Full Motor Research Articles

Neuroprotective Potential of Orientin with Antiepileptic Drugs against Pentylenetetrazole-induced Kindling Model and Evaluation of Behavioral Assessment in Mice

Background:: The neuroprotective effect of bioflavonoids has been demonstrated in epileptic disorder. Objective:: The objective of this study was to investigate the anticonvulsant and adjuvant effects of the bioflavonoid and explore behavioural responses of orientin (Ore) on kindled mice induced by pentylenetetrazole [PTZ]. Methods:: Albino Swiss mice weighing 20-30 g were divided into nine groups [n=6]. Prior to the PTZ dose, alternatively, ore [10 mg/kg, i.p.] was given for 7 days, dissolved in 6% w/v carboxymethylcellulose [CMC] salt. On the 7th day, saline was solubilized with Lamotrigine [Lmt], Phenobarbital [Pb], and Gabapentin [Gbp] and administered as separate intraperitoneal [i.p.] injections 30 minutes prior to the PTZ dose. For the development of kindling seizures in mice, PTZ [30 mg/kg, i.p.] was delivered to all the mice for 12 days, alternatively until the animals appeared to develop full motor muscle jerking seizures. Mice who survived from complete motor seizures were selected for further experimentation. Results:: Data showed that anticonvulsive activity was exhibited by the control. Ore [10 mg/kg] with PB [40 mg/kg, i.p.] was administered on the 12th day and showed an increase in transfer delays [ITL and RTL]. Conclusion:: Anti-seizure efficacy of drugs was investigated at the effective dose of ore at 10 mg/kg + PB 40mg/kg in group 7 and was found to have promising therapeutic outcomes and potency in therapeutic strategies and associated concerns.

Human kinesin-5 KIF11 drives the helical motion of anti-parallel and parallel microtubules around each other.

During mitosis, motor proteins and microtubule-associated protein organize the spindle apparatus by cross-linking and sliding microtubules. Kinesin-5 plays a vital role in spindle formation and maintenance, potentially inducing twist in the spindle fibers. The off-axis power stroke of kinesin-5 could generate this twist, but its implications in microtubule organization remain unclear. Here, we investigate 3D microtubule-microtubule sliding mediated by the human kinesin-5, KIF11, and found that the motor caused right-handed helical motion of anti-parallel microtubules around each other. The sidestepping ratio increased with reduced ATP concentration, indicating that forward and sideways stepping of the motor are not strictly coupled. Further, the microtubule-microtubule distance (motor extension) during sliding decreased with increasing sliding velocity. Intriguingly, parallel microtubules cross-linked by KIF11 orbited without forward motion, with nearly full motor extension. Altering the length of the neck linker increased the forward velocity and pitch of microtubules in anti-parallel overlaps. Taken together, we suggest that helical motion and orbiting of microtubules, driven by KIF11, contributes to flexible and context-dependent filament organization, as well as torque regulation within the mitotic spindle.

The Functional Outcome of Surgical Management of Spondylolisthesis with Posterior Stabilization and Fusion.

Spondylolisthesis is a spinal condition characterized by the forward displacement of one vertebra over another, leading to instability and associated symptoms. Surgical intervention is often recommended for patients with symptomatic spondylolisthesis unresponsive to conservative treatment. The objective of this study was to analyze the functional outcomes of surgical management utilizing posterior stabilization and fusion techniques in patients with spondylolisthesis. This is a prospective study conducted on 30 patients who underwent surgical treatment for spondylolisthesis with posterior trans-pedicular screw fixation with conventional or reduction screws and fusion. Meyerding's grade of listhesis, Japanese Orthopaedic Association (JOA) score, Oswestry disability index (ODI) score and pain scores such as visual analog scale (VAS), numerical rating scale 11 (NRS-11), and pain relief rate were used to analyze the functional outcome. Postoperatively, Meyerding's grade of listhesis and the JOA score had improved significantly. The ODI score and pain scores such as VAS, NRS-11, and pain relief rate were better after surgical interventions. There was full motor recovery in 13 patients and 14 patients had full sensory recovery, while six patients had sensory blunting at the time of the time of the last follow-up. Twenty-six (80.7%) patients had clinically successful results and radiological/clinical fusion while four of the patients did not achieve a clinically successful result and radiological/clinical fusion. The average time for bony fusion was 5.58 months with the earliest being 4 months and the latest 12 months. Intraoperatively, one patient had screw slippage and one had a dural tear. Postoperatively, four patients had infection, two patients were presented with deep infection, and the instrumentation had been removed. This study demonstrated favorable functional outcomes and improvements in pain, disability, and quality of life measures following surgical intervention.

Determination of performance characteristics using FEA-analytical for outer rotor BLDC motor

This paper presents an analytical approach to determine the performance characteristics of an outer rotor Brushless DC (BLDC) motor using finite element analysis (FEA). An accurate performance characteristic is a crucial deliverable during the early motor design process in order to minimize the cost of change while delivering a feasible design to the application. There are several popular methods to determine motor performance, including template-based software as well as FEA. However, these two methods have limitations in terms of geometry and time. Therefore, this paper proposes that the limitations can be addressed by using a combination of FEA and mathematical equations. First, the optimum motor design is determined using an FEA analytical approach. Second, the torque constant <em>K</em><sub>T</sub>, is derived from the FEA results and followed by performance curve generation using the mathematical equation of speed, current, and output power in terms of torque function. Finally, the outcome results are verified against the motor requirements, including an assessment of maximum speed, stall current, and maximum output power. In conclusion, this research introduces a methodology for determining full curve motor performance prior to prototype fabrication. The leverage benefit could be gained through robust design and low-cost development.

Adjunctive hyperbaric oxygen therapy for spinal cord ischemia after complex aortic repair

ObjectiveSpinal cord ischemia (SCI) with paraplegia or paraparesis is a devastating complication of complex aortic repair (CAR). Treatment includes cerebrospinal fluid drainage, maintenance of hemoglobin concentration (>10 g/L), and elevating mean arterial blood pressure. Animal and human case series have reported improvements in SCI outcomes with hyperbaric oxygen therapy (HBOT). We reviewed our center’s experience with HBOT as a rescue treatment for spinal cord ischemia post-CAR in addition to standard treatment. MethodsA retrospective review of the University Health Network’s Hyperbaric Medicine Unit treatment database identified HBOT sessions for patients with SCI post-CAR between January 2013 and June 2021. Mean estimates of overall motor function scores were determined for postoperative, pre-HBOT, post-HBOT (within 4 hours of the final HBOT session), and at the final assessment (last available in-hospital evaluation) using a linear mixed model. A subgroup analysis compared the mean estimates of overall motor function scores between improvement and non-improvement groups at given timepoints. Improvement of motor function was defined as either a ≥2 point increase in overall muscle function score in patients with paraparesis or an upward change in motor deficit categorization (para/monoplegia, paraparesis, and no deficit). Subgroup analysis was performed by stratifying by improvement or non-improvement of motor function from pre-HBOT to final evaluation. ResultsThirty patients were treated for SCI. Pre-HBOT, the motor deficit categorization was 10 paraplegia, three monoplegia, 16 paraparesis, and one unable to assess. At the final assessment, 14 patients demonstrated variable degrees of motor function improvement; eight patients demonstrated full motor function recovery. Seven of the 10 patients with paraplegia remained paraplegic despite HBOT. The estimated mean of overall muscle function score for pre-HBOT was 16.6 ± 2.9 (95% confidence interval [CI], 10.9-22.3) and for final assessment was 23.4 ± 2.9 (95% CI, 17.7-29.1). The estimated mean difference between pre-HBOT and final assessment overall muscle function score was 6.7 ± 3.1 (95% CI, 0.6-16.1). The estimated mean difference of the overall muscle function score between pre-HBOT and final assessment for the improved group was 16.6 ± 3.5 (95% CI, 7.5-25.7) vs −4.9 ± 4.2 (95% CI, −16.0 to 6.2) for the non-improved group. ConclusionsHBOT, in addition to standard treatment, may potentially improve recovery in spinal cord function following SCI post-CAR. However, the potential benefits of HBOT are not equally distributed among subgroups.

Guillain-Barré Syndrome Following Spinal Fusion Surgery in an Elderly Patient: A Case Report

Guillain–Barré syndrome (GBS) is a rare immune-mediated polyneuropathy that rapidly leads to symmetric, ascending progressive weakness. Although GBS is typically associated with various infectious diseases, such as upper respiratory infections or gastroenteritis, it has also been reported following spine surgery. In this report, the authors present a case of GBS in an elderly patient after spinal fusion surgery and emphasize the importance of evaluating new-onset weakness in such cases. A 79-year-old man with diabetes mellitus and hypertension presented with weakness of the lower extremities and neurogenic claudication with chronic radicular pain. Magnetic resonance imaging revealed anterolisthesis at the L4-L5 level and disc protrusions with central and lateral recess spinal stenosis at L3-L4-L5. Following surgery, the patient complained of weakness and paresthesia in both upper extremities, prompting further investigation. An electrophysiologic study confirmed demyelinating neuropathy and cerebrospinal fluid (CSF) analysis showed elevated viral immunoglobulin levels and albumin-cytological dissociation despite negative bacterial and antiganglioside antibody tests. The patient received intravenous immunoglobulin infusion treatment and showed significant improvement, with full motor function recovery in all extremities after 6 weeks. The authors emphasize the importance of considering GBS in patients experiencing deteriorating neurological symptoms after spine surgery and suggest that electrophysiologic studies and CSF analysis are needed for an accurate diagnosis. Additionally, this report highlights the need for increased vigilance regarding the rapid onset of GBS symptoms in elderly patients following spinal surgery.

ANALYZING A THREE HUNDRED TEETH BI-PHASE HYBRID STEPPER MOTOR WITH DIFFERENT NUMBERS OF POLE PAIRS

The paper presents numerical models of a bi-phase, 0.3° full step hybrid stepper motor (HSM), with 16, 24, 32, 40, and, respectively, 48 poles in the stator. For the motor to move with a constant step angle, the stator and the rotor teeth must be shifted against each other with an angle of zero, 90, 180, and 270 electric degrees for each four consecutive stator poles. Due to this, bi-phase steppers with the number of poles in the stator different than eight are hardly seen. Therefore, to allow the construction of HSMs with different numbers of poles, some of the stator poles must be shifted from their symmetrical position. The five topologies' HSM detent and holding torque characteristics and their geometrical and constructive differences are presented. The Finite Element Method (FEM) based models are developed using the professional software COMSOL Multiphysics.

Primary Graviceptive System and Astasia: A Case Report and Literature Review.

Astasia refers to the inability to maintain upright posture during standing, despite having full motor strength. Impairment of the vestibulocerebellar pathway, graviceptive system, and cingulate motor area have been proposed to be related to astasia. However, the responsible neural pathways remain unclear. We hypothesize that there is a common neural network behind astasia. To test the hypothesis, we reviewed all reported cases with astasia, including ours, and focused on the correlation between anatomical destruction and symptom presentation. A total of 26, including ours, non-psychogenic astasia patients were identified in the English literature. Seventy-three percent of them were associated with other neurologic symptoms and sixty-two percent of reported lesions were on the right side. Contralateral lateropulsion was very common, followed by retropulsion, when describing astasia. Infarction (54%) was the most reported cause. The thalamus (65%) was the most reported location. Infarctions were the fastest to recover (mean: 10.6 days), while lesions at the brainstem needed a longer time (mean: 61.6 days). By combining the character of lateropulsion in astasia and the presentation of an interrupted graviceptive system, we concluded that the primary graviceptive system may be the common neural network behind astasia. Future studies on astasia should focus on the pathological changes in the perception of verticality in the visual world and the body.

Dichotomous Profile of Thoraco-Lumbar Dislocation Fractures. Case Report and Review of the Literature

Dislocated thoracolumbar fractures are uncommon injuries following a major trauma. We report a case of thoraco-lumbar dislocated fracture of which radiological finding was in discrepancy with clinical aspect and postoperative neurological recovery. A 32-year-old female admitted in Neurosurgery Department of the University Hospital of Kinshasa for low back pain, functional impotence of lower limbs and urinary retention following a road traffic accident three weeks prior. She presented a painful swelling at level of T12-L2 spinous processes and Wagner's grade IV gluteal pressure sores. Neurologically, on both limbs, the sensation was preserved and motor strength was graded 3/5 globally. CT-Scan showed a fracture of the vertebral body and pedicles of L2 with retrolisthesis of L1/L2 grade IV (Magerl B.3.3). She underwent posterior spinal decompression followed by spinal stabilisation with pedicle screws. The gluteal ulcers were debrided and sutured during the same surgery. Postoperatively, the pressure ulcers healed and the patient recovered full motor and urinary sphincter functions after twelve months of physiotherapy. This case report demonstrates the possibility of discordance between radiological images of dislocated thoracolumbar fractures and spinal cord injury clinical.

Discharge From the Postanesthesia Care Unit With Motor Blockade After Spinal Anesthesia Safely Optimizes Fast Track Recovery in Primary Total Hip and Knee Arthroplasty

BackgroundPost anesthesia care units (PACU) await return of motor function in lower extremities, prior to discharge for patients undergoing spinal anesthesia. The purpose of this study was to assess the impact of a newly utilized recovery protocol that facilitated early discharges of patients undergoing total hip and knee arthroplasties (THA/TKA) to the floor before full motor recovery from spinal anesthesia is achieved. MethodsA total of 647 patients undergoing spinal anesthesia for primary THA (n = 190) and TKA (n = 457) were divided into 2 groups: (1) Early PACU discharge group: patients with partial or full motor blockade at discharge. (2) Control PACU discharge group: patients with full motor recovery at discharge. Readiness for discharge was assessed using a modified Aldrete Score system. The primary outcome was incidences of hypotension or rapid responses post-operatively. ResultsThere was no significant difference in the incidence of hypotension between the two groups (1.4 versus 1.39%, P = 1.0) and zero rapid responses were noted. Early discharge shortened mean PACU LOS time from 86.50 minutes to 70.27 minutes (P < .01). There was no difference in the incidence of nausea (0.55 versus 0%; P = .51) ordizziness (2.22 versus 0.35%; P = .09). ConclusionIn this retrospective observational study, we found that early PACU discharge did not result in an increase in hemodynamic consequences on the surgical floor. Thus, discharge from PACU can be safely and more expeditiously performed without waiting for return of motor function in patients receiving spinal anesthesia for THA/TKA using a modified Aldrete Score recovery protocol.

Demographic, Medical, and Clinical Characteristics of a Population-Based Sample of Patients With Long-lasting Locked-In Syndrome.

Patients with classic locked-in syndrome (LIS), typically caused by ventral pontine stroke, present with quadriplegia, mutism, intact consciousness, and communication skills limited to vertical gazing and/or blinking. Clinical presentations and definitions of LIS differ, especially regarding incomplete LIS. In our study, we explored the functional diversity of LIS, its outcomes, and the complexity of its course along with variations in the location of lesions and their potential significance for outcomes. A national cohort of patients with vascular LIS who remained in the LIS state for at least 6 weeks according to a functional definition of LIS was studied. Demographic, medical, and follow-up data, collected between 2012 and 2022, were obtained from the quality register of the Norwegian National Unit for Rehabilitation of Locked-In Syndrome. Outcomes in verbal communication, motor function, and dependency were evaluated according to criteria for being in or not in the LIS state. The modified Rankin scale and LIS motor recovery scale were applied. Descriptive analysis was performed. The relationship between lesion location and functional outcome was investigated. The sample included 51 patients (median age: 55.7 years, 36 male individuals), 43 of whom had follow-up data. Ischemic stroke was the most common etiology (n = 35). Twenty-three patients had emerged from the LIS state, mostly within 2 years after onset. All but 1 patient achieved some motor improvement, whereas only 3 achieved full motor recovery, and 88% had a persistently high level of dependence. The 3-year survival rate was 87%. Five patients had an isolated pontine lesion, whereas 80% showed various lesions outside the brain stem. Patients who emerged from the LIS state had a significantly lower prevalence of lesions outside the brain stem than patients who remained in the LIS state did. Investigating an unselected population-based sample of patients with vascular LIS offers important insights into the functional diversity of LIS. Although most patients remained severely disabled, even small improvements in function can substantially increase the potential for activity and participation. Additional lesions outside the brain stem seem to be common in long-lasting LIS and might be prognostic for remaining in the LIS state.

188 American Spinal Injury Association (ASIA) Impairment Scale (AIS) Conversion Underestimates Neurological Recovery Following Traumatic Spinal Cord Injury

INTRODUCTION: The predominant tool used in the evaluation of neurological outcomes following spinal cord injury (SCI) is the American Spinal Injury Association (ASIA) Impairment Scale (AIS), calculated within the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). However, there are significant clinical and functional differences within AIS grades A-E that can be better captured by ISNCSCI 0-100 full motor scores. METHODS: 55 patients with acute traumatic SCI who underwent surgery were retrospectively analyzed as part of a prospective cohort study, Transforming Research and Clinical Knowledge in SCI (TRACK-SCI). Clinical, radiographical and treatment parameters were collected, including AIS grades and full motor scores on presentation and discharge, Brain and Spinal Injury Center (BASIC) scores. Multivariable analysis was utilized to evaluate predictors of neurological recovery utilizing AIS grade and motor scores as endpoints. RESULTS: Improvement of at least 1 AIS grade from presentation was noted in 27% of patients (mean improvement of 0.3 AIS grades, p &lt; 0.001) upon discharge. Improvement of total motor scores was noted in 67% with a mean recovery of 8.4 points. The discordance between rate of AIS grade conversion and motor score recovery was greatest in patients with initial AIS grade D (16% vs 72%, respectively). Total motor score improvement was greatest for patients with initial AIS grade C, with a mean improvement of 20 points. Utilizing multivariate analysis, BASIC score and initial total motor score were significant predictors of motor score recovery. However, no variables were prognostic when utilizing AIS conversion as the endpoint. CONCLUSIONS: AIS conversion underestimates true degree of functional improvement following SCI. Changes in full motor score is a more robust outcome metric in the evaluation of factors prognostic of neurological recovery following injury.

PRODUCTION PROCESS OF ZX - 200 5G SIDE FRAME AT PT. OHGISHI INDONESIA

Excavator is one of the heavy equipment used to move material from one place to another. The excavator consists of several parts, one of which is the side frame. The side frame is the bottom part of the excavator which functions to hold the load, steer, support the unit and act as the driving force for the heavy equipment. The data collection method was taken by reading data supporting books, making direct observations and conducting question and answer. The side frame uses SS400 material, SS 400 steel is low carbon steel with carbon content (max 0.17% C) or low carbon steel according to ASTM (American Society for Testing Materials) A36 or JIS (Japanese Industrial Standards) G3101 standards. SS 400 steel can only be hardened by surface hardening such as caburizing. In the process of making the ZX – 200 5G side frame, the first process is tack welding idler bracket and motor bracket which uses 322 watt amperes and 29 – 36 V voltage. Then full idler and motor bracket welding takes ±42 minutes. Followed by the process of full welding of the idler and motor bracket with the middle body using amperes of 275 – 300 A, voltage 33 – 35 V. Then the process of making the center line and ending the process of visual inspection of the welds.

Countermovement Jumps Detect Subtle Motor Deficits in People with Multiple Sclerosis below the Clinical Threshold.

In the early stages of multiple sclerosis (MS), there are currently no sensitive assessments to evaluate complex motor functions. The countermovement jump (CMJ), a high-challenge task in form of a maximal vertical bipedal jump, has already been investigated as a reliable assessment in healthy subjects for lower extremity motor function. The aim was to investigate whether it is possible to use CMJ to identify subthreshold motor deficits in people with multiple sclerosis (pwMS). All participants (99 pwMS and 33 healthy controls) performed three maximal CMJs on a force plate. PwMS with full motor function and healthy controls (HC) did not differ significantly in age, disease duration, Body Mass Index and the Expanded Disability Scale Score. In comparison to HC, pwMS with full motor function demonstrated a significantly decreased CMJ performance in almost all observed kinetic, temporal and performance parameters (p < 0.05). With increasing disability in pwMS, it was also observed that jump performance decreased significantly. This study showed that the CMJ, as a high challenge task, could detect motor deficits in pwMS below the clinical threshold of careful neurological examination. Longitudinal studies are pending to evaluate whether the CMJ can be used as a standardized measure of disease progression.

The molecular basis of proteolytic inactivation in the human LONP1 protease via long-timescale molecular dynamics.

The ATP-dependent protease LONP1 plays a central role in protecting mitochondrial health by degrading misfolded proteins. Dysregulation of LONP1 has been implicated in numerous disease pathways, including neurodegenerative disorders and cancer. Several conformations of LONP1 have been resolved by cryo electron-microscopy, revealing distinct operational modes. However, the mechanism by which LONP1 is activated and uses ATP hydrolysis to power substrate translocation and degradation has remained unclear. In order to elucidate this mechanism, we modelled the full hexameric motor protein, consisting of the ATPase and protease domains, and performed more than 100µs of molecular dynamics simulations using Anton. The results of our simulations suggest a stochastic mechanism of proteolysis. In the absence of substrate, we observe random inactivation of individual proteolytic sites mediated by the formation of a helix and a hydrogen bond, which occlude the site both sterically and chemically. These results suggest both that activation is dependent on the presence of bound substrate, and that individual subunits may be regulated independently. Additionally, we observe nucleotide flips within the ATPase domain, resulting in distinct poses that are stable for several microseconds. Our simulations show that the transitions between these poses allosterically induce conformational changes at the interface of the ATPase and protease domains. These findings provide crucial insight into the mechanism of LONP1 proteolytic activation and regulation, which will ultimately aid in the development of novel therapeutics to protect against mitochondrial dysfunction.

Abstract WP56: Improvement In Motor And Language Domains Mediates Most Of The Effect Of 24h NIHSS Improvement On Functional Independence

Introduction: Improvement in NIH stroke scale scores on 24h follow-up is considered a key prognostic element after endovascular thrombectomy (EVT). We aimed to evaluate the proportion of effect of 24h NIHSS improvement on mRS 0-2 at 90d mediated through improvement in motor and language domains. Methods: From SELECT study, EVT patients with detailed NIHSS components on presentation and 24h follow-up as well as complete mRS on discharge and 90d were selected. Motor improvement was defined as ≥2 point in cumulative arms and legs score or 0 score at 24h and language improvement was defined as ≥1 point in cumulative aphasia and dysarthria scores at 24h. Mediation analysis framework using 4-step method (Figure 1a) was used to evaluate the effect of 24h NIHSS improvement mediated through improvement in motor and language scores. Results: Of 192 eligible EVT patients, 176 demonstrated motor deficits and 187 demonstrated language deficits. 24h NIHSS improvement was significantly associated with mRS 0-2 (aOR:1.15[1.07-1.23], p&lt;0.001) - step 1. 24h NIHSS improvement was also significantly associated with motor (aOR:1.77[1.48-2.12],p&lt;0.001) and speech improvement (aOR:1.25[1.16-1.36],p&lt;0.001) - step 2. In the full model, motor (aOR:3.00[1.07-8.46],p=0.037) and speech improvement (aOR:3.15[1.37-7.27],p=0.007) were significantly associated with mRS 0-2, whereas 24h NIHSS improvement was no longer a significant predictor (aOR:1.05[0.96-1.15],p=0.33) - step 3 of figure 1a. Motor improvement mediated 68% and speech improvement mediated 27% of the association of 24h NIHSS improvement with mRS 0-2 (Figure 1b) - step 4. Conclusions: Almost all (~95%) of the effect of 24h NIHSS improvement on functional independence (mRS 0-2) was mediated through specific improvement in motor and language domains, suggesting a large role of improvement in motor and language domains in achieving better functional independence. Further studies are needed to confirm the findings.

Guillain-Barre Syndrome in a Patient Posted for Elective Caesarean Delivery: An Anaesthetic Dilemma

Guillain-Barre syndrome (GBS) is an acute polyneuropathy most commonly associated with acute flaccid paralysis which may be associated with sensory and autonomic neuropathy. Antecedent infection may trigger an immune response which may cause a cross reaction leading to demyelination and degeneration of axons in nerves. Here we present a case of a 28 year old female, G2P1 at 37 weeks of gestation with a history of previous lower segment caesarean section (LSCS) and oligohydramnios with suspected Guillain-Barre syndrome posted for elective LSCS. She presented with dribbling of saliva from angle of mouth and inability to close both eyes with slurring of speech since 2 days. MRI brain was advised which showed no specific changes. Neurology evaluation was done and Guillain-Barre syndrome with isolated facial diplegia was suspected. Due to risks associated with general anaesthesia and succinylcholine in this patient, a decision was made to proceed with a low dose spinal anaesthesia. Once administered, the level of subarachnoid block was noted to be at T6. The caesarean section proceeded uneventfully with no major hemodynamic changes. A healthy baby girl was delivered and patient was noted to have full motor and sensory recovery in the post-operative period. Providing anaesthesia to patients with Guillain-Barre syndrome can be very challenging. Meticulous pre-anaesthetic planning is needed. A thorough pre-anaesthetic evaluation considering risks and benefits of each modality of anaesthesia is crucial before anaesthetizing these patients.

CHILDHOOD EDUCATION: LUDIC ACTIVITIES THAT FAVOR THE TEACHING-LEARNING OF CHILDREN FROM 0 TO 02 YEARS OLD

Studies have shown the importance of recreational activities in children's lives, because through games they learn and, in addition, provide full physical, cognitive, motor and social development. The purpose of this work is to present a brief study on the historical conceptions and their importance in the child's life involving the ludic. Thus, we present a theoretical approach on Early Childhood Education and its importance for the formation of children, especially those who participate in Early Childhood Education Institutions. Also point out the contributions of some renowned authors on the ludic (jokes and games) and how it is important for the child's cognitive and social development process, as well as contributing with some activities for children from 0 to 02 years old, being which can be adapted for older children. Based on these activity ideas, we can understand how relevant games and games are with a pedagogical objective, as it favors the teaching-learning process and makes the subject more critical and aware of his role in society. For this, a bibliographical research was carried out, with important subjects, based on a better understanding of this process.

Immediate Postoperative Complications and Recovery Profile Following Spinal Anaesthesia: A Comparison Between Pethidine and Bupivacaine

Background: Spinal anaesthesia is a less expensive option to general anaesthesia for surgical procedures below the umbilicus in resource-constrained settings with a shortage of medical gases and specialized an anesthetists. The patient’s airway is not harmed by spinal anaesthesia, and both the patient and the doctor benefits from a host of additional benefits. Following the discontinuation of hyperbaric lidocaine for intrathecal injection because it can results in radiculopathy, bupivacaine is frequently used for spinal anaesthesia. For spinal, doctors employ pethidine, a lipophilic opioid with local aesthetic properties. In this study, pethidine bupivacaine were used as the only anaesthetic a gents to perform spinal anaesthesia, and the immediate postoperative problems and recovery profile were compared. Methodology: For quick surgical procedures on the lower body, 52 American Society of Anesthesiologists physical status I and II patients between the ages of 18 and 60 were randomly assigned to receive spinalanaesthesia. The patients' recovery times for pinprick sensation at S2, plantar flexion, big toe proprioception, and full motor recovery (Bromage score 0) were compared after receiving either 2.5mL of isobaric 0.5 percent bupivacaine or 1mg/Kg of preservative-free pethidine. The immediate postoperative period complications of pain, drowsiness, nausea and vomiting, pruritus, and urine retention were compared. Results: The time to return of pinkprick sensation at S2 was 94.6220.25 minutes and 205.9631.05 minutes, respectively, when pethidine and bupivacaine were compared. Pethidine and bupivacaine had a time to return of plantar flexion of 92.8812.01 minutes and viii 1 93.8539.56 minutes, respectively. Between pedthidine and bupivacaine, the mean recovery times f or the big toe’s proprioception were 31.159.41 and 172.5042.70 minutes, respectively, for full motor recovery (Bromage score 0). All recovery time variation were significant (p 0.0001) across the broad. There was no discernible change in the incidence of pain or sedation in the immediate postoperative period. In the Bupivacaine group, four patients (15. 38%) reported having hardly bearable discomfort. Both groups did not experience any instances of nausea or vomiting. Pruritus was experience by five patients (19.22%) in the pethidine group, but none in the bupivacaine group (0.00 %). Urinary retention incidence varied, and this difference was significant (p = 0.048) Conclusion: Compared to bupivacaine, pethidine had a quicker recovery profile and didn't lead to any major complications right after surgery.

Cerebellar glutamatergic system impacts spontaneous motor recovery by regulating Gria1 expression

Peripheral nerve injury (PNI) often results in spontaneous motor recovery; however, how disrupted cerebellar circuitry affects PNI-associated motor recovery is unknown. Here, we demonstrated disrupted cerebellar circuitry and poor motor recovery in ataxia mice after PNI. This effect was mimicked by deep cerebellar nuclei (DCN) lesion, but not by damaging non-motor area hippocampus. By restoring cerebellar circuitry through DCN stimulation, and reversal of neurotransmitter imbalance using baclofen, ataxia mice achieve full motor recovery after PNI. Mechanistically, elevated glutamate-glutamine level was detected in DCN of ataxia mice by magnetic resonance spectroscopy. Transcriptomic study revealed that Gria1, an ionotropic glutamate receptor, was upregulated in DCN of control mice but failed to be upregulated in ataxia mice after sciatic nerve crush. AAV-mediated overexpression of Gria1 in DCN rescued motor deficits of ataxia mice after PNI. Finally, we found a correlative decrease in human GRIA1 mRNA expression in the cerebellum of patients with ataxia-telangiectasia and spinocerebellar ataxia type 6 patient iPSC-derived Purkinje cells, pointing to the clinical relevance of glutamatergic system. By conducting a large-scale analysis of 9,655,320 patients with ataxia, they failed to recover from carpal tunnel decompression surgery and tibial neuropathy, while aged-match non-ataxia patients fully recovered. Our results provide insight into cerebellar disorders and motor deficits after PNI.