Signs Of Weakness Research Articles

6928 Vitamin D excess in a patient with hypoparathyroidism after parathyroidectomy

Abstract Disclosure: Z. Zavgorodneva: None. A. Barsegian: None. F. Zhang: None. Introduction. We describe a case of a patient with mild persistent hypoparathyroidism after parathyroidectomy with autotransplantation, which was indicated for ESRD-related secondary hyperparathyroidism. The patient presented with nonspecific complaints and was found to have a high Vitamin D level after long-term moderate-dose Vitamin D supplementation. Case report. A 71-year-old male with a past medical history of end-stage renal disease (ESRD) undergoing hemodialysis for the past 18 years, as well as a history of parathyroidectomy with autoimplantation of parathyroid glands in the forearm in 2010 due to severe secondary hyperparathyroidism, presented to the hospital complaining of generalized weakness and lower extremity cramps that had been ongoing for a few weeks. Further investigations did not reveal evidence of infectious processes. A review of medications indicated the absence of statins among his outpatient medications. No focal neurological deficits or objective signs of muscle weakness were identified. Laboratory findings showed no significant metabolic derangements or haematological abnormalities. Inflammatory markers and creatine phosphokinase were within normal ranges. As part of the workup for generalized subjective weakness and ESRD, Vitamin D levels were checked, revealing a result of of120 ng/mL. The patient reported taking over-the-counter 2000 IU of Vitamin D twice daily for the past six years despite having a normal level of Vitamin D checked five years prior to admission. Calcium supplements were initiated in the postoperative period and continue to be administered at a dose of 600 mg daily. Analysis of the PTH-calcium axis demonstrated persistent mild hypoparathyroidism with hypocalcemia since the time of the surgery. However, there was an observed tendency for calcium levels to improve, especially in the last six years. Vitamin D supplement was discontinued, and the patient was subsequently discharged home with the continuation of physical therapy. Discussion. Explaining the origin of the high level of Vitamin D in this patient poses a challenge. There is limited data in the literature regarding the long-term effects of vitamin D use when the initial Vitamin D levels are normal. Additionally, there are numerous abstracts suggesting significantly higher doses of Vitamin D received for up to 6 years without any evident biochemical or clinical consequences. Moreover, the typical consequences of Vitamin D toxicity, such as hypercalcemia, can not be present in patients who underwent parathyroidectomy. Therefore, it is possible to consider that the severe generalized subjective weakness may be a sign of Vitamin D toxicity itself. Presentation: 6/1/2024

Posterior Hip Pericapsular Block (PHPB) with pericapsular nerve group (PENG) block for hip fracture: a case series

BackgroundPain after total hip arthroplasty (THA) for femoral neck fracture (FNF) can be severe, potentially leading to serious complications. PENG block has become an optional local analgesic strategy in hip fracture surgery, but it cannot provide effective pain relief for the posterior capsule of the hip joint. Therefore, we modified the traditional sacral plexus nerve block and named it Posterior Hip Pericapsule Block (PHPB) to complement the blockade of the relevant nerves innervating the posterior hip capsule region. Thereby, we detail the analgesic effect of PHPB combined with PENG block on five hip fracture patients and the effect on their hip motor function.MethodsThis case series was conducted from December 2023 to February 2024. We performed ultrasound-guided PHPB combined with PENG block on five patients with hip fractures. Numerical Rating Scale (NRS) pain scores at rest and maximum NRS pain scores during limb movement of the five patients were recorded within 48 h after surgery. Their hip flexion, abduction, adduction, keen flexion and quadriceps muscle strength were also recorded. Serious postoperative complications, including wound infection, hematoma formation, or nerve injury, were recorded.ResultsThey experienced effective pain control within 48 h postoperatively, with NRS pain scores at rest decreasing from 3.0 (3.0, 4.5) to 0.0 (0.0, 1.0) and maximum NRS pain scores during limb movement from 8.0 (7.5, 8.5) to 1.0 (0.5, 2.0). They can autonomously perform hip flexion, abduction, adduction, and knee flexion within 48 h postoperatively without any signs of movement disorders or quadriceps muscle weakness. No severe postoperative complications, such as wound infections, hematoma formation or nerve damage, were observed in any of the patients.ConclusionsUltrasound-guided PENG block combined with PHPB provided effective analgesia for hip fracture patients in the perioperative period. It maintained hip joint motor function and quadriceps muscle strength within 24 h after THA.

The other face of facioscapulohumeral muscular dystrophy: Exploring orofacial weakness using muscle ultrasound.

One of the most distinct clinical features of facioscapulohumeral muscular dystrophy (FSHD) is facial weakness. It leads to diminished facial expression and functional impairments. Despite its clinical relevance, little else is known about orofacial muscle involvement. We therefore evaluated orofacial muscle involvement in a sizeable cohort of FSHD participants with muscle ultrasound. Muscle ultrasound images of the following orofacial muscles were scored visually and quantitatively: depressor anguli oris (DAO), orbicularis oris (OO), buccinator, temporalis, masseter, digastric, zygomaticus major and minor bilaterally, and the geniohyoid. Reliability analyses of both visual and quantitative evaluations were performed. Ultrasound results were correlated with other measures: the FSHD clinical score, facial weakness score, and facial function scale. We included 107 FSHD participants (male 54%; age 52 ± 14 years), of whom 92% showed signs of facial weakness. The reliability of visual ultrasound analysis varied widely (κ 0.0-1.0). Quantitative ultrasound reliability was high (intraclass correlation analysis ≥ 0.96). The DAO, buccinator, OO, temporalis, and zygomaticus minor muscles were affected most often (15%-39%). The digastric, geniohyoid, zygomaticus major, and masseter muscles were least often affected (<5%). The ultrasound compound score correlated weakly to moderately with other outcome measures used (ρ = 0.3-0.7). This study adds to the understanding of orofacial weakness in FSHD, confirming the involvement of the muscles of facial expression in FSHD using ultrasound. We showed that orofacial muscle ultrasound is feasible and reliable when quantitatively assessed. Future studies should evaluate orofacial muscle ultrasound longitudinally, alongside clinical and patient-reported facial weakness outcome measures, to assess their potential as outcome measures.

Case Report: Cryptocaryonosis in Indian Ocean Oriental Sweetlips (Plectorhinchus vittatus) Fish at the Closed System Quarantine of the Jakarta Aquarium and Safari

Cryptocaryon irritans, known as cryptocaryonosis disease infection in fish, is a significant problem for aquarists because they not only cause the disease but also lead to high mortality in the aquarium population. This case report aims to identify Cryptocaryon irritans infection in four Indian Ocean oriental sweetlips at the Jakarta Aquarium and Safari. Before they died, a total of four fish showed signs of weakness, scratching, excessive mucus, and pale gills. The diagnosis was confirmed through clinical assessment, physical examination, and microscopic analysis of skin scrape and gill clip samples, which revealed the presence of numerous trophonts (the young immature stages) of C. irritans. These findings underscore the importance of vigilant monitoring and prompt intervention to mitigate the impact of C. irritans, especially on marine aquarium fish populations.

Pathologic Changes in and Immunophenotyping of Polymyositis in the Dutch Kooiker Dog.

Earlier, we described a breed-specific inflammatory myopathy in Dutch Kooiker dogs (Het Nederlandse Kooikerhondje), one of the nine Dutch breeds. The disease commonly manifests itself with clinical signs of difficulty walking, muscle weakness, exercise intolerance, and/or dysphagia. In nearly all dogs' creatine kinase (CK) activity was elevated. Histopathology reveals the infiltration of inflammatory cells within the skeletal muscles. The objective of this study was to further investigate and characterize the histopathological changes in muscle tissue and immunophenotype the inflammatory infiltrates. FFPE fixed-muscle biopsies from 39 purebred Kooiker dogs were included and evaluated histopathologically according to a tailored classification scheme for skeletal muscle inflammation. As in other breed-related inflammatory myopathies, multifocal, mixed, and predominantly mononuclear cell infiltration was present, with an initial invasion of viable muscle fibres and the surrounding stroma leading to inflammation, necrosis, and tissue damage. Immunophenotyping primarily revealed lymphohistiocytic infiltrates, with CD3+ T-cells being the predominant inflammatory cell type, accompanied by CD8+ cytotoxic T-cells. The concurrent expression of MHC-II class molecules on myofibres suggests their involvement in initiating and maintaining inflammation. Additionally, CD20+ B-cells were identified, though in lower numbers compared to T-cells, and IBA-1-positive macrophages were frequently seen. These findings suggest a breed-specific subtype of polymyositis in Kooiker dogs, akin to other breeds. This study sheds light on the immune response activation, combining adaptive and innate mechanisms, contributing to our understanding of polymyositis in this breed.

Pharmacotherapy review and clinical, sub-clinical characteristics in limb-girdle muscular dystrophy

Aims: Review pharmacotherapy in limb-girdle muscular dystrophy and describe clinical, and subclinical characteristics in patients of limb-girdle muscular dystrophy (LGMD). Methods: A meta-analysis with data in PubMed, up to May 2023 on the pharmacotherapy of LGMD combined with a cross-sectional study. Patients were diagnosed with LGMD according to the European Neuromuscular Centre (ENMC) in 1995 at E and Bach Mai Hospitals, from December 2022 to May 2023. Results: 21 studies in pharmacotherapy were conducted, and treatment therapies (glucocorticoid, biological antibody, gene therapy) initially showed safety and some effectiveness in muscular strength. There are some potential gene therapies. The clinical characteristic of collected 15 patients with LGMD was high onset age (20.7±12.5 years), and prolonged diagnosis time (6.3±5.5 years). Most patients showed signs of muscle weakness and muscle atrophy (100 and 86.7%), waddling gait, and Gower’s sign (93.3%). 100% of patients had increased creatine kinase (CK) of 1648.5±2235.8 U/l. Most patients had normal inflammatory indexes. On muscular histopathology, the majority of patients had muscle fiber degeneration, hypertrophy, fibrous tissue invasion, and fat infiltration (86.7%). Conclusions: Treatment therapies in LGMD initially showed safety and some effectiveness in muscular strength; the gene therapies are promising. Clinically, all patients showed signs of muscle weakness in the limb-girdle, most of them showed muscle atrophy, waddling gait, Gowers’ sign, increased CK, negative inflammatory markers, and muscle fiber degeneration on histopathology.

Insulinoma: case report

The present study aims to depict a case of insulinoma in a 31-year-old woman, a patient of a private hospital in Maceió, state of Alagoas, presenting informative data regarding the medical follow-up performed during her treatment. She presented signs of mental confusion, behavioral changes, weakness, blurred vision, hypoglycemia, and loss of consciousness. Subsequently, a computed tomography (CT) scan of the abdominal region revealed a suggestive lesion of insulinoma. An endoscopic pancreatic ultrasound was then performed to evaluate the situation of the lesion. A partial pancreatectomy was performed, with enucleation of the pancreatic tumor by videolaparoscopy. The patient was diagnosed with a well-differentiated neuroendocrine tumor, grade 1 (NET G1), and is currently undergoing oncological follow-up every six months, with laboratory and imaging exams, without presenting any pathological or clinical alterations to date.

Electromyographic Study of Facial Nerve Function Using Two Different Surgical Approaches in Low Condylar Fractures of the Mandible: A Randomized Controlled Clinical Trial

Facial nerve (FN) dysfunction is a potential complication during open reduction of mandibular condylar fractures. The purpose of this study was to measure and compare the postoperative FN function following transparotid (TP) and transmasseteric anterior parotid (TMAP) operative approaches in open reduction and internal fixation of condylar fractures using electromyogram. A randomized controlled clinical trial was designed. The study was conducted in a single tertiary-care hospital in the inpatient setting. Patients aged above 18years with unilateral condylar fracture of the jaw or bilateral condylar fractures undergoing surgery on only 1 side were included. Patients were excluded if they had fractures of the head, bilateral condylar fractures with surgery planned on both sides, a previous history of surgery in the retromandibular area, existing lacerations to approach condyle, preoperative signs of FN weakness, or a history of parotid surgery. The predictor variable was the operative approach and the subjects were allocated randomly to TMAP and TP. The primary outcome variable was postoperative FN function in the surgical approach employed using the House-Brackmann scale and electromyography (EMG) to record any subtle weakness in nerve function. The FN function is recorded at 3 time intervals postoperatively 1week (T1), 1month (T2), and 3months (T3). The secondary outcomes studied were operating time and any other complications recorded. Age, sex, fracture pattern with classification of condylar fractures into condylar neck or base fractures according to Loukata etal.4 Any associated fracture of mandible describing the anatomical location viz symphysis and parasymphysis (anterior mandible), body, contralateral condyle or greater than 1 associated fracture were recorded. Similarly, the presence or absence of any associated midface fracture was also recorded to suggest that the study participants were homogenous in all aspects. Analytical statistics included χ2 test, t-test, and repeated measures ANOVA followed by post hoc test to compare EMG data (mean power and mean amplitude) between 2 operative approaches (TP vs TMAP) for facial muscles including frontalis, oculi, and buccinator at different time intervals (T0, T1, T2, T3). Patients within each group were also analyzed to check for nerve recovery occurring during the follow-up period. The level of significance was set at P<.05. The study sample was composed of 22 patients with a mean age of 32.82±11.21years in TMAP and 27.82±8.54years in the TP group respectively (P=.26); male predominance of 81.8 and 90.9% in TMAP and TP group respectively (P=.53) was noted. The FN deficit as assessed by the House-Brackmann scale clinically, was at 54% (T1), 36.4% (T2), and 9.1% (T3) for the TP group and 27% (T1),9% (T2), and 0% (T3) for TMAP group; however, the results were statistically insignificant (P=.31). In surface EMG evaluation, the mean power for the frontalis muscle was significantly higher in the TMAP approach at the T3 time (105.03±9.7 vs 89.56±10; 95% confidence interval -24.28 to -6.65 with P value=.002). TP approach was faster with a mean exposure time of 9.9minutes. The results show that both approaches give comparable long-term results with the TMAP group showing better frontalis muscle activity.

Adeno-Associated Virus Type 9-Mediated Gene Therapy of Choline Acetyltransferase-Deficient Mice.

The enzyme choline acetyltransferase (ChAT) synthesizes acetylcholine from acetyl-CoA and choline at the neuromuscular junction and at the nerve terminals of cholinergic neurons. Mutations in the ChAT gene (CHAT) result in a presynaptic congenital myasthenic syndrome (CMS) that often associates with life-threatening episodes of apnea. Knockout mice for Chat (Chat-/-) die at birth. To circumvent the lethality of this model, we crossed mutant mice possessing loxP sites flanking Chat exons 4 and 5 with mice that expressed Cre-ERT2. Injection of tamoxifen (Tx) at postnatal (P) day 11 in these mice induced downregulation of Chat, autonomic failure, weakness, and death. However, a proportion of Chatflox/flox-Cre-ERT2 mice receiving at birth an intracerebroventricular injection of 2 × 1013 vg/kg adeno-associated virus type 9 (AAV9) carrying human CHAT (AAV9-CHAT) survived a subsequent Tx injection and lived to adulthood without showing signs of weakness. Likewise, injection of AA9-CHAT by intracisternal injection at P28 after the onset of weakness also resulted in survival to adulthood. The expression of Chat in spinal motor neurons of Chatflox/flox-Cre-ERT2 mice injected with Tx was markedly reduced, but AAV-injected mice showed a robust recovery of ChAT expression, which was mainly translated by the human CHAT RNA. The biodistribution of the viral genome was widespread but maximal in the spinal cord and brain of AAV-injected mice. No significant histopathological changes were observed in the brain, liver, and heart of AAV-injected mice after 1 year follow-up. Thus, AAV9-mediated gene therapy may provide an effective and safe treatment for patients severely affected with CHAT-CMS.

CASE REPORT: POSSIBLE EMERGING OF SALMONELLA ENTERICA SUBSP. ENTERICA SEROVAR HAVANA INFECTION IN NEWBORN KID GOATS

Although salmonellosis has been considered an important problem in the ruminant farm from 10 weeks to 14 months old, there is no information about the disease in goats, especially in 2 to 3-day-old kids, in recent years. The goat farmers complained that the 2 to 3-day-old kids showed clinical signs of depression, weakness, lameness, and diarrhea. The kids might die within one week after the symptoms appeared. The mortality reached 60% (48/80). After many antimicrobial agents were dosed, no better outcome was expected. The farmer sent one kid to the official deputy for further investigation. By helping with bacterial and molecular biological techniques, autopsy, serotyping, and histopathological diagnosis, the kids were infected by Salmonella enterica subsp. enterica serovar Havana strain. After a farm visit, a moldy floor contaminated by 2 to 3[Formula: see text]cm thick feces was identified on the floor. After removing the mold and implementing disinfection, the outbreak was stopped. In conclusion, this report proves that salmonellosis has recently been identified in goat farms, especially in kids, within one week. Moreover, good hygiene and keeping feces out of barns are essential to preventing salmonellosis.

Qualitative Phytochemical Investigation and Acute Oral Toxicity Study on Ethanolic Extract of Curcuma longa Leaves

The study focused on evaluating the acute toxicity and phytochemical composition of Curcuma longa leaves using Swiss albino mice. The investigation involved a two-phase acute toxicity test, with doses up to 5000 mg/kg administered orally. The results indicated no toxicity at lower doses, while signs of weakness, salivation, and reduced movement were observed at 1600 mg/kg. Lethal effects were noted at 5000 mg/kg, establishing the LD50 at 2154.06 mg/kg. Phytochemical analysis revealed the presence of alkaloids, flavonoids, glycosides, tannins, and volatile oils in the ethanolic extract. The extract exhibited a 27.37% yield, characterized by a yellowish-orange color and a sticky consistency. This comprehensive investigation sheds light on both the acute toxicity profile and the diverse phytochemical components presents in Curcuma longa leaves.&#x0D; Keywords: Curcuma longa, Phytoconstituent, Acute oral toxicity, Lokes method.

Integrating Trustworthy Mechanisms to Support Data and Information Security in Health Sensors

An important reason to protect provider and medical care patient information and data is digital terrorism. Patient health records and healthcare provider information are sensitive issues that can affect patients’ health or even national security. Many frequent attacks have carried out breaches on health databases/data sets continuously and on remote servers and local servers with wireless sensor networks (WSNs) in different places. Various modern approaches addressed this issue and were designed to prevent these attacks with the aim of providing the security of patient information and data transmitted and collected by WSNs. However, there are still several signs of weakness in these approaches, which are described in the literature review. This research proposes a new trustworthy approach that supports the provision of data security and information collected by WSN and stored on basestation databases. This approach takes advantage of the integration of several security mechanisms including symmetric cryptography for encryption, asymmetric cryptography for signature and access control, as well as the implementation of the Lesamnta-LW function in the signature mechanism. Solid methodology and careful use of these mechanisms protect and hide users’ information from being exposed to attackers. Security analyses, investigative comparisons and rigorous findings indicate that the proposed approach is superior to previous approaches.

Dilated cardiomyopathy in a green-winged saltator (Saltator similis)

Cardiovascular diseases are rarely reported in birds. Among pet birds, they are most documented in psittacine birds. Dilated cardiomyopathy is a myocardial disease frequently found in poultry but with few reports in both pet and wild birds. An elderly male green-winged saltator (Saltator similis) died suddenly after presenting intermittent clinical signs of dyspnea, weakness, and vocalization changes. A general increase in cardiac size with a bulging apex was observed at necropsy. The heart exhibited an enlarged left ventricular space and flaccid musculature on the cut section. The liver was diffusely enlarged with rounded edges. No other gross lesions were observed. Samples were collected in 10% formalin and routinely processed. Histologically, bundles of myocardial fibers were irregularly arranged, with markedly elongated myofibrils and irregular cell contours. Additionally, multifocal areas of disruption were observed between the myofibrils. Diffuse hepatic congestion of sinusoids and portal veins was observed, and diffuse edema in the interstitium and para bronchi was present in the lungs. The clinical signs observed were nonspecific and can be found in several diseases of the cardiovascular and respiratory systems of birds. The gross and histological findings are compatible with what has been described for dilated cardiomyopathy in birds; however, left ventricular dilatation is uncommon in avian patients. Heart diseases in pet birds are still underdiagnosed, and reports of cardiomyopathies are limited to psittacine birds. To the authors’ knowledge, this is the first report of a dilated cardiomyopathy in a passerine bird.

Intussusception in a Nigerian Indigenous Dog: A Case Report and Probable Associated Pathologic Mechanisms

Intussusception, a serious gastrointestinal disorder characterized by invading one segment of the intestine into another, poses significant health risks in veterinary medicine. This case report presents the clinical and pathological findings of intussusception in a 10-month-old brown male Nigerian indigenous dog (NID). The dog, which had no history of vaccination, underwent abdominal surgical procedures including gastrotomy and intestinal resection with anastomosis seven days prior to death. Postoperatively, the dog exhibited clinical signs of vomiting and weakness despite treatment with penicillin-streptomycin antibiotics and a bland diet. Necropsy revealed severe pathological changes, including congested liver, gastric haemorrhage, peritoneal adhesions, leakage of intestinal contents into the peritoneum, peritonitis, intestinal congestion with intussusception, and infarction at anastomosed intestinal sites. These findings highlight the multifaceted nature of intussusception, involving mechanical obstruction, compromised blood supply, and systemic infection. The case emphasizes the challenges in managing post-surgical complications and the importance of early diagnosis and intervention in severe gastrointestinal disorders in dogs. This manuscript, therefore, contributes to the veterinary literature by providing a detailed description of the clinical course, pathological findings, and potential complications associated with intussusception in Nigerian indigenous dogs. The insights gained from this case report are crucial for improving diagnostic accuracy, optimizing treatment strategies, and enhancing clinical outcomes in similar clinical scenarios.

Role of recovery of acetylcholine release in compromised neuromuscular junction function

Everyday physical activities, such as walking, are enabled by repeated skeletal muscle contractions and require a well-functioning neuromuscular transmission. In myasthenic disorders, activities of daily living are debilitated by a compromised neuromuscular transmission leading to muscle weakness and fatiguability in patients. To enable physical activity, acetylcholine (ACh) is released repeatedly from the motor nerve, however, the role of the nerve terminals’ capacity to sustain ACh release to support repetitive contractions under compromised neuromuscular transmission remains unclear. To explore this, we studied synaptic and contractile function during repeated contractions in healthy rat skeletal muscles under conditions of pharmacological induced compromised neuromuscular transmission. Using recordings of endplate potentials, compound muscle action potential (CMAP) and force production in isolated skeletal muscles and living, anesthetized animals, we found that force and CMAP were markedly reduced by even very light activity performed up to 5 s prior to contraction showing that recovery of ACh release was insufficient to maintain synaptic transmission strength. Our results suggest that the timing of depletion and restoration of ACh release may impact clinical signs of weakness and fatigability in patients with impaired neuromuscular transmission and affect the sensitivity of electromyographic recordings in the clinic.

Criminal responsibility of the President of the United States of America

Observed from a wider historical perspective, the most recent period of the constitutional life of the United States of America risks to be remembered as the one during which the presidential impeachment procedure was used incomparably more often than ever before. This sometimes attracts particular attention to the topic of criminal responsibility of the President, on which the Constitution itself remains silent. At the same time, legislation and jurisprudence seem to have been shying away from addressing this important and rather actual issue. The question whether the presidential immunity protects a sitting or a former president from arrest, trial, or punishment for deeds committed during the presidential term of office thus represents a particularly complex legal puzzler. This is particularly the case since the traditional checks-and-balances system appears to be displaying signs of weakness due to an overtly politicized procedure, notably in the absence of firm legal guidelines or clear theoretical perspectives.

Incidental Finding of Subannular Perfused Aortic Root Abscess.

An 83-year-old female presented with aortic valve stenosis requiring surgery, which was diagnosed with a transthoracic echocardiography three years ago. However, the patient declined the surgery at that time due to personal reasons. Three years later she presented again with signs of dizziness and weakness and progression of the aortic valve stenosis. Cardiac catheterization and a computed tomography scan were performed before the planned surgery. Surprisingly, a huge subannular perfused abscess hole around the aortic root companying a pericardial effusion was revealed. The patient underwent an urgent aortic root replacement with a tissue valve and an aortic ascending replacement without any complications. Intraoperative inspection confirmed an active aortic root and valve endocarditis.

An odd case of immune-mediated necrotizing myopathy, complicated with sagittal, transverse and sigmoid sinus thrombosis

INTRODUCTION: Immune-mediated necrotizing myopathy (IMNM) is a rare variant of immune-mediated inflammatory myopathy (IMIM) that exhibits a severe prognosis and is unresponsive to conventional treatment. (1,2)Notably, the incidence of immune-mediated inflammatory myopathies (IMIMs) is low, estimated at 1.16 to 19/million/year and only 3-6% of IMIMs are diagnosed as IMNM. (1,3–5). Systemic inflammation has been found to play a crucial role in promoting the onset of cerebral venous thrombosis. (6,7) MATERIAL AND METHODS: We present the case of a 46-years-old Chinese woman, without any known prior pathology, who was referred to the Rheumatology Department for symmetrical, proximal muscle weakness of the limbs, dysphagia for solid food, and weight loss (5 kg within 2 months). The pathologic clinical examination revealed itchy erythematous plaques on the posterior thoracolumbar region and signs of muscle weakness. Laboratory workup showed significant inflammatory syndrome, severe muscle and hepatic cytolysis syndrome, and positivity for thyroid-specific autoantibodies but with normal thyroid function, positivity for antinuclear antibodies (more precisely: SS-A, Ro-52, SS-B), and myositis antibodies (SRP, Ro-52, SAE1, PM-Scl, MDA5). The CT scan of the thoracic, abdominal, and pelvis showed fibrosis of the lungs, hepatic hypertrophy, and an enlarged uterus, further diagnosed by transvaginal ultrasound as adenomyosis. The positive diagnosis is immune-mediated necrotizing myopathy. Differential diagnoses included dermatomyositis, toxic/infectious myositis, hypothyroidism, and neuro-muscular diseases (5,8). The initial treatment was made with glucocorticoids (pulse therapy followed by oral therapy) and immunosuppressants (Mycophenolate Mofetil – stopped because of severe dyspepsia and myelosuppression). After five days of pulse therapy, the patient developed muscle weakness and paresthesia on the left side of the body, and the cerebral CT scan revealed sagittal, transverse, and sigmoid sinus thrombosis. Thrombophilia screening uncovered the positivity of the lupus anticoagulant. (9) RESULTS: The patient was treated with anticoagulants (low molecular weight heparin, and afterward Vitamin K antagonist), low doses of oral glucocorticoids, and immunosuppressant (Methotrexate), without any other adverse event. CONCLUSION: In the presence of the lupus anticoagulant, even though the antiphospholipid syndrome is not confirmed, the only anticoagulant therapy that has proven its efficacy is the Vitamin K antagonist. Immune inflammatory myopathies, like IMNMs, create a significant inflammatory status that leads to hypercoagulability and endothelial injury, which exposes collagen and tissue factors, promoting further platelet aggregation, and can even lead to cerebral thrombosis. (2,6)

Addressing Urgencies of Democratic Interaction in the Public Spherean: Attempt to Facilitate Disagreement on Audience Dramaturgies of Disagreement

In the research project 'Dramaturgies of Disagreement in Contemporary Theatre,' I examined how theatre performances dramaturgically work with substantial disagreement within audiences and non audiences. In the first part of this article, I present and discuss the cultural politi cal context, the societal backdrop, and the agenda of this research. I argue for the need to deal critically with normative prem ises and closures in this research. In the second part, I exemplify how a move from a normative point of departure towards a more descriptive approach may be realised. I start this part by presenting the applied sociological theory of communities of disa greements (Iversen 2014), before I describe, analyse, and compare three Norwegian par ticipatory performances from recent years. I propose the metaphorical terms of theatre as either arena , laboratory, or catalyst for communities of disagreement to highlight differences between the dramaturgical approaches. I further examine how the rela tion between the limited public space of the theatre and the wider public sphere is con ceptualised differently in the three cases. Finally, I relate the analysed dramaturgies to a spectrum of political theory that spans from deliberative to agonistic democracy to further illuminate and facilitate legit imate disagreement on dramaturgies of disagreement. Art does not need any justification. Yet public funding of the arts in democratic societies is dependent on such justifica tions. And no public funding results in poor conditions for the arts. That means, art is dependent on justifications after all. As a theatre researcher, I contribute to the form ation, affirmation, and negotiation of such justifications, whether I am aware of it and intentionally partake or not. The Nordic welfare states are known for their (relatively) extensive support of the arts. However, the traditionally pre sumed societal consensus on this support has been showing signs of weakness for a while. Hence, the Arts Council Norway and the Danish Arts Foundation11 have called attention to the need for renewed strategies of legitimisation. Their latest research pro gramme, 'Arts and Social Communities,' has been motivated by this need. My research into dramaturgies of disagreement in con temporary theatre has been funded by this programme. What I present and discuss in this article reflects my experiences of con tributing to this programme.

P301L‐Tau Expression Induces Skeletal Muscle Abnormalities in Mouse Model of Tauopathy

AbstractBackgroundPatients suffering from Alzheimer’s disease (AD) and related tauopathies often report signs of muscle weakness. The pathological accumulation of insoluble tau that forms neurofibrillary tangles (NFTs) is a hallmark of AD, yet it is unclear whether pathological tau impacts skeletal muscle. Proper muscle function is necessary for movement and consequently impacts quality of life in tauopathy patients, while concurrently contributing to the physiological maintenance of whole‐body endocrine and metabolic homeostasis. Skeletal muscle crosstalks with other organ systems; therefore, disruption of skeletal muscle health impacts whole‐body processes, such as the formation of pathological tau. The objective of this study was to determine the links between tauopathy and muscle function.MethodI performed intracerebroventricular injections with adeno‐associated viral (AAV) vector encoding P301L human tau (N = 4 females, 7 males) or a control plasmid (empty or a yellow fluorescent protein construct) (N = 5 females, 6 males). At 3 months, I measured grip strength. I harvested the brain, soleus, and tibialis anterior (TA) muscles at 15 months, and measured muscle mechanics concurrently in the soleus and extensor digitorum longus (EDL) muscles. I biochemically detected soluble tau and visualized TA structure immunohistochemically.ResultsGrip strength was reduced at 3 months in the P301L tau‐expressing mice of both sexes. The intrinsic force production of the soleus, but not the EDL, was reduced in P301L tau‐expressing males at 15 months. At this same time point, soluble tau accumulated in the cortex but not the soleus. Aggregation of nuclei were found histologically in the TA of P301L tau expressing mice but not in controls.ConclusionChanges in grip strength preceded insoluble tau accumulation and cognitive decline typical of this model. Reductions in the soleus force production indicate that P301L tau overexpression in the brain impacts intrinsic muscle strength, and occurs independently of innervation. The nuclear clumps detected in the TA of P301L tau‐expressing mice suggest that AAV‐P301L‐tau injections in the brain promote an inflammatory response in muscle. Together these data suggest that pathological tau species that are expressed in the brain reach peripheral tissues and exert deleterious consequences such as skeletal muscle abnormalities.