bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunogenicity of mesenchymal stromal/stem cells
Authors: Chen Wenyan , Lv Lu , Chen Na , Cui Enhai
Published: March 2023

Mesenchymal stromal/stem cells (MSCs) possess the ability to self‐renew and differentiate into other cell types. Because of their anti‐inflammatory and immunomodulatory abilities, as well as their more ready availability compared to other stem cell sources, MSCs hold great promise for the treatment of many diseases, such as haematological defects, acute respiratory distress syndrome, autoimmunity, cardiovascular diseases, etc. However, immune rejection remains an important problem. MSCs are considered to have low immunogenicity, but they do not have full immunological privilege. This review analyzes and discusses the safety of MSCs from the perspective of their immunogenicity, with the aim of providing a reference for future research and clinical application.
A Command Theoretic approach to prosodic smothering
Authors: Branan Kenyon
Published: March 2023

This article presents an analysis of prosodic smothering in Makonde (Bantu). Prosodic smothering is a phenomenon where certain elements require nearby elements to be phrased together with them that would otherwise be phrased apart. Prior analyses of this phenomenon must lexically specify certain elements as triggers of smothering. This article, building on previous work, derives smothering effects from a particular approach to the syntax–prosody mapping, according to which syntactic c‐command relationships between terminal nodes determine prosodic phrasing. Whether or not an element will be a trigger of smothering ends up being by and large a byproduct of the position the element occupies in the syntactic structure.
Tōru Takemitsu's A Bird came down the Walk for viola accompanied by piano: An Analysis
Authors: Douw André
Published: March 2023

In one of his last compositions, A Bird came down the Walk (1995), Tōru Takemitsu uses numbers to organize all parameters of the work and to create an association between the chords ju and gyo, as produced on the traditional Japanese wind instrument shō,
and Messiaen's seven modes à transpositions limitées. With the help of the numbers three, seven, and nine, form and meter build a palindromic architecture around the middle measure of the piece (m. 30), where the piano plays in Messiaen's fourth mode. In Japanese, the
words for "four" and "death" are associated because both are pronounced shi, and thus A Bird may contain a reference to the deaths in 1992 of Olivier Messiaen and John Cage.
 The rigidity of the numeric structure is softened by the application of Messiaen's valeur
ajoutée on all levels. Added values are essential in Takemitsu's technique for designing chords, melodies, and rhythms, breaking up the rigorous symmetry of the serial technique. The omnipresent Japanese philosophical concept ma refers to the unity of space and time (harmony
and rhythm) that obtains meaning when filled with motion (tempo). The tempo indications in A Bird appear to create unity among all the parameters in a truly Western, mid-twentieth-century, and serialistic understanding of the term.
Variation Process in G. A. Frescobaldi's Cento partite sopra passacagli (1637)
Authors: Sunstein Aaron
Published: March 2023

Cento partite sopra passacaglia (1637), the longest keyboard work by Girolamo Frescobaldi (1583–1643), consisting of over 100 tonic-dominant harmonic cycles, exhibits the composer's expansive conception of the art of variation. This article demonstrates that the overarching
formal structure in Cento partite is delineated by interconnected variation processes involving the relative stability/instability of the parameters of genre (passacaglia, ciacona, and corrente) and key (motion away from and returning to the original key of D minor).
These large-scale variation processes relate to and affect rhythmic and motivic content and variation on the local (variation-to-variation) level.
On Form as Conceived in Beethoven's Sonata in D minor, Op. 31, no. 2
Authors: Dahlhaus Carl
Published: March 2023

A translation of Carl Dahlhaus' short analysis from 1980 of the opening allegro from Beethoven's Tempest Sonata, Op. 31, no. 2, together with a contextualizing introduction that emphasizes both Dahlhaus' debt to Adorno and the reception of his analysis in current American music
theory.
Asymmetric colouring of locally compact permutation groups
Authors: Lehner Florian
Published: March 2023

Let be a group of permutations of a countable set . Call a colouring of asymmetric if no preserves all colours. The motion of is the minimal number of elements moved by an element . We show that if is locally compact with respect to the permutation topology and the motion of is infinite, then there is an asymmetric 2‐colouring of . This builds on a recent result by Babai, generalises this result, and confirms a conjecture by Imrich, Smith, Tucker, and Watkins from 2015.
An Observational Case Series Measuring the Energy Expenditure of Elite Tennis Players During Competition and Training by Using Doubly Labeled Water
Authors: Ellis Daniel G. , Speakman John , Hambly Catherine , Morton James P. , Close Graeme L. , Donovan Tim F.
Published: March 2023

Purpose: An understanding of an athlete’s total daily energy expenditure (TEE) is necessary to inform nutritional strategies, particularly where daily training and competitive demands are highly variable. This observational case series assessed the TEE of elite tennis players during high-level competition. Methods: Senior female singles participants (FS: n = 3; 21 [1] y; ranked  Women’s Tennis Association [WTA] top 125–375), an FS junior (n = 1; 16 y; ranked WTA top 350), and a men’s doubles player (n = 1; 26 y; ranked Association of Tennis Professionals [ATP] top 5) were assessed for TEE (using the doubly labeled water method) during a 9- to 14-day period, which included training, Wimbledon Championships, WTA/ATP International Tournaments, Junior/Senior International Tennis Federation, and Wimbledon Junior Championships. One female (FS3) did not exercise from day 4 following injury. Results: TEE for men’s doubles was 4586 kcal·d−1 (67 kcal·kg−1 fat-free mass [FFM]; daily activity 98 [74] min). Noninjured adult female participants’ TEEs were 3396 and 3948 kcal·d−1 (66 and 81 kcal·kg−1 FFM; daily activity durations were 139 [84] min and 150 [66] min, respectively), while TEE for the injured athlete was 2583 kcal·d−1 (45.7 kcal·kg−1; daily nonexercise activity duration was <45 min). The junior player TEE was 3988 kcal·d−1 (78.2 kcal·kg−1 FFM; daily activity of 131 [66] min). Conclusion: This observational case series positions tennis as a highly energetically demanding sport with variability evident between individuals (ie, TEE between 60 and 90 kcal·kg−1 FFM). Accordingly, nutritional strategies that promote sufficient energy availability should be emphasized with individual variability suitably assessed prior to prescription.
A Comparison of Match Load Between Padel and Singles and Doubles Tennis
Authors: Armstrong Cameron , Reid Machar , Beale Callum , Girard Olivier
Published: March 2023

Purpose: To quantify match load associated with padel and compare responses with both singles and doubles tennis. Methods: On separate days, 12 participants (7 men and 5 women) played 60-minute padel (PADEL), singles tennis (SINGLES), and doubles tennis (DOUBLES) simulated games. Participants wore a 10-Hz GPS/100-Hz triaxial accelerometer unit and heart-rate monitor. Exercise-related sensations and blood lactate concentration were monitored every 20 minutes. Match-play characteristics (temporal structure) and shot selection were derived from video analysis. Vertical jump ability was assessed before and after each game. Results: Heart rate, exercise-related sensations (overall perceived exertion and limb discomfort), and physical load (total distance covered, PlayerLoad, acceleration density and load) for SINGLES were higher compared with DOUBLES and PADEL (all P ≤ .05). Blood lactate concentrations remained low (1–2 mmol·L−1) and did not differ between conditions. Effective playing time (P < .001) was lower in SINGLES and DOUBLES compared with PADEL. The number of forehands (P = .002) and backhands (P < .001) was greater for SINGLES than for DOUBLES and PADEL. The number of volleys/smashes and lobs (P < .05) was greater for PADEL compared with SINGLES and DOUBLES. Performance for squat, countermovement, and multirebound jumps was similarly reduced below baseline after match play (P < .05), independent of condition. Conclusion: Padel imposes a unique match load on players that is different from singles tennis and more closely resembles that of doubles tennis. Cardiovascular stimulation and physical load are highest in singles tennis, while padel sees players hit a larger variety of shots with higher effective playing percentages.
Detraining Effect on Cardiac Autonomic Response to an All-Out Sprint Exercise in Trained Adolescent Swimmers
Authors: Ruiz-Navarro Jesús J. , Plaza-Florido Abel , Alcantara Juan M.A. , Gay Ana , Arellano Raúl
Published: March 2023

Purpose: This study aimed to investigate the effects of a 5-week training cessation on the cardiac autonomic response after a 50-m swimming time-trial test. Methods: Twenty trained and highly trained adolescent swimmers (17.1 [2.7] y) performed a 50-m front-crawl all-out test before (visit 1) and after a 5-week training cessation (visit 2). After the warm-up, heart-rate variability (HRV) was recorded in a seated position using a Polar RS800CX heart-rate monitor during the 10 minutes before (preexercise) and immediately after the 50-m front-crawl all-out test (postexercise). Two-way analysis of variance (time × visit) and analysis of covariance were conducted to compute the effect of the 50-m all-out test on vagal-related HRV parameters (mean R-R, standard deviation of R-R intervals [SDNN], square root of the mean squared differences between successive R-R intervals [RMSSD], the percentage number of pairs of adjacent normal R-R intervals differing by more than 50 milliseconds in the entire recording [pNN50], and power in the high frequency [HF]) with Bonferroni post hoc test. Results: All the HRV parameters had a time main effect (P < .05), showing a reduction after the 50 m in both visits (P < .05). All the variables exhibited a visit main effect (P < .05); the preexercise and postexercise mean R-R, natural logarithm SDNN, natural logarithm RMSSD, and natural logarithm HF values declined after the training cessation (P < .05). Natural logarithm pNN50 preexercise values were reduced in visit 2 compared with visit 1 (P < .05). Only mean R-R was further reduced in response to the test in visit 2 compared with visit 1 (P < .05). Conclusions: After 5 weeks of training cessation, all the preexercise and postexercise vagal-related HRV parameters evidenced a reduction, suggesting an impairment in swimmers’ physical status. Coaches should be cautious with training loads at the start of the season.
Is Recovery Optimized by Using a Cycle Ergometer Between Ski-Mountaineering Sprints?
Authors: Krumm Bastien , Luisier Frédéric , Rapillard Arnaud , Faiss Raphael
Published: March 2023

Purpose: To optimize the recovery phase between heats in ski-mountaineering sprint competitions, this study investigated whether an active recovery protocol on an ergocycle could improve subsequent performance compared with a self-selected recovery strategy. Methods: Thirteen elite ski mountaineers (9 men and 4 women) performed 3 sprints with 2 different recovery conditions (Ergo vs Free) in a randomized order. The Ergo condition involved a 10-minute constant-intensity exercise on an ergocycle performed at 70% of maximum heart rate. For the Free condition, the athlete was asked to self-select modality. At the end of the third sprint, a passive recovery (seated) was prescribed for both protocols. Sprint performance (time) and physiological parameters (lactate concentration [La], heart rate [HR], and rating of perceived exertion [RPE]) were recorded from each sprint and recovery phase. Results: In the Ergo vs Free protocols, sprint times (177 [24] s vs 176 [23] s; P = .63), recovery average HR (70% [2.9%] vs 71% [5.2%] of maximal HR), and RPE (16.7 [1.5] vs 16.8 [1.5]; P = .81) were not significantly different. However, [La] decreased more after Ergo (−2.9 [1.8] mmol·L−1) and Free (−2.8 [1.8] mmol·L−1) conditions compared with passive recovery (−1.1 [1.6] mmol·L−1; P < .05). Conclusions: The use of an ergocycle between heat sprints in ski mountaineering does not provide additional benefits compared with a recovery strategy freely chosen by the athletes. However, active conditions provide a faster [La] reduction compared with passive recovery and seem to be a more suitable strategy between multiple-heat sprints.
Interrater Reliability of the Test of Gross Motor Development—Third Edition Following Raters’ Agreement on Measurement Criteria
Authors: Carballo-Fazanes Aida , Rey Ezequiel , Valentini Nadia C. , Varela-Casal Cristina , Abelairas-Gómez Cristian
Published: March 2023

We aimed to calculate interrater reliability of the Test of Gross Motor Development—Third Edition (TGMD-3) after raters reached a consensus regarding measurement criteria. Three raters measured the fundamental movement skills of 25 children on the TGMD-3 at two different times: (a) once when simply following the measurement criteria in the TGMD-3 manual and (b) after a 9-month washout period, following the raters’ consensus building for the measurement criteria for each skill. After calculating and comparing the interrater reliability of these three raters across these two rating times, we found improved interrater reliability after the raters’ consensus-building discussions on ratings of both locomotor skills (moderate-to-good reliability on two of six skills initially and at least moderate-to-excellent on four of six skills following criteria consensus building) and ball skills (moderate-to-good reliability on one of seven skills initially and at least moderate-to-excellent reliability on four of seven skills following criteria consensus building). For subtest scores and overall test scores, raters achieved at least moderate-to-good reliability on their second, postconsensus-building ratings. Based on this improved reliability following consensus building, we recommend that researchers include rater consensus building before assessing children’s fundamental movement skills or guiding curriculum interventions in physical education from TGMD-3 data.
Convergent Validity Between Epoch-Based activPAL and ActiGraph Methods for Measuring Moderate to Vigorous Physical Activity in Youth and Adults
Authors: Ortega Adrian , Forseth Bethany , Hibbing Paul R. , Steel Chelsea , Carlson Jordan A.
Published: March 2023

Purpose: We investigated convergent validity of commonly used ActiGraph scoring methods with various activPAL scoring methods in youth and adults. Methods: Youth and adults wore an ActiGraph and activPAL simultaneously for 1–3 days. We compared moderate to vigorous physical activity (MVPA) estimates from the ActiGraph Evenson 15-s (youth) and Freedson 60-s (adult) cut-point scoring methods and four activPAL scoring methods based on metabolic equivalents (METs), step counts, vertical axis counts, and vector magnitude counts. All activPAL methods were applied to 15-s epochs for youth and 60-s epochs for adults, and the METs method was also applied to 1-s epochs. Epoch-level agreement was examined with classification tests (sensitivity, positive predictive value, and F1) using the ActiGraph methods as the referent. Day-level agreement was examined using tests of mean error, mean absolute error, and Spearman correlations. Results: Relative to ActiGraph methods, which indicated a mean MVPA of 41 min/day for youth and 24 min/day for adults, the activPAL METs method applied to 15-s epochs in youth and 60-s epochs in adults yielded the most comparable estimates of MVPA. Daily MVPA estimated from all other activPAL scoring methods generally had poor agreement with ActiGraph methods in youth and adults. Conclusion: When using the same epoch lengths between monitors, MVPA estimation via the activPAL METs scoring method appears to have good comparability to ActiGraph cut points at the group-level and moderate comparability at the individual-level in youth and adults. When using this scoring method, the activPAL appears to be appropriate for measuring daily minutes of MVPA in youth and adults.
The Impacts of COVID-19 Restrictions on Physical Activity in Children and Youth: A Systematic Review of Qualitative Evidence
Authors: Eaton Andrea , Ball Geoff D.C. , Hwang Yeongho , Carson Valerie , Gokiert Rebecca , Dennett Liz , Rajani Hasu , Zhang Mona , Dyson Michele P.
Published: March 2023

Background: The objectives of this systematic review were to synthesize qualitative evidence on the impacts of COVID-19 restrictions on physical activity (PA) for children and youth, and explore factors perceived to influence those impacts. Methods: Five databases (MEDLINE, Embase, SPORTDiscus, ERIC, and CINAHL) were searched initially in June 2021 and updated in December 2021 to locate qualitative articles considering COVID-19 restrictions and PA for children and youth (≤18 y old), in any setting. Eligibility, quality assessments, and data extraction were completed by 2 independent reviewers. Data were synthesized using meta-aggregation with confidence of findings rated using ConQual. Results: After screening 3505 records, 15 studies were included. Curriculum-based PA, organized sport, and active transportation were negatively impacted by COVID-19 restrictions. Negative changes were affected by COVID-19 exposure risks, inadequate instruction, poor access, screen time, and poor weather. Unstructured PA was inconsistently impacted; outdoor unstructured PA increased for some. Positive changes were facilitated by family co-participation, availability of outdoor space, and perceived mental health benefits. Conclusion: Qualitative data indicated restrictions had a predominantly negative impact on PA for children and youth, but inconsistent impacts on unstructured PA. The improved contextual understanding offered by our review will be foundational knowledge for health strategies moving forward.
“I Realize My White Privilege Certainly Has Contributed to This Whole Experience”: White Undergraduate Sport Management Students Engagement With Racism in a Sport-For-Development Service-Learning Course
Authors: Klein Max , Zastoupil Garret J. , Evanovich Justin
Published: March 2023

Sport management classrooms prepare practitioners and decision makers to work in Sport for Development (SfD). A core issue within SfD is a lack of critical racial reflexivity, particularly with racially White professionals, which maintains inequitable power structures and keeps SfD programs from reaching their intended goal of facilitating positive outcomes. This study, informed by critical Whiteness studies, aimed to understand how White undergraduate sport management students critically reflected upon race while participating in an SfD service-learning course. Analyzing written reflections completed in the course, we found that students utilized Race Evasiveness and Race Explicitness, despite course content and SfD practice explicitly focused on race. Implications for research and practice are discussed.
Induced seismicity in Kansas: Events and responses
Authors: Buchanan Rex C. , Hoffman Ryan , Cochran Mike
Published: March 2023

In September 2013, seismicity suddenly increased in south-central Kansas. That increase was eventually traced to wastewater injection associated with oil exploration and production, including a new wave of horizontal drilling. In response to the seismicity, the state government of Kansas formed a task force composed of representatives of two regulatory agencies and the Kansas Geological Survey, a nonregulatory division of the University of Kansas. That task force developed a seismic action plan that guided regulatory response, which resulted in the staged reduction of permitted volumes of wastewater injection. Seismicity declined shortly after, partly as a response to mandated volume reductions and partly because lower oil prices led to less exploration and production. The Kansas state government response to induced seismicity provides lessons for mitigating natural resource hazards while allowing industry operation.
Peripartum cardiomyopathy: disease or syndrome?
Authors: Baris Lucia , Cornette Jérôme , Johnson Mark R , Sliwa Karen , Roos-Hesselink Jolien W
Published: March 2023

Peripartum cardiomyopathy (PPCM) is a rare form of pregnancy-associated heart failure and is considered to be a diagnosis of exclusion. There are many hypotheses on the aetiology of PPCM; however, the exact pathophysiological mechanism remains unknown. It shows many resemblances to other conditions, such as familial dilated cardiomyopathy or myocarditis, and therefore it can be hard to make a definite diagnosis. We describe four cases of peripartum-onset heart failure in women who were suspected of having PPCM. We discuss the differential diagnosis, pathophysiological mechanisms and various diagnostic modalities.
Management of blood pressure in heart failure
Authors: Pinho-Gomes Ana Catarina , Rahimi Kazem
Published: March 2023

Hypertension is a common comorbidity in patients with heart failure and most drugs that have demonstrated to improve prognosis in this population have the potential to reduce blood pressure. Nonetheless, the relationship between blood pressure and clinical outcomes and the relevance of blood pressure reduction in heart failure remains unclear. This narrative review summarises the evidence currently available to guide blood pressure treatment in this patient group and highlights key questions for further research. In patients with heart failure with reduced ejection fraction, guidelines consensually recommend treating hypertension with drugs that have compelling indications in heart failure, with a target blood pressure of 130/80 mmHg. In patients with heart failure with preserved ejection fraction, guidelines acknowledge that the optimal treatment strategy remains unclear and thus recommend adopting a similar treatment strategy to patients with reduced ejection fraction. In any case, low blood pressure should not deter uptitration of drugs otherwise indicated to improve prognosis in heart failure, provided that patients tolerate drugs without adverse events. In the absence of evidence for modification of treatment efficacy and safety by baseline blood pressure, it is likely that treatment may actually lead to higher absolute risk reduction in patients with the lowest blood pressure. Special considerations and treatment adjustments are needed in the elderly as well as in patients with diabetes, chronic kidney disease and atrial fibrillation. More evidence is needed on blood pressure management in patients with heart failure in general, in whom the increasing burden of multimorbidity adds further complexity to treatment.
Pulmonary artery compliance in different forms of pulmonary hypertension
Authors: McCormick Amber , Krishnan Amita , Badesch David , Benza Raymond L , Bull Todd M , De Marco Teresa , Feldman Jeremy , Hemnes Anna R , Hirsch Russel , Horn Evelyn , Kennedy Jaime , Mathai Stephen C , McConnell Wesley , Pugliese Steven C , Sager Jeffrey S , Shlobin Oksana A , Simon Marc A , Lammi Matthew R
Published: March 2023

Objective

Pulmonary artery compliance (PAC), estimated as stroke volume (SV) divided by pulmonary artery pulse pressure (PP), may be a predictor of survival in pulmonary arterial hypertension (PAH). Resistance–compliance (RC) time, the product of PAC and pulmonary vascular resistance, is reported to be a physiological constant. We investigated if differences in PAC and RC time exist between pulmonary hypertension (PH) subgroups and examined whether PAC is an independent predictor of transplant-free survival in PAH.

Methods

This was a retrospective analysis of adult PAH (n=532) and chronic thromboembolic PH (CTEPH, n=84) patients enrolled in the US Pulmonary Hypertension Association Registry from 2015 to 2019. PAC and RC time were compared between PH subgroups (connective tissue disease-PAH (CTD-PAH), idiopathic/heritable-PAH (i/h-PAH), drug/toxin-PAH (d/t-PAH)). Cox proportional hazards models were constructed for transplant-free survival, adjusting for REVEAL 2.0 risk score.

Results

There were no differences in estimated PAC between PAH subgroups, nor between PAH and CTEPH. RC time was shorter in CTEPH compared with PAH (median 0.55 (IQR 0.45–0.64) vs 0.62 (0.52–0.73) s, p<0.0001). RC time was shortest in CTD-PAH when compared with i/h-PAH and d/t-PAH ((0.59±0.18) vs (0.65±0.20) vs (0.73±0.25) s, p=0.0001). PAC was associated with transplant-free survival (HR 0.72, 95% CI 0.55 to 0.94, p=0.02) but was not an independent predictor of outcome after adjustment for REVEAL 2.0 score.

Conclusion

PAC was similar between PH groups and was not an independent predictor of transplant-free survival in PAH. RC time was different between PH subgroups, challenging RC time constancy.

Trial registration number

NCT04071327
099 A retrospective study of mortality rates in a video-EEG telemetry patient cohort
Authors: Mirza Farhat , Cahill Varduhi , Cooper Paul , Mohanraj Rajiv
Published: March 2023

Rationale

Despite emerging evidence of altered brain connectivity patterns in patients with non-epileptic attack disorder (NEAD), studies on the mortality rates in these patients remain scarce.

Methods

Mortality data was studied retrospectively in a cohort of patients admitted for video-telemetry evaluation at the Manchester Centre for Clinical Neurosciences from 2009 to 2019. The diagnosis of NEAD, epilepsy or both was confirmed by the consensus opinion of experienced epileptologists. Mortality and cause of death were identified from the death alert system linked to the Electronic Patient Record and from coroners’ reports, where available.

Results

Out of 693 patients 662 were included in the study analyses. Death was registered in 23 patients, 82.6% of whom suffered with epilepsy and 17.4% with NEAD. In epilepsy patients, sudden unexpected death was recorded in 42.1%, death from other medical conditions in 52.6% and death from external causes - in 5.3%. In the NEAD group, the causes of death included iatrogenic and other medical conditions.

Conclusions

Mortality rates in the NEAD group of patients are not negligible. With NEAD patients being at risk of unnecessary iatrogenic interventions, increased awareness of the heightened mortality rates in this patient cohort could avert preventable deaths.
101 PET-CT in patients with suspected paraneoplastic neurological conditions
Authors: Cheema Sanjay , Young John , Pencharz Deborah
Published: March 2023

Background

PET-CT is often used to investigate for underlying malignancy in patients with suspected paraneoplastic neurological syndromes (PNS). However, evidence supporting its utility is limited, other than in patients with a ‘classical’ PNS, positive antibodies, and after conventional imaging has already been performed and is negative.

Results

We collected data on 41 consecutive patients with suspected PNS who underwent whole-body PET-CT in our centre. 5/41 (12%) patients were antibody-positive. In 32/41 (78%) CT body imaging had been performed prior to PET-CT.

In only one patient did PET-CT uncover a malignancy which was not already known about. In one patient PET-CT led to the diagnosis of neurosarcoidosis, which would not have been identified otherwise. No patients developed a malignancy in the follow up period (range: 10–33 months, median: 22 months) – a negative prediction value (NPV) of 100%.

In 29% (12/41) PET-CT showed incidental findings which required further investigation or follow up.

Conclusion

We found a low rate of detection of malignancy via PET-CT. This could be explained by low rates of antibody positivity and the small, heterogeneous cohort. The 100% NPV is reassuring. PET-CT identified a non-paraneoplastic condition (sarcoidosis) as a cause of one patient’s symptoms.
102 Episodic memory functional connectivity in temporal lobe epilepsy
Authors: Buck Sarah , Caciagli Lorenzo , Vos Sjoerd , Duncan John S , Sidhu Meneka Kaur
Published: March 2023

Purpose

Functional magnetic resonance imaging (fMRI) has previously demonstrated functional reorganisation of memory representations in people with Temporal Lobe Epilepsy (TLE). Less is known about the changes in functional connectivity within the memory network.

Methods

We studied 77 patients with unilateral TLE (37 left) and 27 controls. All participants performed a memory encoding fMRI paradigm of faces and words. Psychophysiological Interaction (PPI) analysis was conducted to examine brain regions that were time-correlated with activations in the left and right hippocampi.

Results

During word encoding, left TLE patients showed reduced connectivity from the left hippocampus to the prefrontal cortex, compared to controls. During face encoding, right TLE patients showed reduced connectivity from the right hippocampus to the ipsilateral lateral temporal lobe and bilateral fusiform gyri. However, left and right TLE patients showed greater connectivity to posterior hippocampi bilaterally during word and face encoding.

Conclusion

TLE is increasingly recognised as a network disease and correspondingly we demonstrate widespread memory network reorganisation in people with epilepsy. The reorganisation of eloquent functions has important implications in the planning of epilepsy surgery and a network approach may be helpful in the prediction of memory outcome after epilepsy surgery.
105 Ring-enhancing lesions – diagnostic challenge in a DGH
Authors: Oo Aung
Published: March 2023

A 79-year-old male was admitted to stroke ward following two episodes of mild headaches, slurred speech and left arm weakness over the past 3 days. On both occasions, the symptoms resolved within an hour. On admission to the ward he suffered 2 focal seizures. He denies any fever.

He has the background of benign oesophageal stricture which was recently dilated, and melanoma on his neck which was resected 5 years ago.

Neurological examination was unremarkable. WBC- normal, CRP- slightly high. LP was also normal.

The MRI brain revealed 4 ring-enhancing lesions bilaterally. DWI showed restricted diffusion.

After discussion with neuroradiologists and neurosurgeons, antibiotics started for brain abscesses. Despite this, he gradually developed progressive left arm weakness. After another discussion, it was thought that his lesions were metastases. Biopsy/aspiration could not be performed due to limited resources. We stopped antibiotics and started dexamethasone. His left arm weakness subsequently improved. However, MRI scan repeated after 2 weeks showed increase in size of lesions. Thus, antibiotics restarted, and the subsequent scans showed improvement.

Discussion Brain abscess is a rare but serious complication following oesophageal dilation. A cystic lesion that markedly restricts centrally on DWI should be considered an abscess until proven otherwise.
109 The walton headache pathway – design and outcome
Authors: Fletcher Nicholas , Krishnan Anita , Silver Nicholas , Riley Julie , Wilson Martin , Nicolson Andrew
Published: March 2023

Headache is a major component of increasing demand in neurology secondary care - mainly migraine and other primary headache disorders. A headache pathway was developed at the Walton Centre (WCFT), with local GPs, to facilitate and support the diagnosis and management of primary headache disorders (migraine, medication overuse headache and tension headache) in primary care. The pathway was intended to reduce avoidable referrals of patients with straightforward primary headaches to secondary care and improve identification and referral of those with refractory primary headaches, any other (potentially more serious) form of headache or those in whom use of the pathway did not lead to a primary care diagnosis. This was adopted by seven local CCGs after extensive engagement with commissioners and GP educational sessions. The outcome of the pathway in 2016–2018 was a 24% reduction in headache referrals; new patients seen in outpatients with headache reduced by 22%; attendances with migraine reduced by 20% and the number of headache patients discharged after one attendance (a surrogate marker for patients who potentially could have been managed in primary care) reduced by 42%. These results indicate that more patients with migraine and other primary headache disorders were offered more faster treatment in primary care rather than after hospital referral. With clinical engagement, it is possible to share a simple pathway with GPs to reduce headache referral demand in secondary care.
110 Phenotype of new daily persistent headache
Authors: Lobo Rhannon , Lobo Sean , Jacobs Benjamin , Bahra Anish
Published: March 2023

New daily persistent headache (NDPH) is characterized by new onset headache which remains daily from onset for at least three months. So far only a few studies have been reported in this field. The aim of this study is to report on the phenotype and patient characteristics of NDPH as well as considering the strengths and limitations of the current International Classification of Headache Disorders, 3rd edition, beta version (ICHD-3).

In this retrospective study, we studied 216 patients who were seen at our headache clinic at the National Hospital for Neurology and Neurosurgery (from March 2005 to April 2015) and from Whipps Cross University Hospital (from April 2005 to December 2015). All patients fulfilled ICHD-3 criteria for NDPH. Each patients’ medical file was reviewed to record demographic and outcome parameters.

Overall, median age at onset was 37 (IQR 23) and male: female ratio was 0.56. It was found that 83.8% of this patient population had chronic migraine. Other clinical syndromes included tension type headache (6.9%) and primary stabbing headaches (2.8%).

This is one of the largest cohorts of NDPH to integrate ICHD-3, our findings amalgamate those previously reported and include phenotypes which had been previously been omitted.
14.45 Relationships between walking speed, cognition & brain pathologies: an imaging study of the 1946 birth cohort
Authors: Buchanan Sarah M , Parker Thomas D , Lane Christopher A , Keshavan Ashvini , Keuss Sarah E , Schrag Anette E , Fox Nick C , Richards Marcus , Schott Jonathan M
Published: March 2023

Introduction

Slowing of gait is associated with risk of cognitive decline, but whether this is due to brain pathology or a consequence of normal neural ageing remains unclear. We investigate associations between gait speed, cognitive test scores, white matter hyperintensity (WMH) volume, whole brain volume (WBV) and β-amyloid load in a sample of healthy older adults born in the same week of March 1946 in mainland Britain.

Methods

502 participants underwent quantitative gait measurement, neuropsychological assessment, structural MRI and 18F-florbetapir amyloid PET. Excluding individuals with major neurological disease or missing data, 374 individuals (age 70.6 ±0.69 years) were analysed.

Results

Mean self-paced walking speed was 1.44 ± 0.19 ms-1. Slower walking speed was associated with lower performance on the Digit-Symbol Substitution test (p=0.007) and MMSE (p<0.05), but not tests of memory or fluid intelligence. These associations were not significantly altered by adjusting for WBV, WMH volume or PET evidence of cerebral β-amyloid deposition.

Conclusion

In healthy older adults, gait speed is associated with processing speed and global cognition, but not with tests of non-verbal reasoning or memory. These associations were not accounted for by the measured cerebral pathologies. Further analyses incorporating region-specific and microstructural brain imaging are required.
122 Apomorphine infusion-induced ulcers and skin necrosis
Authors: Keh Yann Shern , Kulkarni Omesh
Published: March 2023

Introduction

Subcutaneous apomorphine infusion is a therapeutic modality for patients with Parkinson’s disease with suboptimal control of motor fluctuations on oral medication. Bruising is described but severe skin reactions are only rarely reported. We describe two cases of apomorphine-induced severe skin reactions necessitating therapy cessation.

Case descriptions

We describe the cases of two patients (48- and 66-year-old males) with a 5–7 year history of idiopathic Parkinson’s disease who were commenced on apomorphine infusion due to ongoing motor fluctuations despite high dose oral levodopa with dopamine agonist and MAO-I co-therapy. Despite tolerating apomorphine well initially, within 12–18 months the patients developed superficial necrotic ulcers around infusion sites, to the point where cessation of treatment was required.

The patients were changed onto Duodopa (via jejunostomy) and Opicapone respectively, with good symptom control.

Discussion

Previous apomorphine infusion cohorts report a 2.8% incidence of skin necrosis. In some cases, surgical incision and wound lavage has been required. In most cases described to date, severe skin reactions do not manifest until later on in treatment. It is unclear what factors may increase the risk of developing this complication.

Conclusion

Clinicians should be aware of the potential side effect of skin necrosis when prescribing apomorphine infusions and indications to stop apomorphine and escalate to Duodopa or deep brain stimulation.
123 T and B lymphocyte senescence in parkinson’s disease
Authors: Jensen Melanie , Scott Kirsten , Camacho Marta , Greenland Julia , Kouli Antonina , Wijeyekoon Ruwani , Solim Imtiaz , Barker Roger , Williams-Gray Caroline
Published: March 2023

Introduction

Evidence suggests the immune system contributes to Parkinson’s disease (PD) aetiopathogenesis and this represents a tractable target for disease-modifying therapy. As ageing is a risk factor for PD, it is relevant to investigate age-related immune changes (immunosenescence) in PD.

Methods

Blood samples were collected from 20 early PD patients and 20 controls. T- and B-cell senescence subsets were identified using flow cytometric immunophenotyping. CMV/EBV serostatus was ascertained given its well-documented effect on immunosenescence.

Results

CD4+ TEMRA cells, T-cell senescence markers, were reduced in PD cases versus controls (p=0.046). This was not driven by differences in age or CMV/EBV serostatus across groups. CMV positivity was associated with increased CD4+ TEMRA cells as expected in controls, but not in PD cases. Switched memory B-cells were lower in patients versus controls (p=0.040). No changes were observed in the CD8+ T-cell pool.

Conclusions

These findings suggest that the senescent ‘shift’ induced by viral infection and ageing is atypical in PD. Reductions in senescent lymphocytes may favour the passage of activated lymphocytes across the blood brain barrier, promoting central inflammation and neurodegeneration. Pragmatically, this study shows that immune abnormalities occur in early-stage disease, adding urgency to the search for immune-modulating therapies in PD.
124 Real world use of neurophysiology in differentiating hyperkinetic movement disorders
Authors: Gandhi Sacha E , Silverdale Monty A , Mercer Deborah , Marshall Andrew G , Kobylecki Christopher
Published: March 2023

Neurophysiology constitutes a potentially useful aid in differentiating hyperkinetic movement disorders (HMD). Parameters including presence of a Bereitschaftspotential on back-averaged EEG have been demonstrated to help distinguish between these disorders. In 2008, a Movement Disorder neurophysiology service was established in Greater Manchester to aid in the diagnostic process.

We retrospectively reviewed records of 39 patients with HMD who underwent EEG back-averaging through this service from January 2009 until January 2018. The aim was to determine how frequently neurophysiology altered the final diagnosis.

We reviewed 39 patients (23 females, 16 males), with a mean age at onset of 42.6 years and mean disease duration of 2.0 years. The clinical diagnosis was altered in 23 cases (59%). Distractibility (P=0.001), variability (P=0.002), the presence of a Bereitschaftspotential (P<0.0001), and EMG burst duration > 300 ms (P=0.012) were more frequent in those with a final diagnosis of functional movement disorder than other HMD.

Neurophysiology is an invaluable adjunct in complex HMD, altering the diagnosis and treatment options for a significant proportion of patients. We hope these results will be beneficial for other units considering establishing this type of service.
125 A case of multiple paraneoplastic syndromes associated with CRMP5 antibodies and lung cancer
Authors: Alareed Ahmad , Broad Rebecca , Cousins Oliver , Changaradil Deepthi , Redmond Ian , Caimanque Lorena Flores
Published: March 2023

The collapsin response-mediator protein-5 (CRMP5) autoantibody is a recognised biomarker for small cell lung cancer associated neurological Paraneoplasia.

We describe a 79-year-old lady, who presented with right hemi-chorea. This progressed over one month, becoming bilateral and rendering the patient bedbound.

MRI revealed bilateral signal change within the caudate and lentiform nuclei. CT chest detected mediastinal lymphadenopathy, while PET identified pulmonary malignancy with radiological staging T1bN3M0. Serum CRMP5 antibodies were positive.

Haloperidol and intravenous methylprednisolone lead to some improvement in Chorea and mobility. However, visual acuity deteriorated to finger counting. Fundoscopy revealed mild cataracts, while visual evoked potentials were very delayed on the right and absent on the left, suggesting optic neuropathy.

She deteriorated with leg pain, weakness, and loss of tendon reflexes, as well as cognitive decline and visual hallucinations. Clinically this raised suspicion of radiculoneuropathy and encephalopathy respectively. Whilst retaining capacity the patient refused further investigations and treatment. She was discharged to a nursing home and died 6 months later.

CRMP5 antibodies, targeting intracellular antigens, precipitate an onconeuronal autoimmune process through mechanisms not fully understood. We report a case of combined chorea, optic neuropathy, peripheral neuropathy, and encephalopathy, which highlights the potential for CRMP5 to cause multifocal neurological dysfunction.
126 Quality of life in idiopathic dystonia: a systematic review
Authors: Girach Ayesha , Aragon Ana Vinagre , Zis Panagiotis
Published: March 2023

Objective

Dystonia is characterised by sustained muscular contractions frequently producing repetitive and twisting movements. The primary aim of this systematic review was to establish how quality of life (QoL) is affected in idiopathic focal, multifocal and segmental dystonia. This review aimed to evaluate variations in QoL between different subtypes of dystonia, identify the determinants of QoL and assess the effects of different treatments on QoL.

Methodology

A systematic computer-based literature search was conducted using the PubMed database to search for papers on QoL in idiopathic focal, segmental, multifocal and generalized dystonia. We identified 75 studies meeting our inclusion criteria. Information was extracted regarding prevalence, demographics and response to treatment where indicated.

Results

This review revealed QoL to be a significant yet overlooked issue in idiopathic dystonia. Data consistently showed that dystonia has a negative effect on QoL in patients compared to healthy controls, when measured using disease specific and generic QoL measures. The majority of studies (n=25) involved patients with cervical dystonia, followed by benign-essential blepharospasm (n=10). Along with the beneficial effect to the dystonia symptoms, treatment using Botulinum Toxin and Deep Brain Stimulation is also effective in improving overall QoL across the majority of subtypes.

Conclusion

The findings demonstrate that patients’ QoL should routinely be assessed and monitored, as this may affect subsequent management. Further research will allow for more robust management of non-physical impairments.
129 Validating a new dependency measurement for parkinson’s disease
Authors: Ramsay Neil , Macleod Angus , Counsell Carl
Published: March 2023

Introduction

Functional dependency is a key outcome in Parkinson’s disease (PD). We created an algorithm to dichotomously assess dependency in PD patients, based on the Unified Parkinson’s disease rating scale (UPDRS) part 2, routinely collected in PD studies.

Methods

We defined dependency from items of UPDRS Part 2 (i.e. hygiene, dressing, feeding, getting out of chair and walking). We validated this algorithm using dependency data from 1113 patients from 6 community-based incidence PD cohorts. We also validated against indirect measures relating to cognition, quality of life and motor impairment.

Results

Our algorithm showed high specificity and sensitivity (specificity 94% and sensitivity 70% at baseline; 90% and 84% respectively at 5 years). We found evidence for construct validity with poorer MMSE and quality of life scores in dependent patients.

Discussion

We have validated a algorithm to dichotomously assess dependency in PD patients, which can be widely used in research studies.
130 Trust the patient not the doctor: non-motor symptoms and quality of life in cervical dystonia
Authors: Ndukwe Ihedinachi , O’Riordan Sean , Hutchinson Michael
Published: March 2023

Introduction

Mood disorder is common amongst Cervical Dystonia (CD) patients and can impact on quality of life (QoL). It often precedes the onset of CD and doesn’t improve with botulinum toxin therapy. We hypothesize that mood disorder is part of the primary pathogenic process causing CD.

Aim

To assess the prevalence of mood disorder and measure QoL in relation to severity, disability and pain in CD patients receiving botulinium toxin therapy with good effect.

Methods

We prospectively collected data using questionnaires; TWSTRS for pain, severity and disability; CDIP-58 and Euro-QoL VAS for QoL and BAI, BDI-II & HADS for mood disorder assessment.

Results

In 192 patients with mean age 62 years (SD: 12.67), using the BAI-II and BDI, 56% reported anxiety and/or depression. There was a significant correlation between mood disorder and quality of life using CDIP-58 {(Anxiety: R2=0.39; p<0.0001) and (Depression: R2=0.33; p<0.0001)}. There was weak correlation between disease severity and quality of life; R2=0.09; p<0.0002.

Conclusion

There was a significant correlation between reported mood disorder and QoL in CD but a weak association with severity, pain and disability scales. This shows that patient-reported measures, particularly the CDIP-58, are a significant source of disability reporting which is not determinable by standard recommended measures of CD severity, administered by the neurologist. Therefore it is important to trust the patient.

Acknowledgement

Funding was by Merrion Neuroscience Foundation Programme

I have no financial relationships to disclose