Two cases of granulomatosis polyangiitis presenting with Strawberry gingivitis and a review of the literature.

Hyperplastic gingivitis is a rare manifestation of granulomatosis with polyangiitis (GPA). This gingivitis has a very distinctive clinical appearance (so-called Strawberry gingivitis) and when seen is virtually pathognomic for GPA. Gingivitis often precedes other organ involvement therefore making awareness of this manifestation particularly important to aid early diagnosis and treatment.

Effectiveness and efficiency of training in digital healthcare packages: training doctors to use digital medical record keeping software.

Objective Fiona Stanley Hospital (FSH) is the first hospital in Western Australia to implement a digital medical record (BOSSnet, Core Medical Solutions, Australia). Formal training in the use of the digital medical record is provided to all staff as part of the induction program. The aim of the present study was to evaluate whether the current training program facilitates efficient and accurate use of the digital medical record in clinical practice.

Changes in the functional MR signal in motor and non-motor areas during intermittent fatiguing hand exercise.

The aim of this study was to determine whether there were significant changes in the time course of the functional magnetic resonance imaging (fMRI) signal in motor and non-motor regions of both cerebral hemispheres during a unilateral fatiguing exercise of the hand. Twelve subjects performed a submaximal (30%) intermittent fatiguing handgrip exercise (3 s grip, 2 s release, left hand) for approximately 9 min during fMRI scanning. Regression analysis was used to measure changes in fMRI signal from primary sensorimotor cortex (SM1), premotor cortex and visual cortex (V1) in both hemispheres.

Differential changes in long-interval intracortical inhibition and silent period duration during fatiguing hand exercise.

During fatiguing exercise corticomotor excitability increases as force declines, which may serve to increase motor output to the exercising muscle, but paradoxically at the same time there is an increase in silent period (SP) duration which is thought to represent a build-up of intracortical inhibition. Paired-pulse TMS at long interstimulus intervals can also be used to derive an index of long-interval cortical inhibition (LICI), however this has not yet been investigated in fatigue. Our aim was to measure LICI during and after a fatiguing exercise and determine if the changes in the index of LICI parallel the changes in SP duration.

Reduced functional activation after fatiguing exercise is not confined to primary motor areas.

We have previously shown that following a period of unimanual fatiguing exercise, there is a reduction in primary sensorimotor cortex (SM1) activation with movement of either the fatigued or the non-fatigued hand by Benwell et al. (Exp Brain Res 167:160-164, 2005). In the present study we have investigated whether this reduction is confined to motor areas or is more widespread.

Paired-pulse rTMS at trans-synaptic intervals increases corticomotor excitability and reduces the rate of force loss during a fatiguing exercise of the hand.

Previous studies have shown that the motor evoked potential (MEP) amplitude increases as force declines during a fatiguing muscle contraction, indicating that there is an increase in corticomotor excitability. In spite of this there is a progressive reduction in voluntary motor drive, as shown by an increase in the interpolated twitch force as fatigue develops. The aim of this study was to determine whether, by further increasing corticomotor excitability using a paired-pulse rTMS protocol designed to induce I-wave facilitation (iTMS), force loss during a sustained voluntary contraction could be reduced.

Short-interval cortical inhibition and corticomotor excitability with fatiguing hand exercise: a central adaptation to fatigue?

The central processes occurring during fatiguing exercise are not well understood, however transcranial magnetic stimulation (TMS) studies have reported increases both in corticomotor excitability, as measured by the motor-evoked potential (MEP) amplitude, and in long-interval intracortical inhibition, as measured by the duration of the post-MEP silent period. To determine whether short-interval cortical inhibition (SICI) is modulated by fatiguing exercise, we used single and paired-pulse TMS to measure MEP amplitude and SICI for the first dorsal interosseous (FDI) and abductor digiti minimi (ADM) muscles of the hand during, and for 20 min after, a 10-min intermittent maximal voluntary abduction of the index finger designed to fatigue the FDI muscle. For the FDI, the index of SICI increased at the onset of exercise (from 0.

Primary sensorimotor cortex activation with task-performance after fatiguing hand exercise.

We have compared functional MRI signals in primary sensorimotor cortex (SM1) during a paced motor task of each hand before and after unimanual (right hand) fatiguing exercise. Our aims were to determine whether the degree of activation is different when a motor task is performed after a fatiguing exercise, and whether there are any differences in activation between movement of the fatigued and non-fatigued hands. There was a significant reduction in the number of voxels activated in SM1 in the hemisphere contralateral to movement of both the fatigued hand (38 +/- 5 pre-exercise versus 21 +/- 3 post-exercise; P<0.