Stance instability in spinocerebellar ataxia type 6

Balance impairment is a principal symptom of cerebellar disease, but is poorly understood partly because subjects with heterogenous cerebellar and extracerebellar lesions have often been studied. Spinocerebellar ataxia type 6 (SCA6) provides an opportunity to understand balance dysfunction associated with a relatively homogenous cerebellar lesion. This study investigated stance instability in SCA6 and how it is affected by varying stance width. Body sway, as well as its directional preponderance and distribution across joints, was measured three‐dimensionally in 17 SCA6 and 17 matched healthy control subjects. Subjects stood for 40 seconds on a stable surface with their eyes open and feet positioned at various stance widths (32, 16, 8, 4, and 0 cm). SCA6 subjects swayed faster than controls at every stance width. Decreasing the stance width produced a disproportionate increase in sway speed in SCA6 subjects, compared to controls. Directional preponderance of sway was dependent on stance width, but did not differ between groups. Joint instability was increased by reducing stance width in both groups, but there was greater instability of the ankle joint in the roll plane in the SCA6 group. Measures of global instability correlated strongly with disease severity measured with the Scale for the Assessment and Rating of Ataxia (r = 0.79). The sway characteristics suggest a disruption of sensorimotor processing for balance control in SCA6. The correlation with disease severity implies that balance impairment is a feature of progression of SCA6 clinical syndrome. With stance width standardized, the instability measures employed could provide sensitive, continuous outcome measures of longitudinal or therapeutic change. © 2012 Movement Disorder Society     

Effects of whole body vibration training on balance in adolescents with and without Down syndrome

The present study aimed to determine whether a whole body vibration training program (WBV) is able to improve static standing balance in adolescents with and without Down syndrome (DS). Thirty adolescents with DS aged 11–20 years (DSG) and 27 adolescent, age/sex matched, without DS (CG) joined the study. Participants of each group were divided into two comparable groups, those who performed WVB (in DSG: VDSG; in CG: VCG) and those who did not perform WVB (in DSG: nVDSG; in CG: nVCG). Static-standing-balance under four conditions (C1: openeyes/fixed-foot-support; C2: closed-eyes/fixed-foot-support; C3: openeyes/compliant-foot-support; C4: closed-eyes/compliant-foot-support) was examine, before and after a 20-week WBV training program. For balance study, Postural-Parameters (PPs), based on center of pressure (COP) oscillations (anterior/posterior and medial/lateral COP excursion and COP mean velocity), and PPs ratios among the four conditions were calculated. After WBV training, no significant differences were found in any parameter in the VCG and nVCG and neither in the nVDSG, but there was a decrease of mean values in the analyzed PPs under C4, with significant differences in medial/lateral COP excursion and COP mean velocity, and a significant decrease in the ratio C4/C1 of the mean velocity in VDSG. Therefore, WBV training had positive effects in the balance of DS adolescents although only under specific conditions, with vision and somatosensory input altered. The positive results of this study are encouraging and open a wide field of research, looking for the most efficient program for this population.     

Valosin‐containing protein immunoreactivity in tauopathies,synucleinopathies, polyglutamine diseases and intranuclear inclusion body disease

Valosin‐containing protein (VCP) is associated with multiple cellular functions, including ubiquitin‐dependent protein degradation. Mutations in VCP are known to cause inclusion body myopathy with Paget's disease and frontotemporal dementia and familial amyotrophic lateral sclerosis (fALS; ALS14), both of which are characterized by trans‐activation response DNA protein 43 (TDP‐43)‐positive neuronal cytoplasmic and nuclear inclusions. Recently, immunoreactivity for fALS‐associated proteins (TDP‐43, fused in sarcoma (FUS), optineurin and ubiquilin‐2) were reported to be present in cytoplasmic and nuclear inclusions in various neurodegenerative diseases. However, the extent and frequency of VCP‐immunoreactive structures in these neurodegenerative diseases are uncertain. We immunohistochemically examined the brains of 72 cases with neurodegenerative diseases and five control cases. VCP immunoreactivity was present in Lewy bodies in Parkinson's disease and dementia with Lewy bodies, and neuronal nuclear inclusions in five polyglutamine diseases and intranuclear inclusion body disease, as well as in Marinesco bodies in aged control subjects. However, other neuronal and glial cytoplasmic inclusions in tauopathies and TDP‐43 proteinopathies were unstained. These findings suggest that VCP may have common mechanisms in the formation or degradation of cytoplasmic and nuclear inclusions of neurons, but not of glial cells, in several neurodegenerative conditions.     

Changes in cortical oscillations linked to multisensory modulation of nociception

Pain can be modulated by several contextual factors. For example, simply viewing one's own body can reduce pain, suggesting that the visual context may influence the processing of nociceptive stimuli. We studied changes in electroencephalographic (EEG) oscillatory activity related to visual modulation of nociception, comparing cortical oscillations during innocuous or noxious contact heat, while participants viewed either their own hand or a neutral object at the same location. Viewing the body compared with viewing the object reduced the intensity ratings of noxious stimuli, but not of innocuous heat. Time–frequency analysis of EEG data revealed that noxious, as opposed to warm, stimulation was associated with reduced beta (15–25 Hz) power. Classically, such decreases in oscillatory power indicate increases in sensory cortical activation. These event‐related oscillatory changes were moreover modulated by the visual context; viewing one's own body increased noxious stimulation‐induced beta oscillatory activity bilaterally, relative to viewing a neutral object, possibly indicating inhibition of cortical nociceptive processing. These results demonstrate that visual–nociceptive interactions involve changes in sensorimotor EEG rhythms.     

Dental and periodontal complications of lip and tongue piercing: prevalence and influencing factors

Background: The aim of this study was to compare the prevalence of lip and tongue piercing complications and explore the effect of ornament time wear period, habits, ornament morphology and periodontal biotype on the development of complications. Methods: One hundred and ten subjects with 110 lip and 51 tongue piercings were assessed for abnormal toothwear and/or tooth chipping/cracking (dental defects), gingival recession, clinical attachment loss and probing depth of teeth adjacent to the pierced site. Piercing habits (biting, rolling, stroking, sucking) were recorded. Results: Wear time and habits significantly affected the prevalence of dental defects and gingival recession. Pierced site significantly affected dental defects prevalence, with greater prevalence for tongue than lip piercing. Wear time significantly affected attachment loss and probing depth. Attachment loss and probing depth did not significantly differ between tongue and lip piercings. Gingival recession was significantly associated with ornament height closure and stem length of tongue ornaments. Periodontal biotype was not significantly associated with gingival recession, attachment loss and probing depth. Conclusions: Dental defects prevalence is greater for tongue than lip piercing. Gingival recession is similar for tongue and lip piercing. Longer wear time of tongue and lip piercing is associated with greater prevalence of dental defects and gingival recession, as well as greater attachment loss and probing depth of teeth adjacent to pierced sites. Ornament morphology affects gingival recession prevalence.     

Introduction of the "Rotterdam mandibular distractor" and a biomechanical skull analysis of mandibular midline distraction

The Rotterdam mandibular distractor (RMD) is a slim, rigid, boneborne distractor for use in midline distraction of the mandible. We did a biomechanical study to compare the RMD with the Trans Mandibular Distractor-flex (TMD-flex). This included an anatomical biomechanical study that was conducted on 9 dentate human cadaveric heads using both the RMD and the TMD-flex. In the vertical plane less tipping was measured in the RMD group than in the TMD-flex group. Significantly less skeletal tipping was found in the horizontal plane in the RMD group (P=0.021). There was minimal difference in the intercondylar distance between the groups. As the amount of lateral displacement of the condyle was similar in both groups and there was less rotational movement in the RMD group, the TMD-flex would be expected to increase stress on the temporomandibular joint. As a result of the increased parallel widening in the vertical plane, more basal bone is being created and less relapse is expected using the RMD. The study design involves an in vitro anatomical model and conclusions must be drawn with care. At present clinical studies are under way and results will follow.     

Validity and reliability of the Portuguese version of Mandibular Function Impairment Questionnaire

The aim of this study is to evaluate the validity and reliability of the Mandibular Function Impairment Questionnaire (MFIQ) (Portuguese version). Face and content validity of the Portuguese version were performed. To assess reproducibility of the data gathered with MFIQ, it was applied to 62 individuals who completed the questionnaire on two occasions. Validity and reliability of the data gathered with MFIQ were evaluated in a sample of 249 patients. Construct-related validity was assessed through factorial validity (by means of a confirmatory factor analysis), and convergent and discriminant validities were assessed, respectively, by the average variance extracted (AVE), composite reliability (CC) and bivariate correlations between factors. The internal consistency was estimated by the standardised Cronbach's alpha coefficient (α) and reproducibility by the intra-class correlation coefficient (ICC). All the items of MFIQ showed content validity. Reproducibility was excellent in both the 'functional capacity' dimension (D1) (ICC(D1) =0·895, 95% CI=0·832 to 0·935) and the 'feeding' dimension (D2) (ICC(D2) =0·825, 95% CI= 0·726 to 0·891). Items 1, 2, 6 and 7 of D1 had factor weights below the desired cut-off (0·5), and overall fit of the original bifactorial structure of the MFIQ was poor [(confirmatory fit index) CFI= 0·850, (goodness of fit index) GFI= 0·781, (root mean square error of approximation) RMSEA= 0·118]. Thus, these items were excluded, and the new, reduced version of the MFIQ showed good fit (CFI=0·933, GFI=0·879, RMSEA=0·099). The convergent validity was adequate (AVE≥0·5, CC≥0·7) for both factors. However, their discriminant validity was low (AVE(D1) = 0·51 and AVE(D2) = 0·66 <ρ(2) (D1D2) =0·70). The internal consistency was excellent (α(D1) =0·874; α(D2) =0·918). The Portuguese version of the reduced MFIQ produced data with good validity and reliability.     

螺旋断层固定野和旋转调强放疗技术在全身照射中的应用对比研究

目的 探究使用螺旋断层固定野调强（TD）和螺旋断层旋转调强（HT）放射治疗技术在全身照射（TBI）中的应用对比,并评估TD治疗技术下计划的质量和执行效率,指导临床选择最佳的计划设计方案。方法 对郑州大学第一附属医院收治的8例身高在120 cm左右的已行TBI的急性白血病患者进行回顾性研究,分别选择TD和HT治疗技术进行计划设计,其中TD分别设计2~12内奇数个均分射野的计划,且起始角度分别从180°和0°开始,其余计划参数都保持一致。最后对设计好的计划剂量分布进行统计,比较TD与HT治疗技术下的计划在靶区的平均剂量（PTV_Dmean）、均匀性指数（HI）和危及器官（OARs）受量,以评估计划质量,并比较治疗出束时间以评估治疗效率。结果 9野的TD计划相对于HT计划在PTV_Dmean和靶区HI能达到一致效果,差异无统计学意义。但TD<9野的计划相对于HT计划在PTV_Dmean（t=-3.12、-5.41、-20.33、-4.56、-7.22、-11.27,P<0.05）和靶区HI（t=-2.94、-5.18、-15.66、-4.31、-5.51、-9.13,P<0.05）无剂量学优势,差异有统计学意义。同时TD计划中起始角度对PTV_Dmean和靶区HI没有影响。在危及器官方面,≥ 7野TD计划与HT计划在左肺平均剂量与右肺平均剂量差异无统计学意义;左眼晶状体计划危及体积（PRV）的最大剂量（2.14±0.60）Gy与右眼晶状体PRV最大剂量（3.05±0.10）Gy在3野TD计划与HT计划差异有统计学意义（t=0.77、0.63,P<0.05）,眼晶状体PRV在最大剂量方面具有一定优势。治疗出束时间差异无统计学意义。TD计划中起始角度对左右眼晶状体PRV最大剂量、左肺平均剂量及治疗出束时间没有影响。结论 对于≥ 9野的TD调强计划相对于HT计划在靶区、危及器官及治疗出束时间方面能达到一致的结果,但在眼晶状体PRV最大剂量方面具有一定优势。     

Incidence of Chronic Radiodermatitis after Fluoroscopically Guided Interventions: A Retrospective Study

PurposeTo assess the incidence and risk factors for chronic radiodermatitis after fluoroscopically guided interventions (FGIs) in high-risk patients.Materials and MethodsBetween 2010 and 2016, of 55,782 patients who underwent FGIs, 359 had a risk procedure for skin injury (maximal skin dose > 3 Gy, air kerma > 5 Gy, dose area product [DAP] > 500 Gy.cm², or fluoroscopy time > 60 minutes). Ninety-one of these patients were examined by a dermatologist for radiodermatitis (median time after procedure, 31.2 months [95% confidence interval, 14.2–50.7]). In each case, the clinical features and topography of the skin lesions were recorded and their incidence calculated. The characteristics of the patients and of the FGIs were tested as risk factors.ResultsEight patients (8.8%) had chronic radiodermatitis; 19 (20.9%) had acute radiodermatitis. Body mass index, DAP value, and air kerma were the only risk factors identified.ConclusionsThis study shows that chronic radiodermatitis may be considered a frequent side effect in an at-risk population. The lesions are commonly benign, but extensive sclerosis can occur. Patients should be better informed about the side effects and offered a skin exam periodically.