Persistent Weakness Research Articles

Impact of rigorous muscle strength and power training on mobility among individuals with hip fractures: A randomized controlled trial

Patient’s mobility is not restored to pre-fracture levels until two years following a fractured hip. A persistent weakness in the muscles on the fractured leg may contribute to mobility limitations. A randomized controlled trial was conducted on individuals with hip fractures aged 60-85 to examine the effect of strength and power training twice a week on mobility. A random assignment was made between a 46-person intervention group and a 40 person control group. Over a period of twelve weeks, strength training was conducted twice per week under supervision. All measurements were conducted by a blinded measurer. We assessed mobility by timing the time it takes to climb stairs, get up from a chair, and walk. To analyze the data, we used intention-to-treat analysis. A study of efficacy was conducted for subjects who adhered to training more than 50% of the time (n = 40). 4 of the controls did not show a statistically significant improvement in mobility (p <0.001). Training had no significant effect on walking time or TUG. During the efficacy analysis, the average chair rise time for the exercise group improved by 5.4% (p < 0.005). The results of intense muscle strength and power training were observed in self-reported improvements in mobility. Participants with higher training compliance had an improved chair rise rate.

Neuralgic amyotrophy: An update in evaluation, diagnosis, and treatment approaches.

Neuralgic amyotrophy (NA) is an underrecognized peripheral nerve disorder distinguished by severe pain followed by weakness in the distribution of one or more nerves, most commonly in the upper extremity. While classically felt to carry a favorable prognosis, updates in research have demonstrated that patients frequently endure delay in diagnosis and continue to experience long term pain, paresis, and fatigue even years after the diagnosis is made. A transition in therapeutic approach is recommended and described by this review, which emphasizes the necessity to target compensatory abnormal motor control and fatigue by focusing on motor coordination, energy conservation strategies, and behavioral change, rather than strength training which may worsen the symptoms. The development of structural hourglass-like constrictions (HGCs) on imaging can help confirm the suspected clinical diagnosis, and in association with persistent weakness and limited recovery on electrodiagnostic testing may be considered for surgical consultation. Given the complex nature of management, a multidisciplinary approach is described, which can provide an optimal level of care and support for patients with persistent symptoms from NA and allow more unified guidance of rehabilitation and surgical referrals.

Dynamics of a stochastic impulsive vegetation system with regime switching

This paper describes an analytical and numerical investigation of a novel stochastic impulsive vegetation system with regime switching. Impulsive control, white noise, regime switching, and rainfall are modeled as crucial factors to simulate natural ecological phenomena, with the aim to explore the effects of those factors on the dynamics of vegetation system. Dynamics of the system, including the existence and uniqueness of global positive solutions, extinction, non-persistence in the mean, weak persistence and stochastic persistence, are investigated firstly under the effects of impulsive control and regime switching. For system without impulsive perturbations, we investigate the existence and uniqueness of the stationary distribution for the system, demonstrating that the vegetation can survive forever. Using a sophisticated sensitivity analysis technique, it is found that the vegetation biomass is highly sensitive to the rainfall but least sensitive to the saturation constant of the vegetation consumption. Our numerical results reveal that either the reduced rainfall or increased environmental disturbance can tip the balance of vegetation system, but this relationship can be effectively regulated by implementing impulsive control schemes. Additionally, it is observed that system at high-level rainfall may be detrimental to maintain the balance of vegetation, but regime switching in rainfall patterns can balance different states of vegetation and provide higher survival chance for vegetation. Significantly, it emphasizes that the persistence-extinction behaviors of the vegetation are more sensitive to the change of regime switching, indicating that the proper and general environmental disturbances is beneficial to maintain dynamic balance of vegetation system. These findings may provide new insights into the complex vegetation system dynamics.

Increased Postoperative Deltoid Signal seen after Suprapectoral Biceps Tenodesis: Potential Risk to the Anterior Branch of the Axillary Nerve

BackgroundArthroscopic suprapectoral biceps tenodesis is a common procedure for lesions of the long head of the biceps in the setting of anterior shoulder pain. However, the distal portal poses a theoretical risk to the terminal branches of the axillary nerve as the nerve travels from posterior to anterior to innervate the anterior deltoid. The purpose of this retrospective cohort study was to assess for axillary nerve branch injury, identified by deltoid signal change in postoperative magnetic resonance imaging (MRI) in patients who underwent an arthroscopic suprapectoral biceps tenodesis. MethodsPatients who underwent rotator cuff repair with a concomitant arthroscopic suprapectoral biceps tenodesis, had a postoperative MRI, and at least 1 year of follow-up were included. The incidence of increased deltoid signal consistent with injury to an anterior branch of the axillary nerve on proton density fat saturated sequences was collected. Age, sex, body mass index (BMI), and patient reported outcome measures (PROMs) including the American Shoulder and Elbow Surgeons Shoulder Score (ASES) score, Patient-Reported Outcomes Measurement Information System (PROMIS) pain, physical function (PF), and upper extremity (UE) scores, and Single Assessment Numeric Evaluation (SANE) score were compared in patients with and without increased deltoid signal on postoperative MRI. P<0.05 was used for significance. ResultsTwenty-four patients were eligible for inclusion (9 female, average age 59.0±10.1, BMI 27.6±6.7). Edema-like signal within the anterior deltoid musculature was observed in 9 patients on postoperative MRI. Two patients had a second follow-up MRI performed which demonstrated resolution of signal, and one patient required a second surgery for release of adhesions. Patients with increased deltoid signal had higher BMI (p=0.03). There was no difference in any other demographic or postoperative PROM between patients with increased signal and those without at any follow-up time point. No patient demonstrated persistent weakness or numbness in the axillary nerve distribution at final follow-up. DiscussionOver one third of patients in our cohort had MRI evidence of axillary nerve branch injury as seen on proton density fat saturated MRI sequences postoperatively. The distal arthroscopic portal for a suprapectoral biceps tenodesis may place anterior terminal branches of the axillary nerve at risk for injury. Additional investigation and strategies for avoidance of nerve injury in this area should be pursued.

Pediatric Chronic Inflammatory Demyelinating Polyneuropathy: Challenges in Diagnosis andTherapeutic Strategies.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare autoimmune neurological disorder seen in both pediatric and adult populations. CIDP typically presents with progressive and persistent weakness over at least 4 weeks in addition to sensory symptoms in the extremities. Although CIDP shares common clinical features between children and adults, it sometimes presents as a distinct clinical entity in children that requires close attention and recognition. A major caveat when diagnosing a child with CIDP is the clinical and diagnostic overlap with inherited neuropathies, most commonly Charcot-Marie-Tooth disease (CMT). Demyelinating CMT (dCMT) and CIDP might share similar clinical presentations, and sometimes it might be difficult to differentiate them on the basis of the electrodiagnostic findings or cerebrospinal fluid (CSF) albumino-cytological dissociation. This indeed merits early consideration for genetic testing in patients who do not respond to conventional CIDP therapies. Current treatment options for CIDP include intravenous immunoglobulins (IVIG), corticosteroids (CS), and plasmapheresis (PLEX). The need for novel therapies is essential in instances where patients continue to have symptoms despite the standard therapies or due to adverse effects of long-term use of standard therapies such as CS. This paper reviews the challenges in the diagnosis of CIDP in children and the current as well as novel therapies for CIDP.

A RARE CASE OF JUVENILE MYASTHENIA GRAVIS

Juvenile Myasthenia Gravis is arare auto immune disorder affecting children and adolescents, characterized by ptosis, muscle weakness and fatigability, untreated patients may progress to paralysis of the respiratory muscles and the risk of aspiration, particularly at times when they have an upper respiratory tract infection. Early recognition of this disease helps avoid unnecessary testing, prevent undue parental anxiety and stop the progression of symptoms. An 18 months old girl admitted with progressive dropping of eyelids, swallowing difficulty, loss of head control and generalized fatigability. She had positive acetyl cholinesterase test. Investigation releavedelectro decrementalresponsonse in electromyography. Patient treated with oral pyridostigmine bromide and steroid resulted in improvement in muscle strength and functional ability with regularly followed in OPD.JMG requires prompt recognition and management to prevent complications. This case highlights the importance of considering JMG in children with persistent weakness and fatigue.

Knee flexor strength at 6 months after anterior cruciate ligament reconstruction using hamstring tendon can be predicted from that at 3 months.

This study aimed to identify factors influencing persistent muscle weakness in knee flexor strength after anterior cruciate ligament (ACL) reconstruction using the hamstring tendon and establish a clear cut-off value at 3 months postoperatively for the limb symmetry index (LSI) to exceed 90% at 6 months postoperatively. One hundred forty-eight patients undergoing ACL reconstruction were included and categorised into two groups based on knee flexor strength at 6 months postoperatively: patients with LSI of 90% or greater (achieved group: n = 114) and patients with LSI less than 85% (nonachieved group: n = 34). Items with significant differences between the two groups (preoperative waiting period, LSI to body weight ratio of knee flexor and extensor strength at 3 months postoperativelyand peak torque angle of knee flexor muscle) were included in the multiple logistic regression analysis. Additionally, a receiver operating characteristic curve was used to calculate the cut-off value of the LSI at 3 months postoperatively, which was required to achieve the LSI criteria for knee flexor strength 6 months postoperatively. Multiple logistic regression analysis extracted the preoperative waiting period and LSI for knee flexor strength at 3 months postoperatively. The cut-off value at 3 months postoperatively was 76.9% (area under the curve value, 0.82; sensitivity, 0.76; and specificity, 0.81) of the LSI. The LSI of at least 76.9% for knee flexor strength at 3 months after ACL reconstruction was an indicator for achieving the 6 months postoperatively. This is a criterion to aim for, considering the stress on the graft and the regeneration process of the semitendinosus tendon. Level III.

Congenital Myopathy Due to RyR1 Gene Mutation in a Newborn Masquerading as a Consequence of Hypoxic-ischemic Encephalopathy

Background: Congenital myopathies may be a cause of prolonged and persistent hypotonia and weakness in a newborn, which may be overlooked as a neurological consequence of hypoxic-ischemic encephalopathy. We report such a neonate which turned out to be a case of central core myopathy. Clinical Description: A female neonate born at 38 weeks of gestation suffered birth asphyxia and was referred at 25 days of life due to a persistent need for respiratory support. A review of history revealed that the mother had decreased fetal movements during the third trimester and polyhydramnios. On examination, the baby had a frog-like posture with a paucity of proximal movements with preserved distal movements. Considering the possibility of a congenital myopathy, investigations were carried out. The whole-exome sequencing revealed heterozygous nonsense variation in exon 20 of the RyR1 gene, thus diagnosing the infant as a case of congenital core myopathy. Management and Outcome: The baby was managed with supportive care including ventilatory and nutritional support. Baby remained ventilator dependent, but ultimately succumbed to complications by 2 months of age. Conclusions: A high index of suspicion is required in a newborn with birth asphyxia having unusually persistent hypotonia, thorough clinical examination and appropriate genetic testing can help in identifying an underlying congenital myopathy.

Strategic Planning within Ministries in Iceland: Lessons and Development

Following the 2008 financial crisis, an extensive examination of Icelandic public administration, its policies, procedures, and practices was undertaken. This era spawned various programs, including an assessment of strategic plans issued by the Government Offices (ministries in Iceland). The purpose was to identify strengths and weaknesses within the strategic planning process, leading to the development of a strategic planning manual and efforts to enhance collaboration between ministries through the establishment of a policy council. More than a decade has passed since the comprehensive study of 11 strategies was published in the Icelandic Review of Politics and Administration. This article aims to take stock of progress within the Government Offices by reviewing 11 updated versions of the 2012 strategies, applying the same analytical framework used in 2012. Additionally, 22 new strategies and plans are analyzed for the first time, with the results compared to the updated versions of the original 11 strategies. The analysis highlights that the administration excels in the formulation stage, encompassing preparation, analysis, and goal setting. Moreover, there is an augmented presence of action plans across more strategies, and ministries seem more focused on ensuring compatibility and coordination among them. However, a persistent weakness is observed in the limited connection between actions and the allocation of funds, as well as evaluations of strategies.

Posterior Interosseous Nerve Palsy in Rheumatoid Arthritis: A Systematic Review.

The purpose of this systematic review is to describe the pathoanatomy, presentation, diagnostic workup, treatment modalities, and outcomes of posterior interosseous nerve (PIN) palsy in patients with rheumatoid arthritis (RA). All reported cases of PIN palsy in patients with RA were reviewed to yield 72 cases of PIN palsy in 70 patients. The male-to-female ratio was 1:2.7. Pain involving the elbow was very common (20/33 cases reporting this information), and paralysis or weakness of digit extension was noted in 27/33 cases and 6/33 cases, respectively. Only 1 of the 54 cases undergoing surgical intervention reported persistent weakness, and this 1 patient had undergone a 3-month trial of conservative management. In conclusion, Appropriate pharmacologic management in conjunction with magnetic resonance imaging (MRI) and ultrasound monitoring may be used for conservative management, but surgical decompression should still be utilized for patients with a compressive disease pathology who fail to improve with 6 weeks of conservative treatment, or for those with advanced disease on initial presentation.

Synergistic effect of chimeric antigen receptor modified with Bcl-2 on enhanced solid tumour targeting.

Engineered T cells expressing chimeric antigen receptors (CARs) have shown remarkable therapeutic effects on haematological malignancies. However, CART cells are less effective on solid tumours mainly due to their weak persistence, which might be caused by activation-induced cell death (AICD). To overcome this limitation, CART cell with the antigen, Epidermal growth factor receptor variant III (EGFRvIII), targeting was modified to carry the anti-apoptotic molecule B cell lymphoma 2 (Bcl-2), and the final construct was named as EGFRvIII·CART-Bcl2 cells. Compared with the EGFRvIII·CART cells, EGFRvIII·CART-Bcl2 cells revealed higher capacities of proliferation, anti-apoptosis and tumour cell killing in vitro. Moreover, EGFRvIII·CART-Bcl2 cells had a longer persistence rate and exerted better anti-tumour effects than EGFRvIII·CART cells in cervical carcinoma xenograft model. Taken together, our findings suggest that incorporating anti-apoptotic molecules into CART cells may enhance its therapeutic effects against solid tumours.

Post-tholeiite rifting and the genesis of ultramafic lamprophyres around 65 Ma in the Deccan large igneous province: Implications for the separation of India and Seychelles

This study examines the mineral and whole-rock compositions and paleomagnetic dating of lamprophyres from the West Coast Alkaline Complex (WCAC) within the Deccan Large Igneous Province. We aim to elucidate their connection with the Réunion plume, Deccan tholeiite magmatism, the onset of rifting and separation of Seychelles, and the role of lithospheric thinning.WCAC lamprophyres contain olivine and phlogopite phenocrysts/macrocrysts set in a groundmass of carbonate, clinopyroxene, nepheline, spinel, and melilite. They are characterized by Ti-Al phlogopite and Al-enriched spinels with high Fe2+/(Fe + Mg) ratios. They are undersaturated in silica and rich in MgO, TiO2, and LREEs, resembling the global ultramafic lamprophyres (UMLs).They originated from an enriched garnet lherzolite mantle, metasomatized by silicate and carbonate veins. Trace-element modeling suggests the derivation of melt by ∼1% partial melting of phlogopite-bearing garnet lherzolite mantle, corresponding to moderate pressure depths (3–4 GPa) and lithospheric mantle thickness of 90–100 km. Paleomagnetic investigations corroborate their intrusions, primarily during chron C29n, approximately at 65 Ma, which coincided with amplified plate velocities in the Indian Ocean.Seismic tomography indicates a current lithospheric thickness of about 50 km under the western Indian margin, suggesting a lithospheric delamination of about 40–50 km following the intrusion of lamprophyres at ca. 65 Ma. The initiation of passive rifts in the region, culminating in the separation of the Indian subcontinent and the Seychelles, prompted the UML magmatism. Lithospheric thinning continues along with continental rifting in response to greater plate-tectonic stresses within regions of persistent lithospheric weakness.

ACL Reconstruction Using Quadrupled Semitendinosus Versus Double-Stranded Semitendinosus and Gracilis Autograft: 2-Year Results From a Prospective Randomized Controlled Study

Background: A disadvantage of using hamstring tendon autograft consisting of the semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction is pain from tendon harvesting and persistent hamstring weakness. In the tendon-sparing all-inside technique, a quadrupled semitendinosus graft and adjustable-loop cortical fixation are suggested to give less postoperative flexion deficits while displaying overall similar clinical results to the traditional hamstring technique. However, there are a limited number of high-quality studies comparing these techniques with inconsistent results. Purpose: To investigate differences between the all-inside (quadrupled semitendinosus) and traditional hamstring (double-stranded semitendinosus and gracilis) technique regarding (1) self-reported function, (2) hamstring strength, and (3) knee laxity. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 98 patients were randomized to either the all-inside or the traditional hamstring technique. Perioperatively, duration of surgery and graft size were obtained. The International Knee Documentation Committee 2000 Subjective Knee Form score, Knee injury and Osteoarthritis Outcome Score, Tegner Activity Scale score, knee laxity (KT-1000 arthrometer side-to-side difference and pivot shift), range of motion, isokinetic knee strength, and hop test score were collected preoperatively and 2 years postoperatively. Return-to-sport readiness was evaluated 9 months postoperatively. Results: A total of 89 patients completed 2-year follow-up, 45 patients with the all-inside technique and 44 patients with the traditional hamstring technique. There were no significant differences between groups in any of the outcome measures 2 years after surgery, but there was a tendency in the all-inside group toward having increased anterior translation (mean, 3.6 mm vs 2.7 mm), a higher number of revision surgeries (5 patients vs 2 patients), and more patients having +1 and +2 pivot-shift values (29 vs 18 patients) when compared with the traditional group. Conclusion: The all-inside technique yields equivalent results to the traditional hamstring technique 2 years after surgery and should be considered a reliable technique to use for ACL reconstruction. Sparing the gracilis tendon does not lead to less persistent hamstring weakness. Long-term follow-up is needed to further determine whether the tendency of increased anterior translation seen at 2 years postoperatively will lead to a higher risk of graft failure.

Dynamics of a stage-structured predator-prey system with fear-induced group defense in autonomous and nonautonomous settings.

In this investigation, we construct a predator-prey model that distinguishes between immature and mature prey, highlighting group defense strategies within the mature prey. First, we embark on exploring the positivity and boundedness of the solution, unraveling sustainable equilibrium points, and deducing their stability conditions. Upon further investigation, we observe that the system exhibits diverse bifurcations, including Hopf, saddle-node, transcritical, generalized Hopf, cusp, and Bogdanov-Takens bifurcations. The results reveal that heightened fear decreases mature prey density, potentially causing prey extinction beyond a certain threshold. Increased maturation rates lead to the coexistence of immature and mature prey populations and higher predator density. Stronger group defense boosts mature prey density, while weaker defense results in weak persistence. Lower values of the maturation rate of prey and the decline rate of predators sustain only the predator population, reliant on resources other than focal prey. Furthermore, our model demonstrates intriguing and diverse dynamical phenomena, including various forms of bistability across distinct bi-parameter planes. We also explore the dynamics of a related nonautonomous system, where certain parameters are considered to vary with time. In the seasonally forced model, we set out to define criteria regarding the existence and stability of positive periodic solutions. Numerical investigations into the seasonally forced model uncover a spectrum of dynamics, ranging from simple periodic solutions to higher periodicities, bursting patterns, and chaotic behavior.

Uncommon Bilateral Idiopathic Facial Nerve Palsy (Bell's Palsy) in an Infant: An Atypical Age and Clinical Challenges Explored: A Case Report.

Our case study explores Bell's palsy, a rare lower motor neuron facial nerve paralysis, particularly rare in newborns. While often idiopathic, it can stem from congenital or developmental factors. Unilateral facial paralysis is more prevalent, with Bell's palsy accounting for more than 50%, while bilateral facial paralysis is exceptionally rare. We present a distinctive case of idiopathic Bell palsy in a 3.5-month-old infant, initially affecting the right side and spontaneously resolved within 30 days, followed by involvement on the left side a month later. Despite comprehensive evaluations and treatment, persistent facial weakness was observed on the left side. The patient initially responded well but faced ongoing challenges during the second attack. Our findings underscore the need for further research to improve the understanding and management of these cases.

Potential Diaphragm Muscle Weakness-related Dyspnea Persists 2 Years after COVID-19 and Could Be Improved by Inspiratory Muscle Training: Results of an Observational and an Interventional Clinical Trial.

Rationale: Diaphragm muscle weakness might underlie persistent exertional dyspnea, despite normal lung and cardiac function in individuals who were previously hospitalized for acute coronavirus disease (COVID-19) illness. Objectives: The authors sought, first, to determine the persistence and pathophysiological nature of diaphragm muscle weakness and its association with exertional dyspnea 2 years after hospitalization for COVID-19 and, second, to investigate the impact of inspiratory muscle training (IMT) on diaphragm and inspiratory muscle weakness and exertional dyspnea in individuals with long COVID. Methods: Approximately 2 years after hospitalization for COVID-19, 30 individuals (11 women, 19 men; median age, 58 years; interquartile range [IQR] = 51-63) underwent comprehensive (invasive) respiratory muscle assessment and evaluation of dyspnea. Eighteen with persistent diaphragm muscle weakness and exertional dyspnea were randomized to 6 weeks of IMT or sham training; assessments were repeated immediately after and 6 weeks after IMT completion. The primary endpoint was change in inspiratory muscle fatiguability immediately after IMT. Measurements and Main Results: At a median of 31 months (IQR = 23-32) after hospitalization, 21 of 30 individuals reported relevant persistent exertional dyspnea. Diaphragm muscle weakness on exertion and reduced diaphragm cortical activation were potentially related to exertional dyspnea. Compared with sham control, IMT improved diaphragm and inspiratory muscle function (sniff transdiaphragmatic pressure, 83 cm H2O [IQR = 75-91] vs. 100 cm H2O [IQR = 81-113], P = 0.02), inspiratory muscle fatiguability (time to task failure, 365 s [IQR = 284-701] vs. 983 s [IQR = 551-1,494], P = 0.05), diaphragm voluntary activation index (79% [IQR = 63-92] vs. 89% [IQR = 75-94], P = 0.03), and dyspnea (Borg score, 7 [IQR = 5.5-8] vs. 6 [IQR = 4-7], P = 0.03). Improvements persisted for 6 weeks after IMT completion. Conclusions: To the best of the authors' knowledge, this study is the first to identify a potential treatment for persisting exertional dyspnea in long COVID and provide a possible pathophysiological explanation for the treatment benefit. Clinical trial registered with www.clinicaltrials.gov (NCT04854863, NCT05582642).

Functional MRI evaluation of hyperbaric oxygen therapy’s effect on hand motor recovery in a chronic post-stroke patient: a case report and physiological discussion

The objective of the case report was to evaluate a specific HBOT protocol as an effective treatment for stroke rehabilitation, specifically improving hand motor function in chronic post-stroke patients. Stroke is the second leading cause of long-term disability worldwide. About 80% of individuals with acute stroke present upper-limb motor impairment, and 50–60% will have persistent disability or weakness at the chronic phase. Impaired upper-limb motor function is highly associated with low self-care ability, limited mobility and poor quality of life. In recent years, there has been evidence of the neuroplasticity effects of HBOT, and HBOT was found to induce neuroplasticity in chronic stages, even years after brain injury. While the healthcare system is primarily focused on teaching patients to live with their impairments, this case report evaluates the effect of a specific hyperbaric oxygen therapy (HBOT) protocol on true stroke rehabilitation, specifically, improving upper-limb function. This case report studied motor task functional MRI (fMRI) activation and resting-state functional connectivity (rsFC) in a 61-year-old right-handed male patient who suffered hemiparesis and physical weakness in the right upper limb two years after his acute insult, pre- and post-treatment of 60 daily HBOT sessions. Motor functions were assessed at baseline and after the treatment using the Fugl–Meyer assessment (FMA) and the handgrip maximum voluntary contraction (MVC). Following the HBOT protocol, the patient’s FMA score improved from 17 (severe impairment) to 31 (moderate impairment), and there was an increase in fMRI activation in both the supplementary motor cortex (SMA) and the premotor cortex (PMA) bilaterally during trials involving the right hand. The lateralization index (LI) decreased from 1 to 0.63, demonstrating the recruitment of the contralesional hemisphere. The region of interest, ROI-to-ROI, analysis revealed increased post-intervention inter-hemispheric connectivity (P = 0.002) and a between-network connectivity increase (z-score: 0.35 ± 0.21 to 0.41 ± 0.21, P &lt; 0.0001). Seed-to-voxel-based rsFC analysis using the right SMA as seed showed increased connectivity to the left posterior parietal cortex, the left primary somatosensory cortex and the premotor cortex. This case report provides additional insights into HBOT-induced brain plasticity and functional improvement in chronic post-stroke patients, and shows HBOT’s potential as an effective, valuable treatment option for those suffering with lingering symptoms after a stroke. This work was conducted by a research team at the Sagol Center for Hyperbaric Medicine and Research at Shamir Medical Center and Tel Aviv University, and published in Frontiers in Neurology. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Lymphoma of the central nervous system originating from the septum pellucidum region: Two case reports with literature review.

Central nervous system lymphoma (CNSL) originating from the septum pellucidum is exceptionally rare, presenting unique diagnostic and therapeutic complexities. This case report aims to elucidate the diagnostic challenges, treatment strategies, and outcomes of this rare manifestation. By documenting this case, we seek to enhance understanding within the medical community and contribute valuable insights to the management of CNSL, particularly in atypical locations. A 45-year-old female presented with persistent headaches, blurred vision, and motor weakness, prompting a thorough neurological evaluation. Imaging revealed an enhancing mass in the septum pellucidum, leading to the diagnosis of CNSL. The patient's concerns encompassed not only the physical symptoms but also the emotional impact of her diagnosis and treatment journey. Diagnostic confirmation of CNSL involved cerebrospinal fluid analysis and imaging findings, highlighting the challenge of distinguishing lymphoma from other intracranial pathologies. The case underscores the importance of comprehensive diagnostic evaluation in rare CNSL presentations. Multidisciplinary management included high-dose methotrexate-based chemotherapy and corticosteroids, with consideration for neurosurgical intervention. Psychosocial support and self-care strategies were integrated into the treatment plan to address holistic patient needs. Monitoring revealed a positive treatment response, with a reduction observed in the septum pellucidum mass. Regular assessments ensured adherence to interventions and management of treatment-related side effects, contributing to favorable outcomes and improved quality of life for the patient. This case emphasizes the significance of meticulous diagnostic evaluation and personalized treatment approaches in managing rare CNSL presentations. Collaboration among specialists and comprehensive patient support is paramount in optimizing outcomes and addressing the multifaceted challenges posed by CNSL in unique anatomical locations.

Vitamin D as an intervention for improving quadriceps muscle strength in patients after anterior cruciate ligament reconstruction: study protocol for a randomized double-blinded, placebo-controlled clinical trial

BackgroundThe goal of anterior cruciate ligament reconstruction (ACLR) is to restore the preinjury level of knee function to return to play (RTP). However, even after completing the rehabilitation programme, some patients may have persistent quadriceps muscle weakness affecting knee function which ultimately leads to a failure in returning to play. Vitamin D has been long recognized for its musculoskeletal effects. Vitamin D deficiency may impair muscle strength recovery after ACLR. Correcting vitamin D levels may improve muscle strength.MethodsThis is a double-blinded, randomized controlled trial to investigate the effects of vitamin D supplementation during the post-operative period on quadriceps muscle strength in anterior cruciate ligament (ACL)-injured patients. Patients aged 18–50 with serum vitamin D < 20 ng/ml, unilateral ACL injury, > 90% deficit in total quadriceps muscle volume on the involved leg compared with uninvolved leg, Tegner score 7 + , and no previous knee injury/surgery will be recruited. To assess patient improvement, we will perform isokinetic and isometric muscle assessments, ultrasound imaging for quadriceps thickness, self-reported outcomes, KT-1000 for knee laxity, biomechanical analysis, and Xtreme CT for bone mineral density. To investigate the effect of vitamin D status on quadriceps strength, blood serum samples will be taken before and after intervention.DiscussionPatients with low vitamin D levels had greater quadriceps fibre cross-sectional area loss and impaired muscle strength recovery after ACL. The proposed study will provide scientific support for using vitamin D supplementation to improve quadriceps strength recovery after ACLR.Trial registrationClinicalTrials.gov NCT05174611. Registered on 28 November 2021.

Advancing glenohumeral dysplasia treatment in brachial plexus birth injury: the end-to-side spinal accessory to suprascapular nerve transfer technique

PurposeBrachial plexus birth injury (BPBI) is a common injury with the spectrum of disease prognosis ranging from spontaneous recovery to lifelong debilitating disability. A common sequela of BPBI is glenohumeral dysplasia (GHD) which, if not addressed early on, can lead to shoulder dysfunction as the child matures. However, there are no clear criteria for when to employ various surgical procedures for the correction of GHD.MethodsWe describe our approach to correcting GDH in infants with BPBIs using a reverse end-to-side (ETS) transfer from the spinal accessory to the suprascapular nerve. This technique is employed in infants that present with GHD with poor external rotation (ER) function who would not necessitate a complete end-to-end transfer and are still too young for a tendon transfer. In this study, we present our outcomes in seven patients.ResultsAt presentation, all patients had persistent weakness of the upper trunk and functional limitations of the shoulder. Point-of-care ultrasounds confirmed GHD in each case. Five patients were male, and two patients were female, with a mean age of 3.3 months age (4 days–7 months) at presentation. Surgery was performed on average at 5.8 months of age (3–8.6 months). All seven patients treated with a reverse ETS approach had full recovery of ER according to active movement scores at the latest follow-up. Additionally, ultrasounds at the latest follow-up showed a complete resolution of GHD.ConclusionIn infants with BPBI and evidence of GHD with poor ER, end-to-end nerve transfers, which initially downgrade function, or tendon transfers, that are not age-appropriate for the patient, are not recommended. Instead, we report seven successful cases of infants who underwent ETS spinal accessory to suprascapular nerve transfer for the treatment of GHD following BPBI.