intake enterally with the remainder given parenterally for 4-5 d. Motor activity was recorded, blood drawn for determination of gastrin and motilin, and intestinal tissue harvested for determination of DNA and protein content and morphology. Feeding volumes that provided 30% or more of daily fluid intake significantly increased small intestinal mucosal growth above that of unfed pups, but feeding volumes that provided as little as 10% of daily fluid intake significantly induced maturation of motor patterns beyond that of unfed pups. Plasma concentrations of gastrin and motilin did not differ among groups. We conclude that small enteral feedings typically used for minimal enteral feeding strategies improve feeding tolerance by triggering maturation of motor function but not gut growth in neonatal dogs. Small feeding volumes trigger this maturation as well as large volumes.

Animals↗

Effects of chronic dietary restriction on sensory-motor function and susceptibility to stressor stimuli in the laboratory rat.

Two sets of experiments describing the effects of chronic undernutrition on sensory-motor function and susceptibility to environmental stressors are described. In the first, Fischer 344 rats between 10 and 12 months of age were placed on an every-other-day feeding regimen. Behavioral tests designed to assess sensory function (auditory and visual thresholds), somato-motor competence (hang time from a horizontal wire, balance on a narrow beam, descent of a wire mesh pole), and sensory-motor integrity (auditory startle) were then conducted every 3 to 6 months. Chronic undernutrition significantly increased life span and increased somato-motor competence but did not affect sensory function or sensory-motor integrity. In the second set of experiments both acute and chronic dietary restriction impaired the ability of young adult Sprague-Dawley rats to effectively thermoregulate in response to a cold environment. Body temperature dropped more rapidly and recovered at a slower rate in the dietarily restricted animals. Fischer 344 rats maintained on a restricted diet for 16 months were similarly impaired. The latter findings suggest that techniques for extending life span based on laboratory animal models may have little relevance to either animals or humans living in their natural habitats where a wide variety of environmental stressors are encountered.

Animals↗

Worsening of motor function and mood in a patient with Parkinson's disease after pharmacologic challenge with oral rivastigmine.

Patients with Parkinson's disease (PD) can experience cognitive impairment. There are currently no medications indicated for the treatment of cognitive impairment in PD. Clinicians are faced with the dilemma as to whether or not to treat patients with PD with the acetylcholinesterase inhibitors that are currently approved for use in Alzheimer's disease (AD) and that have shown promise in clinical trials of Dementia with Lewy bodies (DLB). Although these medications may help cognition, there is a theoretical concern that by increasing acetylcholine relative to dopamine, they might worsen motor function. We report the case of a patient with PD and cognitive impairment who developed a marked worsening of motor function, mood, and anxiety in the setting of a pharmacologic challenge study using a 3-mg oral dose of the acetylcholinesterase inhibitor, rivastigmine. We believe that the mechanism of the motor and perhaps psychiatric worsening was increased central cholinergic tone. We conclude that further studies should be done to evaluate the efficacy and tolerability of these agents in this illness but that caution should be exercised when using acetylcholinesterase inhibitors in patients with PD.

Administration, Oral↗

[Effects of functional electrical stimulation on the improvement of motor function of patients with acute stroke: a randomized controlled trial].

OBJECTIVE: To investigate the effects of functional electrical stimulation (FES) on the improvement of motor and walking ability of the lower extremities of the patients with acute stroke. METHODS: Forty-six patients with stroke (including cerebral infarction and hemorrhage), aged 71 +/- 8 (45 - 84), hospitalized within 2 weeks (9 +/- 4 days) after the onset, matched with one another in the baseline measurements before treatment, were assigned randomly into 3 groups: FES group (n = 13), receiving standard rehabilitation combined with FES 30 minutes per day, 5 days per week for 3 weeks, placebo stimulation group (n = 15) receiving standard rehabilitation combined with the installment of the FES apparatus, operated in the same manner as mentioned above, however, without real electric stimulation, and control group (n = 13), receiving standard rehabilitation alone. The score of the composite spasticity scale (CSS) was measured, electromyography was conducted to measure the maximum isometric voluntary contraction (MIVC) of the ankle dorsi-flexors and plantar-flexors, and walking ability by the test of timed "Up and Go" before treatment, weekly during the 3-week treatment, and 8 weeks after the onset of stroke. RESULTS: After 3 weeks of treatment, the percentage of CSS score of the FES group was 31% +/- 35%, significantly lower than those of the placebo and control groups (50% +/- 88% and 65% +/- 65% respectively, both P < 0.05); the ankle dorsiflexion torque of MIVC of the FES group was 9 Nm +/- 5 Nm, significantly higher than those of the placebo and control groups (5 Nm +/- 3 Nm and 4 Nm +/- 5 Nm respectively, both P < 0.05), and the electromyogram co-contraction ratio of the FES group was 8% +/- 5%, significantly lower than those of the placebo and control groups (27% +/- 26% and 28% +/- 19% respectively, both P < 0.05). The time needed to recover the walking ability after the stroke onset of the FES group was 18 +/- 8 days, shorter by 2 approximately 3 days than those of the placebo and control groups (20 +/- 7 and 21 +/- 8 days respectively). The percentage of the patients able to walk with the help of a stick 3 weeks after treatment of the FES group was 85%, significantly higher than those of the placebo and control groups (60% and 46% respectively, both P < 0.05). 84.6% of the patients of the FES group returned home, a percentage significantly higher than those of the placebo and control groups (53% and 46% respectively, both P < 0.05). CONCLUSION: FES, plus standard rehabilitation, is effective in improving the motor and walking ability of the patients with acute stroke, to the degree that most patients are recovered to be able to return home.

Aged, 80 and over↗

An experimental model for the study of transient lower oesophageal sphincter relaxation and motor function of the proximal stomach in humans.

A simple and reliable experimental model would be useful in human research on new drugs which target transient lower oesophageal sphincter (LOS) relaxation. The aim was to investigate the effect of repeated distensions on the rate of transient LOS relaxation, LOS pressure and motor function of the proximal stomach. Twelve healthy subjects were studied with a multilumen manometric assembly incorporating a sleeve sensor for the LOS and a bag positioned in the proximal stomach and connected to a barostat. Intrabag volume was set at 75% of the threshold for gastric discomfort and maintained for two 30-min distension periods separated by a 45-min washout with the bag deflated. The studies lasted 145 +/- 2 min. The rate of transient LOS relaxations was similar during the two distensions, 3.5;2-4 vs 3;2.5-4 (median;interquartile range) and so was LOS pressure. Baseline intrabag pressure, as a measure of gastric tone, and the number of pressure waves, as a measure of phasic contractions, were also similar, 11.3;9.3-12.3 mmHg vs 10.8;9.3-12.5 mmHg and 16;13-28 mmHg vs 19;15-29 mmHg, respectively. Our model allows to perform 1-day studies which can assess two experimental conditions on transient LOS relaxations and motor function of the proximal stomach within an acceptable time span.

Adult↗

[Importance of electrogastrography and pharmacological tests in assessing gastric motor function in vagotomy].

The effect of 6 pharmacological drugs on the motor function of the stomach in patients with ulcer disease was studied. It was established that Cerucal was the best modulator of gastric motor activity. There were three types of reaction of electrogastrogram to the administration of Cerucal. It was noted that in the first type there was a real danger of the development of postvagotomic kinetic disorders. In the second and third types such a danger was as a rule absent. This method of prognosis of motor disorders after vagotomy was successfully used in 81 patients with ulcer disease of the duodenum treated with the help of vagotomy.

Adult↗

Orexins in rat dorsal motor nucleus of the vagus potently stimulate gastric motor function.

Orexins regulate food intake, arousal, and the sleep-wake cycle. They are synthesized by neurons in the lateral hypothalamus and project to autonomic areas in the hindbrain. Orexin A applied to the dorsal surface of the medulla stimulates gastric acid secretion via a vagally mediated pathway. We tested the hypothesis that orexins in the dorsal motor nucleus (DMN) of the vagus regulate gastric motor function. Multibarelled micropipette assemblies were used to administer vehicle, L-glutamate, orexins A (1 and 10 pmol) and B (10 pmol), and a dye marker into this site in anesthetized rats. When the pipette was positioned in the DMN rostral to the obex (where excitation of neurons by L-glutamate evoked an increase in contractility), orexins A and B increased intragastric pressure and antral motility. In contrast, 10 pmol orexin A microinjected into the DMN caudal to the obex (where L-glutamate evokes gastric relaxation through a vagal inhibitory pathway) did not significantly alter gastric motor function. In separate immunocytochemical studies, orexin receptor 1 was highly expressed in neurons in the DMN. Specifically, it was present in retrogradely labeled preganglionic neurons in the DMN that innervate the stomach. These data are consistent with the idea that orexin A stimulates vagal excitatory motor neurons. These are the first data to suggest that orexins in the DMN have potent and long-lasting effects to increase gastric contractility.

Animals↗

The effects of recombinant human hemoglobin on esophageal motor functions in humans.

BACKGROUND & AIMS: Nitric oxide controls lower esophageal sphincter (LES) relaxation and esophageal peristalsis in opossums, but its role in the control of esophageal motility in humans is not defined. Hemoglobin inactivates NO by binding it. Recombinant human hemoglobin (rHb1.1) was used to test the hypothesis that NO mediates esophageal motor functions in humans. METHODS: rHb1.1 or human serum albumin was administered intravenously to fasting male volunteers. Esophageal manometric studies were performed before, during, and up to 6 hours after the infusion. RESULTS: rHb1.1 increased the velocities of peristaltic contractions to produce simultaneous contractions in 6 of 9 subjects. It increased the amplitude and duration of contractile waves in the esophagus. There was no consistent effect on the resting tone of the LES, but LES relaxation was inhibited. Spontaneous, simultaneous high-pressure contractions occurred in 8 of 9 subjects. Lower retrosternal chest pain during swallowing was observed in 4 subjects. CONCLUSIONS: rHb1.1 interfered with esophageal peristalsis and LES relaxation. It precipitated esophageal spasm in some subjects. These data support the hypothesis that the timing of smooth muscle esophageal peristalsis and LES relaxation are mediated by NO. They suggest that some disorders of esophageal motor function may result from defects in NO neuromuscular communication.

Adult↗

Timed tests in the clinical assessment of motor function in Parkinson's disease.

The clinical evaluation section of the Core Assessment Program for Intracerebral Transplantations (CAPIT) for Parkinson's disease (PD) was developed to standardize the clinical evaluation in cell transplantation trials, but also has been used in other therapeutic trials for PD. An important part of the CAPIT protocol is the standardized timed tests of motor function. In a recent revision of CAPIT, the Core Assessment Program for Surgical Interventional Therapies in Parkinson's Disease (CAPSIT-PD), the timed tests have been modified. There are some practical considerations that need attention when timed tests are used. They should be performed under the same circumstances with the patient in a defined condition and according to the same instructions from one time to another. Also, the examiner should not assist the patient, either directly or indirectly, by cueing. In addition to quantification of motor function as an outcome measure in therapeutic trials and other clinical research, timed tests also can be used for determining dopaminergic responsiveness in differential diagnosis of parkinsonism. Our experience is that timed tests are valuable quantitative and objective measures in scientific as well as clinical assessments of PD. Practical guidelines for and examples of these areas of use are provided.

Brain Tissue Transplantation↗

Effects of recombinant human hemoglobin on motor functions of the opossum esophagus.

Chemically altered hemoglobins are being investigated as blood substitutes. They may affect numerous biological processes since free hemoglobin binds nitric oxide (NO). Nitric oxide is a neural mediator of relaxation of the lower esophageal sphincter (LES) and esophageal peristalsis. We hypothesize that recombinant human hemoglobin (rHb1.1) alters esophageal motor function by scavenging NO. Contraction of transverse muscle strips from the opossum esophagus and LES was monitored. Transmembrane potential differences of circular smooth muscle from the esophagus were recorded using glass microelectrodes. Intrinsic esophageal nerves were stimulated electrically. Esophageal manometries were performed with a low-compliance perfused-catheter system. The activity of the enzyme NO synthase was determined with the citrulline assay. Recombinant hemoglobin diminished nerve-induced relaxation of LES muscle but did not alter LES tone. Circular esophageal muscle responded to nerve stimulation with an inhibitory junction potential and a mechanical off response. Recombinant hemoglobin diminished the inhibitory junction potential and shortened the latency of the off response. It increased the velocity of esophageal peristalsis, decreased the amplitudes of these contractions and diminished LES relaxation. Cyanomethemoglobin had little effect on nerve- or swallow-induced responses. Hemoglobin did not inhibit the activity of NO synthase. Recombinant human hemoglobin appears to alter esophageal motor function by scavenging NO.

Amino Acid Oxidoreductases↗

Relative potencies for acute effects of pyrethroids on motor function in rats.

The prevalence of pyrethroids in insecticide formulations has increased in the last decade. A common mode-of-action has been proposed for pyrethroids based on in vitro studies, which includes alterations in sodium channel dynamics in nervous system tissues, consequent disturbance of membrane polarization, and abnormal discharge in targeted neurons. The objective of this work was to characterize individual dose-response curves for in vivo motor function and calculate relative potencies for eleven commonly used pyrethroids. Acute oral dose-response functions were determined in adult male Long Evans rats for five Type I (bifenthrin, S-bioallethrin, permethrin, resmethrin, tefluthrin), five Type II (beta-cyfluthrin, lambda-cyhalothrin, cypermethrin, deltamethrin, esfenvalerate) and one mixed Type I/II (fenpropathrin) pyrethroids (n = 8-18 per dose; 6-11 dose levels per chemical, vehicle = corn oil, at 1 ml/kg). Motor function was measured using figure-8 mazes. Animals were tested for 1 h during the period of peak effects. All pyrethroids, regardless of structural class, produced dose-dependent decreases in motor activity. Relative potencies were calculated based on the computed ED30s. Deltamethrin, with an ED30 of 2.51 mg/kg, was chosen as the index chemical. Relative potency ratios ranged from 0.009 (resmethrin) to 2.092 (esfenvalerate). Additional work with environmentally-based mixtures is needed to test the hypothesis of dose-additivity of pyrethroids.

Administration, Oral↗

Src family kinase inhibitor PP1 improves motor function by reducing edema after spinal cord contusion in rats.

Following spinal cord injury vascular permeability increases around the area of injury, which possibly leads to secondary tissue damage. Vascular endothelial growth factor (VEGF) and Src which exists downstream of VEGF may contribute to edema formation. We here report that the Src family kinase inhibitor PPI could reduce edema and the inflammatory response after spinal cord injury. In this study we have examined the effect of PPI on motor function after mild spinal cord compression injury. We utilized a mild spinal cord compression model in rats. PPI or vehicle only was administered intraperitoneally after cord compression. The motor function of the hind limbs after injury was categorized into 7 grades. At 1, 3, 7 and 14 days after injury, the spinal cord was removed and the extent of edema formation and inflammation were examined using immunohistochemistry with an anti-IgG and anti-ED-1 antibody. The immunohistochemical analysis revealed that the area of edema formation and inflammation was remarkably reduced in animals with PPI. The muscle function was flaccid in both groups immediately after injury. However, at 3 and 8 days after injury, a significant improvement was observed in the PPI group. These results suggest that PPI is a strong candidate for drug treatment of spinal cord injury.

Animals↗

Cross-sectional association between homocysteine and motor function in the elderly.

OBJECTIVE: To determine if there is a cross-sectional association between homocysteine (tHcy) level and measures of gait and balance in elderly subjects. METHODS: We studied 3,609 noninstitutionalized subjects aged 65 to 85 years from the Dijon (France) center of the Three-City Study. tHcy concentration was measured from fasting blood samples. Motor function was assessed by measuring walking speed and by using a modified version of the Tinetti scale. RESULTS: After adjustment for confounders, mean maximum walking speed (MWS) decreased with increasing tHcy levels (p = 0.001). The odds ratio (OR) (95% CI) for having a MWS below the 40th percentile was 1.9 (1.4 to 2.5) in subjects with tHcy levels in the upper quintile compared with those in the lowest quintile. Compared with subjects in the lowest tHcy quintile, the OR for having a modified Tinetti score below 16 ranged from 1.0 (0.8 to 1.4) in the second quintile to 1.9 (1.3 to 2.6) in the upper quintile (p < 0.0001). CONCLUSIONS: Elevated homocysteine concentrations are associated with worse motor performances in the elderly. These findings support the hypothesis of a vascular contribution to motor function.

Age Factors↗

Extraoperative cortical stimulation of motor function in children.

The purpose of the study was to investigate factors altering the amperage threshold needed to provoke functional responses in children with epilepsy. Twenty patients (4-18 years of age) who underwent epilepsy surgery at our institution from 1996-2000 after insertion of subdural grid electrodes were reviewed retrospectively. Extraoperative electrical cortical stimulation was performed with 50-Hz biphasic pulses of 0.2 ms in duration using a "distance reference" technique. Amperage thresholds of primary motor responses and afterdischarges were evaluated. The patients were grouped according to underlying pathology: eight with neuronal migration disorders (group A) and 12 with other disorders (group B). The motor cortex was defined successfully in all children because the afterdischarges threshold was higher than the motor cortical threshold. Amperage thresholds ranged from 2-20 mA (mean = 7.7) for primary motor function. An inverse relationship was found between amperage threshold and age: the younger the patient, the higher the threshold (P = 0.0005). Patients in group A required a higher amperage (2-20 mA, mean = 8.6) for motor cortical mapping than those in group B (2-14 mA, mean = 6.4). Younger children with neuronal migration disorders require a higher amperage threshold to achieve adequate motor functional mapping with careful observation of afterdischarges.

Adolescent↗

Esophageal motor function in patients with myotonic dystrophy.

To investigate pharyngeal and esophageal motor function in myotonic dystrophy (MD), and its relationship to esophageal symptoms, we used low-compliance, high-fidelity esophageal manometry and videofluorography to evaluate 14 consecutive MD patients. Patients exhibited a consistent, typical motor pattern, involving a marked reduction in resting tone of both the upper and lower esophageal sphincters, and a reduction in contraction pressure in the pharynx and throughout the esophagus. Radiology showed hypotonic pharynx with stasis and a hypo- or amotile, often dilated, esophagus. These findings were nonspecific, however, being present in patients both with and without dysphagia, which suggests that MD patients have valid compensatory mechanisms. Dysphagia only correlated to the pharyngeal impairment at manometry. Furthermore, the results of our study suggest that not only the proximal, striated part of the gullet, but also the distal part (in which smooth muscle dominates) is involved in the disease. The latter leads to the impairment of the LES resting tone and competence, highlighting the risk of gastroesophageal reflux disease in these patients.

Adult↗

[Study on esophageal motor function against reflux after esophagogastric anastomosis with mucosal valve].

OBJECTIVE: To find an effective operative procedure against reflux after esophagogastric anastomosis with mucosal valve. METHODS: Four hundred and sixty-four patients with esophageal or cardiac cancer were randomly divided into three groups according to anastomosis modes. Group A underwent esophagogastric anastomosis with mucosal valve (175 cases), group B with mechanical stapler (151 cases) and group C one layer anastomosis with handcraft suture (138 cases). The gastroesophageal reflux index (GERI) was examined by isotope,and 24 h esophageal pH was also monitored. The esophageal motor function was compared among three groups. RESULTS: The reflux rates were 0, 33.3%, and 6.7% in group A, B, C respectively. The esophageal motor function and the 24 h esophageal pH monitoring indicated that the various indexes were approaching to the normal level in group A, but the various indexes in group B and C were significantly different from the normal values (P< 0.05). CONCLUSION: The esophagogastric anastomosis with mucosal valve has better antireflux effect and can prevent the reflux esophagitis after esophageal or cardiac cancer eradication.

Adult↗

The significance of sensory-motor functions as indicators of brain dysfunction in children.

Sensory-perceptual and motor functions are closely dependent on the integrity of the brain and nervous system. Standardized tests have been developed to assess these functions, but such tests are not routinely used to evaluate children who are suspected of having a neuropsychological basis for their difficulties. Higher-level functions (such as verbal and academic abilities, executive functioning, etc.) are obviously important in producing successful performances, but the brain and nervous system correlates of these abilities are less well defined than the correlates for sensory-motor abilities. Our contention is that tests from these two general areas (higher-level and lower-level aspects of brain functioning) can be used effectively in a complementary manner to evaluate individual children. The first step in this process is to evaluate formal sensory-motor tests and to assess their validity as a brief preliminary examination used to differentiate between brain-damaged and control children. The results of this study demonstrated striking differences between the groups and indicated that sensory-motor testing might serve very effectively, when used in conjunction with higher-level tests, to identify those children whose higher-level impairment is due to brain impairment rather than a lack of environmental opportunities or advantages.

Brain Diseases↗

Improvement of motor function with noninvasive cortical stimulation in a patient with chronic stroke.

This manuscript reports the effects of transcranial DC stimulation (tDCS), a technique that enhances cortical plasticity in healthy humans, on motor function in a patient with chronic subcortical ischemic stroke. tDCS but not sham applied in a double-blind protocol to motor regions of the affected hemisphere led to improvements in pinch force, Jebsen-Taylor Hand Function Test, and simple reaction times in the paretic hand that outlasted the stimulation period for at least 40 min. These changes were accompanied by increased corticomotor excitability identified by enhanced recruitment curves and reduced intracortical inhibition to transcranial magnetic stimulation. These results document a beneficial effect of noninvasive brain stimulation on motor function in a human patient with stroke and raise the hypothesis of its potential application in neurorehabilitation.

Aged↗