Normal Motor Research Articles

The contribution of endocytosis to sensitization of nociceptors and synaptic transmission in nociceptive circuits.

Chronic pain involves sensitization of nociceptors and synaptic transmission of painful signals in nociceptive circuits in the dorsal horn of the spinal cord. We investigated the contribution of clathrin-dependent endocytosis to sensitization of nociceptors by G protein-coupled receptors (GPCRs) and to synaptic transmission in spinal nociceptive circuits. We determined whether therapeutic targeting of endocytosis could ameliorate pain. mRNA encoding dynamin (Dnm) 1 to 3 and adaptor-associated protein kinase 1 (AAK1), which mediate clathrin-dependent endocytosis, were localized to primary sensory neurons of dorsal root ganglia of mouse and human and to spinal neurons in the dorsal horn of the mouse spinal cord by RNAScope. When injected intrathecally to mice, Dnm and AAK1 siRNA or shRNA knocked down Dnm and AAK1 mRNA in dorsal root ganglia neurons, reversed mechanical and thermal allodynia and hyperalgesia, and normalized nonevoked behavior in preclinical models of inflammatory and neuropathic pain. Intrathecally administered inhibitors of clathrin, Dnm, and AAK1 also reversed allodynia and hyperalgesia. Disruption of clathrin, Dnm, and AAK1 did not affect normal motor functions of behaviors. Patch clamp recordings of dorsal horn neurons revealed that Dnm1 and AAK1 disruption inhibited synaptic transmission between primary sensory neurons and neurons in lamina I/II of the spinal cord dorsal horn by suppressing release of synaptic vesicles from presynaptic primary afferent neurons. Patch clamp recordings from dorsal root ganglion nociceptors indicated that Dnm siRNA prevented sustained GPCR-mediated sensitization of nociceptors. By disrupting synaptic transmission in the spinal cord and blunting sensitization of nociceptors, endocytosis inhibitors offer a therapeutic approach for pain treatment.

Evaluation of lidocaine for brachial plexus blockade in eastern box turtles (Terrapene carolina carolina)

ObjectiveTo evaluate latency and duration of a brachial plexus block technique in eastern box turtles performed with 2% lidocaine at three dose rates. Study designProspective, randomized, blinded crossover study. AnimalsAdult eastern box turtles, two for drug dose evaluation and a group of six (three male, three female) weighing 432 ± 40 g (mean ± standard deviation) for the main study. MethodsAnimals were randomly assigned to four brachial plexus blocks with lidocaine at 5, 10 and 20 mg kg–1 or 0.9% saline (treatments LID5, LID10, LID20 and CON, respectively), separated by 1 week. Treatment side was randomized and blocks were performed unilaterally. Baseline observations of mentation, heart rate (HR), respiratory rate (fR), skin temperature and limb response to manipulation or toe pinch were evaluated. Assessments were made every 10 minutes until 1 hour of normal sensory and motor function to the treated thoracic limb, or for a total of 2 hours if no block was evident. ResultsMotor and sensory blockade was achieved in treatments LID10 and LID20 in one turtle, with a latency of 10 minutes and duration of 50 minutes for both doses. Raising of the ipsilateral lower palpebra occurred with both blocks. Turtles administered lidocaine experienced higher HR compared with CON, and HR decreased over time for all individuals. Mentation and fR were not changed with any lidocaine dose. ConclusionsThe technique was unreliable in producing brachial plexus motor and sensory blockade at the lidocaine doses evaluated in this study. HR was higher in lidocaine-administered turtles but remained within normal limits for the species. No change in mentation or fR was observed among treatments. Clinical relevanceGeneral anesthesia with systemic analgesia is recommended for surgical procedures involving the chelonian thoracic limb. Further studies are needed to optimize a brachial plexus block in this species.

Facilitation-inhibition control of motor neuronal persistent inward currents in young and older adults.

A well-coordinated facilitation-inhibition control of motor neuronal persistent inward currents (PICs) via diffuse neuromodulation and local inhibition is essential to ensure motor units discharge at required times and frequencies. Present best estimates indicate that PICs are reduced in older adults; however, it is not yet known whether PIC facilitation-inhibition control is also altered with ageing. We investigated the responses of PICs to (i) a remote handgrip contraction, which is believed to diffusely increase serotonergic input onto motor neurones, and (ii) tendon vibration of the antagonist muscle, which elicits reciprocal inhibition, in young and older adults. High-density surface electromyograms were collected from soleus and tibialis anterior of 18 young and 26 older adults during triangular-shaped plantar and dorsiflexion contractions to 20% (handgrip experiments) and 30% (vibration experiments) of maximum torque (rise-decline rate of 2%/s). A paired-motor-unit analysis was used to calculate ∆F, which is assumed to be proportional to PIC strength. ΔF increased in both soleus (0.55peaks per second (pps), 16.0%) and tibialis anterior (0.42pps, 11.4%) after the handgrip contraction independent of age. Although antagonist tendon vibration reduced ΔF in soleus (0.28pps, 12.6%) independent of age, less reduction was observed in older (0.42pps, 10.7%) than young adults (0.72pps, 17.8%) in tibialis anterior. Our data indicate a preserved ability of older adults to amplify PICs following a remote handgrip contraction, during which increased serotonergic input onto the motor neurones is expected, in both lower leg muscles. However, PIC deactivation in response to reciprocal inhibition was impaired with ageing in tibialis anterior despite being preserved in soleus. KEY POINTS: Motor neuronal persistent inward currents (PICs) are facilitated via diffuse neuromodulation and deactivated by local inhibition to ensure motor units discharge at required times and frequencies, allowing normal motor behaviour. PIC amplitudes appear to be reduced with ageing; however, it is not known whether PIC facilitation-inhibition control is also altered. Remote handgrip contraction, which should diffusely increase serotonergic input onto motor neurones, facilitated PICs similarly in both soleus and tibialis anterior of young and older adults. Antagonist tendon vibration, which induces reciprocal inhibition, reduced PICs in soleus in both young and older adults but had less effect in tibialis anterior in older adults. Data from lower-threshold motor units during low-force contractions suggest that PIC facilitation is preserved with ageing in soleus and tibialis anterior. However, the effect of reciprocal inhibition on the contribution of PICs to motor neurone discharge seems reduced in tibialis anterior but preserved in soleus.

Genetics and clinical phenotypes of epilepsy associated with chromosome 2q24.3 microdeletion

Objective: To summarize the genetics and clinical phenotypes of epilepsy children with 2q24.3 microdeletion. Methods: All the patients with 2q24.3 microdeletion were retrospectively collected at the Pediatric Department of Peking University First Hospital from March 2017 to July 2022. The features of clinical manifestations, electroencephalogram (EEG), and neuroimaging were analyzed. Results: There were 13 patients with 2q24.3 microdeletion were included. All 13 patients had de novo copy number variation (CNV) with a deletion size ranged 0.18-7.31 Mb. The main pathogenic genes in the region were SCN3A, SCN2A, TTC21B, SCN1A and SCN9A genes. Among the 13 patients, 7 were boys, and 6 were girls. The onset age of epilepsy was 3.3(2.5, 6.0) months. Multiple seizure types were observed, including focal seizures in 13 patients, generalized tonic-clonic seizures (GTCS) in 6 patients, myoclonic seizures in 3 patients, epileptic spasm in 2 patients, and tonic seizures in 2 patients. Seizures were fever sensitivity in 9 patients. Status epilepticus was observed in 6 patients. One case had normal mental motor development and 12 cases had different degrees of developmental delay. Six patients had craniofacial abnormality, 1 had six-finger deformity of the right thumb, and 1 had multiple system abnormalities. EEG showed focal discharge in 3 cases, multifocal discharges in 5 cases, multifocal and generalized discharges in 1 case. Brain magnetic resonance imaging (MRI) showed enlargement of subarachnoid spaces in the frontal and temporal region in 4 patients, enlargement of lateral ventricle in 4 patients and delayed myelination of white matter in 1 patient. Dravet syndrome was diagnosed in 5 cases. The age at the last follow-up were 2.5(1.4,5.5) years, 1 patient was seizure free longer than 1 year, and 12 patients still had seizures. Conclusions: The epilepsy associated with 2q24.3 microdeletion is mainly induced by the deletion of SCN3A, SCN2A and SCN1A genes. The seizure onset age of 2q24.3 microdeletion related epilepsy was in infancy. Multiple seizure types are observed and the common seizure types include focal seizures and GTCS. Most patients have fever sensitivity and status epilepticus. Most patients have developmental delay. The phenotype of patients with deletion of SCN3A and SCN2A gene is more severe than that of patients with deletion of SCN1A gene only.

Semi-Automatic Solar Powered Grass Cutter

Abstract: Due to the constant rise in fuel prices and the impact of gas emissions from burned fuel into the atmosphere, it became necessary to use the sun's plentiful solar energy as a source of electricity to operate a lawn cutter. Based on the fundamental idea of mowing, a solar-powered lawn cutter was created. Direct current (DC) motor, rechargeable battery, solar panel, stainlesssteel blade, and control switch make up the solar-powered lawn cutter's design. The DC motor, which is directly connected to the shaft of the DC motor and provides the necessary torque to drive the stainless steel blade, is used to mow the lawn. The switch on the board, which shuts the circuit and permits electricity to pass to the motor, which in turn drives the blade used for mowing, is used to operate the solar-powered lawn cutter. The system will use some automation for obstacle identification and direction. A solar panel will be fixed to the top of the robot and serve as the system's power source in addition to a battery. Nobody like moving the lawn cutters when they are driven by a normal motor since it is a hassle. Elderly or younger people may find it difficult to cut the grass since a lawn cutter moving with an engine produces both local air pollution from engine combustion and noise pollution owing to the noisy engine. A motor-powered engine also needs routine maintenance, including changing the oil. Despite being ecologically beneficial, electrified solar grass may still be a pain. Electric grass cutters, like motor-powered ones, are dangerous and difficult for everyone to use. Additionally, if the electric lawn cutter is tethered, cutting might be difficult and dangerous. The prototype will also use solar panels to charge from the sun.

Overview On Neurogenic Bowel Dysfunction in Pediatrics

Neurogenic bowel dysfunction (NBD) is fecal incontinence or constipation which is prevalent in kids with both congenital and acquired neurological disorders. NBD results from loss of normal sensory or motor control and may include both the upper and the lower gastrointestinal (GI) tract Constipation and fecal incontinence are frequent symptoms of neurogenic bowel dysfunction (NBD), which makes it a challenging condition to treat. Also, they have a major impact on quality of life and dignity. Bowel dysfunction is less studied compared to neurogenic bladder, generally prevelant in spina bifida, but practically as prevalent in other neurological conditions. Generally, the objective of neurogenic bowel management is to achieve complete emptying of the rectum on a systematic basis. This may be accomplished through with a multidimensional approach containing of conservative, medical and even surgical approaches. A modified Delphi procedure was used to construct a statement document. This paper discusses the various causes of paediatric NBD. Our aim is to enhance clinical management, numerous therapeutic techniques are given. Due to both the improved survival rate and better diagnosis, there are more children and teenagers with NBD. The number of children and adolescents with NBD is growing as a result of better diagnosis and a greater survival rat NBD can cause either faecal incontinence or constipation, or both, with a fair amount of predictability. However, each patient will experience NBD in a different way depending on a variety of underlying conditions and coexisting conditions. Due to the status of the affected child and caregivers, management of NBD should be individualized using a combined multidisciplinary therapy.

Emotional distress and quality of life among adults with developmental coordination disorder during COVID-19.

Introduction:Individuals with developmental coordination disorder frequently report emotional and functional difficulties. A stressful era as COVID-19 pandemic may enhance emotional load. The present study aimed to (1) examine the emotional distress and quality of life among adults with developmental coordination disorder during COVID-19 as compared to typical controls, and (2) examine the relationships between these factors in adults with developmental coordination disorder.Method:Participants were 317 adults, aged 18–66, recruited during the first year of COVID-19: 227 were included in the developmental coordination disorder group, and 90 in the control group (normal motor performance) based on the Adult Developmental Co-ordination Disorders/Dyspraxia Checklist cutoff score. Participants completed a sociodemographic health status/daily life under COVID-19 questionnaire and self-reports about their emotional status (depression, anxiety, stress) and a quality of life.Results:The developmental coordination disorder group had significantly greater depression, anxiety, stress, and lower quality of life. Participants with developmental coordination disorder who were infected by COVID-19 or reported reduction of working hours due to COVID-19 had the lowest social and environmental quality of life. Depression significantly predicted reduced quality of life and mediated between developmental coordination disorder severity and quality of life.Conclusions:Prevention and intervention programs for adults with developmental coordination disorder should be elaborated, with reference to emotional load and to implications on daily life, especially in times of crisis, like COVID-19.

Potential interactions between cerebellar dysfunction and sleep disturbances in dystonia.

Dystonia is the third most common movement disorder. It causes debilitating twisting postures that are accompanied by repetitive and sometimes intermittent co- or over-contractions of agonist and antagonist muscles. Historically diagnosed as a basal ganglia disorder, dystonia is increasingly considered a network disorder involving various brain regions including the cerebellum. In certain etiologies of dystonia, aberrant motor activity is generated in the cerebellum and the abnormal signals then propagate through a "dystonia circuit" that includes the thalamus, basal ganglia, and cerebral cortex. Importantly, it has been reported that non-motor defects can accompany the motor symptoms; while their severity is not always correlated, it is hypothesized that common pathways may nevertheless be disrupted. In particular, circadian dysfunction and disordered sleep are common non-motor patient complaints in dystonia. Given recent evidence suggesting that the cerebellum contains a circadian oscillator, displays sleep-stage-specific neuronal activity, and sends robust long-range projections to several subcortical regions involved in circadian rhythm regulation, disordered sleep in dystonia may result from cerebellum-mediated dysfunction of the dystonia circuit. Here, we review the evidence linking dystonia, cerebellar network dysfunction, and cerebellar involvement in sleep. Together, these ideas may form the basis for the development of improved pharmacological and surgical interventions that could take advantage of cerebellar circuitry to restore normal motor function as well as non-motor (sleep) behaviors in dystonia.

P.10 Compound CACNA1S heterozygosity resulting in a novel phenotype of congenital myopathy and early onset periodic paralysis: report of two probands

Skeletal muscle contraction is mediated by excitation-contraction coupling (ECC), a process involving the rapid elevation of cytosolic calcium. L-type voltage gated calcium channels located on T-tubule membranes are the voltage sensors of ECC. The dihydropyridine receptor (DHPR) contains the pore forming basic functional elements of these calcium channels and is encoded by the <i>CACNA1S</i> gene. Recessive mutations in the <i>CACNA1S</i> gene have been recently reported with a severe congenital myopathy and facial involvement. We describe two sisters with compound heterozygous mutations involving the <i>CACNA1S</i> gene. Both had neonatal hypotonia, muscle weakness, and delayed motor milestones. Prior to one year of age, periodic paralysis was evident as episodic flaccidity and loss of postural control. Periodic paralysis episodes continued to occur most notably with cold exposure, lasting around 10 minutes each. Lab evaluation revealed normal CPK. Electrophysiological evaluation revealed normal motor and sensory nerve conduction studies, and normal long exercise testing. Limb cooling and cold provocation led to clinical weakness and a drop in motor amplitude. Magnetic resonance imaging of the older sister showed symmetrical tigroid pattern fat replacement and atrophy of bilateral gluteus maximus muscles. Targeted next generation sequencing revealed two variants in the <i>CACNA1S</i> gene: both c.3526-2A>G and c.2831G>A (p.Cys944Tyr) are not described in the gnomAD database. Both variants co-segregated into affected sisters and Sanger sequencing revealed that c.3526-2A>G was inherited from the unaffected mother and c.2831G>A from the unaffected father, thus revealing a recessive pattern of inheritance. The c.3526-2A>G is expected to disrupt the acceptor splice site of intron 27 by <i>in silico</i> analysis, whereas the c.2831G>A variant replaces a highly conserved cysteine residue with tyrosine at codon 944 in the DIII-S5 of the Cav1.1 protein. This novel phenotype of a milder congenital recessive myopathy and early onset periodic paralysis expands the phenotypic spectrum of <i>CACNA1S</i> gene mutations.

SISTEM MANAJEMEN PROTEKSI MOTOR RELAY GE MULTILINE 269 PLUS PADA MOTOR FORCED DRAFT FAN DI PT. INDONESIA POWER PGU SURALAYA

Electrical energy continues to grow over time, power plants with large capacities are the main sources of electricity in Indonesia, one of which is the Steam Power Plant (PLTU). In the field of power plants that use coal always need air during the electricity production process. This study aims 1) to determine the protection management system on the Forced Draft fan motor using GE Multilin 269 Plus, 2) Setting GE Multilin 269 Plus as protection, 3) The results of the protection in the form of Normal Motor, Alarm, and Trip conditions in the accumulation of imbalance (Unbalance) ). The method used is a quantitative research method based on analysis, taking data and then analyzing the data obtained. The results of this quantitative study regarding the Unbalance value or imbalance of the electric motor analyzed resulted in a value of 5.8% for normal conditions, 10.86% for alarm conditions on multilin and 15.50% in trip conditions or the motor had stopped. These values ​​are obtained from the results of calculations comparing negative sequence currents and positive sequence currents (In/Ip). The conclusion obtained is that the GE Multilin 269 Plus protects the electric motor from system damage by using a current sensor and through a setting point that is adjusted to the provisions of NEMA (National Electrical Manufacturers Association) with an unbalance value of more than 15% for trips, more than 10% for alarm conditions and less than 10% under normal conditions

Tremor and Movement Slowness Are Two Unrelated Adverse Effects Induced by Valproate Intake

To date, only a few clinical and neurophysiological studies have assessed the features of valproate-induced tremor (VIT), and whether valproate (VPA) affects voluntary movements is underinvestigated. To better characterize the clinical and neurophysiological features of VIT in patients with epilepsy and the effect of VPA on the execution of voluntary movement. We tested 29 patients with VIT (13 taking VPA alone and 16 taking VPA plus other antiepileptics). Patients underwent a neurological examination,video recordingsand kinematic assessments of postural, kinetic, and resting upper limb tremor using a motion analysis system. Movement execution was tested by kinematic assessment of finger tapping. Data of patients with VIT were compared with those of 13 patients with epilepsy taking VPA but without tremor, 13 patients with epilepsy who were not on VPA treatment, 20 patients with Parkinson's disease (PD), and 20 healthy controls (HCs). Clinical and kinematic evaluations showed that tremor in patients taking VPA alone was less severe than tremor in patients taking VPA plus other antiepileptics. All patients taking VPA, regardless of the presence of tremor, performed slower finger tapping compared with HCs, similar to what was observed in PD, although with no sequence effect. Patients with epilepsy without VPA showed a normal motor performance. Tremor and movement slowness are motor signs induced by VPA. VIT severity is exacerbated when VPA is taken in combination with other antiepileptics. VPA-induced slowness occurs regardless of tremor, may precede tremor development, and is not attributed to epilepsy.

Long-term outcomes of very early treated infantile-onset Pompe disease with short-term steroid premedication: experiences from a nationwide newborn screening programme

BackgroundStarting enzyme replacement therapy (ERT) before severe irreversible muscular damage occurs is important in infantile-onset Pompe disease (IOPD). This long-term follow-up study demonstrates our diagnostic and treatment strategies for IOPD...

A new method to detect phase failure of the motor driving system

This paper proposed a new method to detect phase failure of motor driving system.In this paper,all types of phase failure in a normal three-phase motor driving system are discussed.To detect these faults,this paper propose a method using three-phase current sensors.These current sensors are usually used to detect three-phase currents for motor control in the system.This new method doesn&apos;t need extra hardware.It just need to add a little logical judgement in software.This method has a higher reliability.

Factors Associated with Poorer Outcomes from Triceps Motor Branch to Anterior Axillary Nerve Transfer: A Case-Control Study

We sought to identify predictors of failed triceps motor branch transfer to the anterior division of the axillary nerve (AN) for shoulder abduction reconstruction after a brachial plexus injury (BPI). A case-control study of adult AN or brachial plexus patients treated with a triceps motor branch transfer to the anterior division of the AN with a minimum 18 months of follow-up was performed. The failure group (case group) was defined as modified British Medical Research Council muscle scale (mBMRC) postoperative deltoid grade ≤2 and was compared to the successful outcome group (control group), defined as mBMRC postoperative deltoid grade ≥3. Clinical variables, injury mechanism, time from injury to surgery, root avulsion status, electrodiagnostic studies, rotator cuff injuries, scapula fracture, Disabilities of the Arm Shoulder and Hand scores, and preoperative triceps strength were analyzed. Subgroup analysis was performed for patients with isolated AN injuries and those with BPI. A total of 69 patients met inclusion/exclusion criteria, of whom 23 regained ≥M3 deltoid muscle strength and 52° ± 69° of shoulder abduction (successful outcome group) and 46 regained ≤M2 deltoid muscle strength and 27° ± 30° of shoulder abduction (failure group). Preoperative triceps weakness (M ≤4) was significantly more common in the failure group (63% vs. 30%, P= 0.032); preoperative triceps muscle fibrillations were significantly more common in the failure group (61% vs. 30%, P= 0.02). Isolated AN injuries presented better preoperative motion and postoperative outcomes results compared to BPI. Use of triceps motor branch associated with fibrillations or weakness resulted in statistically poorer outcomes compared to the use of a normal triceps motor branch in the restoration of anterior AN function after nerve transfer.

Mobile-Bearing Total Ankle Replacement In Vivo Kinematic Assessment: A Prospective Study Protocol.

Total ankle prosthesis as a surgical solution in the case of end-stage osteoarthritis has seen a considerable increase in the last two decades. This study protocol arises from the need to understand the in vivo kinematics of mobile-bearing, flat tibial component total ankle replacement, evaluating the real range of motion and the reciprocal relationships between the components during normal motor tasks through the use of model-based radio-stereometric analysis (MB-RSA). In addition, pre- and post-operative evaluation of walking kinematics with inertial motion sensors, proprioception through a dedicated workstation, and clinical outcomes are discussed. We expect that based on our study protocol researchers will be able to improve future prosthetic designs and validate the setup of MB-RSA, as well as to understand “how an ankle prosthesis moves” once implanted in the patient.

How does visual praxis based occupational therapy program effect motor skills in children with hyperactivity and attention disorder? Single blind randomized study design

Attention Deficit and Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized with problems such as; atypical attention skills increased impulsive behaviors at least two of the child’s areas of daily living. In studies investigating developmental aspect of the said problems of children with ADHD, it was stated that the children usually do not demonstrate normal development regarding the motor proficiency and may fall behind their peers in exhibiting normal motor performance. These problems in motor skills are said to cause a hindered development in complex skills which may result in; distorted body image, increased anxiety and poor social communication skills. This study’s aim was to investigate effects of a Visual-Praxis-based Occupational Therapy program (VPOT) on motor proficiency of children with ADHD. The 58 children who were included to the study were assigned numbers from 1 to 58 and randomized into two groups (the intervention group and the control group). Both groups were subjected to the Bruninks-Oserestry Test of Motor Proficiency 2–Brief Form (BOT2-BF). After the initial assessment, the participants in the intervention group were admitted into the VPOT program for a duration of 8 weeks with twice-weekly sessions of 45 minutes. End of the program, BOT2-BF was applied once more. The participants mean age was 8.44±1.39 years. There were no differences between the intervention and the control group in terms of age. When the BOT2-BF results for the intervention group were analyzed, it was found that there were significant differences between pre- and post-intervention scores of all sub-scores and the total score. Due to approaching the motor development aspect of ADHD within the context of motor proficiency and visual perception, this study can be considered to be one of the innovative and pioneer studies in the field and is positively unique regarding the usage of the intervention approach that was used.

Posterior-only debridement, bone fusion, single-segment versus short-segment instrumentation for mono-segmental lumbar or lumbosacral pyogenic vertebral osteomyelitis: minimum five year follow-up outcomes

BackgroundPyogenic vertebral osteomyelitis (PVO), which is a potentially life-threatening condition and is associated with significant morbidity and mortality, is a cause of back pain that can lead to neurologic deficits if not diagnosed in time and effectively treated. The objective of this study is to compare the efficacy of posterior single-segment and short-segment fixation combined with one-stage posterior debridement and fusion for the treatment of mono-segmental lumbar or lumbosacral PVO.MethodsCharts of all patients with mono-segmental lumbar or lumbosacral PVO were treated by single-stage posterior debridement, bone graft fusion, and pedicle screw fixation from April 2012 to January 2016. All patients were divided into two groups: sinlge-segment fixation (Group A, n = 31) and short-segment fixation (Group B, n = 36). These patients were followed up for a minimum of five years. The clinical efficacy was evaluated and compared on average operation time, blood loss, visual analog scale (VAS), erythrocyte sedimentation rate (ESR), C-Reactive protein (CRP), neurological function recovery and local lordotic angle.ResultsAll 67 patients were completely cured during the follow-up. All patients had significant improvement of neurological condition and pain relief at the final follow-up. The VAS was 7.1 ± 0.7 in group A and 7.2 ± 0.6 in group B pre-operatively, which decreased to 2.1 ± 0.6 and 2.0 ± 0.7, respectively, at three months after surgery, then reduced to 0.4 ± 0.5 and 0.5 ± 0.5, respectively, at the final follow-up. ESR, CRP returned to normal limits in all patients 3 months after surgery. The mean blood loss and operation time in group A were less than that in group B (P < 0.05). The local lordotic angle in group A was increased from preoperative − 1.7 ± 7.9° to postoperative 5.8 ± 7.1°, with angle loss of 1.5 ± 0.8° at the final follow-up, respectively (P < 0.05). The local lordotic angle in group B was increased from preoperative − 1.6 ± 7.8° to postoperative 13.5 ± 6.2°, with angle loss of 1.3 ± 0.8° at the final follow-up, respectively (P < 0.05). In the mean postoperative local lordotic angle, there was significant difference between the two groups at the time of immediate postoperative period or the final follow-up (P < 0.05).ConclusionPosterior-only debridement, interbody graft using titanium mesh cage, posterior single-segment instrumentation and fusion represent a safe and effective treatment option for selected patients with mono-segmental lumbar and lumbosacral PVO. This approach may preserve more lumbar normal motor units with less blood loss and operation time when compared with that of short-segment fixation. But short-segment fixation was superior to the single-segment fixation in the correction of kyphosis.

Traumatic Brain Injury in Older Adults: Epidemiology, Etiology, Rehabilitation, and Outcomes

Purpose: Traumatic brain injury (TBI) is a major public health problem, affecting millions of people worldwide each year. TBI presents as a major cause of death and disability in older adults, which is significant in the setting of older adults living longer. Falls are the leading cause of TBI in older adults, and normal sensory, motor, and cognitive changes that occur with aging increase the risk of falling. Multiple medical and cognitive comorbidities put older adults at increased risk for sustaining a TBI, and complicate recovery. Preexisting comorbid conditions, such as hypertension, diabetes, and heart disease, when combined with polypharmacy and aging effects compound the risks, severity, and outcomes following TBI. This clinical focus article addresses the normal effects of aging, the epidemiology of aging, and the relationship of aging to risks, consequences, and prognosis following TBI in older adults. In addition, discussion focuses on medical care and treatment, acute and chronic consequences, and assumptions and controversies in approaches to management of acute TBI in this population. The processes for assessment and treatment of cognitive communication during rehabilitation are explained in detail, including specific measures and strategies for both the acute and chronic phases of rehabilitation. Conclusions: Outcomes following TBI in older adults include persisting cognitive and functional limitations that often require some level of support. However, studies have shown that there are elderly patients with severe TBI who benefit from rehabilitation and may have more favorable outcomes. Determining prognosis after TBI is challenging relative to long-term functional consequences, due to the aging process. Therefore, the best intervention for TBI in older adults is prevention of TBI. As the aging population continues to increase in the United States, the need to design and implement evidence-based, cost-effective measures that focus on prevention of the leading causes of TBI in older adults becomes more urgent.

Two infants with mild, atypical clinical features of Kagami-Ogata syndrome caused by epimutation

Kagami-Ogata syndrome (KOS) is an imprinting disorder characterized by polyhydramnios, bell-shaped thorax with coat-hanger appearance (curved ribs), respiratory distress, abdominal wall defects, and distinct facial features, together with intellectual developmental delay with special needs. Abnormal expression of the imprinted genes on chromosome 14q32.2 causes KOS. Epimutation with aberrant hypermethylation of the MEG3/DLK1: intergenic differentially methylated region (MEG3/DLK1:IG-DMR) and the MEG3:TSS-DMR is one of the etiologies of KOS. We report two infants with KOS caused by epimutation presenting with some characteristic clinical features, mild clinical course, and almost normal motor and intellectual development. Methylation analysis for ten DMRs related to major imprinting disorders using pyrosequencing with genomic DNA (gDNA) extracted from leukocytes showed abnormally increased methylation levels of the MEG3/DLK1:IG-DMR and MEG3:TSS-DMR in both patients, but lower than those in patients with paternal uniparental disomy chromosome 14 (upd(14)pat). The methylation levels in the DMRs other than both DMRs were within normal range. We also conducted methylation analysis for the MEG3/DLK1:IG-DMR and MEG3:TSS-DMR with gDNA extracted from nails and buccal cells of both patients. Methylation levels in the MEG3:TSS-DMR, particularly in buccal cells, were closer to normal range compared to those in leukocytes. Microsatellite analysis for chromosome 14 and array comparative hybridization analysis showed no upd(14)pat or microdeletion involving the 14q32.2 imprinted region in either patient. A differential mosaic ratio of cells with aberrant methylation of DMRs at the 14q32.2 imprinted region among tissues (connective tissue, lung, and brain) might have led to their atypical clinical features. Further studies of patients with epimutation should further expand the phenotypic spectrum of KOS.

Approach to the Treatment of Pediatric Dystonia

Dystonia is the most common movement disorder in the pediatric population. It can affect normal motor development and cause significant motor disability. The treatment of pediatric dystonia can be very challenging as many children tend to be refractory to standard pharmacological interventions. Pharmacological treatment remains the first-line approach in pediatric dystonia. However, despite the widespread use of different ani-dystonia medications, the literature is limited to small clinical studies, case reports, and experts’ opinions. Botulinum neurotoxin (BoNT) is a well-established treatment in adults with focal and segmental dystonia. Despite the widespread use of BoNT in adult dystonia the data to support its use in children is limited with the majority extrapolated from the spasticity literature. For the last 2 decades, deep brain stimulation (DBS) has been used for a wide variety of dystonic conditions in adults and children. DBS gained increased popularity in the pediatric population because of the dramatic positive outcomes reported in some forms of genetic dystonia and the subsequent consensus that DBS is generally safe and effective. This review summarizes the available evidence supporting the efficacy and safety of pharmacological treatment, BoNT, and DBS in pediatric dystonia and provides practical frameworks for the adoption of these modalities.