Sensory Disturbances Research Articles

Craniofacial Injuries Resulting from Polytrauma: Mechanisms, Imaging, and Complications

Purpose: This literature review aims to identify and analyse the most common mechanisms causing injuries in the craniofacial region their diagnosis and possible sequelae. Methods: The study analysed publications from the Medline database made available in PubMed and Google Scholar considering the following keywords "maxillofacial injuries" and/or "maxillofacial trauma" and/or "maxillofacial fractures". Results: Craniofacial injuries in polytrauma patients are often complicated by their heterogeneous nature and coexistence with other injuries. Their incidence and mechanisms vary depending on the country of investigation. Diagnosis includes advanced imaging techniques such as CT scans. Treatment often requires multidisciplinary collaboration. Conclusions: Craniofacial injuries in polytraumatic patients require a complex diagnostic and therapeutic approach. Interdisciplinary collaboration is crucial to achieve the best clinical outcome. The most common causes include road traffic collisions, assaults, falls and sports-related injuries. Despite properly applied treatment protocols, they generate changes in the stomatognathic system, sensory disturbances, blindness and, in extreme cases, can lead to death

A Novel Unilateral Bi/Multi-Portal Endoscopic Transforaminal Interbody Fusion Utilizing Uniaxial Spinal Endoscope Instead of Arthroscope: Technical Note and Preliminary Clinical Results.

Currently, traditional UBE surgery, which is based on arthroscope, has been increasingly employed for complex lumbar degenerative diseases. However, this approach is associated with complications such as intraoperative dural sac tears, nerve root injuries, and postoperative epidural hematomas. In response to these challenges, we propose a novel technique utilizing uniaxial spinal endoscope to replace arthroscope-Unilateral Bi/Multi-Portal Endoscopy (UME). This new method has successfully treated complex lumbar disc herniation and spinal stenosis, resulting in improved postoperative outcomes and a reduction in complications. Based on the previous findings, we utilized uniaxial spinal endoscopy as the primary operating method, with the assistance of multi-portal endoscopic techniques (UME-TLIF), to perform transforaminal lumbar interbody fusion. The feasibility and preliminary clinical results have been presented in this paper. A total of 18 patients (8 men and 10 women, aged 52.6 ± 15.29 years) diagnosed with lumbar degenerative diseases, such as giant lumbar disc herniation, severe lumbar spinal stenosis, or lumbar spondylolisthesis, were included in this study from January 2022 to March 2023. Various parameters including operation time, ambulatory time, intraoperative fluoroscopy times, hospitalization days, and complications were recorded during the perioperative period. Clinically relevant symptoms were evaluated and documented 1, 3, 6, and 12 months postoperatively. Visual analogue scale (VAS) scores for lower back pain and leg pain, as well as the Oswestry disability index (ODI), were measured. The extent of lumbar interbody fusion was assessed using lumbar X-ray and CT scans at the 12-months follow-up. MRI was performed to assess the degree of nerve decompression in patients at the same time points. The paired t-test or Wilcoxon signed-rank test were used as statistical methods. The single-segment UME-TLIF procedure had an average operation time of 211 ± 53.3 min, and the average number of X-rays taken during the operation was 11.78 ± 5.32. Patients were able to walk and perform functional exercises approximately 35.11 ± 8.41 h post-surgery, and the average duration of hospital stay was 8.5 ± 2.27 days. The VAS and ODI values at each time point post-surgery were significantly lower than the respective pre-surgery values (p < 0.05). Two patients developed postoperative sensory disturbances which significantly improved with conservative treatment. Furthermore, a follow-up CT scan conducted 12 months post-surgery showed 100% fusion rate of the surgical segments in all patients. UME-TLIF is an endoscopy-assisted fusion procedure that minimizes muscle damage in patients and allows early rehabilitation. This technique broadens the surgical applications of uniaxial spinal endoscope as a surgical tool, particularly benefitingpatients diagnosed with severe lumbar disc herniation and lumbar instability.

Parkinson's Disease: A Progressive Neurodegenerative Disorder and Structure-Activity Relationship of MAO Inhibitor Scaffolds as an Important Therapeutic Regimen.

Parkinson's disease is considered an advancing neurodegenerative disorder with unknown causes, and its association with some risk factors, including aging, family history, and exposure to chemicals, makes it the second most common occurring neurodegenerative disorder throughout the world with increasing prevalence. Parkinson's disease is associated with slow movement, rigidity, tremors, imbalance, depression, anxiety, cognitive impairment, orthostasis, hyperhidrosis, sleep disorders, pain, and sensory disturbances. In recent decades, there has been a rise in research on the development of effective and potential therapies for the treatment of Parkinson's disease. An important target for neuroprotection is Monoamine Oxidases (MAO), which hydrolyze neurotransmitters like dopamine and produce very reactive free radicals as a by-product. Aging and neurodegenerative illnesses cause overexpression in the brain, which exacerbates neuronal loss. The treatment of Parkinson's disease with MAO inhibitors has shown promising outcomes. Herein, we reported characteristic features of Parkinson's disease, various treatment strategies, and the SAR of potential drugs that can be explored further as lead for the development of newer molecules with improved pharmacological profiles.

Mechanisms Underlying Sensory Nerve-Predominant Damage by Methylmercury in the Peripheral Nervous System.

Sensory disturbances and central nervous system symptoms are important in patients with Minamata disease. In the peripheral nervous system of these patients, motor nerves are not strongly injured, whereas sensory nerves are predominantly affected. In this study, we investigated the mechanisms underlying the sensory-predominant impairment of the peripheral nervous system caused by methylmercury. We found that the types of cell death in rat dorsal root ganglion (DRG) neurons caused by methylmercury included apoptosis, necrosis, and necroptosis. Methylmercury induced apoptosis in cultured rat DRG neurons but not in anterior horn neurons or Schwann cells. Additionally, methylmercury activated both caspase 8 and caspase 3 in DRG neurons. It increased the expression of tumor necrosis factor (TNF) receptor-1 and the phosphorylation of receptor-interacting protein kinase 3 (RIP3) and mixed-lineage kinase domain-like pseudokinase (MLKL). The expression of TNF-α was increased in macrophage-like RAW264.7 cells by methylmercury. The increase was suggested to be mediated by the NF-κB pathway. Moreover, methylmercury induced neurological symptoms, evaluated by a hindlimb extension response, were significantly less severe in TNF-α knockout mice. Based on these results and our previous studies, we propose the following hypothesis regarding the pathogenesis of sensory nerve-predominant damage by methylmercury: First, methylmercury accumulates within sensory nerve neurons and initiates cell death mechanisms, such as apoptosis, on a small scale. Second, cell death triggers the infiltration of macrophages into the sensory fibers. Third, the macrophages are stimulated by methylmercury and secrete TNF-α through the NF-κB pathway. Fourth, TNF-α induces cell death mechanisms, including necrosis, apoptosis through the caspase 8/3 pathway, and necroptosis through the TNFR1-RIP1-RIP3-MLKL pathway, activated by methylmercury in sensory neurons. Consequently, methylmercury exhibits potent cytotoxicity specific to the DRG/sensory nerve cells in the peripheral nervous system. This chain of events caused by methylmercury may contribute to sensory disturbances in patients with Minamata disease.

Clinical Outcomes Following Profunda Artery Perforator Flap Breast Reconstruction: A Systematic Review and Meta-Analysis.

There is a lack of reliable evidence on the surgical outcomes of profunda artery perforator (PAP) flap breast reconstruction. We conducted a meta-analysis to evaluate its safety and compare it with deep inferior epigastric perforator (DIEP) flap, aiming to offer more information on whether the PAP flap was an ideal alternative for autologous breast reconstruction. PubMed, EMBASE, Web of Science and Cochrane Library were searched to retrieve relevant articles. The postoperative complication rates following PAP reconstruction were pooled. Mean differences of patients' age, BMI, mastectomy weight and flap weight between PAP and DIEP group were calculated, and relative risk was estimated to compare their incidence of complications. Twenty-four articles reporting 1612 PAP flap breast reconstructions were included. The surgical success rate was 99.6%; the incidence of total and partial flap loss was 0.4% and 0.0%; the incidence of infection, hematoma, seroma, fat necrosis and wound dehiscence in recipient sites was 0.3%, 1.4%, 1.0%, 3.3% and 0.3%, respectively; the incidence of infection, hematoma, seroma, wound dehiscence and sensory disturbance in donor sites was 2.0%, 0.9%, 3.5%, 9.2% and 0.6%, respectively. Compared to the DIEP group, the average age, BMI, mastectomy weight and final flap weight were significantly lower in the PAP group. No significant difference was observed in terms of flap failure, breast fat necrosis and donor site wound dehiscence. This systematic review demonstrates similar levels of postoperative morbidities for the PAP and DIEP flaps with some subtle differences and verifies the PAP flap as a second-line treatment for patients when the DIEP is unavailable or undesirable. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Small Fiber Neuropathy in Burning Mouth Syndrome: A Systematic Review.

Burning mouth syndrome (BMS) is a chronic idiopathic orofacial pain disorder, characterized by persistent burning sensations and pain without clear pathological causes. Recent research suggests that small fiber neuropathy (SFN) may play a significant role in the neuropathic pain and sensory disturbances associated with BMS. Following PRISMA guidelines, this systematic review aims to evaluate and synthesize current evidence supporting SFN's involvement in BMS. The protocol is registered in PROSPERO (CRD42024555839). The results show eight studies reported reductions in nerve fiber density in tongue biopsies (ranging from 30% to 60%), along with morphological changes indicative of small fiber damage. Additionally, an increase in TRPV1-positive, NGF-positive, and P2X3-positive fibers, overexpression of Nav1.7, and slight underexpression of Nav1.9 mRNA were observed in BMS patients. Quantitative Sensory Testing in seven studies revealed sensory abnormalities such as reduced cool detection and cold pain thresholds. Blink reflex and corneal confocal microscopy also indicated peripheral and central small fiber damage, along with increased artemin mRNA expression. The evidence strongly supports SFN as a key factor in the pathophysiology of BMS, particularly due to reductions in nerve fiber density and altered sensory thresholds. However, variability across studies highlights the need for larger, standardized research to establish causal relationships and guide therapeutic strategies.

Refining the Diagnosis and Treatment of Cubital Tunnel Syndrome: A Comprehensive Review of Anatomy and Surgical Approaches

Cubital tunnel syndrome (CuTS) is a prevalent but often under-recognized compressive neuropathy of the upper extremities, involving the entrapment of the ulnar nerve within the cubital tunnel at the elbow. CuTS is common, but remains relatively unfamiliar to many neurosurgeons compared to other neuropathies. It frequently presents with sensory disturbances and motor deficits in the hand, particularly affecting the ulnar digits, and it may be linked to specific usage patterns or even considered a form of neurotrauma. Its diagnosis typically involves a clinical assessment supplemented by imaging and electrophysiological studies to evaluate the extent of nerve involvement. While conservative management may be sufficient in the early stages, surgical intervention is often necessary for advanced cases, and various techniques offer differing outcomes. This review underscores the importance of a thorough anatomical understanding in guiding an accurate diagnosis and effective treatment, ultimately contributing to improved patient outcomes. These insights are essential for clinicians encountering the complexities of CuTS in diverse clinical scenarios.

Lexical Expression of Presentiment in Mongolic Languages

This article considers a number of lexemes used to express premonition in Mongolic languages in order to identify, if possible, the motives of nomination and their connection with the psychophysiological state of a person who has a premonition of something, in most cases bad. The word ǰöng assumes the “voicing” of a feeling of anxiety comparable to an internal buzz. It indicates the syncretism of the semantics of linguistic units, semantic features, which motivate metaphorical and metonymic transfers to intermodal spheres. It demonstrates the phenomenon of synesthesia in the field of designating physical sensations. In the word iru-a, the leading role in the nomination is given to the trembling of the tongue at the moment of articulation of the sonant [r], which conveys disturbing sensations, mainly localized in the thoracic part. In the word belge, there was probably a metonymic transfer from the meaning of ‘sign as a material object’ to ‘sign, omen’. Research in this way allows deeper understanding the importance of the system of interpretation of sensory information transmitted through various sensations in the body.

The biology of water homeostasis.

Water homeostasis is controlled by a brain-kidney axis that consists of central osmoreceptors, synthesis and secretion of arginine vasopressin (AVP) and AVP-responsive aquaporin-2 (AQP2) water channels in kidney collecting duct principal cells that facilitate water reabsorption. In addition to AVP, thirst represents a second line of defense to maintain water balance. Water balance disorders arise because of deficiency, resistance or inappropriate secretion of AVP or disturbances in thirst sensation (hypodipsia, polydipsia). People with water balance disorders are prone to develop hyponatremia or hypernatremia, which expose cells to osmotic stress and activate cell volume regulation mechanisms. This review covers several recent insights that have expanded our understanding of central osmoregulation, AQP2 regulation and cell volume regulation. This includes the role of with-no-lysine kinase 1 (WNK1) as a putative central osmolality sensor and, more generally, as an intracellular crowding sensor that coordinates the cell volume rescue response by activating sodium and potassium cotransporters. Furthermore, several new regulators of AQP2 have been identified, including for AVP-dependent AQP2 regulation (yes-associated protein, nuclear factor of activated T-cells, microRNAs) and AVP-independent AQP2 regulation (epidermal growth factor receptor, fluconazole, prostaglandin E2). It is also becoming increasingly clear that long-term cell volume adaptation to chronic hypotonicity through release of organic osmolytes comes at the expense of compromised organ function. This potentially explains the complications of chronic hyponatremia, including cognitive impairment, bone loss and vascular calcification. This review will illustrate why these new insights derived from basic science are also relevant for developing new approaches to treat water balance disorders.

Health Effects of Methylmercury in Coastal Areas of the Yatsushiro Sea, Far from Minamata.

Minamata disease, caused by ingesting seafood contaminated with methylmercury dumped by corporations, was discovered in 1956; however, there has been no continued investigation to determine the full extent of the damage. Since 2004, it has been discovered that affected patients can be found in areas further away from Minamata than previously known. In the present study, we investigated various symptoms and somatosensory disturbances in western Miyanokawachi District, northern Himedo District, southwestern Nagashima District, and the uncontaminated Amami district and calculated the proportion of patients with sensory disturbances as a percentage of the population in each area. Both touch and pain sensations, with a predominance of the peripheral extremities, were observed in 58.6% of patients in Miyanokawachi, 53.9% in Himedo, 37.8% in Nagashima, and 1.4% in Amami. The lowest estimates of attributable fractions of the exposed group for four-limb-predominant sensory disturbance in the population of the contaminated districts were 94.1% in Miyanokawachi, 94.6% in Himedo, and 91.4% in Nagashima, and general and perioral sensory disturbances were also high. This suggests that the presence or absence of these sensory disturbances is useful in the diagnosis of Minamata disease, even in more distant parts of the Yatsushiro Sea area.

Unraveling Epilepsy: Investigating stem cell approaches for innovative treatment and future cure

Epilepsy is a persistent neurological disorder characterized by repeated, spontaneous seizures that arise without a specific cause. These seizures result from abnormal electrical activity in the brain, leading to a range of symptoms, from brief periods of unconsciousness or minor sensory disturbances to severe convulsions. The management of epilepsy remains a significant challenge, as current treatment modalities, primarily involving antiepileptic drugs and surgical interventions to remove seizure foci, often provide adequate control for a substantial portion of patients. For this reason, stem cell therapies have become a hopeful approach because of their ability to potentially restore and renew impaired neural networks, which is particularly relevant for neurological disorders like epilepsy. This review investigates the present state of stem cell therapies in epilepsy, analyzing distinct types of stem cells, their mode of action, preclinical and clinical trials, as well as future research prospects.

Design and construction of a GAP-43 reporter system for potential identification of effective therapeutics for peripheral nerve regeneration

Background: Peripheral nerve injury (PNI) is a condition that can result in muscle paralysis and sensory disturbances. Electrical stimulation and/or the application of exogenous neurotrophic factors and cytokines are effective at enhancing nerve regeneration and is mediated via the expression of regeneration associated genes (RAGs) such as the growth associated protein GAP-43. Therapeutic upregulation of GAP-43 has potential use as a treatment for improving recovery from PNI. Few studies have investigated the potential of increasing GAP-43 for PNI therapeutic purposes and current methods for measuring GAP-43 expression are limited. Aims and Objectives: The broader aim of this work was to construct a motor neuron-like cell model with a GAP-43 reporter system. Such a model would have potential use in screening for novel therapeutics that upregulate GAP-43 and in the optimisation of electrical stimulation treatment in combination with these therapies. The key aim of the work was to design and construct a Cas9 expressing plasmid bearing a gRNA that targets GAP-43 cleavage and a donor plasmid bearing a reporter GFP or Neo cassette flanked with 5’ and 3’ GAP-43 homology arms (HAs) to facilitate the insertion of the reporter immediately 3’ of the GAP-43 promoter via CRISPR/Cas9 homology directed repair (HDR). Such an insertion would enable quantitative measurement of endogenous expression of the GAP-43 gene. Methods and Results: To guide the Cas9 nuclease to the target location, GAP-43 gRNA oligomers were designed and cloned downstream of the U6 promoter in the Cas9 expression plasmid px330, which also expresses the Cas9 gene and the cloned gRNA when transfected into cells. For CRISPR/Cas9 HDR, the 5’ and 3’ GAP-43 HAs were amplified from mouse genomic DNA and cloned into the donor plasmid using Gibson Assembly so that they flanked the reporter cassette. Results: This work successfully constructed the Cas9 gRNA expressing plasmid to target cleavage of the GAP-43 gene in mouse cell lines and has provided the complete design and construction foundation for generation of the reporter system for the endogenous GAP-43 gene in mice.

Chinese expert consensus on diagnosis and treatment of spinal cord glioma

Spinal cord glioma is a group of tumors originated from spinal cord glial cells. They typically have an insidious onset, with early symptoms in patients including sensory disturbances, motor disorder, and sphincter dysfunction. When the course of disease develops to a certain extent, it can lead to paralysis, dyspnea, and even result in death. The spinal cord bears the role of nerve conduction, and acts as a lower central hub for somatic and visceral activities and primary neural reflexes. Because the self-repair ability after injury is limited, spinal cord injury caused by tumor and treatment may be permanent, potentially causing huge economic and social burden. To further standardize the diagnosis and treatment of spinal cord glioma, the expert group formulated The Chinese Expert Consensus on the Diagnosis and Treatment of Spinal Cord Glioma according to the current situation of diagnosis and treatment of spinal cord glioma at home and abroad. This consensus elaborates the epidemiology, natural course, clinical manifestations, diagnosis, treatment, follow-up, and prognosis of spinal gliomas and formulates 17 recommendations. It aims to offer reference for medical personnel and other related individuals.

Cold Environment-Associated Extremity Lesions or Severe Hypothermia Help Differentiate Between Frostbitten and Trench Foot (Immersion Foot).

Cold associated foot injuries, such as frostbite and trench foot (immersion foot) are relatively common in cold environments. The former is classified as a freezing cold injury, and the latter as a nonfreezing cold injury. Trench foot is sometimes misdiagnosed as frostbite, and rapid rewarming exacerbates the condition. This paper aims to help differentiate between frostbitten foot and trench foot. This study included patients with frostbitten foot or trench foot treated at our hospital between December 2005 and May 2023. The differences in sex, age, month of injury, conditions at the time of injury, injury distribution, foot lesion laterality, other complications upon arrival (finger frostbite, immersion hand, or hypothermia), and presence and distribution of sensory disturbance at discharge were noted among the groups. A total of 16 patients (14 men) with frostbitten foot and 3 patients (3 men) with trench foot were identified. Finger frostbite observed in nine and zero patients with frostbitten foot and trench foot, respectively; and severe hypothermia on arrival observed in five and zero patients with frostbitten foot and trench foot, respectively. Physical findings at the initial examination showed that the frostbitten feet were dry, and the lesions were distal and clearly demarcated, whereas feet with trench foot were wet, and the lesions covered the entire sole and were not clearly demarcated. Accurate differentiation between frostbitten foot and trench foot and appropriate initial treatment are important. The presence of finger frostbite, immersion hand or severe hypothermia may help to differentiate between frostbitten foot and trench foot.

Prognostic factors associated with worse outcomes in patients with GBS: A systematic review.

Guillain-Barré syndrome (GBS) is an autoimmune polyradiculoneuropathy with diverse clinical subtypes, characterized by rapidly evolving motor weakness, sensory disturbances and areflexia. The global prevalence of GBS has been steadily increasing, with regional disparities. Mortality rates vary but remain elevated in patients requiring mechanical ventilation. This systematic review aimed to evaluate the predictive risk factors for the severity of the disease and poor shortand long-term outcomes of GBS. The literature search was conducted using the PubMed database by 2 independently working researchers. After a screening process of studies published before November 2023, a total of 109 articles were selected. Original articles, systematic and narrative reviews, meta-analyses, and editorials were selected based on their clinical relevance. The exclusion criteria included patients under 18 years of age, pregnant women and articles in languages other than English and Polish. Long-lasting GBS complications included pain, fatigue and persistent neurological deficits, affecting patients for years after recovery. Identifying the appropriate therapeutic methods, risk factors and prognoses of GBS at an early stage is crucial. Various risk factors for death and poor functional outcomes were found, regarding patient characteristics, the clinical course of GBS, laboratory and neurographic results, as well as treatment methods.

B-301 Deciphering Neuropathy features in the Context of Nitrous Oxide abuse: An Integrated Analysis of Electrophysiology and Metabolism

Abstract Background Nitrous oxide (N2O), used medically for its analgesic and anxiolytic properties, has emerged as a common recreational substance, leading to a rise in chronic toxicity cases. N2O abuse induces peripheral neurological damage with a spectrum of clinical presentations, ranging from mild sensory disturbances to severe motor deficits. Neurological complications from N2O include axonal and demyelinating neuropathies, leading to diagnostic and prognostic challenges. The pathophysiology of N2O toxicity is linked to functional inactivation of vitamin B12, resulting in biochemical and electrophysiological alterations. This study aims to enhance understanding of N2O pathophysiology by examining metabolic changes in consumers with axonal and demyelinating patterns. Methods This study included 35 patients with recent N2O abuse (last declarative consumption within the past week) who were treated at Lille University Hospital between March 2020 and April 2023 and underwent electromyography. The collected clinical features encompassed sensory symptoms, motor weakness, gait abnormalities and deep tendon reflexes. Patients were classified based on clinical phenotypes, distinguishing between length-dependent and non-length dependent, sensory or sensory-motor involvement and their peripheral neuropathy disability (PND) score (ranging from I to IV). Neurophysiological data analysis followed the criteria of Hadden et al. to identify patients with demyelinating criteria, while those lacking demyelinating criteria were categorized as “axonal” in the neuropathy group. Simultaneously, biochemical evaluations of serum vitamin B12 and B9 by CLIA methods (Roche), along with plasma homocysteine by LC/MS/MS and CLIA methods (Snibe), methylmalonic acid (MMA), and methionine by LC/MS/MS, were systematically performed for all patients. Results 40% of the selected patients exhibited demyelination criteria. The demyelinated group showed a significantly higher disability PND score compared to the axonal group (3.0 and 2.2, respectively; p-value = 0.028). Elevated levels of homocysteine and methylmalonic acid were found in all patients. Interestingly, plasma concentrations of homocysteine were significantly higher in the group of patient with axonal outcomes compared to the demyelinating group (90 µM and 114 µM; p-value = 0.04), suggesting an involvement of homocysteine in the type of lesion related to N2O abuse. Conclusions This study highlights the diverse electrophysiological manifestations of N2O-induced neuropathy and highlight the potential role of metabolic parameters as biomarkers to understand the pathophysiology. Indeed, lower hyperhomocysteinemia levels were observed in demyelinating patterns, highlighting a potentially biochemical difference between the groups: plasma homocysteine could also be used as a marker of neurological severity. The homocysteine assay used in these conditions must enable the patient to be managed rapidly: it would therefore be preferable to use rapid methods such as immunoanalysis. On the other hand, plasma methylmalonic acid did not differ between groups, which also suggests that other mechanisms have yet to be identified in the pathophysiology of N2O abuse.

Comparative analysis of imaging data in sensory and motor disorders in lumbar neurocompressive syndrome

Introduction Lumbar neurocompressive syndrome is a condition characterized by radicular pain, motor, sensory and reflex changes, as well as paresthesia or numbness in the lower limb. These symptoms can be triggered by positions and/or movements of the spine. In lumbar radiculopathy, both mechanical and inflammatory factors play significant roles. Material and methods The study included 102 patients with signs of lumbar neurocompressive syndrome. Of these, 51 (group I) patients were examined using MRI and the other 51 patients (group II) were examined using conventional radiographic investigation of the lumbosacral region of the spine. Results By analyzing the magnetic resonance imaging data of the lumbar spine, a threshold of statistical significance was determined (of 10%, p &lt; 0.10) for patients with sensory disturbances in the lower limb in cases of stenosis of the lumbar spinal canal, and in patients with motor disorders in the lower limb, in the case of disc protrusions. The analysis of the magnetic resonance imaging data determined a significance threshold (of 5%, p &lt; 0.05) in patients with sensory disorders (in the case of disc sequestrations and in the case of disc extrusions) as well as for motor disorders (in the case of disc extrusions, disc sequestrations and static disorders of the spine). The analysis of standard radiographs of the lumbar spine allowed the determination of the threshold of statistical significance (of 5%, p &lt; 0.05) in patients with sensory disorders in the lower limb in cases of coxofemoral osteoarthritis and Schmorl’s hernias. For patients with motor disorders at the level of the lower limb, conventional radiography was informative in the presence of calcification of the intervertebral discs and in coxofemoral osteoarthritis. Conclusion MRI can be considered the first-choice imaging technique for diagnosis of the lumbar spine pathologies characterized by sensory and motor changes in the lower limbs.

Frailty and outcomes after unilateral MRI-guided focused ultrasound thalamotomy for tremor.

Frailty is recognized as an important predictor of neurointerventional outcomes. MRI-guided focused ultrasound (MRgFUS) thalamotomy is a treatment option for patients with refractory essential tremor (ET) and tremor-dominant Parkinson's disease (TdPD). The aim of this study was to evaluate whether frailer MRgFUS thalamotomy patients had worse tremor outcomes or more complications. The authors performed a cohort analysis of patients treated with MRgFUS between 2020 and 2023. Inclusion criteria were unilateral MRgFUS thalamotomy for ET or TdPD with available follow-up data (minimum 3-month follow-up). Frailty was assessed using the 11-item modified frailty index (mFI-11), which includes 11 medical comorbidities. Tremor outcomes were assessed using the Clinical Rating Scale for Tremor Part B. Complications assessed included disturbances of sensation, speech and swallowing, balance and gait, and strength. In total, 169 eligible patients were identified, including 135 (79.9%) ET and 34 (20.1%) TdPD patients. Frailty did not result in significant differences in tremor outcomes in the combined (p = 0.833), ET (p = 0.902), or TdPD (p = 0.501) cohort, or in any adverse events at the last follow-up (all p > 0.05). The combined mean follow-up was 10.3 ± 5.8 months (range 3-24 months), with cohort-specific mean follow-ups of 10.8 ± 6.0 months for ET and 8.6 ± 4.6 months for TdPD. Between the ET and TdPD cohorts, no significant differences existed in age, sex, handedness, side treated, skull density ratio, number of sonications, peak and average temperatures, energy delivered, BMI, or American Society of Anesthesiologists classification. For medical comorbidities, only hypertension was significantly different (65.9% ET, 47.1% TdPD; p = 0.043). The ET patients were significantly frailer overall, with 20.7% ET and 35.3% TdPD patients considered robust (mFI-11 score of 0), 14.8% ET and 32.4% TdPD patients prefrail (mFI-11 score of 1), 25.9% ET and 8.8% TdPD patients frail (mFI-11 score of 2), and 38.5% ET and 23.5% TdPD patients severely frail (mFI-11 score ≥ 3) (p = 0.007). Increasing frailty is not associated with worse outcomes, suggesting that MRgFUS may be appropriate even for frailer patients. ET patients are frailer than TdPD patients selected for MRgFUS.

Prevalence and associated factors of non-traumatic shoulder pain during spike and serve movements in male high school volleyball players: a cross-sectional study

BackgroundNontraumatic shoulder pain is a prevalent issue among male high school volleyball players, but its comprehensive assessment has been lacking in prior research, which often isolated specific aspects of shoulder function. This study aimed to identify contributing factors to shoulder pain in this population. HypothesisThe hypothesis posited that limited shoulder internal rotation (IR) range of motion (ROM), imbalance in rotator cuff muscle strength, intrinsic sensory disturbance, and joint stability are associated with shoulder pain in male high school volleyball players. Additionally, there was an anticipation that a substantial proportion of players would experience shoulder pain but refrain from reporting it to coaches. MethodsForty-nine male volleyball players aged 15-17 years were evaluated between February and June 2023. Questionnaires assessed the prevalence of shoulder pain during spiking and/or serving, as well as the frequency of reporting this pain to coaches. Various factors, including acromio-humeral distance, shoulder ROM, isometric strength, proprioception, joint stability (Upper Quarter Y-Balance Test), joint position sense, and upper extremity power (Seated Medicine Ball Throw Test; SMBT), were quantified. Logistic regression analyses was conducted to explore potential connections between these variables and shoulder pain. ResultsShoulder pain was reported by 39% of participants, but it was rarely communicated to coaches (95%). Jump serves (odds ratio 1.84, p=0.02) and reduced shoulder IR ROM (odds ratio 0.94, p=0.03) were associated with shoulder pain. ConclusionThis study provides crucial insights into the prevalence, severity, and associated factors of shoulder pain among male high school volleyball players. The findings underscore the importance of improving athlete-coach communication to facilitate early intervention and preventive measures. Significant associations were observed between the use of jump serves, reduced shoulder internal rotation range of motion, and shoulder pain, highlighting the relevance of specific volleyball techniques in injury prevention. These findings offer valuable guidance to coaches and trainers in developing interventions aimed at mitigating the risk of shoulder pain and enhancing player performance.

A hiatus in the rivalry between Pierre Marie and Jules Dejerine: a collaborative study on sensory disorders by Andre Pierre Marie and Gustave Roussy.

Personal and professional rivalries involving prominent neurologists mark the history of nineteenth-century French neurology. One of the great examples is the feud between Pierre Marie and Jules Dejerine. The dispute between the two, nevertheless, did not prevent Pierre Marie's son, André Marie, and Gustave Roussy - one of Dejerine's favorite pupils, from collaborating on significant research that led to the doctoral dissertation by Andre Marie regarding sensory disturbances associated with painful hemiagnosia found in thalamic lesions.