Motor Abnormalities In Patients Research Articles

Objective and automatic assessment approach for diagnosing attention-deficit/hyperactivity disorder based on skeleton detection and classification analysis in outpatient videos

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is diagnosed in accordance with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria by using subjective observations and information provided by parents and teachers. However, subjective analysis often leads to overdiagnosis or underdiagnosis. There are two types of motor abnormalities in patients with ADHD. First, hyperactivity with fidgeting and restlessness is the major diagnostic criterium for ADHD. Second, developmental coordination disorder characterized by deficits in the acquisition and execution of coordinated motor skills is not the major criterium for ADHD. In this study, a machine learning-based approach was proposed to evaluate and classify 96 patients into ADHD (48 patients, 26 males and 22 females, with mean age: 7y6m) and non-ADHD (48 patients, 26 males and 22 females, with mean age: 7y8m) objectively and automatically by quantifying their movements and evaluating the restlessness scales.MethodsThis approach is mainly based on movement quantization through analysis of variance in patients’ skeletons detected in outpatient videos. The patients’ skeleton sequence in the video was detected using OpenPose and then characterized using 11 values of feature descriptors. A classification analysis based on six machine learning classifiers was performed to evaluate and compare the discriminating power of different feature combinations.ResultsThe results revealed that compared with the non-ADHD group, the ADHD group had significantly larger means in all cases of single feature descriptors. The single feature descriptor “thigh angle”, with the values of 157.89 ± 32.81 and 15.37 ± 6.62 in ADHD and non-ADHD groups (p < 0.0001), achieved the best result (optimal cutoff, 42.39; accuracy, 91.03%; sensitivity, 90.25%; specificity, 91.86%; and AUC, 94.00%).ConclusionsThe proposed approach can be used to evaluate and classify patients into ADHD and non-ADHD objectively and automatically and can assist physicians in diagnosing ADHD.

Kinematic Analysis of Handwriting Movements in Individuals with Intellectual Disabilities with and without Obsessive Compulsive Symptoms

Theory/calculation: Movement disorders such as disturbances of coordination, clumsiness, and hand-related stereotypies are a frequent phenomenon in individuals with intellectual disabilities (ID). Obsessive-compulsive symptoms are also common in persons with ID. Our aim was to investigate hand motor dysfunction in persons with ID with and without OCD, using a digitizing tablet and the kinematic analysis of handwriting and drawing movements. Methods: We examinedthe hand motor performance of 23 individuals (12 males, 11 females, 42.6 ± 13.7 years old) with ID of heterogeneous aetiology. All subjects were required to write a sentence and draw circles under various conditions. Kinematic parameters were calculated to quantify hand motion. Results: Individuals with ID exhibit serious hand motor impairments suggestive of bradykinesia, irregularity, and micrographia. More than half of our ID patients (60.9%) displayed obsessive-compulsive symptoms of moderate severity (Y-BOCS total score: 16.6 ± 8.3). Interestingly, the ID patients with OCD displayed smaller amplitudes of hand motor movements than did patients with no obsessive-compulsive symptoms, while differences observed in the writing and drawing concentric circles trials were significant. Conclusions: The results of this pilot study support the use of kinematic analyses of handwriting movements to evaluate motor abnormalities in patients with ID and comorbid mental illnesses.

Progress in the studies of perioperative peripheral nerve injury

Peripheral nerve injury (PNI) is one of the common perioperative complications, which can cause short-term sensory and motor abnormalities in patients, and even permanent sensorimotor disorders. Current studies emphasize that the incidence of perioperative PNI can be reduced through enhancing the awareness of perioperative peripheral nerve protection and implementing effective preventive measures. This paper reviewed the incidence, predisposing factors, injury factors, injury mechanism, preventive measures and treatment regimens of perioperative PNI, so as to provide reference to avoid PNI during clinical anesthesia. Key words: Perioperative; Peripheral nerve injury

Handwriting movements for assessment of motor symptoms in schizophrenia spectrum disorders and bipolar disorder.

The main aim of the present study was to explore the value of several measures of handwriting in the study of motor abnormalities in patients with bipolar or psychotic disorders. 54 adult participants with a schizophrenia spectrum disorder or bipolar disorder and 44 matched healthy controls, participated in the study. Participants were asked to copy a handwriting pattern consisting of four loops, with an inking pen on a digitizing tablet. We collected a number of classical, non-linear and geometrical measures of handwriting. The handwriting of patients was characterized by a significant decrease in velocity and acceleration and an increase in the length, disfluency and pressure with respect to controls. Concerning non-linear measures, we found significant differences between patients and controls in the Sample Entropy of velocity and pressure, Lempel-Ziv of velocity and pressure, and Higuchi Fractal Dimension of pressure. Finally, Lacunarity, a measure of geometrical heterogeneity, was significantly greater in handwriting patterns from patients than from controls. We did not find differences in any handwriting measure on function of the specific diagnosis or the antipsychotic dose. Results indicate that participants with a schizophrenia spectrum disorder or bipolar disorder exhibit significant motor impairments and that these impairments can be readily quantified using measures of handwriting movements. Besides, they suggest that motor abnormalities are a core feature of several mental disorders and they seem to be unrelated to the pharmacological treatment.

Exam 2: Esophageal Motor Abnormalities in Patients With Scleroderma: Heterogeneity, Risk Factors, and Effects on Quality of Life

Exam 2: Esophageal Motor Abnormalities in Patients With Scleroderma: Heterogeneity, Risk Factors, and Effects on Quality of Life

Esophageal Motor Abnormalities in Patients With Scleroderma:Heterogeneity, Risk Factors, and Effects on Qualityof Life.

Systemic scleroderma (SSc) is associated with esophageal aperistalsis and hypotensive esophagogastric junction pressure, although there could be a gradation in esophageal motor dysfunction. We characterized esophageal motor function by high-resolution esophageal manometry (HRM) and assessed associations between SSc severity, health-related quality of life (HRQOL), and HRM findings in patients. We performed a prospective study of 200 patients with SSc and 102 patients without SSc (controls) who underwent HRM at Mayo Clinic Arizona from May 2006 through January 2015. We used data on integrated relaxation pressure, distal contractile integral, and distal latency to classify esophageal motility disorders according to the Chicago Classification v 3.0. A subset of subjects (n= 122) completed SSc-specific gastrointestinal symptom and HRQOL questionnaires. HRM findings, symptoms, and HRQOL data were compared among diffuse SSc, limited SSc, and control subjects. Categorical variables were compared by using the χ2 or Fisher exact test; continuous variables were compared by using Mann-Whitney or Kruskal-Wallis test. Multivariable logistic regression was used to assess the association between severity of esophageal dysmotility and baseline clinical factors. Among patients with SSc, 83 had diffuse SSc (42%), and 117 had limited SSc (58%). Absent contractility was more frequent in patients with SSc than in controls (56% vs 13%; P < .001). HRM findings varied among the patients; absent contractility (56%) was the most frequent diagnosis, followed by normal motility (26%) and ineffective esophageal motility (10%). Classic scleroderma esophagus (esophagogastric junction pressure with absent contractility) was only observed in 33% of patients (34% with diffuse SSc vs 32% limited SSc) (P= .880). Severe esophageal dysmotility was associated with disease duration, interstitial lung disease, and higher gastrointestinal symptom scores (P < .001). HRQOL was decreased in patients with SSc and severe esophageal dysmotility. Although severe dysmotility is more common in patients with SSc than in controls, we observed the so-called scleroderma esophagus in only one-third of patients with SSc. Esophageal motor function appears to be heterogeneous in SSc. Esophageal dysmotility reduces HRQOL in patients with SSc.

How Do I Examine Blepharospasm?

Blepharospasm, which is the most frequent cranial dystonia, is characterized clinically by bilateral, synchronous, and symmetric involuntary orbicularis oculi muscle contractions. Assessment of motor abnormalities in patients with blepharospasm is an important issue in the clinical practice of movement disorders. This video highlights the most important aspects in the clinical evaluation of blepharospasm. We will show how we approach the main motor abnormalities related to blepharospasm. Additional features that often characterize blepharospasm, such as increased blinking, sensory tricks that can transiently improve muscle spasms, and apraxia of eyelid opening will also be discussed. Then, we will summarize the main aspects that differentiate patients with blepharospasm from other conditions characterized by eyelid disturbances. Finally, we will take into account the possible therapeutic implications of an accurate clinical examination of patients.

Classification of functional bowel disorders by objective physiological criteria based on endoluminal image analysis.

We have previously developed an original method to evaluate small bowel motor function based on computer vision analysis of endoluminal images obtained by capsule endoscopy. Our aim was to demonstrate intestinal motor abnormalities in patients with functional bowel disorders by endoluminal vision analysis. Patients with functional bowel disorders (n = 205) and healthy subjects (n = 136) ingested the endoscopic capsule (Pillcam-SB2, Given-Imaging) after overnight fast and 45 min after gastric exit of the capsule a liquid meal (300 ml, 1 kcal/ml) was administered. Endoluminal image analysis was performed by computer vision and machine learning techniques to define the normal range and to identify clusters of abnormal function. After training the algorithm, we used 196 patients and 48 healthy subjects, completely naive, as test set. In the test set, 51 patients (26%) were detected outside the normal range (P < 0.001 vs. 3 healthy subjects) and clustered into hypo- and hyperdynamic subgroups compared with healthy subjects. Patients with hypodynamic behavior (n = 38) exhibited less luminal closure sequences (41 ± 2% of the recording time vs. 61 ± 2%; P < 0.001) and more static sequences (38 ± 3 vs. 20 ± 2%; P < 0.001); in contrast, patients with hyperdynamic behavior (n = 13) had an increased proportion of luminal closure sequences (73 ± 4 vs. 61 ± 2%; P = 0.029) and more high-motion sequences (3 ± 1 vs. 0.5 ± 0.1%; P < 0.001). Applying an original methodology, we have developed a novel classification of functional gut disorders based on objective, physiological criteria of small bowel function.

A functional study of the esophagus in patients with non-cardiac chest pain and dysphagia.

Nutcracker esophagus and non-specific motility disorders are the main causes of non-cardiac chest pain (NCCP), with gastroesophageal reflux in 60% of cases. Achalasia and diffuse esophageal spasm are the most frequent anomalies described in patients with dysphagia. The goal of this study was to evaluate the occurrence of esophageal body and lower esophageal sphincter motor abnormalities in patients with dysphagia, NCCP, or both. This study is a retrospective analysis of 716 patients with NCCP and/or dysphagia tested between January 1994 and December 2010. 1023 functional studies were performed, 707 of which were esophageal manometries, 225 esophageal pH-meters, and 44 bilimetries. We divided the patients into three groups: group 1 was composed of patients affected with dysphagia, group 2 with NCCP and group 3 with NCCP and dysphagia. Manometric anomalies were detected in 84.4% of cases (p<0.001). The most frequent esophageal motility alteration was achalasia (36%). The lower esophageal sphincter was normal in 45.9% of patients (p<0.001). In all 3 groups, 80.9%, 98.8%, and 93.8, respectively, of patients showed normal upper esophageal sphincter (p=0.005). Our data differs from those of other studies because they were collected from and analyzed by a single tertiary level referral center by a single examiner. This could have eliminated the variability found in different hands and different experiences. The high percentage of symptomatic patients with non-pathologic esophageal motility pattern suggests an unclear origin of the disease, with possible neuromuscular involvement. As a result, these patients may need more-detailed diagnostic studies.

Tu1186 Assessment of Esophageal Motor Function in Patients With Symptoms Suggestive of Esophageal Disorders - Prevalence of Esophageal Dysfunction and Its Impact of Quality of Life

Background & Aims: Available prospectively acquired data on the distribution of esophageal motor abnormalities in patients complaining of symptoms suggestive of esophageal disorders is relatively scarce in Japan, although several studies revealed some differences in the recognition of gastrointestinal (GI) symptoms such as heartburn between Asian countries and Western countries. There has been few data regarding the association between the symptom and its impact of quality of life. The aim of this study was to evaluate the distribution of esophageal motor abnormalities in Japanese patients with symptoms suggestive of esophageal disorders and its impact on the quality of life by using a high-resolution manometry (HRM). Methods: From September 2007 through September 2012, after excluding patients with organic diseases by using blood tests, ultrasonography, laryngoscope and upper GI endoscopy, 303 consecutive patients including normal subjects (163 men, 140 women; mean age 58.0 years) who underwent MII-EM were recruited. Each subject received ten 5-mL room temperature boluses of saline solution in HRM examination. They all completed a selfadministered 7-point Likert scale questionnaire about their symptoms and health-related quality of life (HRQOL) based on results of the Short-Form Health Survey (SF-8) before undergoing diagnostic tests. Results: There were 139 patients with globus sensation, 76 patients with dysphagia, 33 patients with heartburn, 8 patients with non-cardiac chest pain and 47 control subjects. Of all patients, 155 patients (60.5%) had some esophageal motility dysfunctions. The frequency of esophageal dysfunctions disaggregated by GI symptoms was 49.2% for globus sensation, 90.8% for dysphagia, 45.5% for heartburn and 37.5% for noncardiac chest pain, respectively (Table 1). As to HRQOL disaggregated by symptoms, the SF-8 physical summary score (PSC) of each symptom was significantly lower than that of the control subjects (P , 0.01). On the other hand, differences in the SF-8 mental summary score (MSC) compared to controls were detected only in patients with globus sensation or dysphagia (P , 0.01): MSC was 45.4±9.0 points in globus sensation, 45.9±7.5 points in dysphagia, and 50.2±5.0 points in controls, respectively. Conclusions: Esophageal dysfunctions could be detected in 60.5% of Japanese patients suggestive of esophageal disorders. The most common esophageal motility abnormality in patients with globus sensation or heartburn was ineffective esophageal motility, while the most common esophageal motility abnormality in patients with dysphagia or non-cardiac chest pain was achalasia. Significant differences in PSC compared to controls were detected in all patients, while significant differences in MSC were only detected in patients with globus sensation or dysphagia. The distribution of esophageal motor abnormalities in patients with symptoms suggestive of esophageal disorders

Tu1188 Comparison Between Esophageal Dysphagia in Elderly Patients (>69 Years) and Dysphagia in Younger Patients in Japan

Background & Aims: Available prospectively acquired data on the distribution of esophageal motor abnormalities in patients complaining of symptoms suggestive of esophageal disorders is relatively scarce in Japan, although several studies revealed some differences in the recognition of gastrointestinal (GI) symptoms such as heartburn between Asian countries and Western countries. There has been few data regarding the association between the symptom and its impact of quality of life. The aim of this study was to evaluate the distribution of esophageal motor abnormalities in Japanese patients with symptoms suggestive of esophageal disorders and its impact on the quality of life by using a high-resolution manometry (HRM). Methods: From September 2007 through September 2012, after excluding patients with organic diseases by using blood tests, ultrasonography, laryngoscope and upper GI endoscopy, 303 consecutive patients including normal subjects (163 men, 140 women; mean age 58.0 years) who underwent MII-EM were recruited. Each subject received ten 5-mL room temperature boluses of saline solution in HRM examination. They all completed a selfadministered 7-point Likert scale questionnaire about their symptoms and health-related quality of life (HRQOL) based on results of the Short-Form Health Survey (SF-8) before undergoing diagnostic tests. Results: There were 139 patients with globus sensation, 76 patients with dysphagia, 33 patients with heartburn, 8 patients with non-cardiac chest pain and 47 control subjects. Of all patients, 155 patients (60.5%) had some esophageal motility dysfunctions. The frequency of esophageal dysfunctions disaggregated by GI symptoms was 49.2% for globus sensation, 90.8% for dysphagia, 45.5% for heartburn and 37.5% for noncardiac chest pain, respectively (Table 1). As to HRQOL disaggregated by symptoms, the SF-8 physical summary score (PSC) of each symptom was significantly lower than that of the control subjects (P , 0.01). On the other hand, differences in the SF-8 mental summary score (MSC) compared to controls were detected only in patients with globus sensation or dysphagia (P , 0.01): MSC was 45.4±9.0 points in globus sensation, 45.9±7.5 points in dysphagia, and 50.2±5.0 points in controls, respectively. Conclusions: Esophageal dysfunctions could be detected in 60.5% of Japanese patients suggestive of esophageal disorders. The most common esophageal motility abnormality in patients with globus sensation or heartburn was ineffective esophageal motility, while the most common esophageal motility abnormality in patients with dysphagia or non-cardiac chest pain was achalasia. Significant differences in PSC compared to controls were detected in all patients, while significant differences in MSC were only detected in patients with globus sensation or dysphagia. The distribution of esophageal motor abnormalities in patients with symptoms suggestive of esophageal disorders

Apple Sauce Improves Detection of Esophageal Motor Dysfunction During High-Resolution Manometry Evaluation of Dysphagia

BackgroundEsophageal manometry utilizes water swallows to evaluate esophageal motor abnormalities in patients with dysphagia, chest pain, or reflux symptoms. Although manometry is the gold standard for evaluation of these symptoms, patients with dysphagia often have normal results in manometry studies.AimThe objective of this work was to test the hypothesis that challenging the esophagus with viscous apple sauce boluses uncovers motor abnormalities in patients with dysphagia not seen when using water swallows.MethodsHigh-resolution esophageal manometry was performed using ten water swallows followed by ten apple sauce swallows in consecutive subjects presenting with dysphagia. Subjects with grossly abnormal water swallow evaluations were excluded. Each swallow was categorized as normal, hypotensive (distal isobaric contour plots of <30 mmHg over >5 cm), or simultaneous (distal esophageal velocity ≥8.0 cm/s). Ineffective esophageal motility (IEM) was defined as ≥30% hypotensive swallows, and pressurization was defined as ≥20% simultaneous pressure waves.ResultsData from 41 subjects was evaluated. Overall, 96.3% of water swallows were normal, 2.9% hypotensive, and 0.7% simultaneous. Only 70.3% of viscous swallows were normal; 16.7% were hypotensive and 13.0% were simultaneous (P < 0.001 all groups). Seven (17.1%) met criteria for IEM, and pressurization with viscous swallows was observed for nine (22.0%). Fourteen subjects (34.1%) had abnormal results from viscous studies. The presence of any abnormal water swallows was predictive of abnormal viscous swallows (OR = 9.00, CI = 2.15–80.0), although the presence of hypotensive or simultaneous water swallows was not associated with IEM (OR = 0.63, CI = 0.16–2.17) or pressurization (OR = 7.00, CI = 0.90–315.4) with viscous apple sauce.ConclusionsApple sauce challenge increased identification of classifiable motor disorders in patients with dysphagia and may be preferred to alternative bolus materials.

Neurologic abnormalities in HTLV-I– and HTLV-II–infected individuals without overt myelopathy

Human T-lymphotropic virus (HTLV) type I is the causative agent of HTLV-associated myelopathy (HAM)/tropical spastic paraparesis, and a number of HAM cases with HTLV-II infection have also been reported. However, despite some reports, it is unclear whether HTLV-I or -II infection is associated with other neurologic manifestations. An analysis of medical histories and screening neurologic examinations from a prospective cohort of 153 HTLV-I, 388 HTLV-II, and 810 HTLV-seronegative individuals followed up for means of 11.5, 12.0, and 12.2 years was performed. Participants diagnosed with HAM were excluded. We calculated odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for age, sex, race or ethnicity, income, educational attainment, body mass index, alcohol and cigarette consumption, injection drug use, diabetes, and hepatitis C virus status, using generalized estimating equations for repeated measures. HTLV-I and -II participants were more likely than seronegative participants to have leg weakness (ORs 1.67 [95% CI 1.28-2.18] and 1.44 [1.16-1.78]), impaired tandem gait (ORs 1.25 [95% CI 1.07-1.47] and 1.45 [1.27-1.64]), Babinski sign (ORs 1.54 [95% CI 1.13-2.08] and 1.51 [1.18-1.93]), impaired vibration sense (ORs 1.16 [95% CI 1.01-1.33] and 1.27 [1.14-1.42]), and urinary incontinence (ORs 1.45 [95% CI 1.23-1.72] and 1.70 [1.50-1.93]). For both HTLV-I and -II participants, higher odds of sensory neuropathy by monofilament examination were no longer significant after adjustment for confounding. These results provide strong evidence that human T-lymphotropic virus (HTLV)-I and -II are associated with a spectrum of predominantly motor abnormalities in patients without overt HTLV-associated myelopathy. Further investigation of the clinical course and etiology of these abnormalities is warranted.

The Aging of Human-Immunodeficiency-Virus-Associated Neurocognitive Disorders

This special issue proposes a new era for studies of the humanimmunodeficiency-virus-type-one (HIV-1) -associated neurological disorders serving to highlight cognitive abnormalities in infected aging patients. It has been 15 years since the “Third Workshop on NeuroAIDS” was held (Black and Sager 1994). At that time, NeuroAIDS (or the AIDS dementia complex) was the principal manifestation of cognitive, behavioral, and motor abnormalities in patients with the acquired immunodeficiency syndrome (AIDS). This has all but changed. Indeed, after introduction of highly active antiretroviral therapy (HAART) in 1996 and1997, the prevalence of severe manifestations of NeuroAIDS was significantly reduced, and the HIV patients show reduced disease morbidities and mortality. According to the Centers for Disease Control, the number of people 50 years and older infected with HIV has increased from 77% from 2001 to 2005. As HIV disease becomes a treatable medical disorder, morbidities in the HAART era abound including those linked to antiretroviral toxicities and viral infection per se as well as common disorders that all aging patients face, such as chronic obstructive pulmonary disease, diabetes, atherosclerosis-linked heart, vascular and kidney failure, bleeding ulcers, depression, cancers, and osteoporosis. Recent studies on aged HIV patient brain suggest a new type of neurological disorders distinct from HIV-1-associated dementia (HAD) and now termed HIV-associated neurocognitive disorders (HAND). HAND in aged population is linked, in part, to early signs of beta-amyloidosis or microtubule-associated tau aggregation commonly seen in Alzheimer’s disease (AD) or tauopathy brain. However, whereas extracellular amyloid plaques (senile plaques) are the major amyloid pathology in AD, HAND brains show intraneuronal amyloid accumulation or perivascular diffuse amyloid deposition, indicating distinct mechanisms and brain disease development. Considering the increase in the aged HIV population, this issue of the Journal of Neuroimmune Pharmacology will specifically focus for the first time on age-associated neurodegeneration in HIV patients. Special emphasis was made on beta-amyloidosis contributed by an outstanding line of seven investigators representing the cutting edge of HAND research activities. Peer-reviewed original research and review articles provide clear direction for forthcoming HAND research directives. The issue is lead by a comprehensive review of neurodegeneration and aging in the HAART era (Brew et al. 2009). This review discusses the history of NeuroAIDS, HAART, and persistent neurodegeneration in HAARTtreated patients. The implication of neurodegeneration in post-HAART patients is provocative and highlighted in its association with HIV, aging, and inflammation. Potential mechanisms common to specific diseases, such as AD and Parkinson’s disease, and therapeutic inventions are proposed. HAND pathogenesis, in the context of selective vulnerability of specific neuronal populations, epidemiology, and risk factors, is reviewed by Jayadev and Garden (2009). This article discusses a variety of host and viral factors that are associated with increased risk of developing HAND, and some of which are associated with the development of AD. Here, they propose a different view of how viral J Neuroimmune Pharmacol (2009) 4:161–162 DOI 10.1007/s11481-009-9155-5

Reversal of Asynchrony Between Circular and Longitudinal Muscle Contraction in Nutcracker Esophagus by Atropine

Patients with high-amplitude esophageal contractions (nutcracker esophagus [NCE]) show asynchrony of circular muscle (CM) and longitudinal muscle (LM) contraction during peristalsis. The goal of our study was to determine if this asynchrony is related to an increase in the cholinergic receptor activity. High-frequency intraluminal ultrasound images and pressures of the esophagus were recorded simultaneously in 10 normal subjects and 10 patients with NCE. Recordings were obtained at 2 cm above the lower esophageal sphincter under 2 study conditions in normal subjects (before and after 80 microgm/kg of edrophonium), and under 3 study conditions in the NCE patients (control, 5 microgm and 10 microgm/kg of atropine). In normal subjects, edrophonium induced an increase in the CM and LM contraction amplitude, an increase in the contraction duration, and asynchrony of LM and CM contraction during peristalsis. On the other hand, increased contraction amplitude, duration, and asynchrony of LM and CM contraction observed at the baseline in the NCE patients were reversed by atropine in a dose-dependent fashion. These data prove that the esophageal motor abnormalities in patients with nutcracker esophagus, including asynchrony of CM and LM contraction, are related to a hypercholinergic state.

Gastroesophageal Reflux Disease–Associated Esophagitis Induces Endogenous Cytokine Production Leading to Motor Abnormalities

Gastroesophageal reflux disease is a condition frequently associated with esophagitis and motor abnormalities. Recent evidence suggests that proinflammatory cytokines, such as interleukin (IL)-1beta and IL-6, may be implicated because they reduce esophageal muscle contractility, but these results derive from in vitro or animal models of esophagitis. This study used human esophageal cells and tissues to identify the cellular source of cytokines in human esophagitis investigate whether cytokines can be induced by gastric refluxate, and examine whether esophageal tissue- or cell-derived mediators affect muscle contractility. Endoscopic mucosal biopsy specimens were obtained from patients with and without esophagitis, organ-cultured, and undernatants were assessed for cytokine content. The cytokine profile of esophageal epithelial, fibroblast, and muscle cells was analyzed, and esophageal mucosa and cell products were tested in an esophageal circular muscle contraction assay. The mucosa of esophagitis patients produced significantly greater amounts of IL-1beta and IL-6 compared with those of control patients. Cultured esophageal epithelial cells produced IL-6, as did fibroblasts and muscle cells. Epithelial cells exposed to buffered, but not denatured, gastric juice produced IL-6. Undernatants of mucosal biopsy cultures from esophagitis patients reduced esophageal muscle contraction, as did supernatants from esophageal epithelial cell cultures. The human esophagus produces cytokines capable of reducing contractility of esophageal muscle cells. Exposure to gastric juice is sufficient to stimulate esophageal epithelial cells to produce IL-6, a cytokine able to alter esophageal contractility. These results indicate that classic cytokines are important mediators of the motor disturbances associated with human esophageal inflammation.

Chronic alcoholism and esophageal motor activity: A 24‐h ambulatory manometry study

Stationary esophageal manometry has shown esophageal motor abnormalities in patients with chronic alcoholism. The abnormalities identified in different studies are not consistent. Twenty-four hour ambulatory esophageal manometry enables monitoring of esophageal motor activity under a variety of physiological conditions and gives a more complete assessment. Twenty-four hour ambulatory esophageal manometry and pH-metry were performed using a combined pH and pressure catheter. Subjects with chronic alcoholism with no other illness and not in withdrawal were studied with age- and sex-matched healthy controls. Autonomic nerve functions tests were performed in all subjects. Twenty-three chronic alcoholic subjects and 12 control subjects completed the study. The median ethanol consumption was 95 g/day (range 75 -175 g/day) for 12 years (range 5-30 years) among alcoholic subjects. Eight alcoholic subjects had heartburn and regurgitation but none had dysphagia. Ten (43%) alcoholic subjects had autonomic neuropathy and four (17%) had increased gastroesophageal acid reflux. Lower esophageal sphincter hypertension was observed in alcoholic subjects with autonomic neuropathy. Esophageal body motility parameters (i.e. frequency, duration, amplitude and percentage of peristaltic waves) were not significantly different between alcoholic subjects and controls. Results of ambulatory esophageal manometry on subjects with chronic alcoholism seem to indicate that long-term ethanol intake has no major effects on esophageal motor activity other than lower esophageal sphincter hypertension among those with alcoholic autonomic neuropathy.

Assessment of oesophageal motor function in patients with dysphagia or chest pain — the Clinical Outcomes Research Initiative experience

Available prospectively acquired data on the distribution of oesophageal motor abnormalities in patients being evaluated for non-cardiac chest pain and/or dysphagia are relatively scarce. To evaluate the distribution of oesophageal motor abnormalities in patients with dysphagia, non-cardiac chest pain or both using the national Clinical Outcomes Research Initiative (CORI) database. The CORI oesophageal motility database originates from 19 community, university and VA medical centres. Data were collected using a computerized motility report-generating program, combined with the CORI module. Data from each site were encrypted and sent to the CORI National Repository for analysis. The database includes the assessment of the lower and upper oesophageal sphincter function and the motor activity of the oesophageal body. Five hundred and eighty-seven consecutive patients who underwent motility studies between 1998 and 2001 were included in the CORI database and analysed for this report. Four hundred and three patients (69%) had dysphagia as their primary indicator for the examination, 140 patients (24%) had non-cardiac chest pain and 44 patients (7%) had both dysphagia and non-cardiac chest pain. In all three groups, a normal motility study was the most frequent finding (dysphagia, 53%; chest pain, 70%; both, 55%). The most common motility abnormality in the group with non-cardiac chest pain was a hypotensive lower oesophageal sphincter (61%). Nutcracker oesophagus and non-specific oesophageal motility disorders were each diagnosed in only 10% of patients with non-cardiac chest pain. In patients with dysphagia, ineffective peristalsis was the most common oesophageal dysmotility (27%), followed by achalasia and non-specific oesophageal motility disorders (18% and 14%, respectively). Achalasia and non-specific oesophageal motility disorders were the most common oesophageal motility abnormalities in patients with both chest pain and dysphagia (35% and 25%, respectively). The most common oesophageal motility abnormality in patients with non-cardiac chest pain is a hypotensive lower oesophageal sphincter; nutcracker oesophagus and non-specific oesophageal motility disorders are relatively uncommon; the most common oesophageal motility abnormality in patients with dysphagia is ineffective peristalsis and, for those with both dysphagia and non-cardiac chest pain, it is achalasia.

Organization of the human motor system as studied by functional magnetic resonance imaging

Blood oxygenation level dependent functional magnetic resonance imaging (BOLD fMRI), because of its superior resolution and unlimited repeatability, can be particularly useful in studying functional aspects of the human motor system, especially plasticity, and somatotopic and temporal organization. In this survey, while describing studies that have reliably used BOLD fMRI to examine these aspects of the motor system, we also discuss studies that investigate the neural substrates underlying motor skill acquisition, motor imagery, production of motor sequences; effect of rate and force of movement on brain activation and hemispheric control of motor function. In the clinical realm, in addition to the presurgical evaluation of neurosurgical patients, BOLD fMRI has been used to explore the mechanisms underlying motor abnormalities in patients with neuropsychiatric disorders and the mechanisms underlying reorganization or plasticity of the motor system following a cerebral insult.

Small intestinal motor abnormalities in patients with functional dyspepsia demonstrated by ambulatory manometry.

In 30 patients with functional dyspepsia and in 20 healthy volunteers, ambulatory duodenojejunal manometry was performed to examine the interdigestive and postprandial small intestinal motility patterns in relation to symptoms. In the fasting state, the number of migrating motor complex cycles mean (SEM) was significantly lower in patients, especially in patients with dysmotility-like dyspepsia, than in control subjects (3.8 (0.4), 2.6 (0.5), and 5.3 (0.7) cycles, respectively; p < 0.05), due to a longer duration of phase II. Non-propagated and retrogradely propagated phase III activity was more prevalent in patients than in control subjects (48% v 15%; p = 0.020). During phase II and after dinner no differences were found in contraction incidence, mean amplitude or motility index. However, 1 1/2 hours after completing breakfast the motility index was higher in patients at all three recording levels (p < 0.05). Burst activity was more prevalent in patients than in control subjects (22% v 6% of the subjects; p = 0.003). In 41% of the patients the symptom index was > 75%. These results suggest that small intestinal motor abnormalities, especially during fasting, participate in the pathogenesis of symptoms in patients with functional dyspepsia. Ambulatory manometry of the small intestine is a valuable tool to demonstrate these abnormalities in outpatients pursuing their daily activities.