Chest Research Articles

Evaluation of the efficacy of percutaneous spinal cord stimulation according to the single or double leads

AimThe aim of the study was to compare the efficacy of single or double lead in percutaneous spinal cord stimulation (SCS).MethodFollow-up data of 41 patients (20 patients with double lead, 21 patients with single lead) who underwent percutaneous SCS were analysed. Demographic and clinical examination findings (gender, age, pain characteristic, neurological examination, medications used) and visual analogue scale (VAS) scores were recorded. VAS pain scores, clinical and neurological examination and complication findings were recorded at 1st and 12th months at post-procedure follow-up.ResultsTwenty patients had double lead and 21 patients had single lead. Five patients had root avulsion, 1 patient had complex regional pain syndrome, 1 patient had postherpetic neuralgia, 2 patients had phantom pain, 3 patients had ischaemic pain and 29 patients had postlaminectomy syndrome. In 10 patients, leads were placed in the cervical region and in 31 patients in the thoracic region. There was at least 50% reduction in VAS scores in 71.4% (15 patients) with single lead implantation and 65% (13 patients) with double lead implantation (p = 0.7). Infection was significantly higher in patients with double lead than in patients with single lead implantation (p < 0.05). In 1 patient, generator exchange was performed because the generator was exposed due to skin necrosis. No major complication was recorded.ConclusionSCS with single and double lead is an effective method in chronic pain syndromes. SCS with single lead can be preferred in terms of time, cost and labour saving.

Brain and Spine Magnetic Resonance Imaging (MRI) Characteristics of a Pediatric Cohort With MOGAD.

Myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently defined demyelinating disorder with an age-related phenotypic spectrum. At disease onset, there is considerable clinical overlap between MOGAD and other demyelinating conditions, and it remains difficult to identify MOGAD radiographically. This study aims to further describe neuroimaging findings in the brain and the spine at presentation and throughout relapses in children with MOGAD. We present a retrospective cohort study including all children presenting to a single center between 2010 and 2020 with acute demyelination who were positive for serum MOG-IgG antibodies and negative for serum aquaporin-4 antibodies. For each patient, magnetic resonance imaging (MRI) scans of the brain and spine at presentation and on each relapse were reviewed and categorized in a blinded fashion by 2 pediatric neuroradiologists. Sixteen patients met the inclusion criteria. Four had diffuse and bilateral fluid-attenuated inversion recovery signal in the white matter, but only on initial presentation. The area postrema was never affected. All 5 patients with optic neuritis had pre-chiasmatic (but not chiasmatic) involvement on presentation. The brachium pontis was involved in 3 patients on initial presentation, and in 8 patients at any time. Eleven patients demonstrated spinal cord involvement, and the cervical, thoracic, and lumbar regions were involved at similar frequencies. The radiographic features of MOGAD in children appear to reflect their presenting demyelinating syndromes. However, certain features, such as diffuse fluid-attenuated inversion recovery hyperintensities and expansile fluid-attenuated inversion recovery signal in the brachium pontis, may be more frequent in MOGAD compared with other demyelinating disorders.

Active Arm Swing During Running Improves Rotational Stability of the Upper Body and Metabolic Energy Efficiency

Abstract Purpose The kinematic benefits of arm swing during running for upper body stability have been previously investigated, while its role in metabolic energy efficiency remains controversial. To address this, this study aimed to test the hypothesis that active arm swing during running reduces both torso angular motion around the longitudinal axis and metabolic energy consumption. Methods We employed forward dynamics musculoskeletal running simulations with different arm conditions to investigate the hypothesis. Full-body musculoskeletal running models, incorporating 150 muscles, were developed using artificial neural network-based running controllers. Three arm conditions were simulated using the running models and controllers: active arm swing, passive arm swing, and fixed arms. Results Our results revealed that the active arm swing model demonstrated the lowest total metabolic energy consumption per traveling distance. The costs of transport were 5.52, 5.73, and 5.82 J/kg-m for active, passive, and fixed arm models, respectively. Interestingly, while metabolic energy consumption in the upper limb muscles was higher during active arm swing, the total energy consumption was lower. Additionally, the longitudinal rotation of the torso was minimal in the active arm swing condition. Conclusion These findings support our hypothesis, demonstrating that active arm swing during running reduces the angular motion of the torso and the metabolic energy consumption. This study provides evidence that arm swing during running is performed actively as an energy-saving mechanism. These results contribute to understanding of running biomechanics and may have implications for performance optimization in sports and rehabilitation settings.

Assessing the Relevance of the Kansas City Cardiomyopathy Questionnaire in Patients With Tricuspid Regurgitation: The Tri-QOL Qualitative Study.

Validly measuring disease-specific health status is critical in patients with severe tricuspid regurgitation (TR) to quantify the benefit of different interventions. The Kansas City Cardiomyopathy Questionnaire (KCCQ) has been used to assess health status in patients with severe TR, but its content validity in this patient population is unknown, including whether additional questions are needed to supplement the KCCQ. Twenty participants with symptomatic severe TR from 2 midwestern clinical sites were interviewed in 2023 using a semistructured guide. The interview guide addressed symptoms, physical and social functioning, and quality of life concepts of the KCCQ, as well as other potential TR symptoms not represented in the KCCQ. Interview transcripts were analyzed using inductive and deductive coding and content analysis, with additional participants recruited until thematic saturation occurred. Mean age of the participants was 80 (41-89), and 75% were female. Shortness of breath and fatigue were reported by virtually all participants (n=20 and n=19, respectively) and had a marked negative impact on their physical and social functioning and quality of life. Lower limb edema was also reported by 10 participants. Although these concepts are captured by the KCCQ, other symptoms were also reported, including appetite loss (n=8) and upper body edema (n=4), but did not seem to markedly affect participants' function or quality of life. In addition, all participants who experienced these other symptoms reported symptoms that were already captured by the KCCQ. All participants experienced symptoms captured by the KCCQ, and these symptoms had a substantial impact on their physical and social functioning and quality of life. Although some participants reported additional symptoms not assessed by the KCCQ, their incorporation would only marginally improve content validity. Thus, the current KCCQ appears to be appropriate for capturing the disease-specific health status of patients with severe TR.

Factors Associated With Physical Activity in Alzheimer's Disease: A Cross-Sectional Study of Individuals and Their Caregivers.

Physical activity (PA) is associated with better outcomes in individuals living with Alzheimer's and related dementia (ADRD). We examined environmental, intra-, and interpersonal correlates of PA for persons living with ADRD. PA (accelerometry), cognitive function, physical function, and sociodemographic factors were collected in adults with ADRD and their caregivers. Spearman's correlations and generalized linear models were used to evaluate factors associated with PA of persons living with ADRD. Valid data were obtained from 65 pairs of adults living with ADRD (73.6 ± 8.4 years, 39.4% female) and caregivers (69.4 ± 9.4 years, 69.2% female, 93.8% spouse). Moderate-to-vigorous PA (MVPA) and light PA of persons living with ADRD were correlated with upper and lower body strength, aerobic fitness, and agility. MVPA and sedentary time of persons living with ADRD were associated with that of their caregiver. Physical function and caregiver PA may be targets for interventions in those living with ADRD.

Classification of young adult motor fluctuation phenotypes in gait.

Stride-to-stride fluctuations are natural in gait. These fluctuations are marked by inter-individual variability, suggesting that different fluctuation strategies (i.e., phenotypes) may exist. This study investigates the presence of gait fluctuation phenotypes. Whole-body kinematics were measured from young, healthy males and females (N = 51) while walking on a treadmill at their preferred speed. Motor fluctuation metrics (i.e., magnitude of variability, local dynamic stability, and regularity) were measured for 32 joint angles across the upper and lower body. These metrics were reduced to principal components (PCs) via principal component analysis and then grouped into clusters using the k-means method. One-way ANOVAs were conducted to test for cluster differences in motor fluctuation PCs. Three PCs were extracted, explaining 39.7% of all 96 motor fluctuation metrics. Higher PC1 scores represent more fluctuation across all joints, higher PC2 scores represent greater upper limb fluctuations with fewer fluctuations in the lower limb, and PC3 scores represent less regularity in fluctuations. PC scores best grouped into four clusters in 54.0% of iterations. Clusters 1-4 each had a significantly different PC1 score (p<0.022), and Cluster 3 had a higher PC2 score than all other clusters (p<0.022). Motor fluctuations in treadmill gait of young adults were characterised by four gait fluctuation phenotypes, interpreted as repeaters, replacers, moderate fluctuators, and mixed fluctuators (i.e. more upper limb but fewer lower limb fluctuations); extending the repeaters vs replacers hypothesis. The identified phenotypes add a new perspective that may help clarify the link between motor fluctuations and gait instability.

Predictive Value of Lung Ultrasound Combined With ACEF Score for the Prognosis of Acute Myocardial Infarction.

Lung ultrasound (LUS) and the ACEF score (age, creatinine, and ejection fraction) have been shown to be pivotal in predicting an unfavorable prognosis in acute myocardial infarction (AMI). The aim of this study is to investigate the prognostic value of LUS combined with ACEF score in AMI. The ACEF score and the total number of B-lines in eight thoracic regions of LUS were calculated. Adverse events were recorded during hospitalization and follow-up, defined as all-cause death and other cardiovascular events. Multivariate logistic regression identified predictors of adverse events during hospitalization. Multivariate Cox regression identified predictors of adverse events during follow-up. We enrolled 204 patients. The B-lines (adjusted OR 1.08, [95% CI: 1.03-1.13], p < 0.01) and the ACEF score (adjusted OR 2.71 [95% CI: 1.07-6.81], p < 0.05) independently predicted adverse events during hospitalization. The C-index values were 0.81 (p < 0.01) for the ACEF score, 0.81 (p < 0.01) for LUS, and 0.86 (p < 0.01) for their combination. One hundred seventy-one patients were followed up for 12 months (IQR, 8.13-15.93). Both the B-lines (adjusted HR 1.06 [95% CI: 1.03-1.09], p < 0.05) and the ACEF score (adjusted HR 1.95 [95% CI: 1.10-3.43], p < 0.05) remained associated with an increased risk of adverse events during follow-up. The C-index values were 0.74 (p < 0.01) for the ACEF score, 0.73 (p < 0.01) for LUS, and 0.80 (p < 0.01) for their combined predictive ability. The B-lines and ACEF score are associated with adverse events in AMI patients. When combined, they provide increasing value in assessing the risk of adverse events, which has significant implications for risk stratification.

The Importance of Upper Body Strength Testing and Training For Performance of High-Intensity Actions in Professional Soccer Players: A Survey Exploring Perceptions and Current Practices of Soccer Strength and Conditioning Coaches

This study aimed to investigate the perception of soccer strength and conditioning (S&amp;C) coaches on the importance of upper body (UB) strength training for the performance of high-intensity actions (HIA) (i.e., sprinting, repeated sprint ability, change of direction, and jumping) in professional soccer players, and to identify current practices with regards to UB strength testing and training methodologies within this sport. Eighty-six S&amp;C coaches working with professional soccer players volunteered to complete the survey. Twenty-two fixed responses and three open-ended questions were grouped into three sections: (a) demographic information, (b) perspectives on the importance of UB strength and UB strength training for HIA, and (c) current practices of UB strength training in soccer. Frequency analysis was used to assess fixed response questions, and thematic analysis established clear and recognisable themes for open-ended questions. Relative to “not important” options, UB strength was perceived as important for all HIA, especially for jumping (89%) and acceleration (87%). Coaches strongly supported the idea that UB strength plays a role in enhancing HIA, with particular influence on jumping (100%), acceleration (97%) and COD (93%). This positive influence is believed to be realised via improved force transmissions (97%) and neural drive (94%). Notably, however, surveyed coaches overwhelmingly use moderate resistance in their sessions (100%) without substantial emphasis on high-velocity contractions (64%). In conclusion, S&amp;C practitioners value UB strength training for enhancing the performance of HIA in professional soccer players. Further research is needed to explore this link and provide clearer guidance on the implementation of UB strength training in professional soccer.

Considering the Effects of Upper Body, Lower Body, and Their Combination on Post-Activation Performance Enhancement of Bowling Velocity Among Amateur Cricket Players

Considering the Effects of Upper Body, Lower Body, and Their Combination on Post-Activation Performance Enhancement of Bowling Velocity Among Amateur Cricket Players

P-2333. Evaluation of Clinical Characteristics, Risk Factors and Prognosis of Herpes Zoster (Shingles) Infection in Türkiye: VARICOMP-Adult-2 Study

Abstract Background The varicella-zoster virus induces a primary infection known as varicella (chickenpox) and subsequently becomes latent in the dorsal root or cranial nerve ganglia. Later in life, the virus may reactivate, leading to a secondary infection called herpes zoster (shingles). Despite the increasing population at risk, research on shingles infection in Türkiye is limited. This study aimed to assess the clinical and demographic characteristics of shingles and the risk factors for postherpetic neuralgia among adults in Türkiye.Table 1.Demographic and clinical information of the patients Methods This retrospective, descriptive, multicentre (n=11) study was conducted between January 2016 and January 2022. All patients aged ≥ 18 years who were diagnosed with shingles following screening based on ICD-10 codes related to these conditions were included. Logistic regression analysis was conducted to identify independent risk factors for postherpetic neuralgia.Table 2.Comparative analyses regarding postherpetic neuralgia development of the patients Results A total of 6114 patients with herpes zoster infection were evaluated. The demographic and clinical characteristics of the patients are presented in Tables 1 and 2. The age groups with the highest proportion of shingles were 61-70-year (22.2%, n=1359) and 51-60-year (21.0%, n=1285), respectively. The most prevalent comorbidities were cardiovascular diseases (9.0%, n=542) and diabetes mellitus (7.1%, n=426). Concerning dermatome distribution, the most affected region was the thoracic region (46.6%, n=1718). Significant independent risk factors for developing postherpetic neuralgia were being ≥ 50 years of age (OR=3.356, 95% CI, 1.795-6.274), trigeminal involvement (OR=2.496, 95% CI, 1.450-4.298), and antiviral use (OR=0.165, 95% CI, 0.094-0.290) (Figure1).Figure 1.Risk factors for the development of postherpetic neuralgia. OR: Odds ratio; CI: Confidence interval. Conclusion This study results revealed that shingles increase with advanced age and comorbidities. It is anticipated that the burden of shingles disease and related complications will increase due to the increasing aging population and comorbidities in Türkiye. Given the burden, especially in the ≥ 50 years age group, it underscores the importance of employing protective measures such as herpes zoster immunization and using antiviral treatments to prevent postherpetic neuralgia. Disclosures Ozge Ozgen-Top, Asisst. Prof., MD, GSK Biologicals SA: Honoraria|GSK Biologicals SA: The study was funded by GSK Biologicals SA;GSK Biologicals SA reviewed a preliminary version of the abstract;authors have the final responsibility Esin T. Senol, Prof., MD, GSK Biologicals SA: Grant/Research Support|GSK Biologicals SA: Esin Şenol will receive honoraria for IDWeek 2024 if the abstract is accepted.

Body position influence on cerebrospinal fluid volume redistribution inside the cranial and spinal CSF compartments

IntroductionIt is generally accepted that during body position changes from horizontal to vertical there is a short-lasting shift of a certain CSF volume from the cranium into the hydrostatically lower parts of the spinal space, which leads to transitory CSF pressure decrease to negative values.MethodsIn order to test this, we performed MRI volumetry of cranial and spinal part of the CSF space in healthy volunteers of both genders (n = 22) in three different body positions [horizontal (H); elevated head and upper body (H-UP) under an angle about 30° from the base; elevated lower body (B-UP) under an angle about 30° from the base].ResultsVolumes of brain and spinal cord tissue did not change during body position changes. Significant CSF volume (ml) changes occur inside the spinal space in the tested body positions, primarily in the lumbosacral segment (H-UP – 38.1 ± 7.0; H – 34.4 ± 6.5; B-UP – 28.7 ± 6.5), while at the same time no significant CSF volume changes have been observed inside the cranium in two tested positions (H and B-UP) in which it was possible to measure intracranial CSF volume changes or if we sum up cervical and cranial CSF volumes in those positions.ConclusionObserved results suggest that during the changes of body position CSF volume redistribution occurs, primarily inside the spinal and not the cranial space. This is in accordance with the new hypothesis by which spinal intradural space can significantly change its volume due to its elasticity, thus adjusting to the influence of gravity and pressure changes.

Assessing Anti-Acne Potentials Via in-vitro, Ex-vivo, and in-vivo Models: A Comprehensive Approach.

Acne vulgaris is the 8th most commonly prevailing skin disorder worldwide. Its pervasiveness has been predominant in juveniles, especially males, during adolescence and in females during adulthood. The lifestyle and nutrition adopted have been significantly reported to impact the occurrence and frequency of acne. It typically occurs over the regions of the forehead, upper chest, and back of the body, which are regions with high proportions of active sebaceous follicles. The market today is flooded with the pool of anti-acne medications (oral, topical/systemic) that contain either a single therapeutic agent or a blend targeting multiple pathological pathways. However, the clinical applicability of these preparations is limited due to formulation stability, drug penetrability, and targeting, the incidence of secondary effects, antibiotic resistance, etc. Moreover, the effectiveness of the former therapies varies as per the type and severity of acne. Therefore, it is necessary to extensively research skin physiology under normal and diseased conditions so that newer, safer, and more effective medications can be devised. Moreover, their safety and efficacy should be validated by employing various acne models, and their comparative profiling should be done with standard marketed anti-acne preparations. Acne models assist to uncover the complex disease pathogenesis and identify the potential targets for therapeutic interventions. This review is an attempt to highlight varied in-vitro, ex-vivo, and in-vivo testing procedures done to assess drug efficacy, track disease progression, and compare test substances with existing treatments. By presenting a unified approach to acne modeling, this review will assist researchers in selecting the most appropriate model for their specific research goals, helping them to generate valuable and reproducible data to support the development of effective acne therapies.

Effect of temperature cycles on the sleep-like state in Hydra vulgaris

BackgroundSleep is a conserved physiological phenomenon across species. It is mainly controlled by two processes: a circadian clock that regulates the timing of sleep and a homeostat that regulates the sleep drive. Even cnidarians, such as Hydra and jellyfish, which lack a brain, display sleep-like states. However, the manner in which environmental cues affect sleep-like states in these organisms remains unknown. In the present study, we investigated the effects of light and temperature cycles on the sleep-like state in Hydra vulgaris.ResultsOur findings indicate that Hydra responds to temperature cycles with a difference of up to 5° C, resulting in decreased sleep duration under light conditions and increased sleep duration in dark conditions. Furthermore, our results reveal that Hydra prioritizes temperature changes over light as an environmental cue. Additionally, our body resection experiments show tissue-specific responsiveness in the generation ofthe sleep-like state under different environmental cues. Specifically, the upper body can generate the sleep-like state in response to a single environmental cue. In contrast, the lower body did not respond to 12-h light–dark cycles at a constant temperature.ConclusionsThese findings indicate that both light and temperature influence the regulation of the sleep-like state in Hydra. Moreover, these observations highlight the existence of distinct regulatory mechanisms that govern patterns of the sleep-like state in brainless organisms, suggesting the potential involvement of specific regions for responsiveness of environmental cues for regulation of the sleep-like state.

МОРФОЛОГІЧНИЙ ПРОФІЛЬ ЮНИХ СПОРТСМЕНІВ ІЗ РІЗНИМИ ТИПАМИ ПОСТАВИ

The relevance of the research topic. The last decade in Ukraine has seen a decline in the overall health status of children. There has been an increase in the number of children with various pathological conditions: musculoskeletal disorders, various pathologies of internal organs, which, according to scientists, are mainly associated with connective tissue damage, in particular, connective tissue dysplasia. Young athletes deserve special attention, as even minor manifestations of connective tissue dysplasia can lead to serious diseases of the musculoskeletal system and other body systems during daily training and competition. The purpose of the article is to determine the morphological profile of young rugby players with different types of posture. To achieve this goal, the following research methods were used: analysis of scientific and methodological literature and documentary materials, anthropometry, and a pedagogical experiment. The results obtained in the course of the study were processed using mathematical statistics. All calculations were carried out using IBM SPSS Statistics 21 software, and graphical material was prepared in Microsoft Excel. Results. Characterising the morphological profile of young rugby players, we note that most athletes have average and above average values of body weight and chest circumference. They are characterised by harmonious physical development with a tendency to hypersthenic body constitution, with a large chest girth and a massive upper body. The search for differences between athletes with different types of posture showed that they almost do not differ in anthropometric parameters, with the exception of the lower leg circumference, which is much larger in children with scoliotic posture compared to other groups. Conclusions. It was found that rugby players already at the stage of initial training have certain deviations in posture and a rather specific morphological profile.

O-06 CUSHING’S SYNDROME DUE TO BILATERAL IMMUNHISTOCHEMICALLY-PROVEN ACTH POSITIVE ADRENAL NEOPLASMS

Abstract Introduction Ectopic ACTH secretion is a rare cause of endogenous hypercortisolism. Herein, a case of Cushing’s syndrome due to bilateral immunhistochemically-proven ACTH positive adrenal neoplasms is presented. Clinical Case A 60 year old women was admitted with acute-onset severe hypokalemia and hyperglycemia. She had severe metabolic alkalosis and her serum K levels kept being below 1.5 mmol/L, if left untreated. Physical examination demonstrated facial and upper body flushing, but was otherwise normal. Laboratory analyses were; early morning plasma ACTH: 211 pg/ml, early morning serum cortisol: 88.9 mcg/dl, late night serum cortisol: 58.8 mcg/dl, late night plasma ACTH:42.3 pg/ml, total testosterone: 1.79 ng/ml (0.120-0.350), DHEAS: 377.8 mcg/dl (29.7-182.2), 24 H urine free cortisol (UFC): 6696 mcg/24 h (urinary volume:2.7L), plazma aldosterone: 1.43 ng/dl, PRA&amp;lt;0.1 ng/ml/saat, 17-OH-progesterone: 2.91 ng/ml, calcitonin &amp;lt;2.0 pg/ml. Relying on rapid-onset of severe findings and very high UFC, our prediagnosis was Ectopic ACTH Syndrome. Thorax CT, 18-FDG-PET and Ga-68-PET scans did not exhibit any source. Abdominal CT scan revealed diffuse enlargement of both adrenal glands. Then Desmopressin test was performed and demonstrated central gradient (Table 1). However, pituitary MRI demonstrated no lesion, but thinning of the global gland. Accordingly inferior petrosal sinus sampling (IPSS) was compatible with ectopic ACTH syndrome (Table 2). Due to life-threatening hypercortisolemia of unknown origin, a decision was made in favor of bilateral adrenalectomy. Fluconazole 2x200mg/day iv was started, and after 48 hours, serum cortisol dropped significantly. The operation was performed safely, the patient’s general condition and serum potassium improved rapidly. Pathological specimen was reported as bilateral adrenocortical oncocytic neoplasms, and Ki-67 index was &amp;lt;1%. Immunohistochemistry (IHC) showed strong staining for ACTH in both lesions (Figure). Conclusion Although very rare, adrenals should be kept in mind as a source of ectopic ACTH syndrome.Figure:Immunohistochemical (IHC) staining demonstrating ACTH-secreting adrenal tumors (original magnification x100) Table 1:Plasma ACTH levels following 10 mcg desmopressin given intravenously Table 2:Plasma ACTH levels during Inferior Petrosal Sinus Sampling test performed with desmopressin

Repetitive Sprinting and Running Fatigue in Children with Different Levels of Motor Competence

Background: Children with motor delays often experience challenges in health-related fitness, but the impact on running skills remains unclear. Previous research has shown that children with motor coordination problems have lower cardiorespiratory fitness, muscle strength, endurance, and higher body weight compared to peers. Few studies have examined anaerobic capacity, muscular power, endurance, running performance, and fatigue in children with developmental coordination disorder (DCD). This study aims to compare repetitive running and running-induced fatigue in typically developing children and those with varying degrees of motor coordination problems. Methods: Groups were classified using the Movement Assessment Battery for Children, second edition (MABC-2), as probably having DCD (p-DCD, ≤5th percentile, age 9.7 (SD 1.6), n = 141), at risk for DCD (r-DCD, 6th–16th percentile, age 9.9 (SD1.6), n = 160), and typically developing (TD, &gt;16th percentile, age 9.6 (SD 1.6), n = 191). Anaerobic fitness and fatigue were assessed using the Children’s Repetitive and Intermittent Sprinting Performance test (CRISP), while lower and upper body muscular strength, running, and agility were measured with the performance and fitness (PERF-FIT) test battery Power and Agility subscale. Age groups (6–9 and 10–12 years) were analyzed to determine when performance deficits emerged. Results: The p-DCD group was significantly slower, had less power, and fatigued more than the r-DCD and TD children (p &lt; 0.01). This was already clearly the case in the 6–9-year-olds, who slowed down already after the first runs, while the older poorly coordinated children started slower than their peers and showed a more gradual decrease in performance over the runs. Conclusions: Moderate coordination differences between r-DCD and TD children did not significantly impact fatigue, but p-DCD children exhibited greater fatigue due to overestimating their start speed, higher body weight, lower power, and reduced agility, especially in younger age groups. (Too) High starting speed, especially in the younger less coordinated children (p-DCD), is likely to lead to more fatigue.

Acquired Chiari malformation type I (pseudo-Chiari malformation) and intracranial hypotension: Clinical observation and literature review

One of the complications of latent intracranial hypotension is a dystopia of the tonsils of the cerebellum, which can lead to an erroneous diagnosis of “Chiari malformation type 1”. The aim of the work is to pay attention to the symptoms, course and diagnosis of acquired (pseudomalformation) Chiari in intracranial hypotension syndrome. The work is based on clinical and neurological data and magnetic resonance imaging of the brain and spinal cord of a woman aged 28 years, obtained during dynamic observation over a number of years. At the acute onset of the disease with severe postural headache, minimal neurological symptoms, magnetic resonance imaging revealed a dynamic dystopia of the cerebellar tonsils from the plane of the large occipital foramen 15 mm below it and stable hydromyelia in the thoracic region, which inclined to the diagnosis of Chiari malformation type 1. However, flattening of the bridge, thickening of the dura mater, the tendency to rounding of the sagittal sinus, narrowing of subarachnoid spaces, basal cisterns, prolapse of the bottom of the 3rd ventricle into the prebridge cistern indicated the possibility of intracranial hypotension caused by latent liquorrhea, which was confirmed by magnetic resonance imaging with intravenous administration of gadolinium containing contrast agent in the mode of a strongly weighted T2-three-dimensional image with inversion and weakening of fluid – revealed hidden liquorrhea at the cervical level. A diagnosis of Chiari pseudomalformation has been established, which excludes surgical intervention – decompression of the posterior cranial pit. When diagnosing Chiari malformation type 1 and detecting cerebellar tonsillar dystopia, it is always necessary to exclude Chiari pseudomalformation associated with other primary pathology, in particular, with latent cerebrospinal liquor, the consequence of which is intracranial hypotension, which has specific signs in magnetic resonance imaging, and requires a different therapeutic tactic.

Health-Related Quality of Life (HRQoL) Assessments in Research on Patients with Adult Rare Solid Cancers: A State-of-the-Art Review

Background: Health-related quality of life (HRQoL) is an important patient-reported outcome for all cancer patients, including adult patients with rare solid cancers. However, current knowledge of HRQoL in this population is limited, which hinders the delivery of personalized care. This review aimed to explore the heterogeneity of HRQoL among adult patients with a solid rare cancer across the ten European Reference Network for Rare Adult Solid Cancers (EURACAN) domains and to summarize the HRQoL measures used in clinical research. Methods: A systematic literature search was conducted to identify all clinical studies assessing HRQoL in adult patients with a solid rare cancer. Four databases (MEDLINE, PubMed, PsycINFO, and Web of Science/Scopus) were searched (February 2023). Results: The search yielded 18,704 articles, of which 1416 articles were fully screened and 463 were eligible for analysis. Of these, 397 studies used generic tools to assess HRQoL, while 270 used tumor-specific instruments. Three EURACAN domains (sarcoma, endocrine tumors, and thoracic tumors) primarily assessed HRQoL using generic questionnaires. Additionally, the rare gynecological tumor, rare male genitourinary, and sarcoma EURACAN domains lacked specific HRQoL measures. Brain, head and neck, and uveal melanoma EURACAN domains used tumor- or domain-specific questionnaires in more than half of the studies. Conclusions: This state-of-the-art literature review shows that HRQoL assessment is gradually becoming more prevalent in adult solid rare cancer research. A combination of generic, tumor-specific, and domain-specific questionnaires across various rare cancer domains has proven effective in capturing a broad range of HRQoL issues. However, many EURACAN domains still lack specific strategies for assessing HRQoL, which limits the ability to fully understand and address patients’ experiences. Future research should prioritize developing comprehensive and robust HRQoL measurement strategies and tools to enable meaningful clinical research and to ensure that the patient voice is incorporated in their clinical care.

Acute Dystonia-Induced Airway Compromise During Emergence from Anaesthesia: Implications of Propofol and Ondansetron Administration to&amp;nbsp; Patients with Previous Neuroexcitatory Phenomena

Acute dystonic reactions have been reported during emergence from anaesthesia following the use of propofol or/and ondansetron. We present a 37-year-old lady who developed recurrent and severe involuntary movements and abnormal postures in the upper body during emergence from anaesthesia following propofol and ondansetron, given as part of a general anaesthetic for a gynaecological procedure. Reactions were recurrent and severe with associated spells of severe desaturation. Abnormal movements were reported previously following metoclopramide (IV). Acute dystonic reactions with associated laryngeal dystonia were suspected in the context of clinical findings and by exclusion of others. The frequency and severity of reactions were reduced following benztropine (IM) and midazolam (IV). They were completely controlled following the second dose of benztropine, which was given two hours after the first dose. Oxygenation and ventilation were maintained with gentle bag/mask ventilation during the spells of desaturation. As reported in the literature, Propofol and/or ondansetron are the most likely causative agent(s) alone or in combination. She made an uneventful recovery. Evidence for dystonic reactions following propofol and ondansetron is limited, hence likely to be underdiagnosed and treated empirically with disastrous outcomes. We alert the anaesthetists and intensivists to use propofol and ondansetron with caution in patients who reported previous neuroexcitatory phenomena.

Extra-Pulmonary Hydatid Cyst from Afghanistan: A Case Report

Hydatid cysts, caused by the larval stages of Echinococcus tapeworms, are a significant parasitic infection primarily affecting the liver and lungs. This case report presents a rare instance of an extrapulmonary hydatid cyst located in the pleural of a 45-year-old housewife female patient from Afghanistan. The patient exhibited symptoms of chest pain, headaches, dizziness, and a dry cough over three years. Diagnostic CT imaging revealed a mass in the right thoracic region. Following thorough surgical preparation, a right posterior-lateral thoracotomy was performed, leading to the excision of the hydatid cyst. Postoperatively, the patient was prescribed albendazole to facilitate cyst degradation. This case underscores the importance of early diagnosis and an integrated treatment approach, combining medical therapy and surgical excision, to improve patient outcomes and manage the complications of hydatid disease effectively.