•UCM studies in adults with neurological impairment are generally of good quality.•Several neurological diseases consistently reduce UCM synergy strength.•Anticipatory UCM synergy adjustments are ...deficient after neurological impairment.•The relationship between UCM synergy indices and function needs more investigation.
Analysis of sensorimotor synergies has been greatly advanced by the Uncontrolled Manifold (UCM) approach. The UCM method is based on partitioning inter-trial variance displayed by elemental variables into ‘good’ (VUCM) and ‘bad’ (VORT) variability that, respectively, indicate maintenance or loss of task stability. In clinical populations, these indices can be used to investigate the strength, flexibility, stereotypy and agility of synergistic control.
How are synergies affected by neurological impairment in adults? Specifically, this study aimed to determine i) the impact of pathology on VUCM, VORT, and their ratio (synergy index); ii) the relationship between synergy indices and functional performance; iii) changes in anticipatory synergy adjustments (ASAs); and iv) the effects of interventions on synergies.
Systematic review of UCM studies on adults with neurological impairment.
Most of the 17 studies had moderate to high quality scores in the adapted Critical Review Form and the UCM reporting quality checklist developed for this review. i) Most of the studies found reduced synergy indices for patients with Parkinson's disease (PD), olivo-ponto-cerebellar atrophy, multiple sclerosis and spinocerebellar degeneration, with variable levels of change in VUCM and VORT. Reduction in synergy indices was not as consistent for stroke, in three out of six studies it was unchanged. ii) Five of seven studies found no significant correlations between scores on motor function scales and UCM indices. iii) Seven studies consistently reported ASAs that are smaller in magnitude, delayed, or both, for patients compared to healthy controls. iv) Two studies reported increased synergy indices, either via increase in VUCM or decrease in VORT, after dopaminergic drugs for patients with PD. There were similar synergy indices but improved ASAs after deep brain stimulation for patients with PD.
UCM can provide reliable and sensitive indicators of altered synergistic control in adults with neurological impairment.
•Melodic music influences the release of brain monoamines.•Auditory stimulation by music increases DA activity in the CPu and NAcc.•Auditory stimulation by music increases 5-HT turnover in the CPu ...but not the NAcc.•Serotonergic pathways likely modulate DA activity in the CPu during music exposure.•Music-induced changes in monoamines in the CPu and NAcc are not correlated.
Listening to melodic music is regarded as a non-pharmacological intervention that ameliorates various disease symptoms, likely by changing the activity of brain monoaminergic systems. Here, we investigated the effects of exposure to melodic music on the concentrations of dopamine (DA), serotonin (5-HT) and their respective metabolites in the caudate-putamen (CPu) and nucleus accumbens (NAcc), areas linked to reward and motor control. Male adult Wistar rats were randomly assigned to a control group or a group exposed to music. The music group was submitted to 8 music sessions Mozart’s sonata for two pianos (K. 488) at an average sound pressure of 65 dB. The control rats were handled in the same way but were not exposed to music. Immediately after the last exposure or control session, the rats were euthanized, and their brains were quickly removed to analyze the concentrations of 5-HT, DA, 5-hydroxyindoleacetic acid (5-HIAA) and 3,4-dihydroxyphenylacetic acid (DOPAC) in the CPu and NAcc. Auditory stimuli affected the monoaminergic system in these two brain structures. In the CPu, auditory stimuli increased the concentrations of DA and 5-HIAA but did not change the DOPAC or 5-HT levels. In the NAcc, music markedly increased the DOPAC/DA ratio, suggesting an increase in DA turnover. Our data indicate that auditory stimuli, such as exposure to melodic music, increase DA levels and the release of 5-HT in the CPu as well as DA turnover in the NAcc, suggesting that the music had a direct impact on monoamine activity in these brain areas.
The most common surgical risk after total thyroidectomy remains the recurrent laryngeal nerve (RLN) injury. Nowadays, the use of intraoperative nerve monitoring systems (IONM) such as the ...endotracheal tube‐based is recommended to prevent RLN palsy. The use of the nerve monitoring is standardized by dedicated guidelines on the basis of a normal laryngeal anatomy, but previous head and neck surgical procedures may complicate its application. The authors herewith present a case of a non‐conventional use of endotracheal tube‐based IONM in a 72‐year‐old patient who underwent to a second‐stage total thyroidectomy for metastatic papillary cancer incidentally detected after an open partial horizontal laryngectomy (OPHL) extended to one arytenoid (Type IIa + ary left) for squamous cell carcinoma. The use of the endotracheal tube‐based IONM in such particular case where the function of the only remaining arytenoid had to be absolutely preserved was effective in avoiding the RLN accidental injury. The authors reviewed the non‐traditional use of IONM and described the procedure in case of thyroidectomy in patients previously treated by OPHL.
Intraoperative Neuro‐monitoring can offer a paramount surgical benefit in case of unconventional surgical scenarios such as OPHL. It can represent a safe and reliable indicator for the recurrent laryngeal nerve identification when facing with major anatomical changes hazarding laryngeal function.
Background: The present study analyzed the impact of margin status on local control and survival, and the management of close/positive margins after transoral CO2 laser microsurgery for early glottic ...carcinoma. Methods: 351 patients (328 males, 23 females, mean age 65.6 years) underwent surgery. We identified the following margin statuses: negative, close superficial (CS), close deep (CD), positive single superficial (SS), positive multiple superficial (MS), and positive deep (DEEP). Results: A total of 286 patients (81.5%) had negative margins, 23 (6.5%) had close margins (8 CS, 15 CD) and 42 (12%) had positive margins (16 SS, 9 MS, 17 DEEP). Among the 65 patients with close/positive margins, 44 patients underwent enlargement, 6 radiotherapy and 15 follow-up. Twenty-two patients (6.3%) recurred. Patients with DEEP or CD margins showed a higher risk of recurrence (hazard ratios of 2.863 and 2.537, respectively), compared to patients with negative margins. Local control with laser alone, overall laryngeal preservation and disease-specific survival decreased significantly in patients with DEEP margins (57.5%, 86.9% and 92.9%, p < 0.05). Conclusions: Patients with CS or SS margins could be safely submitted to follow-up. In the case of CD and MS margins, any additional treatment should be discussed with the patient. In the case of DEEP margin, additional treatment is always recommended.
We used experimental chambers to evaluate the effect of the temperature increasing and microbial conditioning degree on the survival and leaf consumption of two plant species
Protium spruceanum
...(Burseraceae) and
Goupia glabra
(Celastraceae) by larvae of the shredder
Phylloicus elektoros
. We also evaluated the sporulation rate of the conditioned leaf debris. The leaf discs were incubated for 0, 7, and 15 days in a stream. Posteriorly, the treatments were inserted in chambers with temperatures of 23.2 °C and 27.5 °C. The higher sporulation rate was found in leaves of
G
.
glabra
, with no difference in sporulation among the microbial conditioning treatments. The larval survival was lower in treatments with leaves of
P
.
spruceanum
, and in the warming temperature. The microbial conditioning time did not influence larval survival. The effect of the conditioning time and temperature on the leaf consumption depended on the plant species. The foreseen temperature increases and reduction of the palatability of the leaves due to the climate change may result in negative effects on the leaf consumption and survival of larvae of
P
.
elektoros
.
An external focus of attention can improve performance, but there is little research on effects for the elderly in every day, well-learned mobility tasks. 57 older and 59 young adults performed the ...sit-to-stand and stand-to-sit while holding a cup, at three difficulty levels (cup empty or full, at normal or fast speed). Half were instructed to focus internally (on their movements) and half externally (on the cup). The effects of focus, age, and difficulty level were tested for movement time, mean inclination of the cup, inclination variability, and smoothness with 2 × 2 × 3 ANOVAs. Significant effects of difficulty were consistent across variables (p < 0.05). An effect of focus was present only for the inclination variability of the stand-to-sit (p < 0.03), favoring an internal focus (less variability). The age × focus interaction was significant for mean cup inclination, but post hoc tests failed to reveal any significant differences. The results of this study, together with the literature, suggest that an external focus may not benefit the performance of young or older adults in general mobility activities of daily living. The prevalent assumption that an external focus is always beneficial for performance needs further empirical testing.
We here report the successful recovery from coronavirus disease-19 (COVID-19) pneumonia in a patient with β-thalassemia major (β-TM) and severe pulmonary arterial hypertension (PAH), focusing on the ...patient's comorbidities, therapeutic course and drug interaction.
Background
Superficial siderosis (SS) of the central nervous system is a rare and heterogeneous condition due to deposition of hemosiderin on the surface of the brain and spinal cord. The usually ...progressive clinical course is characterized by a combination of hearing loss, cerebellar ataxia, and myelopathy. There is no known treatment for SS, but the iron chelator deferiprone (DFP) has been proposed as a potentially useful treatment.
Methods
We present a long-term (average 3.7 years) evaluation of four cases of SS treated with DFP (15 mg/kg po bid).
Results
Treatment with DFP proved safe and well tolerated. Two out of the four subjects were unchanged while the other two presented a clinical improvement with reduction of postural instability and cerebellar signs. Blinded evaluation of magnetic resonance imaging (performed every 6 months during follow-up) showed a reduction of the abnormal iron deposition for all patients.
Conclusions
This long-term observational study suggests that DFP may be effective in the management of the neurological manifestations associated with iron accumulation in SS.
Clinicaltrials.gov
identifier
NTC00907283
Sickle cell disease (SCD) is an inherited red blood cell disorder caused by a structural abnormality of hemoglobin called sickle hemoglobin (HbS). Clinical manifestations of SCD are mainly ...characterized by chronic hemolysis and acute vaso-occlusive crisis, which are responsible for severe acute and chronic organ damage. SCD is widespread in sub-Saharan Africa, in the Middle East, Indian subcontinent, and some Mediterranean regions. With voluntary population migrations, people harboring the HbS gene have spread globally. In 2006, the World Health Organization recognized hemoglobinopathies, including SCD, as a global public health problem and urged national health systems worldwide to design and establish programs for the prevention and management of SCD. Herein we describe the historical experience of the network of hemoglobinopathy centers and their approach to SCD in Italy, a country where hemoglobinopathies have a high prevalence and where SCD, associated with different genotypes including ß-thalassemia, is present in the native population.
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