Step initiation interferes with working memory in nondisabled patients with the earliest multiple sclerosis–A dual-task study

Balance and cognition are affected by multiple sclerosis (MS). Cognitive-motor interference (CMI) is important for balance impairment in MS, however little is known about CMI at the earliest stages of the disease. Step initiation (SI) with anticipatory postural adjustments (APAs) has been linked to postural instability and falls in subjects with MS, therefore we aimed to assess CMI between SI and the two storage systems of working memory in patients with clinically isolated syndrome (presented as optic neuritis-ON) suggestive of MS. Twenty patients with normal/near normal visual acuity and 20 age-, weight-, height-, sex- and education-matched control subjects were included. APAs were studied using center of pressure measures in three conditions: SI alone, SI + Brooks’ spatial- and SI + 2-back verbal working memory task. Decrements (% change) in performance on cognitive tasks and in APA parameters were calculated. CMI was assessed combining the two decrements scores. Performance on both cognitive tasks was more affected by dual-tasking in patients compared to healthy subjects. In both groups APA parameters were not influenced by dual-tasking. CMI was higher in patients compared to healthy subjects. Our results suggest that the disease affects CMI in its earliest stages. Since both cognitive tasks were similarly affected by dual-tasking in patients and controls central executive seems to play the major role in CMI between SI and working memory. Patients prioritizing motor over cognitive task for balance maintenance suggests reduced divided attention capacity as a cause of increased CMI in the earliest MS.     

Gait and cognitive abnormalities are associated with regional cerebellar atrophy in elderly fallers – A pilot study

ObjectivesTo investigate cerebellar lobule atrophy patterns in elderly fallers (EFs) and their association with gait and cognitive performance.BackgroundCognitive impairments, gait, and balance deficits are major risk factors for falls in older adults, however, their neural fingerprints remain poorly understood. Recent evidence from neuroimaging studies highlight the role of the cerebellum in both sensorimotor and cognitive networks, suggesting that it may contribute to fall risk.MethodsFourteen EFs (mean age ± SD = 78 ± 1.5 yrs.) and 20 healthy controls (HCs) (mean age ± SD = 69.6 ± 1.3 yrs.) underwent a 3 T MRI scan obtaining 3D T1-weighted images, cognitive, and gait assessments. Cerebellar lobule segmentation was performed, and the obtained cerebellar lobules volumes were adjusted for intracranial volume (ICV). The relationship between lobules volumes, gait, and cognitive performance scores was assessed using hierarchical multiple linear regression adjusted for age and gender.ResultsEFs exhibited lower cerebellar volumes in the posterior cerebellum, lobules V, VI, VIIB, VIIIA, VIIIB, and Crus II, and significantly higher volumes in the anterior cerebellum and lobule IV (p = 0.018 and p = 0.046) compared to HCs. In EFs, lobule V, VI, VIIB, VIIIA, VIIIB, and anterior cerebellum volumes were found to be independent predictors of usual walking (UW) gait speed, dual-task (DT) gait speed, mini Best, MOCA, CTTa, and CTTb (p < 0.05).ConclusionsThe observed patterns of cerebellar lobule atrophy and their associations with motor and cognitive performance scores suggest that cerebellar atrophy contributes to the pathophysiology of fall risk in EFs.     

Gait kinetics of total hip replacement patients—A large scale,long-term follow-up study

BackgroundIt is not known if lower limb gait kinetics of total hip replacement (THR) patients reach normal levels at long term follow-up post-operatively.MethodsThree-dimensional gait analysis was performed on 134 THR patients with identical implants 10-years post-operatively. Lower limb moments and powers were compared between different age strata (54–64 years, 65–69 years, 70–74 years, 75–79 years and over 80 years) and a normal elderly control group.ResultsHip extensor moment and hip power generation were significantly reduced in all age groups compared to normal. External hip rotation moment was significantly reduced in all age groups, apart from the youngest group, compared to normal. However, in contrast to previous short term follow-up studies there was no significant difference in hip abduction moment between any of the age groups and the normal group.ConclusionThis large cohort study shows that, at long term follow-up following THR, some hip joint kinetics (hip extensor and external rotation moments and hip power generation) do not reach normal levels, but that peak abduction moment is preserved. THR patients recovery could potentially benefit from intensive rehabilitation focusing on hip extension and external rotation in the post-operative, and perhaps preoperative, period.     

Are there really many runners out there? Is the proportion of runners increasing over time? A population-based 12-year repeated cross-sectional study with 625,460 Brazilians

ObjectivesTo investigate the proportion of individuals who practice running, its temporal trend, and to describe the runners’ characteristics.DesignPopulation-based repeated cross-sectional study.MethodsThe data from the Protective and Risk Factors for Chronic Diseases by Telephone Survey (Vigitel) from Brazil were used. Telephone interviews were conducted with adults from the Brazilian capitals (27 cities) between 2006–2017. The interviewer read the questions and recorded the participants’ responses immediately in a questionnaire. Data analyses were conducted using a Bayesian approach.ResultsThe Vigitel database consisted of 625,460 Brazilian participants composed of 295,681 exercisers and within them 15,529 runners. The mean yearly proportion of runners was about 2.45% (95% Bayesian credible interval [CrI] 1.93 to 3.11) and 5.32% (95%CrI 4.29 to 6.54) in the entire study population and within exercisers, respectively. The absolute increase in the proportion of runners per year over the 12-year period was 0.13% and 0.17% in the entire study population and within exercisers, respectively. Runners were more likely to be younger, men, within normal body mass index, highly educated, moderate alcohol drinkers, non-smokers, less exposed to TV, living near physical activity/sports facilities and less exposed to health conditions such as arterial hypertension, diabetes and dyslipidaemia.ConclusionThere was a 95% probability that the yearly proportion of runners lies between 1.93% and 3.11% in the population of the 27 Brazilian capitals, and between 4.29% and 6.54% within exercisers. There has been an increase in the proportion of runners over time. Runners were associated with healthier characteristics compared to non-runners and non-exercisers.     

Not the typical Tornwaldt's cyst this time? A nasopharyngeal cyst associated with canalis basilaris medianus

We report a patient with a cystic structure in the nasopharynx mimicking a Tornwaldt's cyst, which was felt to represent a different entity owing to the lack of the distinct features of a typical Tornwaldt's cyst. It was associated with a bony cleft in the basiocciput that was considered to be a canalis basilaris medianus (CBM), thought to represent an embryological vestige of the cephalic end of the notochord along its course within the basiocciput.     

Accelerometer-measured sedentary time and physical activity—A 15 year follow-up of mortality in a Swedish population-based cohort

Objectives

To investigate the associations of objectively assessed sedentary time, light intensity physical activity (PA), moderate to vigorous intensity PA (MVPA), and total PA with all-cause mortality and mortality from cardiovascular disease (CVD) or cancer in a Swedish population-based cohort with 15 years follow-up time.

Analysis of risk factors of dowry death – A south Indian study

Dowry deaths in the newly married brides are a burning problem of southern India. The objective of the current study was to identify the risk groups. This prospective study was carried out on 140 cases. Results revealed that majority of the victims (83%) were young aged between 18 and 26 years, childless (65.7%) and mostly died within 4 years of marriage (77.2%). About 80% of the victims were illiterates (53%), house wives of rural background (62.9%) and from middle socio-economic group (81%). Husband alone or along with in laws (75%) and joint family (85%) were mainly responsible for death. The common causes of death implicated are hanging, burning and poisoning. Mostly the place of occurrence was in-laws house. Suicidal deaths accounted in 57% and the rest being homicide. At the end some potential risk factors and their remedial measures suggested.     

Which laboratory variable is related with time trial performance time in the Tour de France?

Objective: To investigate the relationship between several physiological variables that can be easily obtained during cycle ergometer gradual testing (for example, peak power output (W_peak), VO_2max, or ventilatory threshold (VT)) and actual (>50 km) time trials (TT) time performance during the Tour de France.

Methods: We collected data in professional cyclists from the first TT of the 1998 Tour de France (TT1, 58 km distance; n = 6 cyclists) and the first (TT2, 56.5 km; n = 5) and second TT of the 1999 Tour de France (TT3, 57 km; n = 5).

Results: A negative relationship was found between power output (W) at VT (VT_Watt) and TT final time (s) in TT1 (r = –0.864; p = 0.026; standard error of estimate (SEE) of 73 s; and 95% confidence limits (95% CL) –0.98; –0.18), TT2 (r = –0.77; p = 0.27; SEE of 139 s; and 95% CL –0.98; 0.35), and TT3 (r = –0.923; p = 0.025; SEE of 94 s; and 95% CL –1.00; –0.22).

Conclusions: Actual performance in long TT during the Tour de France (>50 km distance, performed after at least 1–2 weeks of continuous competition), in which some cumulative fatigue inevitably occurs, is related, at least in part, to the power output that elicits the VT. No other routine physiological variable (for example, VO_2max or W_peak) is related to performance in this type of event.

     

Late recanalisation beyond 24 hours is associated with worse outcome: an observational study

Objectives

We evaluated the rate of late recanalisation beyond 24 h after intravenous thrombolysis (IVT) and its relationship with haemorrhagic transformation and outcome.

Methods

We reviewed prospectively collected clinical and imaging data from acute ischaemic stroke patients with distal internal carotid artery or proximal middle cerebral artery occlusion who underwent angiography on admission, 24 h and 1 week after IVT. Patients were trichotomised according to vascular status: timely recanalisation (<24 h), late recanalisation (24 h-7 days), and no recanalisation.

Results

Non-invasive angiography revealed timely recanalisation in 52 (50.0 %) patients, late recanalisation in 25 (24.0 %) patients, and no recanalisation in 27 (26.0 %) patients. Pre-existing atrial fibrillation was associated with the occurrence of late recanalisation (odds ratio 6.674; 95 % CI: 1.197 to 37.209; p?=?0.030). In patients without timely recanalisation, shift analysis indicated that late recanalisation led to a worse modified Rankin Scale score (odds ratio 6.787; 95 % CI: 2.094 to 21.978; p?=?0.001).

Conclusions

About half of all patients without recanalisation by 24 h after IVT may develop late recanalisation within 1 week, along with higher mRS scores by 3 months. Pre-existing atrial fibrillation is an independent predictor for late recanalisation.

Key Points

? About half of patients may develop late recanalisation within 1 week. ? Pre-existing atrial fibrillation was associated with the occurrence of late recanalisation. ? Late recanalisation led to a higher mRS score than no recanalisation.

     

Intracerebral hemorrhage associated with Sneddon's syndrome: is ischemia-related angiogenesis the cause? Case report and review of the literature

Sneddon's syndrome is characterized by livedo reticularis and multiple ischemic infarcts often associated with antiphospholipid antibodies. Intracerebral hemorrhage (ICH) is unusual in Sneddon's syndrome and has not been reported as the presenting complaint. We report a 38-year-old woman with a history of two miscarriages, Raynaud's phenomenon and livedo reticularis who presented acutely with ICH. Angiography showed prominent leptomeningeal and transdural anastomoses (pseudoangiomatosis). Anticardiolipin antibodies were positive. A right frontal brain biopsy failed to reveal vasculitis and a skin biopsy was nonspecific. MRI showed residual intracerebral hemorrhage (ICH), diffuse atrophy, multiple small white matter infarcts and leptomeningeal enhancement. This is the first report of Sneddon's syndrome presenting with an ICH. It shares features with the Divry-van Bogaert syndrome. We discuss the cause of the pseudoangiomatosis pattern and its role in the genesis of the hemorrhage and suggest that cerebral angiography should be done in every patient with Sneddon's syndrome, as it could impact therapy.     

Estimation of the time since death—reconsidering the re-establishment of rigor mortis

In forensic medicine, there is an undefined data background for the phenomenon of re-establishment of rigor mortis after mechanical loosening, a method used in establishing time since death in forensic casework that is thought to occur up to 8 h post-mortem. Nevertheless, the method is widely described in textbooks on forensic medicine. We examined 314 joints (elbow and knee) of 79 deceased at defined time points up to 21 h post-mortem (hpm). Data were analysed using a random intercept model. Here, we show that re-establishment occurred in 38.5% of joints at 7.5 to 19 hpm. Therefore, the maximum time span for the re-establishment of rigor mortis appears to be 2.5-fold longer than thought so far. These findings have major impact on the estimation of time since death in forensic casework.     

Reliability of spatial–temporal gait parameters during dual-task interference in people with multiple sclerosis. A cross-sectional study

PurposeTo evaluate the reliability and minimum detectable change (MDC) of spatial–temporal gait parameters in subjects with multiple sclerosis (MS) during dual tasking.MethodThis cross-sectional study involved 25 healthy subjects (mean age 49.9 ± 15.8 years) and 25 people with MS (mean age 49.2 ± 11.5 years). Gait under motor-cognitive and motor–motor dual tasking conditions was evaluated in two sessions separated by a one-day interval using the GAITRite^® Walkway System. Test–retest reliability was assessed using intraclass correlation coefficients (ICCs), standard errors of measurement (SEM), and coefficients of variation (CV). MDC scores were computed for the velocity, cadence, step and stride length, step and stride time, double support time, the % of gait cycle for single support and stance phase, and base of support.ResultsAll of the gait parameters reported good to excellent ICCs under both conditions, with healthy subject values of >0.69 and MS subject values of >0.84. SEM values were always below 18% for both groups of subjects. The gait patterns of the people with MS were slightly more variable than those of the normal controls (CVs: 5.88–41.53% vs 2.84–30.48%).ConclusionsThe assessment of quantitative gait parameters in healthy subjects and people with MS is highly reliable under both of the investigated dual tasking conditions.     

Reliability of spatial–temporal gait parameters during dual-task interference in people with multiple sclerosis. A cross-sectional study

PurposeTo evaluate the reliability and minimum detectable change (MDC) of spatial–temporal gait parameters in subjects with multiple sclerosis (MS) during dual tasking.MethodThis cross-sectional study involved 25 healthy subjects (mean age 49.9 ± 15.8 years) and 25 people with MS (mean age 49.2 ± 11.5 years). Gait under motor-cognitive and motor–motor dual tasking conditions was evaluated in two sessions separated by a one-day interval using the GAITRite^® Walkway System. Test–retest reliability was assessed using intraclass correlation coefficients (ICCs), standard errors of measurement (SEM), and coefficients of variation (CV). MDC scores were computed for the velocity, cadence, step and stride length, step and stride time, double support time, the % of gait cycle for single support and stance phase, and base of support.ResultsAll of the gait parameters reported good to excellent ICCs under both conditions, with healthy subject values of >0.69 and MS subject values of >0.84. SEM values were always below 18% for both groups of subjects. The gait patterns of the people with MS were slightly more variable than those of the normal controls (CVs: 5.88–41.53% vs 2.84–30.48%).ConclusionsThe assessment of quantitative gait parameters in healthy subjects and people with MS is highly reliable under both of the investigated dual tasking conditions.     

Is postural asymmetry associated with emotional stability in healthy subjects? A preliminary study

Purpose

Considering that musculo-skeletal system and nervous system reciprocally are connected by the presence of proprioceptors and interoceptors, the aim of this study was to investigate the relationship between emotional stability and posture.

Methods

We recruited 100 healthy volunteers (age 30.2 ± 9.8 years) who regularly practiced physical activity, and we evaluated posture (vertical line of Barrè) and emotional stability (a specific component of the Big Five Questionnaire—BFQ). Chi-square test was used to evaluate the distribution of the postural evaluation by sex. ANOVA with Bonferroni correction was used to evaluate the differences of the BFQ in the groups of Barrè (ascending, descending, mixed, and disharmonic). A multiple regression models was set to assess the factors related to gender, age, and posture. P < 0.05 was considered significant.

Results

In 86 subjects, we found asymmetric posture expressed by malalignment of the Barrè line with respect to the median line. Control of Emotion did not differ between the different groups in Barrè assessment test (p = 0.07), but for Impulse Control, there were significant differences between mixed and descending and between mixed and neutral posture (p = 0.03). In emotional stability, we observed significant differences between mixed and descending and mixed and neutral (p = 0.02). The subjects who had greater control of emotions and impulses had a mixed or a descending-type posture of the vertical evaluation in the Barrè test (p < 0.01).

Conclusions

Emotional stability was associated with postural adjustment, affecting, in particular, the cervical spine and legs. We could hypothesize that symmetrical posture is not necessarily related to psychological balance, while asymmetric posture may represent a sign of good control of emotions and impulses.