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Iannuzzo F, Cicatiello AG, Sagliocchi S, Schiano E, Nappi A, Miro C, Stornaiuolo M, Mollica A, Tenore GC, Dentice M, Novellino E. Therapeutic Effect of an Ursolic Acid-Based Nutraceutical on Neuronal Regeneration after Sciatic Nerve Injury. Int J Mol Sci 2024; 25:902. [PMID: 38255977 PMCID: PMC10815361 DOI: 10.3390/ijms25020902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Peripheral nerve injuries lead to severe functional impairments and long recovery times, with limited effectiveness and accessibility of current treatments. This has increased interest in natural bioactive compounds, such as ursolic acid (UA). Our study evaluated the effect of an oleolyte rich in UA from white grape pomace (WGPO) on neuronal regeneration in mice with induced sciatic nerve resection, administered concurrently with the induced damage (the WGPO group) and 10 days prior (the PRE-WGPO group). The experiment was monitored at two-time points (4 and 10 days) after injury. After 10 days, the WGPO group demonstrated a reduction in muscle atrophy, evidenced by an increased number and diameter of muscle fibers and a decreased Atrogin-1 and Murf-1 expression relative to the denervated control. It was also observed that 85.7% of neuromuscular junctions (NMJs) were fully innervated, as indicated by the colocalization of α-bungarotoxin and synaptophysin, along with the significant modulation of Oct-6 and S-100. The PRE-WGPO group showed a more beneficial effect on nerve fiber reformation, with a significant increase in myelin protein zero and 95.2% fully innervated NMJs, and a pro-hypertrophic effect in resting non-denervated muscles. Our findings suggest WGPO as a potential treatment for various conditions that require the repair of nerve and muscle injuries.
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Affiliation(s)
- Fortuna Iannuzzo
- Department of Pharmacy, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (F.I.); (A.M.)
| | - Annunziata Gaetana Cicatiello
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Napoli, Italy; (A.G.C.); (S.S.); (A.N.); (C.M.)
| | - Serena Sagliocchi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Napoli, Italy; (A.G.C.); (S.S.); (A.N.); (C.M.)
| | - Elisabetta Schiano
- Healthcare Food Research Center, Inventia Biotech s.r.l., S. S. Sannitica, 81020 Caserta, Italy; (E.S.); (E.N.)
| | - Annarita Nappi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Napoli, Italy; (A.G.C.); (S.S.); (A.N.); (C.M.)
| | - Caterina Miro
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Napoli, Italy; (A.G.C.); (S.S.); (A.N.); (C.M.)
| | - Mariano Stornaiuolo
- Department of Pharmacy, University of Naples Federico II, Via Domenico Montesano 59, 80131 Napoli, Italy; (M.S.); (G.C.T.)
| | - Adriano Mollica
- Department of Pharmacy, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (F.I.); (A.M.)
| | - Gian Carlo Tenore
- Department of Pharmacy, University of Naples Federico II, Via Domenico Montesano 59, 80131 Napoli, Italy; (M.S.); (G.C.T.)
| | - Monica Dentice
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Napoli, Italy; (A.G.C.); (S.S.); (A.N.); (C.M.)
| | - Ettore Novellino
- Healthcare Food Research Center, Inventia Biotech s.r.l., S. S. Sannitica, 81020 Caserta, Italy; (E.S.); (E.N.)
- Faculty of Medicine and Surgery, Catholic University of the Sacred Heart, 00168 Roma, Italy
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Edwards V, Vari C, Rose M, Graham CD, O'Connell N, Taylor E, McCracken LM, Radunovic A, Rakowicz W, Norton S, Chalder T. Participant experiences of guided self-help Acceptance and Commitment Therapy for improving quality of life in muscle disease: a nested qualitative study within the ACTMus randomized controlled trial. Front Psychol 2023; 14:1233526. [PMID: 38106380 PMCID: PMC10722278 DOI: 10.3389/fpsyg.2023.1233526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction In adults, muscle disease (MD) is typically a chronic long-term condition that can lead to a reduced quality of life (QoL). Previous research suggests that a psychological intervention, in particular Acceptance and Commitment Therapy (ACT), may help improve QoL for individuals living with chronic conditions such as MD. Methods This nested qualitative study was incorporated within a randomized controlled trial which evaluated a guided self-help ACT intervention for people living with MD to explore their experiences of the intervention. Semi-structured interviews (n = 20) were conducted with those who had received ACT. Data were analyzed via thematic analysis. Results There were four overarching themes. (1) Views on whether therapy sessions would help with a medical condition: participants' expectations regarding ACT varied. Some participants were skeptical about mindfulness. (2) I was able to look at things in a different way: participants described increased meaningful activity, greater awareness of thoughts and emotions and acceptance or adaptation to mobility problems. Some described improvement in the quality of relationships and a sense of feeling free. (3) Treating the body and the mind together: following the intervention participants noted that a holistic approach to healthcare is beneficial. (4) Intervention delivery: The remote delivery was generally seen as helpful for practical reasons and allowed participants to speak openly. Participants voiced a need for follow-up sessions. Discussion Overall, the intervention was experienced as acceptable. Suggested improvements included de-emphasizing the role of mindfulness and adding follow-up sessions.
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Affiliation(s)
- Victoria Edwards
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Chiara Vari
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Michael Rose
- Department of Neurology, King's College Hospital, London, United Kingdom
| | - Christopher D. Graham
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom
| | - Nicola O'Connell
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Emma Taylor
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | | | - Wojtek Rakowicz
- Wessex Neurological Service, University Hospital Southampton, Southampton, United Kingdom
| | - Sam Norton
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Inflammation Biology, Centre for Rheumatic Disease, Faculty of Life Sciences and Medicine, King's College London, Weston Education Centre, London, United Kingdom
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Li Z, Wei H, Hu D, Li X, Guo Y, Ding X, Guo H, Zhang L. Research Progress on the Structural and Functional Roles of hnRNPs in Muscle Development. Biomolecules 2023; 13:1434. [PMID: 37892116 PMCID: PMC10604023 DOI: 10.3390/biom13101434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
Heterogeneous nuclear ribonucleoproteins (hnRNPs) are a superfamily of RNA-binding proteins consisting of more than 20 members. These proteins play a crucial role in various biological processes by regulating RNA splicing, transcription, and translation through their binding to RNA. In the context of muscle development and regeneration, hnRNPs are involved in a wide range of regulatory mechanisms, including alternative splicing, transcription regulation, miRNA regulation, and mRNA stability regulation. Recent studies have also suggested a potential association between hnRNPs and muscle-related diseases. In this report, we provide an overview of our current understanding of how hnRNPs regulate RNA metabolism and emphasize the significance of the key members of the hnRNP family in muscle development. Furthermore, we explore the relationship between the hnRNP family and muscle-related diseases.
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Affiliation(s)
| | | | | | | | | | | | | | - Linlin Zhang
- Key Laboratory of Animal Breeding and Healthy Livestock Farming, College of Animal Science and Veterinary Medicine, Tianjin Agricultural University, Tianjin 300392, China; (Z.L.); (H.W.); (D.H.); (X.L.); (Y.G.); (X.D.); (H.G.)
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Cerda C, Lezcano MF, Marinelli F, Alarcón J, Fuentes R. Determination of Mandibular Position and Mouth Opening in Healthy Patients and Patients with Articular and/or Muscular Pathology: A Pilot Study with 3D Electromagnetic Articulography and Surface Electromyography. J Clin Med 2023; 12:4822. [PMID: 37510936 PMCID: PMC10381668 DOI: 10.3390/jcm12144822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 07/30/2023] Open
Abstract
Temporomandibular disorders (TMDs) are a group of pathologies that affect the temporomandibular joint and its related structures, producing intracapsular and muscular pathologies. The aim of this study is to describe, by electromagnetic articulography (EMA) and simultaneous electromyography (sEMG), the mandibular postural position and mouth opening in healthy patients and with articular and/or muscular pathology. MATERIALS AND METHODS A pilot study was conducted with a sample of sixteen participants aged 18 years or older who attended the TMDs and Orofacial Pain Polyclinic of the University of La Frontera due to TMDs. The physiological inoculation space was evaluated from the mandibular postural position (MPP) with swallowing command and without command, in both healthy patients and patients with articular, muscular, and mixed TMDs, measured simultaneously with EMA and sEMG. An angular measurement of the oral opening was also performed with the data obtained. RESULTS The physiological inoculation space was obtained from the determination of the MPP through the procedures with swallowing command and without command, and different mouth opening degrees were evaluated. CONCLUSIONS Simultaneous position and sEMG records can be produced from EMA, and different characterization variables such as the vertical distance, Euclidean distance, and angle can be obtained.
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Affiliation(s)
- Camila Cerda
- Master Program in Dental Science, Dental School, Universidad de La Frontera, Temuco 4780000, Chile
| | - María Florencia Lezcano
- Cybernetics Laboratory, Department of Bioengineering, Facultad de Ingeniería, Universidad Nacional de Entre Ríos, Oro Verde 3100, Argentina
| | - Franco Marinelli
- Research Centre in Dental Sciences (CICO-UFRO), Dental School, Facultad de Odontología, Universidad de La Frontera, Temuco 4780000, Chile
| | - Josefa Alarcón
- Research Centre in Dental Sciences (CICO-UFRO), Dental School, Facultad de Odontología, Universidad de La Frontera, Temuco 4780000, Chile
- Doctoral Program in Morphological Sciences, Faculty of Medicine, Universidad de La Frontera, Temuco 4780000, Chile
| | - Ramón Fuentes
- Research Centre in Dental Sciences (CICO-UFRO), Dental School, Facultad de Odontología, Universidad de La Frontera, Temuco 4780000, Chile
- Department of Integral Adults Dentistry, Dental School, Facultad de Odontología, Universidad de La Frontera, Temuco 4780000, Chile
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Gibertini S, Ruggieri A, Cheli M, Maggi L. Protein Aggregates and Aggrephagy in Myopathies. Int J Mol Sci 2023; 24:ijms24098456. [PMID: 37176163 PMCID: PMC10179229 DOI: 10.3390/ijms24098456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/02/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
A number of muscular disorders are hallmarked by the aggregation of misfolded proteins within muscle fibers. A specialized form of macroautophagy, termed aggrephagy, is designated to remove and degrade protein aggregates. This review aims to summarize what has been studied so far about the direct involvement of aggrephagy and the activation of the key players, among others, p62, NBR1, Alfy, Tollip, Optineurin, TAX1BP1 and CCT2 in muscular diseases. In the first part of the review, we describe the aggrephagy pathway with the involved proteins; then, we illustrate the muscular disorder histologically characterized by protein aggregates, highlighting the role of aggrephagy pathway abnormalities in these muscular disorders.
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Affiliation(s)
- Sara Gibertini
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Alessandra Ruggieri
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Marta Cheli
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
| | - Lorenzo Maggi
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", 20133 Milan, Italy
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Lillback V, Savarese M, Sandholm N, Hackman P, Udd B. Long-term favorable prognosis in late onset dominant distal titinopathy: Tibial muscular dystrophy. Eur J Neurol 2023; 30:1080-1088. [PMID: 36692225 DOI: 10.1111/ene.15688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/15/2022] [Accepted: 10/11/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE Tibial muscular dystrophy (TMD) is a dominant late onset distal titinopathy. It was first described in Finnish patients 3 decades ago. TMD patients with several other TTN mutations occur in many European populations. In this retrospective study, we were able to obtain longitudinal follow-up data of the disease progression over 15 years in 137 TMD patients. METHODS We retrieved clinical data retrospectively from three examinations spanning a period of 15 years. The data were analyzed in R. Frequencies, percentages, and median values were used to describe data. Probability values were determined with the chi-squared test. RESULTS In the cohort, the first symptoms were walking difficulties (97.8%) and weakness in distal lower limbs (98.5%). The progression of the weakness in distal lower limbs was moderate, and in the proximal lower limbs and proximal upper limbs it was mild. The distal upper limbs were not affected. Magnetic resonance imaging results indicated fatty degeneration preferentially in lower leg anterior muscles, gluteus minimus, and hamstring muscles. Serum creatine kinase values in the cohort were mostly normal (40.7%) or mildly elevated (53.7%). The data suggest that 50% of patients need walking aids by the age of 88 years. CONCLUSIONS Despite individual variability of severity, the overall disability due to walking difficulties and upper limb weakness remained moderate even at very advanced ages, and cardiomyopathy did not develop due to the titin defect alone. The acquired results promote the correct identification of TMD, and the obtained trajectories of disease evolution can be used as natural history data for any therapeutic intervention.
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Affiliation(s)
- Victoria Lillback
- Folkhälsan Research Center, Helsinki, Finland
- Medicum, University of Helsinki, Helsinki, Finland
| | - Marco Savarese
- Folkhälsan Research Center, Helsinki, Finland
- Medicum, University of Helsinki, Helsinki, Finland
| | | | - Peter Hackman
- Folkhälsan Research Center, Helsinki, Finland
- Medicum, University of Helsinki, Helsinki, Finland
| | - Bjarne Udd
- Folkhälsan Research Center, Helsinki, Finland
- Tampere Neuromuscular Center, Tampere University Hospital, Tampere, Finland
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Machikhin A, Huang CC, Khokhlov D, Galanova V, Burlakov A. Single-shot Mueller-matrix imaging of zebrafish tissues: In vivo analysis of developmental and pathological features. J Biophotonics 2022; 15:e202200088. [PMID: 35582886 DOI: 10.1002/jbio.202200088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/05/2022] [Accepted: 05/14/2022] [Indexed: 06/15/2023]
Abstract
Zebrafish is a well-established animal model for developmental and disease studies. Its optical transparency at early developmental stages allows in vivo tissues visualization. Interaction of polarized light with these tissues provides information on their structure and properties. This approach is effective for muscle tissue analysis due to its birefringence. To enable real-time Mueller-matrix characterization of unanesthetized fish, we assembled a microscope for single-shot Mueller-matrix imaging. First, we performed a continuous observation of 48 species within the period of 2 to 96 hpf and measured temporal dependencies of the polarization features in different tissues. These measurements show that hatching was accompanied by a sharp change in the angle and degree of linearly polarized light after interaction with muscles. Second, we analyzed nine species with skeletal disorders and demonstrated that the spatial distribution of light depolarization features clearly indicated them. Obtained results demonstrated that real-time Mueller-matrix imaging is a powerful tool for label-free monitoring zebrafish embryos.
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Affiliation(s)
- Alexander Machikhin
- Laboratory of Acousto-optical Spectroscopy, Scientific and Technological Center of Unique Instrumentation, Russian Academy of Sciences, Moscow, Russia
| | - Chih-Chung Huang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Demid Khokhlov
- Laboratory of Acousto-optical Spectroscopy, Scientific and Technological Center of Unique Instrumentation, Russian Academy of Sciences, Moscow, Russia
| | - Victoria Galanova
- Laboratory of Acousto-optical Spectroscopy, Scientific and Technological Center of Unique Instrumentation, Russian Academy of Sciences, Moscow, Russia
- Department of Laser and Opto-Electronic Systems, Bauman Moscow State Technical University, Moscow, Russia
| | - Alexander Burlakov
- Laboratory of Acousto-optical Spectroscopy, Scientific and Technological Center of Unique Instrumentation, Russian Academy of Sciences, Moscow, Russia
- Department of Ichthyology, Faculty of Biology, Lomonosov Moscow State University, Moscow, Russia
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St-Laurent A, Zysman-Colman Z, Zielinski D. Respiratory prehabilitation in pediatric anesthesia in children with muscular and neurologic disease. Paediatr Anaesth 2022; 32:228-236. [PMID: 34865276 DOI: 10.1111/pan.14359] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 01/03/2023]
Abstract
Children with neuromuscular, chronic neurologic, and chest wall diseases are at increased risk of postoperative respiratory complications including atelectasis, pneumonia, and respiratory failure with the possible need for reintubation or even tracheostomy. These complications negatively impact patient outcomes, including increased healthcare resource utilization and increased surgical mortality. In these children, the existing respiratory reserve is often inadequate to withstand the stresses brought on during anesthesia and surgery. A thorough clinical assessment and objective evaluation of pulmonary function and gas exchange can help identify which children are at particular risk for poor postoperative outcomes and thus merit preoperative interventions. These may include initiation and optimization of non-invasive ventilation and mechanical insufflation-exsufflation. Furthermore, such an evaluation will help identify children who may require a postoperative extubation plan tailored to neuromuscular diseases. Such strategies may include avoidance of pre-extubation lung decruitment by precluding continuous positive airway pressure trials, aggressively weaning to room air and directly extubating to non-invasive ventilation with a high inspiratory to expiratory pressure differential of at least 10 cm H20. Children with cerebral palsy and other neurodegenerative or neurodevelopmental disorders are a more heterogeneous group of children who may share some operative risk factors with children with neuromuscular disease; they may also be at risk of sleep-disordered breathing, may also require non-invasive ventilation or mechanical insufflation-exsufflation, and may have associated chronic lung disease from aspirations that may require perioperative treatment.
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Affiliation(s)
- Aaron St-Laurent
- Division of Respirology, Department of Paediatrics, London Health Sciences Centre Children's Hospital, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Zofia Zysman-Colman
- Division of Respiratory Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - David Zielinski
- Division of Respiratory Medicine, Department of Pediatrics, Montreal Children's Hospital, Montreal Children's Hospital Research Institute, McGill University, Montreal, Quebec, Canada
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de Albuquerque AL, Zanzarini Delfiol DJ, Andrade DGA, Albertino LG, Sonne L, Borges AS, Valberg SJ, Finno CJ, Oliveira-Filho JP. Prevalence of the E321G MYH1 variant in Brazilian Quarter Horses. Equine Vet J 2021; 54:952-957. [PMID: 34606642 DOI: 10.1111/evj.13521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/21/2021] [Accepted: 09/30/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND In the Quarter Horse (QH), myosin heavy chain myopathy (MYHM), which is characterised by nonexertional rhabdomyolysis or immune-mediated myositis (IMM) with acute muscle atrophy, is strongly associated with the missense E321G MYH1 mutation. OBJECTIVES To document the existence of MYHM in the Brazilian QH population, this study includes a case report of two related QH foals with the E321G MYH1 mutation that had clinical signs of MYHM, with histological confirmation of IMM in one of the foals. This prompted an investigation the aim of which was to determine the allele frequency of the E321G MYH1 variant across QHs using a DNA archive in Brazil. STUDY DESIGN Cross sectional. METHODS To estimate the allele frequency of the E321G MYH1 variant in Brazilian QHs, 299 DNA samples from QHs used in different disciplines (reining, barrel racing, halter, cutting and racing) were analysed. DNA fragments containing the region with the mutation were amplified by PCR and used for direct genomic sequencing. RESULTS Of the 299 genotyped QHs, 44 animals (14.7%) were heterozygous (My/N) for the E321G MYH1 variant, and 255 (85.3%) were homozygous for the wild-type allele (N/N), implying an allele frequency of 0.074. Reining horses had a significantly higher prevalence of heterozygosity than horses in other disciplines (P = .008). MAIN LIMITATIONS The DNA samples were collected from 2010 to 2014. As only registered QHs were evaluated, the results may not reflect the actual incidence in the general population of Brazilian QHs. CONCLUSIONS The reported cases of MYHM and the high prevalence of the MYH1 mutation found in the assessed Brazilian QH population, particularly in reining QHs, suggests that MYHM should be included in genetic screening. Reasonable control measures are important to prevent an increase in the incidence of MYHM in QHs in Brazil.
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Affiliation(s)
- Ana L de Albuquerque
- Department of Veterinary Clinical Science, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, Brazil
| | | | - Danilo G A Andrade
- Department of Veterinary Clinical Science, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, Brazil
| | - Lukas G Albertino
- Department of Veterinary Clinical Science, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, Brazil
| | - Luciana Sonne
- Sector of Veterinary Pathology, Veterinary Faculty, Federal University of Rio Grande Sul, Porto Alegre, Brazil
| | - Alexandre S Borges
- Department of Veterinary Clinical Science, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, Brazil
| | - Stephanie J Valberg
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Carrie J Finno
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Jose P Oliveira-Filho
- Department of Veterinary Clinical Science, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, Brazil
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Cung S, Ritz ML, Masaracchia MM. Regional anesthesia in pediatric patients with preexisting neurological disease. Paediatr Anaesth 2021; 31:522-530. [PMID: 33590927 DOI: 10.1111/pan.14152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 12/01/2022]
Abstract
Preexisting neurological disease in pediatric patients presents unique challenges to the anesthesiologist. In-depth knowledge of the disease processes and awareness of sequalae that uniquely influence the risks and benefits of anesthetics are needed to make informed decisions. Because these vulnerable populations are often susceptible to perioperative airway or cardiopulmonary complications, the use of regional anesthesia can be advantageous. However, these clinical conditions already involve compromised neural tissue and, as such, create additional concern that regional anesthesia may result in new or worsened deficits. The following discussion is not intended to be a full review of each disease process, but rather provides a concise, yet thorough, discussion of the available literature on regional anesthesia in the more common, but still rare, pediatric neurological disorders. We aim to provide a framework for pediatric anesthesiologists to reengage in a healthy discussion about the risks and benefits of utilizing regional anesthesia in this vulnerable population.
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Affiliation(s)
- Stephanie Cung
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Matthew L Ritz
- Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Melissa M Masaracchia
- University of Colorado School of Medicine, Aurora, CO, USA.,Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
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Foreman M, Cherubini GB. Dexamethasone Can Be Safely and Effectively Used for Treatment of Masticatory Muscle Myositis in Dogs. Top Companion Anim Med 2021; 44:100538. [PMID: 33933701 DOI: 10.1016/j.tcam.2021.100538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 04/07/2021] [Accepted: 04/19/2021] [Indexed: 11/18/2022]
Abstract
Dexamethasone is the glucocorticoid of choice in many human inflammatory and immune-mediated conditions, given its reported effectiveness and limited side effect profile. In veterinary medicine, the glucocorticoid of choice is prednisone, however the safety of longer-term use of dexamethasone has not previously been studied. The aim of this study was to evaluate the safety, effectiveness and side effects of dexamethasone use as the glucocorticoid treatment for masticatory muscle myositis in dogs - an immune-mediated inflammatory condition. 93% of dogs showed a clinical improvement within two weeks of treatment, and 100% by ten weeks. 35% of dogs showed adverse reactions, however these were all mild and resolved with tapering of the dexamethasone dose. In conclusion, dexamethasone can be safely and effectively used for the treatment of masticatory muscle myositis in dogs, and should be considered for use in these cases, either alone or alongside additional immunosuppressive medications. Side effects are mild and resolve with tapering of the dexamethasone dose.
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Affiliation(s)
- Max Foreman
- Department of Neurology and Neurosurgery, Dick White Referrals, Six Mile Bottom, Cambs, UK.
| | - Giunio Bruto Cherubini
- Department of Neurology and Neurosurgery, Dick White Referrals, Six Mile Bottom, Cambs, UK
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Lawal TA, Patankar A, Todd JJ, Razaqyar MS, Chrismer IC, Zhang X, Waite MR, Jain MS, Emile-Backer M, Witherspoon JW, Liu CY, Grunseich C, Meilleur KG. Ryanodine Receptor 1-Related Myopathies: Quantification of Intramuscular Fatty Infiltration from T1-Weighted MRI. J Neuromuscul Dis 2021; 8:657-668. [PMID: 33646171 PMCID: PMC8385519 DOI: 10.3233/jnd-200549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Ryanodine receptor 1-related myopathy (RYR1-RM) can present with a selective pattern and gradient of intramuscular fatty infiltration (IMFI) on magnetic resonance imaging (MRI). Objective: To demonstrate an automated protocol for quantification of IMFI in the lower extremity muscles of individuals with RYR1-RM using T1-weighted MRI and to examine the relationships of IMFI with motor function and clinical severity. Methods: Axial images of the lower extremity muscles were acquired by T1-weighted fast spin-echo and short tau inversion recovery (STIR) sequences. A modified ImageJ-based program was used for quantification. IMFI data was analyzed by mode of inheritance, motor function, and clinical severity. Results: Upper and lower leg IMFI from 36 genetically confirmed and ambulatory RYR1-RM affected individuals (26 dominant and 10 recessive) were analyzed using Grey-scale quantification. There was no statistically significant difference in IMFI between dominant and recessive cases in upper or lower legs. IMFI in both upper and lower legs was inversely correlated with participant performance on the motor function measure (MFM-32) total score (upper leg: p < 0.001; lower leg: p = 0.003) and the six-minute walk test (6MWT) distance (upper leg: p < 0.001; lower leg: p = 0.010). There was no significant difference in mean IMFI between participants with mild versus severe clinical phenotypes (p = 0.257). Conclusion: A modified ImageJ-based algorithm was able to select and quantify fatty infiltration in a cohort of heterogeneously affected individuals with RYR1-RM. IMFI was not predictive of mode of inheritance but showed strong correlation with motor function and capacity tests including MFM-32 and 6MWT, respectively.
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Affiliation(s)
- Tokunbor A Lawal
- Tissue Injury Branch, National Institute of Nursing Research (NIH), Bethesda, MD, USA
| | - Aneesh Patankar
- Neurogenetics Branch, National Institute of Neurological Disorders and Stroke (NIH), Bethesda, MD, USA
| | - Joshua J Todd
- Tissue Injury Branch, National Institute of Nursing Research (NIH), Bethesda, MD, USA
| | - Muslima S Razaqyar
- Tissue Injury Branch, National Institute of Nursing Research (NIH), Bethesda, MD, USA
| | - Irene C Chrismer
- Tissue Injury Branch, National Institute of Nursing Research (NIH), Bethesda, MD, USA
| | - Xuemin Zhang
- Tissue Injury Branch, National Institute of Nursing Research (NIH), Bethesda, MD, USA
| | - Melissa R Waite
- Mark O. Hatfield Clinical Research Center, NIH, Bethesda, MD, USA
| | - Minal S Jain
- Mark O. Hatfield Clinical Research Center, NIH, Bethesda, MD, USA
| | - Magalie Emile-Backer
- Tissue Injury Branch, National Institute of Nursing Research (NIH), Bethesda, MD, USA
| | - Jessica W Witherspoon
- Tissue Injury Branch, National Institute of Nursing Research (NIH), Bethesda, MD, USA
| | - Chia-Ying Liu
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Christopher Grunseich
- Neurogenetics Branch, National Institute of Neurological Disorders and Stroke (NIH), Bethesda, MD, USA
| | - Katherine G Meilleur
- Tissue Injury Branch, National Institute of Nursing Research (NIH), Bethesda, MD, USA
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13
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Abstract
Skeletal muscle is composed of multinucleated, mature muscle cells (myofibers) responsible for contraction, and a resident pool of mononucleated muscle cell precursors (MCPs), that are maintained in a quiescent state in homeostatic conditions. Skeletal muscle is remarkable in its ability to adapt to mechanical constraints, a property referred as muscle plasticity and mediated by both MCPs and myofibers. An emerging body of literature supports the notion that muscle plasticity is critically dependent upon nuclear mechanotransduction, which is transduction of exterior physical forces into the nucleus to generate a biological response. Mechanical loading induces nuclear deformation, changes in the nuclear lamina organization, chromatin condensation state, and cell signaling, which ultimately impacts myogenic cell fate decisions. This review summarizes contemporary insights into the mechanisms underlying nuclear force transmission in MCPs and myofibers. We discuss how the cytoskeleton and nuclear reorganizations during myogenic differentiation may affect force transmission and nuclear mechanotransduction. We also discuss how to apply these findings in the context of muscular disorders. Finally, we highlight current gaps in knowledge and opportunities for further research in the field.
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Affiliation(s)
- Saline Jabre
- Sorbonne Université, INSERM UMRS-974 and Institut de Myologie, 75013 Paris, France;
- Department of Biology, Faculty of Arts and Sciences, Holy Spirit University of Kasik (USEK), Jounieh 446, Lebanon;
| | - Walid Hleihel
- Department of Biology, Faculty of Arts and Sciences, Holy Spirit University of Kasik (USEK), Jounieh 446, Lebanon;
- Department of Basic Health Sciences, Faculty of Medicine, Holy Spirit University of Kaslik (USEK), Jounieh 446, Lebanon
| | - Catherine Coirault
- Sorbonne Université, INSERM UMRS-974 and Institut de Myologie, 75013 Paris, France;
- Correspondence:
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Brollier LD, Matuszczak M, Marri T, Carbajal JG, Moorman AT, Sorial EM, Jain R. Anesthetic management of pediatric patients undergoing intrathecal nusinersen administration for treatment of spinal muscular atrophy: A single-center experience. Paediatr Anaesth 2021; 31:160-166. [PMID: 32623818 DOI: 10.1111/pan.13964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/25/2020] [Accepted: 06/27/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Spinal muscular atrophy is a group of autosomal recessive inherited neurological disorders secondary to a genetic mutation that leads to progressive muscle weakness and atrophy. Recently approved by the Food and Drug Administration, Nusinersen is the first treatment specifically for spinal muscular atrophy. This drug must be administered intrathecally, as it does not cross the blood-brain barrier. AIMS Retrospective review of the individualized perioperative care of spinal muscular atrophy type I and II patients for intrathecal Nusinersen injection. METHODS After approval from the Institutional Review Board and obtaining informed written consent from parents, we reviewed the anesthetic charts of nine patients who underwent 58 Nusinersen injections over a 23-month period from February 2017 to December 2018. An individualized anesthetic plan was formulated based on the patient's disease severity, anxiety level, and comfort of parents as well as the provider performing the procedure. Patients underwent intrathecal Nusinersen injection under fluoroscopic guidance, with either general anesthesia, monitored anesthesia care with medications or monitored anesthesia care without medications. Patients recovered in the postanesthesia care unit for a minimum of 1 hour after injection, irrespective of the anesthetic method utilized. Analysis included patient demographics, anesthesia type relative to spinal muscular atrophy type I vs. II, and postanesthesia recovery. RESULTS Nine patients with spinal muscular atrophy types I and II underwent 58 encounters. Five spinal muscular atrophy type I patients underwent 31 encounters, general anesthesia (9), monitored anesthesia care with medications (2), and monitored anesthesia care without medications (20). Four spinal muscular atrophy type II patients underwent 27 encounters, general anesthesia (22), monitored anesthesia care with medications (2), and monitored anesthesia care without medications (3). There were no perioperative complications. CONCLUSION The anesthetic plan for Nusinersen injections must be individualized to the patient's specific needs and clinical manifestations of the disease. When carefully tailored to each patient, anesthetic care is safe and successful.
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Affiliation(s)
| | - Maria Matuszczak
- Department of Anesthesia, McGovern Medical School, Houston, TX, USA
| | - Tejaswi Marri
- Department of Anesthesia, McGovern Medical School, Houston, TX, USA
| | - Jael G Carbajal
- Department of Anesthesia, McGovern Medical School, Houston, TX, USA
| | - Andrew T Moorman
- Department of Anesthesia, McGovern Medical School, Houston, TX, USA
| | - Emad M Sorial
- Department of Anesthesia, McGovern Medical School, Houston, TX, USA
| | - Ranu Jain
- Department of Anesthesia, McGovern Medical School, Houston, TX, USA
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15
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Sztretye M, Szabó L, Dobrosi N, Fodor J, Szentesi P, Almássy J, Magyar ZÉ, Dienes B, Csernoch L. From Mice to Humans: An Overview of the Potentials and Limitations of Current Transgenic Mouse Models of Major Muscular Dystrophies and Congenital Myopathies. Int J Mol Sci 2020; 21:ijms21238935. [PMID: 33255644 PMCID: PMC7728138 DOI: 10.3390/ijms21238935] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 12/24/2022] Open
Abstract
Muscular dystrophies are a group of more than 160 different human neuromuscular disorders characterized by a progressive deterioration of muscle mass and strength. The causes, symptoms, age of onset, severity, and progression vary depending on the exact time point of diagnosis and the entity. Congenital myopathies are rare muscle diseases mostly present at birth that result from genetic defects. There are no known cures for congenital myopathies; however, recent advances in gene therapy are promising tools in providing treatment. This review gives an overview of the mouse models used to investigate the most common muscular dystrophies and congenital myopathies with emphasis on their potentials and limitations in respect to human applications.
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16
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Alshouibi EN, Almansour LA, Alqurashi AM, Alaqil FE. The Effect of Number of Patients Treated, Dental Loupes Usage, Stress, and Exercise on Musculoskeletal Pain among Dentists in Jeddah. J Int Soc Prev Community Dent 2020; 10:336-340. [PMID: 32802781 PMCID: PMC7402259 DOI: 10.4103/jispcd.jispcd_2_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/23/2020] [Accepted: 03/04/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives: The aim of this study was to investigate the prevalence of musculoskeletal pain (MSP) and to explore its potential risk factors among dentists in Jeddah, Saudi Arabia. Materials and Methods: A cross-sectional survey of private and government dentists in Jeddah, Saudi Arabia was undertaken between January and December 2018. A self-administered questionnaire was distributed randomly to consenting participants. Descriptive data analysis involved measures of central tendency and percentages, t test, chi-square, and logistic regression analysis were used to evaluate relationships among the variable “having MSP experience after dental work” and other potential predictors among dentists. Results: A total of 300 dentists completed the questionnaires. The overall prevalence of MSP was 68%, with back pain as the most frequently reported symptom (54%). The results revealed significant association of MSP with number of patients treated per day, nonuse of dental loupes during dental work, stress, and lack of regular exercise (P < 0.05). Conclusion: The prevalence of MSP among dentists in Jeddah is high attributable to poor ergonomics and stress, which further impact the quality of life of practitioners.
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Affiliation(s)
- Ehab N Alshouibi
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Lolo A Almansour
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Faten E Alaqil
- Department of Restorative Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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17
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Votion DM, Habyarimana JA, Scippo ML, Richard EA, Marcillaud-Pitel C, Erpicum M, Gustin P. Potential new sources of hypoglycin A poisoning for equids kept at pasture in spring: a field pilot study. Vet Rec 2019; 184:740. [PMID: 31048500 DOI: 10.1136/vr.104424] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 11/20/2018] [Accepted: 03/25/2019] [Indexed: 11/04/2022]
Abstract
Equine atypical myopathy in Europe results from hypoglycin A (HGA) exposure through the ingestion of samaras or seedlings of the sycamore maple tree. This pilot study aimed at better defining sources of HGA intoxication in spring. Samaras fallen on the ground and then seedlings were collected at two-week intervals from sycamore, Norway, and field maple trees over the spring 2016. In early April, rainwater from wet seedlings collected after a rainy night was harvested to be analysed. Mid-May, samaras of the box elder, common ash, and inflorescences of sycamore maples were collected on the tree. Quantification of HGA in samples was performed using high performance thin layer chromatography. Hypoglycin A was detected in all samples from sycamore including rainwater but tested negative for Norway, field maples. The samaras of the box elder found in the present study area did not contain a seed within their husk and thus tested negative. From the maximum HGA concentrations found, it may be extrapolated that at some periods and locations, about 20 g of samaras, 50 seedlings, 150 g of inforescences or 2 liters of water that has been in contact with seedlings would contain the maximum tolerated dose per day for a horse.
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Affiliation(s)
- Dominique M Votion
- Equine Pole, Fundamental and Applied Research for Animals & Health (FARAH), University of Liege, Faculty of veterinary Medicine, Liege, Belgium
| | - Jean Adelite Habyarimana
- Department of Functional Sciences, Fundamental and Applied Research for Animals & Health (FARAH), University of Liege, Faculty of veterinary Medicine, Liege, Belgium
| | - Marie-Louise Scippo
- Department of Food Sciences, Laboratory of Food Analysis, Fundamental and Applied Research for Animals & Health (FARAH), University of Liege, Faculty of veterinary Medicine, Liege, Belgium
| | - Eric A Richard
- Animal Health Department, Frank Duncombe Laboratory, Caen, France
| | | | - Michel Erpicum
- Department of Geography, University of Liege, Liege, Belgium
| | - Pascal Gustin
- Department of Functional Sciences, Fundamental and Applied Research for Animals & Health (FARAH), University of Liege, Faculty of veterinary Medicine, Liege, Belgium
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18
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Bielsky AR, Fuhr PG, Parsons JA, Yaster M. A retrospective cohort study of children with spinal muscular atrophy type 2 receiving anesthesia for intrathecal administration of nusinersen. Paediatr Anaesth 2018; 28:1105-1108. [PMID: 30284761 DOI: 10.1111/pan.13500] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 08/22/2018] [Accepted: 08/27/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Spinal muscular atrophy is characterized by loss of motor neurons in the anterior horn of the spinal cord with resultant proximal muscle weakness. Intrathecal nusinersen has revolutionized the treatment of spinal muscular atrophy. We reviewed the perioperative care of 61 anesthetics performed on eight patients with spinal muscular atrophy type 2 who received nusinersen over 30 months in conjunction with nusinersen's phase 3 clinical trials. METHODS Anesthesia was induced in all patients with sevoflurane, nitrous oxide, and oxygen (30%) via facemask. A peripheral intravenous line was placed after the loss of consciousness in all but three procedures. General anesthesia was maintained in 58 anesthetics with a propofol infusion at 250-300 μg/kg/min, while the remainder was maintained with inhalational anesthetics. The airway was managed via facemask or nasal cannula in all but two procedures, in whom a laryngeal mask airway was placed. We analyzed patient demographics, duration of anesthesia and of postanesthesia care unit stay, discharge destination, preprocedure oxygen saturation (SaO2 ), postanesthesia care unit discharge oxygen saturation, and occurrence of unanticipated admission or postdischarge hospitalization. RESULTS Eight American Society of Anesthesiologists physical status three patients (3 male: 5 female) with a median age of 4.1 (2.1-7.8) years and median weight of 13.2 (10-24.7) kg, underwent 61 anesthetics for nusinersen administration or sham procedure. There were no intraoperative anesthetic complications of unanticipated cardiovascular instability, major neurologic events, respiratory failure, or death. Anesthesiologists performed 83% of the procedures. CONCLUSION Nusinersen has revolutionized the care of patients with spinal muscular atrophy type 2 and anesthesiologists will be involved in its administration. We found that routine anesthetic care was safe and effective.
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Affiliation(s)
- Alan R Bielsky
- Departments of Anesthesiology and Neurology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Peter G Fuhr
- Departments of Anesthesiology and Neurology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Julie A Parsons
- Departments of Anesthesiology and Neurology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Myron Yaster
- Departments of Anesthesiology and Neurology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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Saffarian P, Fooladi AAI. Topical Botulinum Toxin: A Non-invasive Way for Treatment of Muscle Disorders. Curr Drug Deliv 2018; 15:1375-1380. [PMID: 30058489 DOI: 10.2174/1567201815666180730140704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/21/2018] [Accepted: 07/14/2018] [Indexed: 11/22/2022]
Abstract
Botulinum neurotoxin type A (BoNT/A) is a toxin that inhibits the release of stimulatory neurotransmitter (acetylcholine) at the neuromuscular synapses. In recent years, many patients with muscle contraction disorders have greatly benefited from the therapeutic ability of this biological drug. On the other hand, the injection of this bio drug is accompanied by some side effects such as irritation, bruising, inflammation, pain, bleeding at the site of injection. Recently, a tendency has been observed among scientists to create new techniques to offer conventional injectable drugs the ability of transdermal delivery. Such promising drugs can be applied in various forms from gel, cream, and ointments to ready-to-use pads. This would eliminate a need for high drug doses to release the drug gradually at the site of application while at the same time, lower the side effects. Here, we discuss the possibility of noninvasive administration of BoNT/A in order to reduce the side effects of drug injection.
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Affiliation(s)
- Parvaneh Saffarian
- Department of Biology, School of Basic Sciences, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Abbas Ali Imani Fooladi
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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20
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Bosman L, Hoeks SE, González Candel A, van den Hout HJM, van der Ploeg AT, Staals LM. Perioperative management of children with glycogen storage disease type II-Pompe disease. Paediatr Anaesth 2018; 28:428-435. [PMID: 29575534 DOI: 10.1111/pan.13361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pompe disease is a rare metabolic disorder caused by a deficiency of the lysosomal enzyme acid α-glucosidase. Glycogen accumulation damages skeletal, cardiac, and smooth muscles, causing a progressive and debilitating muscle weakness and cardiomyopathy. As life expectancy has much improved since the introduction of enzyme replacement therapy an increasing number of patients are referred for surgical procedures. Due to the potential cardiopulmonary complications, these patients form a high-risk group for the anesthesiologist. AIMS In this study, we investigated the incidence of perioperative complications in children with Pompe disease treated in our hospital since the introduction of enzyme replacement therapy. METHODS Anesthetic and perioperative data of children with Pompe disease treated between 1999 and 2015 in the Erasmus MC-Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands, were collected, retrospectively. RESULTS Of the 65 children with Pompe disease, 34 patients underwent in total 77, mostly low-risk, surgical procedures. Twenty-one children had the classic infantile form and 13 had a nonclassic presentation of Pompe disease. In 13 (16.8%) procedures, 1 or more perioperative complications occurred. Perioperative desaturation was the main complication (12.9%), followed by arrhythmia (3.8%) and heart failure requiring diuretic treatment (2.6%). One child died 2 days postoperatively, but this was considered unrelated to the procedure. CONCLUSION Despite the potentially high anesthetic risk for children with Pompe disease under enzyme replacement therapy, the incidence of perioperative complications in our study was relatively low. Our data suggest that with proper precautionary measures and a critical choice of timing of the operation, general anesthesia in children with Pompe disease could be relatively safe nowadays.
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Affiliation(s)
- Linelot Bosman
- Department of Anesthesiology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Sanne E Hoeks
- Department of Anesthesiology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Antonia González Candel
- Department of Anesthesiology, Erasmus MC-Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands
| | - Hannerieke J M van den Hout
- Division of Metabolic Diseases and Genetics, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands
| | - Ans T van der Ploeg
- Division of Metabolic Diseases and Genetics, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands
| | - Lonneke M Staals
- Department of Anesthesiology, Erasmus MC-Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands
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21
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Shiga T, Uchida K, Chambers JK, Nakayama H. Immunohistochemical analysis of canine and feline muscle disorders using formalin-fixed, paraffin-embedded tissues. J Vet Diagn Invest 2017; 29:805-813. [PMID: 28599613 DOI: 10.1177/1040638717715287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Histochemical techniques used in examination of muscle biopsies typically require frozen sections. Given that most of the specimens submitted to a veterinary laboratory for diagnosis are formalin-fixed, the choice of staining methods is limited. We aimed to further advance the diagnostic capabilities of pathologists presented with formalin-fixed muscle samples and to describe the differences in immunohistopathologic findings between neurogenic and myogenic muscle disorders. Based on hematoxylin and eosin staining, we defined in dogs the histologic lesions in 4 neurogenic disorders (degenerative myelopathy and polyneuropathy) and 2 myogenic disorders (dystrophin-deficient muscular dystrophy). In cats, we defined the lesions in 2 neurogenic disorders (lymphoma of nerve roots and spinal cords) and 1 myogenic disorder (laminin α2-deficient muscular dystrophy). Immunohistochemistry for slow and fast myosins revealed angular and group atrophy of type 1 and type 2 fibers in dogs and cats, and fiber type grouping in dogs. These immunohistopathologic findings were specific to neurogenic muscle disorders. Immunohistochemistry for nestin and myogenin revealed nestin-positive fibers and myogenin-positive nuclei in dogs and cats. They were not specific, but these fibers in myogenic disorders can be interpreted as regenerating fibers. The immunohistochemical method described herein appears to be useful for discriminating neurogenic and myogenic disorders in formalin-fixed, paraffin-embedded muscle tissue of dogs and cats.
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Affiliation(s)
- Takanori Shiga
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, the University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kazuyuki Uchida
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, the University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - James K Chambers
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, the University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Nakayama
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, the University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Abstract
BACKGROUND The nondystrophic skeletal muscle channelopathies are a group of disorders caused by mutations of various voltage-gated ion channel genes, including nondystrophic myotonia and periodic paralysis. METHODS We identified patients with a diagnosis of muscle channelopathy from our neuromuscular database in a tertiary care pediatric center from 2005 to 2015. We then performed a retrospective review of their medical records for demographic characteristics, clinical features, investigations, treatment, and follow-up. RESULTS Thirty-three patients were identified. Seventeen had nondystrophic myotonia. Seven of them had chloride channelopathy (four Becker disease and three Thomsen disease). Warm-up phenomenon and muscle hypertrophy were common clinical manifestations in this subgroup. Ten patients had sodium channelopathy (four paramyotonia congenita and six other sodium channel myotonia). Stiffness of the facial muscles was an important presenting symptom, and eyelid myotonia was a common clinical finding in this subgroup. The majority of these patients had electrical myotonia. Mexiletine was effective in controlling the symptoms in patients who had received treatment. Sixteen children had periodic paralysis (four hyperkalemic periodic paralysis, eight hypokalemic periodic paralysis, and four Andersen-Tawil syndrome). Acetazolamide was commonly used to prevent paralytic attacks and was found to be effective. CONCLUSIONS Nondystrophic muscle channelopathies present with diverse clinical manifestations (myotonia, muscle hypertrophy, proximal weakness, swallowing difficulties, and periodic paralysis). Cardiac arrhythmias are potentially life threatening in Andersen-Tawil syndrome. Timely identification of these disorders is helpful for effective symptomatic management and genetic counseling.
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Affiliation(s)
- Fouad Al-Ghamdi
- Department of Neurology, Boston Children's Hospital, Boston, MA
| | - Basil T Darras
- Department of Neurology, Boston Children's Hospital, Boston, MA
| | - Partha S Ghosh
- Department of Neurology, Boston Children's Hospital, Boston, MA.
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23
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Abstract
Anesthesia-induced rhabdomyolysis and malignant hyperthermia occur in response to the same agents and present with similar clinical features. Distinguishing between these diagnoses can be challenging in a clinical crisis yet making the distinction is critical as prompt appropriate management may be life-saving, whereas delayed recognition and/or inappropriate management will almost certainly result in death. This focused review examines the differences between these conditions and focuses on the emergency management of anesthesia-induced rhabdomyolysis.
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Affiliation(s)
- Rebecca M Gray
- Division of Paediatric Anaesthesia, Department of Anaesthesia and PeriOperative Medicine, University of Cape Town, Cape Town, South Africa
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Devi MG, Sharma A, Mohanty S, Jain N, Verma K, Padma MV, Pal P, Chabbra HS, Khadilkar S, Prabhakar S, Singh G. Report: Stem cell applications in neurological practice, an expert group consensus appraisal. Ann Indian Acad Neurol 2016; 19:367-73. [PMID: 27570390 PMCID: PMC4980961 DOI: 10.4103/0972-2327.186825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Introduction: Neurologists in their clinical practice are faced with inquiries about the suitability of stem cell approaches by patients with a variety of acute and chronic (namely neurodegenerative) disorders. The challenge is to provide these patients with accurate information about the scope of stem cell use as well as at the same time, empowering patients with the capacity to make an autonomous decision regarding the use of stem cells. Methods: The Indian Academy of Neurology commissioned an Expert Group Meeting to formulate an advisory to practicing neurologists to counsel patients seeking information and advice about stem cell approaches. Results and Conclusions: In the course of such counselling, it should be emphasized that the information provided by many lay websites might be unsubstantiated. Besides, standard recommendations for the stem cell research, in particular, the application of several layers of oversight should be strictly adhered in order to ensure safety and ethical use of stem cells in neurological disorders.
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Affiliation(s)
- M Gourie Devi
- Department of Neurology, Institute of Human Behavior and Allied Sciences, New Delhi, India
| | - Alka Sharma
- Department of Biotechnology, Government of India, New Delhi, India
| | - Sujata Mohanty
- Stem Cell Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Neeraj Jain
- National Brain Research Institute, Gurgaon, Haryana, India
| | - Kusum Verma
- Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India
| | - M Vasantha Padma
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Pramod Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - H S Chabbra
- Indian Spinal Injuries Center, New Delhi, India
| | - Satish Khadilkar
- Department of Neurology, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Sudesh Prabhakar
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gagandeep Singh
- Department of Neurology, Dayanand Medical College, Ludhiana, Punjab, India
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25
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Abstract
We retrospectively reviewed 2030 childhood electromyograms performed over an 11-year period (2004-2014). Twenty children (1%) with myotonic discharges were identified and placed into 2 groups. Group A (electrical and clinical myotonia) comprised 9 children (8 with myotonia congenita and 1 with paramyotonia congenita); all of them had diffuse myotonic discharges without clinical weakness or elevated creatine kinase. Group B (electrical myotonia without clinical myotonia) comprised 11 children (4 with inflammatory myopathy; 3, congenital myopathy, 3, muscular dystrophy; and 1, congenital muscular dystrophy). Clinical weakness was demonstrated in all of them and elevated creatine kinase in 6; all had a myopathic electromyogram and scattered myotonic discharges. We conclude that myotonic discharges are a rare but characteristic spontaneous discharge identified during electrodiagnostic studies in children. The presence of electrical and clinical myotonia provides helpful clues to differentiate between various muscle disorders in children.
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Affiliation(s)
- Partha S Ghosh
- Department of Neurology, Mayo Clinic, Rochester, MN, USA Department of Neurology, Boston Children's Hospital, Boston, MA, USA
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26
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Graham CD, Simmons Z, Stuart SR, Rose MR. The potential of psychological interventions to improve quality of life and mood in muscle disorders. Muscle Nerve 2015; 52:131-6. [PMID: 25297932 DOI: 10.1002/mus.24487] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2014] [Indexed: 12/22/2022]
Abstract
Quality of life (QoL) and mood are reduced in many patients with muscle disorders. Psychological variables appear to be contributors to both QoL and mood, suggesting that psychological interventions could improve these outcomes, yet research in this area is sparse. We review the roles of psychological variables, plus context and disease severity, in explaining QoL. A cognitive-behavioral model of disease self-management, with acceptance as the central component, is discussed. This model is then used to describe how psychological interventions derived from cognitive behavioral therapy (CBT), in particular Acceptance and Commitment Therapy (ACT), might be applied to address the issues of distress, nonadherence to treatments, pain, and fatigue in people with muscle disorders.
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Affiliation(s)
- Christopher D Graham
- NHS Lothian, Department of Clinical Neuropsychology, Astley Ainslie Hospital, Edinburgh, United Kingdom, EH9 2HL.,Department of Clinical Psychology, School of Health in Social Sciences, University of Edinburgh, Teviot Place, Edinburgh, United Kingdom
| | - Zachary Simmons
- Department of Neurology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Simon R Stuart
- Department of Clinical Psychology, School of Health in Social Sciences, University of Edinburgh, Teviot Place, Edinburgh, United Kingdom
| | - Michael R Rose
- Department of Neurology, King's College Hospital, London, United Kingdom
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27
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Fidan F, Alkan B, Uğurlu G, Boyraz E, Tosun A, Ardıçoğlu Ö, Akkuş S. Spinning-induced rhabdomyolysis: A case report and review of literature. Eur J Rheumatol 2015; 2:37-38. [PMID: 27708920 DOI: 10.5152/eurjrheumatol.2014.14054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 08/01/2014] [Indexed: 11/22/2022] Open
Abstract
Rhabdomyolysis is a condition of skeletal muscle breakdown in which muscle injury causes a release of myoglobin and the muscle enzymes creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and transaminases. Exertional rhabdomyolysis, which is precipitated by exercise or exertion, ranges from mild muscle injury with negligible symptoms or systemic effects to fulminant cases. Herein, we report a 26-year-old female patient who was admitted to our Physical Medicine and Rehabilitation outpatient clinics with severe bilateral thigh pain persisting for 5 days after participating in a spinning class and diagnosed with exertional rhabdomyolysis. Timely diagnosis and treatment prevented the potentially life-threatening consequences. We assume that it is essential to raise the awareness of this phenomenon not only by physicians but also by the community, since regular exercise and being physically active are increasingly encouraged in modern life.
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Affiliation(s)
- Fatma Fidan
- Clinic of Physical Medicine and Rehabilitation, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Berat Alkan
- Clinic of Physical Medicine and Rehabilitation, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Gülçin Uğurlu
- Clinic of Physical Medicine and Rehabilitation, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Elif Boyraz
- Clinic of Physical Medicine and Rehabilitation, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Aliye Tosun
- Clinic of Physical Medicine and Rehabilitation, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Özge Ardıçoğlu
- Clinic of Physical Medicine and Rehabilitation, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Selami Akkuş
- Clinic of Physical Medicine and Rehabilitation, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
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28
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Witting N, Mensah A, Køber L, Bundgaard H, Petri H, Duno M, Milea D, Vissing J. Ocular, bulbar, limb, and cardiopulmonary involvement in oculopharyngeal muscular dystrophy. Acta Neurol Scand 2014; 130:125-30. [PMID: 24611576 DOI: 10.1111/ane.12244] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess skeletal muscle weakness and progression as well as the cardiopulmonary involvement in oculopharyngeal muscular dystrophy (OPMD). MATERIALS AND METHODS Cross-sectional study including symptomatic patients with genetically confirmed OPMD. Patients were assessed by medical history, ptosis, ophthalmoplegia, facial and limb strength, and swallowing capability. Cardiopulmonary function was evaluated using forced expiratory capacity in 1 s (FEV1), electrocardiogram (ECG), Holter monitoring, and echocardiography. RESULTS We included 13 symptomatic patients (six males, mean age; 64 years (41-80) from 8 families. Ptosis was the first symptom in 8/13 patients followed by limb weakness in the remaining 5 patients Dysphagia was never the presenting symptom. At the time of examination, all affected patients had ptosis or had previously been operated for ptosis, while ophthalmoplegia was found in 9 patients. Dysphagia, tested by cold-water swallowing test, was abnormal in 9 patients (17-116 s, ref <8 s). Six patients could not climb stairs of whom two were wheelchair bound and one used a rollator. Six patients had reduced FEV1 (range 23%-59%). No cardiac involvement was identified. CONCLUSIONS Limiting limb weakness is common in OPMD and can even be the presenting symptom of the disease. In contrast, dysphagia was not the initial symptom in any of our patients, although it was obligatory for diagnosing OPMD before genetic testing became available. Mild respiratory dysfunction, but no cardiac involvement, was detected.
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Affiliation(s)
- N. Witting
- Department of Neurology and Neuromuscular Research Unit; University of Copenhagen; Rigshospitalet; Copenhagen Denmark
| | - A. Mensah
- Department of Ophthalmology; Glostrup Hospital; Glostrup Denmark
| | - L. Køber
- Department of Cardiology; The Heart Centre; University of Copenhagen; Rigshospitalet; Copenhagen Denmark
| | - H. Bundgaard
- Department of Cardiology; The Heart Centre; University of Copenhagen; Rigshospitalet; Copenhagen Denmark
| | - H. Petri
- Department of Cardiology; The Heart Centre; University of Copenhagen; Rigshospitalet; Copenhagen Denmark
| | - M. Duno
- Clinical Genetics; University of Copenhagen; Rigshospitalet; Copenhagen Denmark
| | - D. Milea
- Department of Ophthalmology; Glostrup Hospital; Glostrup Denmark
- Singapore National Eye Centre; Singapore Eye Research Institute and Duke-NUS; Singapore City Singapore
| | - J. Vissing
- Department of Neurology and Neuromuscular Research Unit; University of Copenhagen; Rigshospitalet; Copenhagen Denmark
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29
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Abstract
Mitochondrial disease, once thought to be a rare clinical entity, is now recognized as an important cause of a wide range of neurologic, cardiac, muscle, and endocrine disorders . The incidence of disorders of the respiratory chain alone is estimated to be about 1 per 4-5000 live births, similar to that of more well-known neurologic diseases . High-energy requiring tissues are uniquely dependent on the energy delivered by mitochondria and therefore have the lowest threshold for displaying symptoms of mitochondrial disease. Thus, mitochondrial dysfunction most commonly affects function of the central nervous system, the heart and the muscular system . Mutations in mitochondrial proteins cause striking clinical features in those tissues types, including encephalopathies, seizures, cerebellar ataxias, cardiomyopathies, myopathies, as well as gastrointestinal and hepatic disease. Our knowledge of the contribution of mitochondria in causing disease or influencing aging is expanding rapidly . As diagnosis and treatment improve for children with mitochondrial diseases, it has become increasingly common for them to undergo surgeries for their long-term care. In addition, often a muscle biopsy or other tests needing anesthesia are required for diagnosis. Mitochondrial disease represents probably hundreds of different defects, both genetic and environmental in origin, and is thus difficult to characterize. The specter of possible delayed complications in patients caused by inhibition of metabolism by anesthetics, by remaining in a biochemically stressed state such as fasting/catabolism, or by prolonged exposure to pain is a constant worry to physicians caring for these patients. Here, we review the considerations when caring for a patient with mitochondrial disease.
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Affiliation(s)
- Julie Niezgoda
- Department of Pediatric Anesthesiology, Cleveland Clinic, Cleveland, USA
| | - Phil G Morgan
- Department of Anesthesiology and Pain Medicine, University of Washington and Seattle Children’s Hospital, Seattle, USA
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30
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Abstract
Patients with neuromuscular disorders undergoing general anesthesia present a special set of respiratory problems for perioperative management. While there are disease-specific concerns, there are many common themes in the respiratory management of patients with neuromuscular disorders. These problems are discussed in this review. Such common perioperative concerns include upper airway obstruction, chest wall restriction, postoperative hypoventilation, inadequate airway clearance, and chronic lower airway disease. Each of these challenges has an effective management approach, and careful planning can help avoid perioperative respiratory complications.
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Affiliation(s)
- Joshua A Blatter
- Division of Pulmonary Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
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31
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Abstract
We describe a young woman with a group C streptococcal throat infection complicated by rhabdomyolysis. Muscle biopsy from quadriceps was normal, and molecular studies showed no evidence of direct microbial invasion. This is only the second case in which the usually benign group C streptococcus has been linked with muscle destruction.
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Affiliation(s)
| | | | - Laurence A Bindoff
- Institute of Clinical Medicine, University of Bergen, Norway; ; Department of Neurology, Haukeland University Hospital, Bergen, Norway
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32
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Rana SS, Schramke CJ, Sangha A, Karpinski AC. Comparison of psychosocial factors between patients with benign fasciculations and those with amyotrophic lateral sclerosis. Ann Indian Acad Neurol 2010; 12:108-10. [PMID: 20142856 PMCID: PMC2812734 DOI: 10.4103/0972-2327.53079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Revised: 09/22/2008] [Accepted: 03/01/2009] [Indexed: 11/04/2022] Open
Abstract
In this retrospective study, we compared the initial presentation of patients who were eventually diagnosed with either benign fasciculations (BF) or amyotrophic lateral sclerosis (ALS). We found a significantly higher number of patients with BF reporting a past history of psychiatric symptoms, life stressors, and concurrent psychosomatic symptoms. There was no difference between the two groups in patient report of current anxiety or depression symptoms. These findings support our hypothesis that BF are a manifestation of psychological distress due to somatization and that reviewing psychosocial history is important when patients are being evaluated for fasciculations. Patients seeking medical attention for fasciculations and who do not report a history of underlying psychiatric or psychosomatic disorders should be followed closely as fasciculations have been reported to be a presenting feature of ALS.
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Affiliation(s)
- Sandeep S Rana
- Department of Neurology, Allegheny General Hospital, Pittsburgh; Philadelphia, PA, The Ohio State University, Columbus, OH, USA
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