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Özenç B, Işık K, Odabaşı Z. Isolated Bilateral Triceps Weakness in Myasthenia Gravis. Acta Neurol Taiwan 2024; 33(2):73-75. [PMID: 37848221] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
PURPOSE Myasthenia gravis (MG) is the most common autoimmune disease that affects the neuromuscular junction and can cause weakness in various muscle groups. The most commonly affected muscles are the eye, facial, and neck flexors. Focal or dominant weakness of the triceps muscle is rare. In this case, we aimed to describe a rare form of MG consisting of selective or dominant triceps muscle weakness. CASE REPORT We present a 45-year-old male patient whose initial complaints were diplopia and ptosis. Acetylcholine receptor antibody was positive. After 10 years of well-being following thymectomy, bilateral triceps weakness was added to his ocular symptoms despite regular medication (pyridostigmine and prednisone). Repetitive nerve stimulation (RNS) showed decremental responses in the right triceps muscles. CONCLUSION It is important to recognize this type of myasthenia gravis to facilitate diagnosis and appropriate treatment and to avoid unnecessary investigations and treatments.
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Affiliation(s)
- Betül Özenç
- Neurology Department, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Kübra Işık
- Neurology Department, Şanlıurfa Suruç State Hospital
| | - Zeki Odabaşı
- Neurology Department, Gülhane Medical School, Ankara, Turkey
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Mustafa B, Yousaf Q, Aslam A, Farooq M, Ashraf A, Ehsan M, Zahid A, Athar F. Rarest of the rare: a case of pharyngeal-cervical-brachial variant of Guillain-Barré syndrome presenting with a demyelinating neuropathy. Int J Neurosci 2024; 134:53-55. [PMID: 35658783 DOI: 10.1080/00207454.2022.2084090] [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: 02/09/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is a heterogeneous disease characterized by rapidly progressive, symmetrical limb weakness with hyporeflexia or areflexia. The rare pharyngeal-cervical-brachial (PCB) variant of GBS occurs in 3% of patients, presenting as rapidly progressive oropharyngeal and cervicobrachial weakness characterised by axonal, rather than a demyelinating neuropathy on nerve conduction studies. CASE DESCRIPTION A 35 year old male presented with a 5-day history of dysphagia, dysarthria, slurred speech and upper limb weakness. Physical examination showed bilateral facial nerve weakness and an impaired gag reflex. Nerve conduction study was suggestive of sensory and motor polyneuropathy of predominantly demyelinating variety. As the condition of the patient worsened, respiratory support was required and plasmapharesis was started. There was significant improvement in his condition after completion of 5 sessions of plasmapharesis. CONCLUSION The rare PCB variant may present with a predominantly demyelinating neuropathy. Early clinical recognition of this variant and prompt treatment with plasmapharesis is essential for preventing respiratory complications.
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Affiliation(s)
- Biah Mustafa
- Department of Neurology, King Edward Medical University, Lahore, Pakistan
| | - Qudsum Yousaf
- Department of Neurology, Central Park Teaching Hospital, Lahore, Pakistan
| | - Ayesha Aslam
- Department of Neurology, King Edward Medical University, Lahore, Pakistan
| | - Minaam Farooq
- Department of Neurology, King Edward Medical University, Lahore, Pakistan
| | - Arfa Ashraf
- Department of Neurology, CMH LMC & IOD, Lahore, Pakistan
| | - Muhammad Ehsan
- Department of Neurology, King Edward Medical University, Lahore, Pakistan
| | - Afra Zahid
- Department of Neurology, King Edward Medical University, Lahore, Pakistan
| | - Farwa Athar
- Department of Neurology, King Edward Medical University, Lahore, Pakistan
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3
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Walford SL, Rankin JW, Mulroy SJ, Neptune RR. Differences in Glenohumeral Joint Contact Forces Between Recovery Hand Patterns During Wheelchair Propulsion With and Without Shoulder Muscle Weakness: A Simulation Study. J Biomech Eng 2024; 146:041005. [PMID: 38270963 PMCID: PMC10983712 DOI: 10.1115/1.4064590] [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: 05/08/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
The majority of manual wheelchair users (MWCU) develop shoulder pain or injuries, which is often caused by impingement. Because propulsion mechanics are influenced by the recovery hand pattern used, the pattern may affect shoulder loading and susceptibility to injury. Shoulder muscle weakness is also correlated with shoulder pain, but how shoulder loading changes with specific muscle group weakness is unknown. Musculoskeletal modeling and simulation were used to compare glenohumeral joint contact forces (GJCFs) across hand patterns and determine how GJCFs vary when primary shoulder muscle groups are weakened. Experimental data were analyzed to classify individuals into four hand pattern groups. A representative musculoskeletal model was then developed for each group and simulations generated to portray baseline strength and six muscle weakness conditions. Three-dimensional GJCF peaks and impulses were compared across hand patterns and muscle weakness conditions. The semicircular pattern consistently had lower shear (anterior-posterior and superior-inferior) GJCFs compared to other patterns. The double-loop pattern had the highest superior GJCFs, while the single-loop pattern had the highest anterior and posterior GJCFs. These results suggest that using the semicircular pattern may be less susceptible to shoulder injuries such as subacromial impingement. Weakening the internal rotators and external rotators resulted in the greatest increases in shear GJCFs and decreases in compressive GJCF, likely due to decreased force from rotator cuff muscles. These findings suggest that strengthening specific muscle groups, especially the rotator cuff, is critical for decreasing the risk of shoulder overuse injuries.
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Affiliation(s)
- Shelby L. Walford
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX 78712-1591
| | - Jeffery W. Rankin
- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, Downey, CA 90242; Rehabilitation Engineering, Rancho Los Amigos National Rehabilitation Center, Downey, CA 90242
| | - Sara J. Mulroy
- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, Downey, CA 90242; Rehabilitation Engineering, Rancho Los Amigos National Rehabilitation Center, Downey, CA 90242
| | - Richard R. Neptune
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX 78712-1591
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Moloney NB, Ong J, Irani N. Severe papilloedema with vision loss secondary to Guillain-Barré syndrome. BMJ Case Rep 2024; 17:e259813. [PMID: 38565226 PMCID: PMC10989155 DOI: 10.1136/bcr-2024-259813] [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] [Indexed: 04/04/2024] Open
Abstract
We discuss a patient who presented with bilateral VI and VII cranial nerve palsies, symmetric upper and lower limb weakness and areflexia, 2 weeks following an flu-like illness. At presentation, there was no papilloedema, and her visual function was normal. Cerebrospinal fluid analysis and electrophysiology supported the diagnosis of Guillain-Barré Syndrome (GBS). She received intravenous immunoglobulins. She subsequently developed headaches and vision loss. Funduscopy demonstrated severe papilloedema with visual acuity of 6/18 right eye, 6/12 left eye with bitemporal visual field depression. Lumbar puncture revealed elevated opening pressure with high protein and normal cell count. She received acetazolamide. There was resolution of papilloedema and normal visual function at 3 months. Of note, the patient's body mass index was 17 kg/m2Our case highlights the rare occurrence of papilloedema in GBS, reiterating the importance of performing funduscopy on patients with any neurological diagnosis. Early detection and prompt management of papilloedema can prevent permanent vision loss.
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Affiliation(s)
- Niamh Bridget Moloney
- Ophthalmology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Jessica Ong
- Ophthalmology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Neha Irani
- Neuro-Ophthalmology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Neuro-Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia
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Latham CM, Balawender PJ, Thomas NT, Keeble AR, Brightwell CR, Ismaeel A, Wen Y, Fry JL, Sullivan PG, Johnson DL, Noehren B, Owen AM, Fry CS. Overexpression of manganese superoxide dismutase mitigates ACL injury-induced muscle atrophy, weakness and oxidative damage. Free Radic Biol Med 2024; 212:191-198. [PMID: 38154571 PMCID: PMC10842887 DOI: 10.1016/j.freeradbiomed.2023.12.037] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/21/2023] [Accepted: 12/25/2023] [Indexed: 12/30/2023]
Abstract
Oxidative stress has been implicated in the etiology of skeletal muscle weakness following joint injury. We investigated longitudinal patient muscle samples following knee injury (anterior cruciate ligament tear). Following injury, transcriptomic analysis revealed downregulation of mitochondrial metabolism-related gene networks, which were supported by reduced mitochondrial respiratory flux rates. Additionally, enrichment of reactive oxygen species (ROS)-related pathways were upregulated in muscle following knee injury, and further investigation unveiled marked oxidative damage in a progressive manner following injury and surgical reconstruction. We then investigated whether antioxidant protection is effective in preventing muscle atrophy and weakness after knee injury in mice that overexpress Mn-superoxide dismutase (MnSOD+/-). MnSOD+/- mice showed attenuated oxidative damage, atrophy, and muscle weakness compared to wild type littermate controls following ACL transection surgery. Taken together, our results indicate that ROS-related damage is a causative mechanism of muscle dysfunction after knee injury, and that mitochondrial antioxidant protection may hold promise as a therapeutic target to prevent weakness and development of disability.
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Affiliation(s)
- Christine M Latham
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA; Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | | | - Nicholas T Thomas
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA; Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Alexander R Keeble
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA; Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA; Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Camille R Brightwell
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA; Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Ahmed Ismaeel
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA; Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Yuan Wen
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA; Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY, USA; Division of Biomedical Informatics, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Jean L Fry
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA; Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Patrick G Sullivan
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Darren L Johnson
- Department of Orthopaedic Surgery and Sports Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Brian Noehren
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA; Department of Orthopaedic Surgery and Sports Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA; Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Allison M Owen
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA; Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA.
| | - Christopher S Fry
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA; Department of Athletic Training and Clinical Nutrition, College of Health Sciences, University of Kentucky, Lexington, KY, USA.
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Schwartz J, Tilley AE. Pseudotumoral Calcinosis Causing Diaphragmatic Paralysis. Am J Respir Crit Care Med 2024; 209:454-455. [PMID: 38207104 DOI: 10.1164/rccm.202307-1169im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 01/10/2024] [Indexed: 01/13/2024] Open
Affiliation(s)
- Jacob Schwartz
- Department of Internal Medicine: Pulmonary Disease and Critical Care, Northwell Health Lenox Hill Hospital, New York, New York
| | - Ann E Tilley
- Department of Internal Medicine: Pulmonary Disease and Critical Care, Northwell Health Lenox Hill Hospital, New York, New York
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Kounatidou NE, Kondylis G, Klavdianou O, Venkateswaran N, Fryssira E, Palioura S. Progressive Keratoconus in a Patient With Severe Pectus Excavatum and a Cartilage Oligomeric Matrix Protein Gene Mutation: A Case Report. Eye Contact Lens 2024; 50:48-51. [PMID: 37934178 DOI: 10.1097/icl.0000000000001053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Keratoconus is a progressive ocular disorder associated with numerous systemic diseases, many of which affect the musculoskeletal system. Although the etiology and pathophysiology of the disorder remain elusive, recent studies suggest a significant role of genetic predisposition in the pathogenesis of keratoconus. This case report aims to elucidate a potential genetic association in a patient presenting with keratoconus, severe pectus excavatum, generalized muscular weakness, and skeletal deformities. CASE DESCRIPTION A 31-year-old Iranian man presented with progressively diminishing vision in both eyes over the years, eventually diagnosed with keratoconus. The patient's history and further examination indicated generalized muscular weakness, skeletal deformities, and severe pectus excavatum with cardiac and large vessel displacement. Whole-exome sequencing identified two heterozygous gene variants: one in the Cartilage Oligomeric Matrix Protein (COMP) gene and another in the Regulating Synaptic Membrane Exocytosis 1 gene. The patient's systemic and ocular symptoms, combined with the gene variants identified, suggested a connective tissue systemic disorder, potentially within the clinical spectrum of COMPopathies. CONCLUSION This is the first documented case of bilateral progressive keratoconus associated with severe pectus excavatum, generalized musculoskeletal dystrophy, and a COMP gene mutation. It highlights the necessity of continued search into the pathogenic genes of keratoconus, particularly in cases with coexisting systemic manifestations, to further our understanding of the etiology and pathogenesis of this complex disease.
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Affiliation(s)
- Nefeli Eleni Kounatidou
- Department of Ophthalmology (N.E.K.), University of Hamburg, Hamburg, Germany; National and Kapodistrian University of Athens (G.K., O.K., E.F.), Athens, Greece; Department of Ophthalmology (N.V.), Massachusetts Eye and Ear, Harvard Medical School, Boston, MA; and Department of Ophthalmology (S.P.), University of Cyprus Medical School, Nicosia, Cyprus
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Lipka AF, Verschuuren JJGM. Lambert-Eaton myasthenic syndrome. Handb Clin Neurol 2024; 200:307-325. [PMID: 38494285 DOI: 10.1016/b978-0-12-823912-4.00012-8] [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] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Lambert-Eaton myasthenic syndrome (LEMS) is a rare autoimmune disease characterized by proximal muscle weakness, loss of tendon reflexes, and autonomic dysfunction. Muscle weakness usually starts in the upper legs and can progress to oculobulbar and in severe cases respiratory muscles. P/Q-type voltage-gated calcium channels (VGCCs) localized in the presynaptic motor nerve terminal and in the autonomic nervous system are targeted by antibodies in LEMS patients. These antibodies can be detected in about 90% of patients, and the presence of decrement and increment upon repetitive nerve stimulation is also a highly sensitive diagnostic test. Rapid diagnosis is important because of the association with SCLC in 50%-60% of patients, which stresses the need for vigorous tumor screening after diagnosis. Clinical parameters can predict tumor probability and guide frequency of tumor screening. Treatment of the tumor as well as symptomatic treatment and immunosuppression can effectively control symptoms in the majority of patients.
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Affiliation(s)
- Alexander F Lipka
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Groene Hart Hospital, Gouda, The Netherlands.
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Kakutani T, Yoshizawa M. Myasthenia gravis with inclusion body myositis: A case report. Mod Rheumatol Case Rep 2023; 8:83-85. [PMID: 37210209 DOI: 10.1093/mrcr/rxad026] [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: 01/30/2023] [Revised: 04/08/2023] [Accepted: 05/09/2023] [Indexed: 05/22/2023]
Abstract
We present the case of a 75-year-old man diagnosed with myasthenia gravis (MG) based on lower leg weakness and ptosis for the past 2 months before admission to our hospital. The patient was anti-acetylcholine receptor antibody-positive at admission. He was treated with pyridostigmine bromide and prednisolone, which improved the ptosis, but the lower leg muscle weakness remained. An additional lower leg magnetic resonance imaging examination suggested myositis. Inclusion body myositis (IBM) was diagnosed after a subsequent muscle biopsy. Although MG is often associated with inflammatory myopathy, IBM is rare. There is no effective treatment for IBM, but various treatment possibilities have recently been proposed. This case emphasises that myositis complications, including IBM, should be considered when elevated creatine kinase levels are observed and conventional treatments do not address chronic muscle weakness.
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Affiliation(s)
- Takuya Kakutani
- Division of Rheumatology, Shonan Kamakura General Hospital, Kamakura city, Kanagawa, Japan
| | - Masaki Yoshizawa
- Division of Rheumatology, Shonan Kamakura General Hospital, Kamakura city, Kanagawa, Japan
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Walsh M, Bettendorf B, Zahn C. Dermatomyositis presenting with diffuse calcinosis. BMJ Case Rep 2023; 16:e257288. [PMID: 38103899 PMCID: PMC10728952 DOI: 10.1136/bcr-2023-257288] [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] [Indexed: 12/19/2023] Open
Abstract
We present the case of a woman in her early 50s who initially presented to an orthopedist for nodules located near the posterior knee. Imaging revealed diffuse subcutaneous calcifications and she was subsequently referred to rheumatology. Additional testing included myositis panel, electromyography (EMG) and muscle biopsy which indicated the presence of an inflammatory myopathy. It was determined that this patient had an uncommon presentation of dermatomyositis in which her primary complaint was calcinosis cutis. While rash and muscle weakness are often the symptoms most commonly associated with dermatomyositis, it is essential to have a wide differential for patients presenting with calcium deposition in soft tissues. This is particularly important in patients with certain antibodies, including the NXP-2 antibody, which can be associated with malignancy and should prompt an appropriate malignancy workup.
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Affiliation(s)
- Madalyn Walsh
- Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Brittany Bettendorf
- Division of Immunology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Carleigh Zahn
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
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Guzmán-David CA, Ruiz-Ávila HA, Camargo-Rojas DA, Gómez-Alegría CJ, Hernández-Álvarez ED. Ultrasound assessment of muscle mass and correlation with clinical outcomes in critically ill patients: a prospective observational study. J Ultrasound 2023; 26:879-889. [PMID: 37783892 PMCID: PMC10632208 DOI: 10.1007/s40477-023-00823-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/07/2023] [Indexed: 10/04/2023] Open
Abstract
PURPOSE Muscular atrophy implies structural and functional alterations related to muscular force production and movement. This condition has been reported to be the main reason for generalized muscle weakness; it reflects the severity of the disease and can have a profound impact on short- and long-term clinical outcomes. The purpose of this study was to determine whether muscle atrophy ultrasound parameters early predict muscle weakness, morbidity, or 28-days mortality. METHODS This was a prospective, observational single center cohort study. Ultrasound was used to determine the cross-sectional area and muscle thickness of the rectus femoris on the first and third day of ICU stay. The main outcome was the incidence of significant muscle atrophy (≥ 10%). RESULTS Ultrasound measurements were made in 31 patients, 58% (18/31) of which showed significant muscle atrophy. The relative loss of muscle mass per day was 1.78 at 5% per day. The presence of muscle atrophy presents increased risk for limb muscle weakness and handgrip weakness. The 28-days mortality rate was similar in both subgroups. CONCLUSION The presence of muscle atrophy presents an increased clinical risk for the development of limb ICUAW and handgrip, although these observations were not statistically significant. The results could be used to plan future studies on this topic.
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Affiliation(s)
- Cristian Arvey Guzmán-David
- Master's in Physiology, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
- Intensive Care Unit, Hospital Universitario Nacional de Colombia, Bogotá, Colombia.
- Intensive Care Research Group, Universidad Nacional de Colombia (GICI-UN), Bogotá, Colombia.
- Kinesiotherapy Deepening Research Group, Universidad Nacional de Colombia, Bogotá, Colombia.
| | - Héctor Andrés Ruiz-Ávila
- Intensive Care Unit, Hospital Universitario Nacional de Colombia, Bogotá, Colombia
- Intensive Care Research Group, Universidad Nacional de Colombia (GICI-UN), Bogotá, Colombia
| | - Diana Alexandra Camargo-Rojas
- Department of Human Body Movement, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
- Health and Development Research Group, Kinesiology, Universidad Nacional de Colombia, Bogotá, Colombia
| | | | - Edgar Debray Hernández-Álvarez
- Kinesiotherapy Deepening Research Group, Universidad Nacional de Colombia, Bogotá, Colombia
- Department of Human Body Movement, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
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Okura K, Suto A, Sato Y, Takahashi Y, Hatakeyama K, Nagaki Y, Wakita A, Kasukawa Y, Miyakoshi N, Minamiya Y. Preoperative inspiratory muscle weakness as a risk factor of postoperative pulmonary complications in patients with esophageal cancer. J Surg Oncol 2023; 128:1259-1267. [PMID: 37671598 DOI: 10.1002/jso.27436] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/02/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVE We examined whether preoperative inspiratory muscle weakness (IMW) is a risk factor for postoperative pulmonary complications (PPCs) in patients with esophageal cancer who underwent subtotal esophagectomy. METHODS This single-center retrospective cohort study enrolled patients with esophageal cancer who underwent a scheduled subtotal esophagectomy between June 2020 and May 2022. Maximal inspiratory pressure (MIP) was measured as inspiratory muscle strength using a respiratory dynamometer, and we defined IMW as MIP < 80% of the predicted value. Our primary outcome comprised overall PPCs. We investigated the relationship between IMW and PPCs using the Bayesian logistic regression model. RESULTS After exclusion, 72 patients were included in this study. IMW was identified in 26 patients (36%), and PPCs developed in 28 patients (39%). Among patients with IMW, 15 (58%) developed PPCs. Preoperative IMW was associated with PPCs (mean odds ratio [OR]: 3.58; 95% credible interval [95% CrI]: 1.29, 9.73) in the unweighted model. A similar association was observed in the weighted model adjusted for preoperative and intraoperative contributing factors (mean OR: 4.15; 95% CrI: 2.04, 8.45). CONCLUSIONS Preoperative IMW was associated with PPCs in patients with esophageal cancer who underwent subtotal esophagectomy. This association remained after adjusting for preoperative and intraoperative contributing factors.
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Affiliation(s)
- Kazuki Okura
- Division of Rehabilitation, Akita University Hospital, Akita City, Japan
| | - Akiyoshi Suto
- Department of Data Science, Yokohama City University Graduate School of Data Science, Yokohama City, Japan
| | - Yusuke Sato
- Department of Esophageal Surgery, Akita University Hospital, Akita City, Japan
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita City, Japan
| | - Yusuke Takahashi
- Division of Rehabilitation, Akita University Hospital, Akita City, Japan
| | | | - Yushi Nagaki
- Department of Esophageal Surgery, Akita University Hospital, Akita City, Japan
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita City, Japan
| | - Akiyuki Wakita
- Department of Esophageal Surgery, Akita University Hospital, Akita City, Japan
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita City, Japan
| | - Yuji Kasukawa
- Department of Rehabilitation Medicine, Akita University Hospital, Akita City, Japan
| | - Naohisa Miyakoshi
- Department of Rehabilitation Medicine, Akita University Hospital, Akita City, Japan
| | - Yoshihiro Minamiya
- Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita City, Japan
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Yamashiro M, Ohnari K, Higuchi Y, Hashiguchi H, Takashima H, Okada K. [A case of Charcot-Marie-Tooth disease type 2 caused by homozygous MME gene mutation]. Rinsho Shinkeigaku 2023; 63:743-747. [PMID: 37880116 DOI: 10.5692/clinicalneurol.cn-001870] [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] [Indexed: 10/27/2023]
Abstract
The patient is a 44-year-old man. His parents are consanguineous. He experienced muscle weakness in his toe and distal tingling sensation in his feet at 42 years of age, which gradually progressed. Additionally, a marked cyanotic discoloration of the feet appeared and worsened progressively. Neurological examination revealed loss of tendon reflexes and distal muscle weakness in the lower extremities. Findings from nerve conduction studies indicated axonal polyneuropathy. Upon detection of the MME gene mutation, the patient was diagnosed with autosomal-recessive Charcot-Marie-Tooth disease 2T (ARCMT2T). In this case, cyanosis of the lower extremities possibly was associated with ARCMT2T, and it was suggested to be due to neprilysin deletion linked with the MME mutation. This represents the first documented occurrence of cyanosis as a distinctive feature of CMT with MME mutation.
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Affiliation(s)
- Masataka Yamashiro
- Department of Neurology, School of Medicine, University of Occupational and Environmental Health
| | - Keiko Ohnari
- Department of Neurology, School of Medicine, University of Occupational and Environmental Health
| | - Yujiro Higuchi
- Department of Neurology and Clinical Neuroscience, Kagoshima University Graduate School of Medical Science
| | - Hiroaki Hashiguchi
- Department of Neurology and Clinical Neuroscience, Kagoshima University Graduate School of Medical Science
| | - Hiroshi Takashima
- Department of Neurology and Clinical Neuroscience, Kagoshima University Graduate School of Medical Science
| | - Kazumasa Okada
- Department of Neurology, School of Medicine, University of Occupational and Environmental Health
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14
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Takahashi Y, Takamiya M, Ichimura Y, Okiyama N, Nishino I, Morimoto N. [Two cases of anti-nuclear matrix protein 2 antibody-positive dermatomyositis sine dermatitis with severe diffuse subcutaneous edema and dysphagia]. Rinsho Shinkeigaku 2023; 63:737-742. [PMID: 37880118 DOI: 10.5692/clinicalneurol.cn-001863] [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] [Indexed: 10/27/2023]
Abstract
Case 1 involved a 68-year-old woman who was admitted to our hospital because of muscle weakness, diffuse subcutaneous edema, dysphagia, and an elevated serum creatine kinase level that had worsened within the previous month. Case 2 involved a 78-year-old woman who was admitted to our hospital because of muscle weakness, bilateral shoulder pain, diffuse subcutaneous edema, and dysphagia that had gradually worsened during the past 5 months. Both patients showed severe diffuse subcutaneous edema and dysphagia and underwent enteral tube feeding. Although they had no skin lesions consistent with dermatomyositis, muscle biopsies showed myxovirus resistance protein A (MxA) expansion, and blood tests showed positivity for anti-nuclear matrix protein 2 (anti-NXP-2) antibody. Therefore, both presents were diagnosed with anti-NXP-2 antibody-positive dermatomyositis sine dermatitis (DMSD). Anti-NXP-2 antibody-positive dermatomyositis has been reported to be closely associated with DMSD, severe edema and dysphagia. Differential diagnosis for patients who develop myositis with severe subcutaneous edema and dysphagia should include anti-NXP-2 antibody-positive dermatomyositis, and it is important to consider measurement of anti-NXP-2 antibody.
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Affiliation(s)
| | | | - Yuki Ichimura
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Naoko Okiyama
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry
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15
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Mou X, He B, Zhang M, Zhu Y, Ou Y, Chen X. Causal influence of muscle weakness on cardiometabolic diseases and osteoporosis. Sci Rep 2023; 13:19974. [PMID: 37968290 PMCID: PMC10651997 DOI: 10.1038/s41598-023-46837-y] [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: 02/10/2023] [Accepted: 11/06/2023] [Indexed: 11/17/2023] Open
Abstract
The causal roles of muscle weakness in cardiometabolic diseases and osteoporosis remain elusive. This two-sample Mendelian randomization (MR) study aims to explore the causal roles of muscle weakness in the risk of cardiometabolic diseases and osteoporosis. 15 single nucleotide polymorphisms (SNPs, P < 5 × 10-8) associated with muscle weakness were used as instrumental variables. Genetic predisposition to muscle weakness led to increased risk of coronary artery disease (inverse variance weighted [IVW] analysis, beta-estimate: 0.095, 95% confidence interval [CI]: 0.023 to 0.166, standard error [SE]:0.036, P-value = 0.009) and reduced risk of heart failure (weight median analysis, beta-estimate: - 0.137, 95% CI - 0.264 to - 0.009, SE:0.065, P-value = 0.036). In addition, muscle weakness may reduce the estimated bone mineral density (eBMD, weight median analysis, beta-estimate: - 0.059, 95% CI - 0.110 to - 0.008, SE:0.026, P-value = 0.023). We found no MR associations between muscle weakness and atrial fibrillation, type 2 diabetes or fracture. This study provides robust evidence that muscle weakness is causally associated with the incidence of coronary artery disease and heart failure, which may provide new insight to prevent and treat these two cardiometabolic diseases.
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Affiliation(s)
- Xiaoqing Mou
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Bin He
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Muzi Zhang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yong Zhu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yunsheng Ou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaojun Chen
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China.
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16
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Ueta Y, Kimura T, Fujimori K, Yunaiyama D, Taguchi T, Terashi H. [Foot drop and cyclic sensory disturbance of the right lower limb due to endometriosis]. Rinsho Shinkeigaku 2023; 63:676-679. [PMID: 37779019 DOI: 10.5692/clinicalneurol.cn-001892] [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] [Indexed: 10/03/2023]
Abstract
We report the case of a 40-year-old woman, with endometriosis, who presented with a history of foot drop and cyclic sensory disturbance of the right lower limb. She was initially diagnosed with lumbar disc herniation. Neurological examination revealed muscle weakness and sensory disturbance associated with the right sciatic nerve. Nerve conduction studies revealed a low amplitude sensory nerve action potential in the right superficial fibular and sural nerves. Pelvic magnetic resonance imaging revealed an endometriotic cyst in the right ovary, and an endometriotic lesion extending from the right ovary, pelvis, and the right sciatic nerve. Though her symptoms moderately improved with hormonal therapy, the foot drop remained. Our case and previous reports suggest that endometriosis with sciatic neuropathy shows cyclic neurological symptoms during menstruation, with a higher incidence on the right extremity. This case highlights that endometriosis should be considered as a potential differential diagnosis in women of reproductive age with sciatic nerve dysfunction. Its cyclic neurological manifestations should be investigated.
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Affiliation(s)
- Yuki Ueta
- Department of Neurology, Tokyo Medical University Hachioji Medical Center
| | | | - Koji Fujimori
- Department of Obstetrics and Gynecology, Kikkoman General Hospital
| | | | - Takeshi Taguchi
- Department of Neurology, Tokyo Medical University Hachioji Medical Center
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17
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Meiling JB, Bishop AT, Young NP. Posttraumatic Ruptured Axillary Mononeuropathy Without Shoulder Dislocation in an American Football Player: A Case Report and Review of the Literature. Am J Phys Med Rehabil 2023; 102:e133-e136. [PMID: 36882314 DOI: 10.1097/phm.0000000000002222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
ABSTRACT A high school-aged right-handed adolescent boy presented with a 5-mo history of persistent proximal right arm weakness and numbness after an American football stinger injury without a documented history of a shoulder dislocation or humeral fracture. He developed diffuse deltoid muscle atrophy, persistent shoulder abduction weakness, and reduced pinprick sensation confined to the axillary distribution over 5 mos. Needle electromyography demonstrated dense fibrillation potentials and no voluntary activation in all three deltoid muscle heads, indicating a severe posttraumatic ruptured axillary mononeuropathy. The patient then underwent a complex three-cable sural nerve graft repair for attempted reinnervation of the axillary-innervated muscles. Isolated axillary nerve injuries are usually associated with anterior shoulder dislocations; however, a severe isolated persistent axillary mononeuropathy from a ruptured axillary nerve may occur in trauma patients without a clear history of shoulder dislocation. These patients may present with only mild persistent weakness of shoulder abduction. Electrodiagnostic testing to fully assess axillary nerve function should still be considered to identify patients with high-grade nerve injuries that may benefit from sural nerve grafting. The rapid recovery of our patient's initial symptoms with persistent severe axillary injury suggests a unique vulnerability of the nerve due to the neuroanatomy and possibly other factors.
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Affiliation(s)
- James B Meiling
- From the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota (JBM); Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota (ATB); and Department of Neurology, Mayo Clinic, Rochester, Minnesota (NPY)
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18
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Laucius O, Drūteika J, Balnytė R, Petrikonis K, Ališauskienė M, Vaitkus A. Sonographic Phrenic Nerve Changes in Amyotrophic Lateral Sclerosis. Medicina (Kaunas) 2023; 59:1745. [PMID: 37893463 PMCID: PMC10608041 DOI: 10.3390/medicina59101745] [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] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/19/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that affects both the upper and lower motor neurons in the nervous system, causing muscle weakness and severe disability. The progressive course of the disease reduces the functional capacity of the affected patients, limits daily activities, and leads to complete dependence on caregivers, ultimately resulting in a fatal outcome. Respiratory dysfunction mostly occurs later in the disease and is associated with a worse prognosis. Forty-six participants were included in our study, with 23 patients in the ALS group and 23 individuals in the control group. The ultrasound examination of the phrenic nerve (PN) was performed by two authors using a high-resolution "Philips EPIQ 7" ultrasound machine with a linear 4-18 MHz transducer. Our study revealed that the phrenic nerve is significantly smaller on both sides in ALS patients compared to the control group (p < 0.001). Only one significant study on PN ultrasound in ALS, conducted in Japan, also showed significant results (p < 0.00001). These small studies are particularly promising, as they suggest that ultrasound findings could serve as an additional diagnostic tool for ALS.
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Affiliation(s)
- Ovidijus Laucius
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
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19
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Nagao K, Kadoya M, Shimizu Y, Murahara N, Fujii H, Takechi C, Aono S. Magnetic Resonance Imaging-negative Acute Inflammatory Myelopathy following Severe Acute Respiratory Syndrome Coronavirus 2 Infection. Intern Med 2023; 62:2267-2272. [PMID: 37164679 PMCID: PMC10465296 DOI: 10.2169/internalmedicine.1344-22] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/23/2023] [Indexed: 05/12/2023] Open
Abstract
A 55-year-old woman was admitted to our hospital because of gait disturbance and urinary retention that acutely emerged 1 week after severe acute respiratory syndrome coronavirus 2 infection. Acute inflammatory myelopathy was clinically suspected, based on bilateral lower-limb weakness with an extensor plantar response and an elevated immunoglobulin G level in the cerebrospinal fluid. Whole-spine magnetic resonance imaging findings were normal. The central conduction time was extended, based on somatosensory evoked potentials. Her lower-limb weakness was partially ameliorated with immunosuppressive therapy. Postinfectious myelopathy is a rare neurological complication of coronavirus disease 2019 and can develop with normal radiological findings.
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Affiliation(s)
- Kaori Nagao
- Department of Internal Medicine, Japan Self-Defense Forces Central Hospital, Japan
| | - Masato Kadoya
- Department of Internal Medicine, Japan Self-Defense Forces Central Hospital, Japan
| | - Yukie Shimizu
- Department of Internal Medicine, Japan Self-Defense Forces Central Hospital, Japan
| | - Nami Murahara
- Department of Internal Medicine, Japan Self-Defense Forces Central Hospital, Japan
| | - Hiroko Fujii
- Department of Internal Medicine, Japan Self-Defense Forces Central Hospital, Japan
| | - Chizuko Takechi
- Department of Internal Medicine, Japan Self-Defense Forces Central Hospital, Japan
| | - Shigeaki Aono
- Department of Internal Medicine, Japan Self-Defense Forces Central Hospital, Japan
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20
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Paik JJ, Lubin G, Gromatzky A, Mudd PN, Ponda MP, Christopher-Stine L. Use of Janus kinase inhibitors in dermatomyositis: a systematic literature review. Clin Exp Rheumatol 2023; 41:348-358. [PMID: 35766013 PMCID: PMC10105327 DOI: 10.55563/clinexprheumatol/hxin6o] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 02/17/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022]
Abstract
Dermatomyositis (DM) is an idiopathic inflammatory myopathy that commonly manifests with proximal muscle weakness and is associated with extramuscular pathology, including characteristic skin lesions such as Gottron's papules and heliotrope rash, as well as lung, gastrointestinal, joint, and cardiac involvement. Systemic corticosteroids are a cornerstone of therapy, and more recently intravenous immunoglobulin (IVIG; OCTAGAM®) has been approved by the US Food and Drug Administration for the treatment of adults with DM. Both steroids and IVIG represent nonspecific anti-inflammatory therapy, and more targeted approaches are lacking. Transcriptomics has identified upregulation of interferon (IFN)-regulated genes as key features of both adult DM and juvenile DM (JDM). Accordingly, blocking IFN signalling through inhibition of the Janus kinase (JAK) pathway represents a potential treatment option for DM. Placebo-controlled trial data assessing the use of JAK inhibitors for the treatment of DM are limited; as such, a systematic literature review was undertaken to assess the evidence of JAK inhibitors in the treatment of patients with DM. Terms related to DM and JAK inhibitors were searched using PubMed, Embase, Web of Science, Scopus, and Dimensions to identify peer-reviewed publications reporting patients with DM who were treated with a JAK inhibitor. Baseline demographics, clinical characteristics, and treatment outcome data were extracted. A total of 48 publications reporting 145 unique patients (adult DM, n=84; JDM, n=61) were identified. Among cases of adult DM, 61 of 84 (73%) had refractory skin disease at baseline, and all (61 of 61) reported improvement in cutaneous symptoms. Of patients with adult DM, 16 of 84 (19%) had refractory muscle disease at baseline, and all (16 of 16) reported improvement in muscle symptoms. In patients with adult DM complicated by interstitial lung disease (ILD; n=33), 31 (94%) patients improved with JAK inhibitor treatment. Among cases of JDM with refractory skin disease at baseline (60 of 61), most patients (57 of 60; 95%) showed improvements in skin symptoms after JAK inhibitor treatment. Of patients with JDM with refractory muscle disease at baseline (36 of 61), most (30 of 36; 83%) reported improvement in muscle symptoms. Four patients with JDM and ILD experienced improvement in lung disease activity following treatment with a JAK inhibitor. Among both DM and JDM cases, all patients (17 with DM and 16 with JDM) who had elevated serum IFN and/or IFN-stimulated gene expression at baseline showed reduction in IFN or IFN gene expression. Although the conclusions that can be drawn from this analysis are limited because of the differences in assessments used across publications, overall treatment of patients with DM or JDM with a JAK inhibitor was associated with significant improvement of a wide range of DM manifestations, including skin lesions, muscle weakness, and ILD. Our systematic literature review suggests that JAK inhibitors may be a viable treatment option for DM/JDM, and randomised controlled trials are necessary to confirm these findings.
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Affiliation(s)
- Julie J. Paik
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD
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21
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Younger DS. Critical illness-associated weakness and related motor disorders. Handb Clin Neurol 2023; 195:707-777. [PMID: 37562893 DOI: 10.1016/b978-0-323-98818-6.00031-5] [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] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Weakness of limb and respiratory muscles that occurs in the course of critical illness has become an increasingly common and serious complication of adult and pediatric intensive care unit patients and a cause of prolonged ventilatory support, morbidity, and prolonged hospitalization. Two motor disorders that occur singly or together, namely critical illness polyneuropathy and critical illness myopathy, cause weakness of limb and of breathing muscles, making it difficult to be weaned from ventilatory support, commencing rehabilitation, and extending the length of stay in the intensive care unit, with higher rates of morbidity and mortality. Recovery can take weeks or months and in severe cases, and may be incomplete or absent. Recent findings suggest an improved prognosis of critical illness myopathy compared to polyneuropathy. Prevention and treatment are therefore very important. Its management requires an integrated team approach commencing with neurologic consultation, creatine kinase (CK) measurement, detailed electrodiagnostic, respiratory and neuroimaging studies, and potentially muscle biopsy to elucidate the etiopathogenesis of the weakness in the peripheral and/or central nervous system, for which there may be a variety of causes. These tenets of care are being applied to new cases and survivors of the coronavirus-2 disease pandemic of 2019. This chapter provides an update to the understanding and approach to critical illness motor disorders.
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Affiliation(s)
- David S Younger
- Department of Clinical Medicine and Neuroscience, CUNY School of Medicine, New York, NY, United States; Department of Medicine, Section of Internal Medicine and Neurology, White Plains Hospital, White Plains, NY, United States.
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22
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Tomoda Y, Ando T, Hashimoto R, Nakamura S, Kubota M, Fukutake T. [A case of idiopathic spinal cord herniation with incomplete Brown-Séquard syndrome]. Rinsho Shinkeigaku 2022; 62:797-800. [PMID: 36184414 DOI: 10.5692/clinicalneurol.cn-001767] [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] [Indexed: 06/16/2023]
Abstract
A 50-year-old man was referred to our hospital with myelitis associated with a 10-months history of progressive muscle weakness in the left leg. Neurological examinations demonstrated diffuse muscle weakness of the left leg, touch hypoesthesia of the right leg, reduced pain sensation below the right nipple, left pyramidal sign, and urinary incontinence. On the basis of thoracic spinal MRI and thoracic CT myelography, revealing anterior displacement of the spinal cord and enlargement of the posterior subarachnoid space at the Th4 vertebral level, we diagnosed the patient as having idiopathic spinal cord herniation with incomplete Brown-Séquard syndrome. After microsurgical release of the spinal cord and subsequent covering of the anterior dural defect with an artificial dura mater, the symptoms improved without progression. Clinicians should consider spinal cord herniation as a cause of slowly progressive thoracic myelopathy with Brown-Séquard syndrome.
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Affiliation(s)
- Yoko Tomoda
- Department of Neurology, Kameda Medical Center
- Present Address: Department of Neurology, Kyoto University Graduate School of Medicine
| | - Tetsuo Ando
- Department of Neurology, Kameda Medical Center
| | | | | | - Motoo Kubota
- Department of Neurospinology, Kameda Medical Center
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23
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Li S, Sun C, Zhang L, Han J, Yang H, Gao S, He L, Zhang P, Lu X, Shu X, Wang G. Clinical Heterogeneity of Patients With Antinuclear Matrix Protein 2 Antibody-Positive Myositis: A Retrospective Cohort Study in China. J Rheumatol 2022; 49:922-928. [PMID: 35705242 DOI: 10.3899/jrheum.211234] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Accepted: 04/11/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Heterogeneity exists among patients with myositis who have antinuclear matrix protein 2 (anti-NXP2) antibodies, although they usually present with severe muscle weakness. This study aimed to investigate the differences in phenotypes and prognoses among adult patients with myositis who have anti-NXP2 antibodies. METHODS Adult patients with myositis who have anti-NXP2 antibodies were enrolled from January 2010 to December 2019. Their clinical features and laboratory data were recorded retrospectively. We followed up on their survival status until June 30, 2020. A hierarchical cluster analysis, Kaplan-Meier curves, and classification and regression trees were used to analyze the data. RESULTS A total of 70 adult patients with myositis who have anti-NXP2 antibodies were enrolled. All patients experienced muscle weakness. A total of 11 patients did not present with rashes during disease progression, and 43 patients developed dysphagia. In total, 21 patients had interstitial lung disease (ILD), whereas no patients had rapidly progressive ILD. Hierarchical cluster analysis identified 2 clusters. Patients in cluster 1 were younger at disease onset, had a higher incidence of subcutaneous calcification, and had a lower incidence of V sign and shawl sign. Patients in cluster 2 had a higher frequency of ILD, accompanied by lower levels of lymphocytes and higher levels of serum ferritin. Moreover, patients in cluster 2 had worse prognoses. CONCLUSION Patients with myositis who have anti-NXP2 antibodies may present with different phenotypes that are characterized by unique features and prognoses.
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Affiliation(s)
- Shanshan Li
- S. Li, MD, C. Sun, MM, H. Yang, MD, L. He, MD, X. Lu, MD, X. Shu, MD, G. Wang, MD, Department of Rheumatology, Key Laboratory of Myositis, China-Japan Friendship Hospital
| | - Chao Sun
- S. Li, MD, C. Sun, MM, H. Yang, MD, L. He, MD, X. Lu, MD, X. Shu, MD, G. Wang, MD, Department of Rheumatology, Key Laboratory of Myositis, China-Japan Friendship Hospital
| | - Ling Zhang
- L. Zhang, MD, P. Zhang, MD, Department of Radiology, China-Japan Friendship Hospital
| | - Junfeng Han
- J. Han, PhD, Key Laboratory of Advanced Optoelectronic Quantum Architecture and Measurement, Ministry of Education, School of Physics, Beijing Institute of Technology
| | - Hanbo Yang
- S. Li, MD, C. Sun, MM, H. Yang, MD, L. He, MD, X. Lu, MD, X. Shu, MD, G. Wang, MD, Department of Rheumatology, Key Laboratory of Myositis, China-Japan Friendship Hospital
| | - Suhao Gao
- S. Gao, MSc, School of Statistics, Renmin University of China, Beijing, China
| | - Linrong He
- S. Li, MD, C. Sun, MM, H. Yang, MD, L. He, MD, X. Lu, MD, X. Shu, MD, G. Wang, MD, Department of Rheumatology, Key Laboratory of Myositis, China-Japan Friendship Hospital
| | - Peiyao Zhang
- L. Zhang, MD, P. Zhang, MD, Department of Radiology, China-Japan Friendship Hospital
| | - Xin Lu
- S. Li, MD, C. Sun, MM, H. Yang, MD, L. He, MD, X. Lu, MD, X. Shu, MD, G. Wang, MD, Department of Rheumatology, Key Laboratory of Myositis, China-Japan Friendship Hospital
| | - Xiaoming Shu
- S. Li, MD, C. Sun, MM, H. Yang, MD, L. He, MD, X. Lu, MD, X. Shu, MD, G. Wang, MD, Department of Rheumatology, Key Laboratory of Myositis, China-Japan Friendship Hospital;
| | - Guochun Wang
- S. Li, MD, C. Sun, MM, H. Yang, MD, L. He, MD, X. Lu, MD, X. Shu, MD, G. Wang, MD, Department of Rheumatology, Key Laboratory of Myositis, China-Japan Friendship Hospital
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24
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Wada S, Hirano H, Uehara N, Kurotobi Y, Tsuzaki K, Takamatsu N, Fujita M, Hamano T. Cervical Root Enlargement in Segmental Zoster Paresis: A Study with Magnetic Resonance Imaging and Nerve Ultrasound. Intern Med 2022; 61:2361-2365. [PMID: 35022345 PMCID: PMC9424074 DOI: 10.2169/internalmedicine.8538-21] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 72-year-old woman presented with acute-progressive muscle weakness after a rash in the left upper limb. Muscle weakness was restricted to the left C5 innervated muscles. Short inversion time inversion recovery magnetic resonance imaging (MRI) showed a high-intensity signal in the left C5 nerve root, and nerve ultrasound showed its enlargement. She was diagnosed with segmental zoster paralysis (SZP) and treated with acyclovir and methylprednisolone. Her muscle strength gradually recovered, and the abnormal signal and enlargement in the left C5 nerve root improved. This is the first SZP case of confirmed improvement of abnormal findings on MRI and nerve ultrasound in association with muscle power recovery.
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Affiliation(s)
- Shinichi Wada
- Department of Neurology, Kansai Electric Power Hospital, Japan
- Division of Clinical Neurology, Kansai Electric Power Medical Research Institute, Japan
| | - Hirohisa Hirano
- Department of Rehabilitation, Kansai Electric Power Hospital, Japan
| | - Naoko Uehara
- Department of Neurology, Kansai Electric Power Hospital, Japan
- Division of Clinical Neurology, Kansai Electric Power Medical Research Institute, Japan
| | - Yuri Kurotobi
- Department of Neurology, Kansai Electric Power Hospital, Japan
| | - Koji Tsuzaki
- Department of Neurology, Kansai Electric Power Hospital, Japan
- Division of Clinical Neurology, Kansai Electric Power Medical Research Institute, Japan
| | | | - Masaaki Fujita
- Department of Clinical Immunology and Rheumatology, Kansai Electric Power Hospital, Japan
| | - Toshiaki Hamano
- Department of Neurology, Kansai Electric Power Hospital, Japan
- Division of Clinical Neurology, Kansai Electric Power Medical Research Institute, Japan
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25
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Kumar P, Jadhav DV, Ravat SH, Jain N. Challenging case of tumour-induced osteomalacia. BMJ Case Rep 2022; 15:15/5/e249200. [PMID: 35589273 DOI: 10.1136/bcr-2022-249200] [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] [Indexed: 11/03/2022] Open
Abstract
Tumour-induced osteomalacia (TIO), also known as oncogenic osteomalacia, is an uncommon paraneoplastic syndrome which poses a diagnostic challenge. The hallmark feature is severe acquired hypophosphataemic osteomalacia due to renal phosphate wasting because of increased secretion of fibroblast growth factor 23 (FGF-23). A man in his 30s, presented with a 4-year history of severe muscle aches, bone pain and proximal muscle weakness, was referred for evaluation. His laboratory examination revealed severe hypophosphataemia as a result of urinary phosphate wasting, low 1,25-dihydroxyvitamin D, high alkaline phosphatase and elevated FGF-23. We could localise the tumour to his right femur and the biopsy showed a mesenchymal origin. The treatment with pharmacotherapy and radiofrequency ablation helped in the normalisation of blood chemistry and resulted in significant clinical improvement. Hypophosphataemia, phosphaturia, elevated FGF-23 and low 1,25-dihydroxyvitamin D level with severe musculoskeletal pain and muscle weakness necessitate careful evaluation of TIO.
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Affiliation(s)
- Piyush Kumar
- Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | | | | | - Neeraj Jain
- Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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26
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Kelly CR, Saw JL, Thapa P, Mandrekar J, Naddaf E. Systemic Manifestations and Symptom Burden of Facioscapulohumeral Muscular Dystrophy in a Referral Cohort. Muscle Nerve 2022; 65:415-421. [PMID: 35020192 DOI: 10.1002/mus.27493] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/31/2021] [Revised: 01/01/2022] [Accepted: 01/06/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION/AIMS The full spectrum of the clinical phenotype of facioscapulohumeral muscular dystrophy (FSHD), beyond skeletal muscle weakness, remains poorly characterized. In this study, we describe systemic manifestations and symptom burden in a large series of FSHD patients. METHODS We performed a retrospective chart review of FSHD patients seen at our institution between 2000 and 2017. We reviewed patients' responses to a comprehensive review of symptoms and the results of diagnostic testing for sensorineural hearing loss, cardiac disease, dysphagia, ocular abnormalities, and respiratory insufficiency. We assessed the association between disease manifestations and age of onset, genetic profile, and disease duration. RESULTS We identified 87 patients with FSHD. The most common reported symptoms included pain (71%), difficulty sleeping (41%), headaches (27%), and altered mood (24%). When tested, 7/16 (44%) patients had sensorineural hearing loss, 20/60 (33%) had cardiac arrhythmias or conduction defects, 17/45 (38%) had echocardiogram abnormalities, 12/25 (48%) had reduced forced vital capacity, and 4/10 (40%) had oropharyngeal dysphagia. However, patients with these abnormalities represented 8%, 23%, 20%, 14%, and 5% of total number of patients respectively, as uniform screening was lacking. Ocular pathology attributable to FSHD was not detected. DISCUSSION FSHD demonstrates a broad clinical phenotype. Increased vigilance among neurologists to screen for systemic manifestations of the disease is warranted. More uniform screening and future population-based studies are needed to compare the findings in FSHD patients to the general population.
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Affiliation(s)
- Cecilia R Kelly
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jacqui-Lyn Saw
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Prabin Thapa
- Department of Internal Medicine-Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Jay Mandrekar
- Department of Internal Medicine-Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Elie Naddaf
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Sinsheimer A, Mohsen AW, Bloom K, Karunanidhi A, Bharathi S, Wu YL, Schiff M, Wang Y, Goetzman ES, Ghaloul-Gonzalez L, Vockley J. Development and characterization of a mouse model for Acad9 deficiency. Mol Genet Metab 2021; 134:156-163. [PMID: 34556413 PMCID: PMC8588265 DOI: 10.1016/j.ymgme.2021.09.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/02/2021] [Accepted: 09/04/2021] [Indexed: 11/27/2022]
Abstract
Acyl CoA Dehydrogenase 9 (ACAD9) is a member of the family of flavoenzymes that catalyze the dehydrogenation of acyl-CoAs to 2,3 enoyl-CoAs in mitochondrial fatty acid oxidation (FAO). Inborn errors of metabolism of all family members, including ACAD9, have been described in humans, and represent significant causes of morbidity and mortality particularly in children. ACAD9 deficiency leads to a combined defect in fatty acid oxidation and oxidative phosphorylation (OXPHOS) due to a dual role in the pathways. In addition to its function in mitochondrial FAO, ACAD9 has a second function as one of 14 factors responsible for assembly of complex I of the electron transport chain (ETC). Considerable controversy remains over the relative role of these two functions in normal physiology and the disparate clinical findings described in patients with ACAD9 deficiency. To better understand the normal function of ACAD9 and the pathophysiology of its deficiency, several knock out mouse models were developed. Homozygous total body knock out appeared to be lethal as no ACAD9 animals were obtained. Cre-lox technology was then used to generate tissue-specific deletion of the gene. Cardiac-specific ACAD9 deficient animals had severe neonatal cardiomyopathy and died by 17 days of age. They had severe mitochondrial dysfunction in vitro. Muscle-specific mutants were viable but exhibited muscle weakness. Additional studies of heart muscle from the cardiac specific deficient animals were used to examine the evolutionarily conserved signaling Intermediate in toll pathway (ECSIT) protein, a known binding partner of ACAD9 in the electron chain complex I assembly pathway. As expected, ECSIT levels were significantly reduced in the absence of ACAD9 protein, consistent with the demonstrated impairment of the complex I assembly. The various ACAD9 deficient animals should serve as useful models for development of novel therapeutics for this disorder.
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Affiliation(s)
- Andrew Sinsheimer
- University of Pittsburgh, Graduate School of Public Health, Human Genetics, Pittsburgh, PA, United States of America
| | - Al-Walid Mohsen
- University of Pittsburgh, Graduate School of Public Health, Human Genetics, Pittsburgh, PA, United States of America; University of Pittsburgh, School of Medicine, Pediatrics, Pittsburgh, PA, United States of America
| | - Kailyn Bloom
- University of Pittsburgh, School of Medicine, Pediatrics, Pittsburgh, PA, United States of America
| | - Anuradha Karunanidhi
- University of Pittsburgh, School of Medicine, Pediatrics, Pittsburgh, PA, United States of America
| | - Sivakama Bharathi
- University of Pittsburgh, School of Medicine, Pediatrics, Pittsburgh, PA, United States of America
| | - Yijen L Wu
- Department of Developmental Biology, University of Pittsburgh, and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States of America
| | - Manuel Schiff
- University of Pittsburgh, School of Medicine, Pediatrics, Pittsburgh, PA, United States of America; Inserm UMR_S1163, Institut Imagine, Paris, France
| | - Yudong Wang
- University of Pittsburgh, School of Medicine, Pediatrics, Pittsburgh, PA, United States of America
| | - Eric S Goetzman
- University of Pittsburgh, Graduate School of Public Health, Human Genetics, Pittsburgh, PA, United States of America; University of Pittsburgh, School of Medicine, Pediatrics, Pittsburgh, PA, United States of America
| | - Lina Ghaloul-Gonzalez
- University of Pittsburgh, Graduate School of Public Health, Human Genetics, Pittsburgh, PA, United States of America; University of Pittsburgh, School of Medicine, Pediatrics, Pittsburgh, PA, United States of America
| | - Jerry Vockley
- University of Pittsburgh, Graduate School of Public Health, Human Genetics, Pittsburgh, PA, United States of America; University of Pittsburgh, School of Medicine, Pediatrics, Pittsburgh, PA, United States of America.
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Manzar H, Abdulhussein D, Yap TE, Cordeiro MF. Cellular Consequences of Coenzyme Q10 Deficiency in Neurodegeneration of the Retina and Brain. Int J Mol Sci 2020; 21:E9299. [PMID: 33291255 PMCID: PMC7730520 DOI: 10.3390/ijms21239299] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 11/07/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 12/11/2022] Open
Abstract
Coenzyme Q10 (CoQ10) is a ubiquitous cofactor in the body, operating in the inner mitochondrial membrane, where it plays a vital role in the generation of adenosine triphosphate (ATP) through the electron transport chain (ETC). In addition to this, CoQ10 serves as an antioxidant, protecting the cell from oxidative stress by reactive oxygen species (ROS) as well as maintaining a proton (H+) gradient across lysosome membranes to facilitate the breakdown of cellular waste products. Through the process of ageing, the body becomes deficient in CoQ10, resulting in several systemic manifestations. On a cellular level, one of the consequences of CoQ10 deficiency is apoptosis, which can be visualised in tissues of the central nervous system (CNS). Diseases affecting the retina and brain such as age-related macular degeneration (AMD), glaucoma, Alzheimer's disease (AD) and Parkinson's disease (PD) have shown defects in cellular biochemical reactions attributed to reduced levels of CoQ10. Through further research into the pathogenesis of such conditions, the effects of CoQ10 deficiency can be counteracted through supplementation, early detection and intervention.
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Affiliation(s)
- Haider Manzar
- Imperial College Ophthalmology Research Group, Western Eye Hospital, 153-173 Marylebone Road, Marylebone, London NW1 5QH, UK; (H.M.); (D.A.); (T.E.Y.)
| | - Dalia Abdulhussein
- Imperial College Ophthalmology Research Group, Western Eye Hospital, 153-173 Marylebone Road, Marylebone, London NW1 5QH, UK; (H.M.); (D.A.); (T.E.Y.)
| | - Timothy E. Yap
- Imperial College Ophthalmology Research Group, Western Eye Hospital, 153-173 Marylebone Road, Marylebone, London NW1 5QH, UK; (H.M.); (D.A.); (T.E.Y.)
| | - M. Francesca Cordeiro
- Imperial College Ophthalmology Research Group, Western Eye Hospital, 153-173 Marylebone Road, Marylebone, London NW1 5QH, UK; (H.M.); (D.A.); (T.E.Y.)
- Glaucoma & Retinal Neurodegeneration Research Group, Institute of Ophthalmology, University College London, London EC1V 9EL, UK
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Debattisti V, Horn A, Singh R, Seifert EL, Hogarth MW, Mazala DA, Huang KT, Horvath R, Jaiswal JK, Hajnóczky G. Dysregulation of Mitochondrial Ca 2+ Uptake and Sarcolemma Repair Underlie Muscle Weakness and Wasting in Patients and Mice Lacking MICU1. Cell Rep 2020; 29:1274-1286.e6. [PMID: 31665639 PMCID: PMC7007691 DOI: 10.1016/j.celrep.2019.09.063] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/07/2019] [Accepted: 09/20/2019] [Indexed: 01/29/2023] Open
Abstract
Muscle function is regulated by Ca2+, which mediates excitation-contraction coupling, energy metabolism, adaptation to exercise, and sarcolemmal repair. Several of these actions rely on Ca2+ delivery to the mitochondrial matrix via the mitochondrial Ca2+ uniporter, the pore of which is formed by mitochondrial calcium uniporter (MCU). MCU's gatekeeping and cooperative activation are controlled by MICU1. Loss-of-protein mutation in MICU1 causes a neuromuscular disease. To determine the mechanisms underlying the muscle impairments, we used MICU1 patient cells and skeletal muscle-specific MICU1 knockout mice. Both these models show a lower threshold for MCU-mediated Ca2+ uptake. Lack of MICU1 is associated with impaired mitochondrial Ca2+ uptake during excitation-contraction, aerobic metabolism impairment, muscle weakness, fatigue, and myofiber damage during physical activity. MICU1 deficit compromises mitochondrial Ca2+ uptake during sarcolemmal injury, which causes ineffective repair of the damaged myofibers. Thus, dysregulation of mitochondrial Ca2+ uptake hampers myofiber contractile function, likely through energy metabolism and membrane repair.
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Affiliation(s)
- Valentina Debattisti
- MitoCare Center for Mitochondrial Imaging Research and Diagnostics, Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Adam Horn
- Center for Genetic Medicine Research, Children's National Health System, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Department of Genomics and Precision Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA
| | - Raghavendra Singh
- MitoCare Center for Mitochondrial Imaging Research and Diagnostics, Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Erin L Seifert
- MitoCare Center for Mitochondrial Imaging Research and Diagnostics, Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Marshall W Hogarth
- Center for Genetic Medicine Research, Children's National Health System, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Department of Genomics and Precision Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA
| | - Davi A Mazala
- Center for Genetic Medicine Research, Children's National Health System, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Department of Genomics and Precision Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA
| | - Kai Ting Huang
- MitoCare Center for Mitochondrial Imaging Research and Diagnostics, Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rita Horvath
- Wellcome Centre for Mitochondrial Research, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Jyoti K Jaiswal
- Center for Genetic Medicine Research, Children's National Health System, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Department of Genomics and Precision Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA.
| | - György Hajnóczky
- MitoCare Center for Mitochondrial Imaging Research and Diagnostics, Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA.
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Abstract
Diabetic lumbosacral radiculoplexus neuropathy, also known as diabetic amyotrophy, has a characteristic course of sudden onset of unilateral pain in the thigh and hip, which may spread to the other side in weeks to months and proceeds with progressive lower extremity weakness, often resulting in the inability to walk unassisted. The syndrome is typically monophasic, and most patients will recover at least to some degree. Less typical features include lack of pain, distal predominant weakness, absence of diabetes, and upper extremity involvement. This article provides a series of interesting cases to highlight the diagnostic challenges and discusses management decision making.
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Affiliation(s)
| | - Duaa Jabari
- Neuromuscular Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard MS 2012, Kansas City, KS 66160, USA
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Kadoya T, Sakakibara A, Kitayama K, Yamada Y, Higuchi S, Kawakita R, Kawasaki Y, Fujino M, Murakami Y, Shimura M, Murayama K, Ohtake A, Okazaki Y, Koga Y, Yorifuji T. Successful treatment of infantile-onset ACAD9-related cardiomyopathy with a combination of sodium pyruvate, beta-blocker, and coenzyme Q10. J Pediatr Endocrinol Metab 2019; 32:1181-1185. [PMID: 31473688 DOI: 10.1515/jpem-2019-0205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/16/2019] [Indexed: 11/15/2022]
Abstract
Mitochondrial acyl-CoA dehydrogenase 9 (ACAD9) deficiency is one of the common causes of respiratory chain complex I deficiency, which is characterized by cardiomyopathy, lactic acidemia, and muscle weakness. Infantile cardiomyopathy is the most common phenotype and is usually lethal by the age of 5 years. Riboflavin treatment is known to be effective in ~65% of the patients; however, the remaining are unresponsive to riboflavin and are in need of additional treatment measures. In this report, we describe a patient with ACAD9 deficiency who developed progressive cardiomyopathy at 8 months of age. As the patient's left ventricular ejection fraction (LVEF) kept decreasing to 45.4% at 1 year 8 months, sodium pyruvate treatment was introduced together with a beta-blocker and coenzyme Q10. This resulted in a steady improvement, with full and sustained normalization of cardiac function without riboflavin. The therapy, therefore, might be a useful addition for the treatment of ACAD9 deficiency.
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Affiliation(s)
- Takumi Kadoya
- Division of Pediatric Endocrinology and Metabolism, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Azumi Sakakibara
- Division of Pediatric Endocrinology and Metabolism, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Kana Kitayama
- Division of Pediatric Endocrinology and Metabolism, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Yuki Yamada
- Division of Pediatric Endocrinology and Metabolism, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Shinji Higuchi
- Division of Pediatric Endocrinology and Metabolism, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Rie Kawakita
- Division of Pediatric Endocrinology and Metabolism, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
- Department of Genetic Medicine, Osaka City General Hospital, Osaka, Japan
| | - Yuki Kawasaki
- Division of Pediatric Cardiology, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Mitsuhiro Fujino
- Division of Pediatric Cardiology, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Yosuke Murakami
- Division of Pediatric Cardiology, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Masaru Shimura
- Center for Medical Genetics and Division of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Kei Murayama
- Center for Medical Genetics and Division of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Akira Ohtake
- Department of Pediatrics, Faculty of Medicine, Saitama Medical University, Saitama, Japan
- Center for Intractable Diseases, Saitama Medical University Hospital, Saitama, Japan
| | - Yasushi Okazaki
- Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Yasutoshi Koga
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Tohru Yorifuji
- Division of Pediatric Endocrinology and Metabolism, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
- Department of Genetic Medicine, Osaka City General Hospital, Osaka, Japan
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Carvalho LP, Pion CH, El Hajj Boutros G, Gaudreau P, Chevalier S, Bélanger M, Morais JA, Aubertin-Leheudre M. Effect of a 12-week mixed power training on physical function in dynapenic-obese older men: does severity of dynapenia matter? Aging Clin Exp Res 2019; 31:977-984. [PMID: 30293107 DOI: 10.1007/s40520-018-1048-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 06/14/2018] [Accepted: 09/24/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Mobility disability affects nearly 15% of people aged 65 or over worldwide. Excess weight or obesity (OB), along with an accentuated loss of muscle strength (dynapenia), is recognized to be one of the most common risk factors for mobility impairment among the elderly. OBJECTIVE To investigate the effect of a 12-week mixed power training (MPT high-velocity resistance training mixed with functional exercises) on physical function in obese older men exhibiting different severities of dynapenia. METHODS Community-dwelling older men (69 ± 6 years) were assigned to the study if they were considered obese (OB, fat mass ≥ 25% body weight, BW) and to one of the two groups according to severity of dynapenia [(handgrip strength-HS)/BW]: type 1(OB-DY1) or type 2(OB-DY2), < 1 or 2SD from a young reference group. Participants followed a 12-week MPT, three times/week, 75 min/session. Main outcomes included the performance on the 4-m and 6-min walking tests, Timed Up and Go, stair and balance tests. RESULTS AND DISCUSSION At baseline, OB-DY1 performed better than OB-DY2 in all functional tests (p < 0.05). Following the intervention, medium-to-large training effect size (ES) were observed for fat (ES = 0.21) and lean (ES = 0.32, p < 0.001) masses, functional performance (ES 0.11-0.54, p < 0.05), HS (ES = 0.10, p < 0.05) and lower limb muscle strength (ES = 0.67, p < 0.001) and power (ES = 0.60, p < 0.05). Training-by-group interaction showed that OB-DY1 lost more FM (ES = 0.11, p = 0.03) and OB-DY2 improved more HS (ES = 0.19, p = 0.006) than their counterparts. CONCLUSIONS Seniors with obesity and severe dynapenia have poorer physical function than those in the early stage of dynapenia. Both seem to benefit from a high-velocity resistance training mixed with functional exercises, although by slightly different pathways.
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Affiliation(s)
- Livia P Carvalho
- Département des Sciences de l'Activité Physique, Université du Québec à Montréal, (UQAM) Pavillon des sciences biologiques (SB), 4th Floor, 141 Avenue Président-Kennedy, SB-4615, Montreal, QC, H3C 3P8, Canada.
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Université de Montréal, Montreal, Canada.
| | - Charlotte H Pion
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Université de Montréal, Montreal, Canada
- Département de Biologie, Université du Québec à Montréal, Montreal, Canada
| | - Guy El Hajj Boutros
- Département des Sciences de l'Activité Physique, Université du Québec à Montréal, (UQAM) Pavillon des sciences biologiques (SB), 4th Floor, 141 Avenue Président-Kennedy, SB-4615, Montreal, QC, H3C 3P8, Canada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Université de Montréal, Montreal, Canada
| | - Pierrette Gaudreau
- Centre Hospitalier de l'Université de Montréal, Faculté de Médecine, Université de Montréal, Montreal, Canada
| | - Stéphanie Chevalier
- McGill University Health Centre, Research Institute and Geriatric Medicine, Faculty of Medicine, McGill University, Montreal, Canada
| | - Marc Bélanger
- Département des Sciences de l'Activité Physique, Université du Québec à Montréal, (UQAM) Pavillon des sciences biologiques (SB), 4th Floor, 141 Avenue Président-Kennedy, SB-4615, Montreal, QC, H3C 3P8, Canada
| | - José A Morais
- McGill University Health Centre, Research Institute and Geriatric Medicine, Faculty of Medicine, McGill University, Montreal, Canada
| | - Mylène Aubertin-Leheudre
- Département des Sciences de l'Activité Physique, Université du Québec à Montréal, (UQAM) Pavillon des sciences biologiques (SB), 4th Floor, 141 Avenue Président-Kennedy, SB-4615, Montreal, QC, H3C 3P8, Canada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Université de Montréal, Montreal, Canada
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Leahy S, Cassarino M, O' Connell MDL, Glynn L, Galvin R. Dynapaenic obesity and its association with health outcomes in older adult populations: protocol for a systematic review. BMJ Open 2019; 9:e027728. [PMID: 31129591 PMCID: PMC6538200 DOI: 10.1136/bmjopen-2018-027728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/28/2019] [Accepted: 04/12/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Two major global health challenges are the rapidly ageing population and the high prevalence of obesity in all age groups. Older adults are also susceptible to age-related loss of muscle strength, termed dynapaenia. The co-occurrence of both obesity and dynapaenia, termed dynapaenic obesity (DO), has been associated with poorer health outcomes and increased healthcare usage compared with either state alone. The purpose of this systematic review is to quantify the prevalence and incidence of DO in older adult populations, and to explore the association between DO and health outcomes, specifically chronic disease and multimorbidity, functional disability and healthcare usage. METHODS AND ANALYSIS Using the Meta-analyses Of Observational Studies in Epidemiology guidelines, we will conduct a systematic review of cross-sectional and longitudinal observational studies of older adults, which include measures of DO and specified outcomes. Detailed literature searches of will be conducted using six electronic databases: Excerpta Medica dataBASE (EMBASE), PubMed, MEDLINE, SCOPUS, ScienceDirect and Cumulative Index of Nursing and Allied Health Complete (CINAHL), including articles published from database inception until Febuary 2019. The reference lists of included articles will also be searched. Two independent reviewers will undertake a three-step screening and review process using the Population, Risk Factor, Outcome framework to define eligibility. The Newcastle Ottawa Scale for non-randomised studies will be used to assess risk of bias and to rate study quality. The findings will be synthesised in a narrative summary, and a meta-analysis will be conducted where appropriate. ETHICS AND DISSEMINATION Ethical approval is not required for this systematic review. Findings from this research will be submitted for peer-reviewed publication in academic journals, and presented at relevant academic conferences. PROSPERO REGISTRATION NUMBER CRD42018112471.
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Affiliation(s)
- Siobhan Leahy
- Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Marica Cassarino
- School of Allied Health, University of Limerick Faculty of Education and Health Sciences, Limerick, Ireland
| | | | - Liam Glynn
- Graduate Entry Medical School and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland
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Maslarska M, Weis C, Bode C, Hehrlein C. Shear Wave Elastography of Peripheral Muscle Weakness in Patients with Chronic Congestive Heart Failure. Ultrasound Med Biol 2018; 44:2531-2539. [PMID: 30286950 DOI: 10.1016/j.ultrasmedbio.2018.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 03/10/2018] [Revised: 08/16/2018] [Accepted: 08/17/2018] [Indexed: 06/08/2023]
Abstract
Forty-five study participants (28 chronic heart failure [CHF] patients and 17 control participants) were prospectively enrolled in this study to investigate the clinical potential of ultrasound shear wave elastography (SWE) in identifying peripheral muscle weaknesses in chronic heart failure patients. Muscle stiffness in the gastrocnemius muscle during extension (stretch) and the lower arm flexor muscles during flexion was assessed via shear wave elastography, measuring the shear modulus (kPa) for the resting and contractile states in a range of 0-300 kPa. Resting kPa revealed no significant difference between CHF and CP, but exercise kPa for extension and flexion was significantly lower in CHF than CP. The area under the receiver operating characteristic curve of the denominator kPa-Exercise stretch was 0.916, associated with a sensitivity of 89%, a specificity of 71% and a corresponding cutoff value of 81.1 kPa. Shear wave elastography is thus a reproducible and sensitive ultrasound method for evaluating peripheral muscle deficits in patients with CHF.
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Affiliation(s)
- Mariya Maslarska
- Department of Cardiology I, University Heart Center Freiburg, Freiburg, Germany
| | - Christoph Weis
- Department of Cardiology I, University Heart Center Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology I, University Heart Center Freiburg, Freiburg, Germany
| | - Christoph Hehrlein
- Department of Cardiology I, University Heart Center Freiburg, Freiburg, Germany.
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Kleiner G, Barca E, Ziosi M, Emmanuele V, Xu Y, Hidalgo-Gutierrez A, Qiao C, Tadesse S, Area-Gomez E, Lopez LC, Quinzii CM. CoQ 10 supplementation rescues nephrotic syndrome through normalization of H 2S oxidation pathway. Biochim Biophys Acta Mol Basis Dis 2018; 1864:3708-3722. [PMID: 30251690 DOI: 10.1016/j.bbadis.2018.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 05/18/2018] [Revised: 08/03/2018] [Accepted: 09/05/2018] [Indexed: 12/11/2022]
Abstract
Nephrotic syndrome (NS), a frequent chronic kidney disease in children and young adults, is the most common phenotype associated with primary coenzyme Q10 (CoQ10) deficiency and is very responsive to CoQ10 supplementation, although the pathomechanism is not clear. Here, using a mouse model of CoQ deficiency-associated NS, we show that long-term oral CoQ10 supplementation prevents kidney failure by rescuing defects of sulfides oxidation and ameliorating oxidative stress, despite only incomplete normalization of kidney CoQ levels and lack of rescue of CoQ-dependent respiratory enzymes activities. Liver and kidney lipidomics, and urine metabolomics analyses, did not show CoQ metabolites. To further demonstrate that sulfides metabolism defects cause oxidative stress in CoQ deficiency, we show that silencing of sulfide quinone oxido-reductase (SQOR) in wild-type HeLa cells leads to similar increases of reactive oxygen species (ROS) observed in HeLa cells depleted of the CoQ biosynthesis regulatory protein COQ8A. While CoQ10 supplementation of COQ8A depleted cells decreases ROS and increases SQOR protein levels, knock-down of SQOR prevents CoQ10 antioxidant effects. We conclude that kidney failure in CoQ deficiency-associated NS is caused by oxidative stress mediated by impaired sulfides oxidation and propose that CoQ supplementation does not significantly increase the kidney pool of CoQ bound to the respiratory supercomplexes, but rather enhances the free pool of CoQ, which stabilizes SQOR protein levels rescuing oxidative stress.
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Affiliation(s)
- Giulio Kleiner
- Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Emanuele Barca
- Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Marcello Ziosi
- Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Valentina Emmanuele
- Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Yimeng Xu
- Department of Pathology, Columbia University Medical Center, New York, NY, United States
| | | | - Changhong Qiao
- Irving Institute for Clinical and Translational Research, Columbia University Medical Center, New York, NY, United States
| | - Saba Tadesse
- Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Estela Area-Gomez
- Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Luis C Lopez
- Department of Physiology, Faculty of Medicine, University of Granada, Granada, Spain
| | - Catarina M Quinzii
- Department of Neurology, Columbia University Medical Center, New York, NY, United States.
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Liu Y, Wu BY, Ma ZS, Xu JJ, Yang B, Li H, Duan RS. A retrospective case series of segmental zoster paresis of limbs: clinical, electrophysiological and imaging characteristics. BMC Neurol 2018; 18:121. [PMID: 30131076 PMCID: PMC6102897 DOI: 10.1186/s12883-018-1130-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/15/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Segmental zoster paresis (SZP) of limbs, characterized by focal weakness of extremity, is recognized as a rare complication of herpes zoster (HZ). The following study analyzes the clinical characteristics and data from electromyography and MRI scans in patients with motor weakness after zoster infection. METHODS One thousand three hundred ninety-three patients from our database (Shandong Provincial Qianfoshan Hospital) suffering from HZ were retrospectively reviewed from June 2015 to July 2017. Patients who fulfilled the diagnostic criteria for SZP were included in the analysis. The clinical characteristics, as well as electromyography findings and MRI scans were analyzed. RESULTS SZP was present in 0.57% of patients with HZ (8/1393). The average age of symptom onset in 8 SZP patients was 69 years old (SD: 13, range 47-87). The severity of muscle weakness ranged from mild to severe. The electrophysiological testing revealed the characteristics of axonopathy. Radiculopathy (2/8), plexopathy (2/8), radiculoplexopathy (3/8) and combined radiculopathy and mononeuropathy (1/8) were also identified. MRI revealed hyperintensity of the affected spinal dorsal horns, nerve roots or peripheral nerves. CONCLUSIONS SZP is associated with obvious limb weakness, nerve axons lesions and localization to nerve roots, plexus or peripheral nerves.
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Affiliation(s)
- Ying Liu
- Department of Electromyography, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 People’s Republic of China
| | - Bing-Yun Wu
- Department of Electromyography, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 People’s Republic of China
| | - Zhen-Shen Ma
- Department of radiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 People’s Republic of China
| | - Juan-Juan Xu
- Department of Electromyography, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 People’s Republic of China
| | - Bing Yang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 People’s Republic of China
| | - Heng Li
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 People’s Republic of China
| | - Rui-Sheng Duan
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014 People’s Republic of China
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Chabanon A, Seferian AM, Daron A, Péréon Y, Cances C, Vuillerot C, De Waele L, Cuisset JM, Laugel V, Schara U, Gidaro T, Gilabert S, Hogrel JY, Baudin PY, Carlier P, Fournier E, Lowes LP, Hellbach N, Seabrook T, Toledano E, Annoussamy M, Servais L. Prospective and longitudinal natural history study of patients with Type 2 and 3 spinal muscular atrophy: Baseline data NatHis-SMA study. PLoS One 2018; 13:e0201004. [PMID: 30048507 PMCID: PMC6062049 DOI: 10.1371/journal.pone.0201004] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 07/05/2018] [Indexed: 12/20/2022] Open
Abstract
Spinal muscular atrophy (SMA) is a monogenic disorder caused by loss of function mutations in the survival motor neuron 1 gene, which results in a broad range of disease severity, from neonatal to adult onset. There is currently a concerted effort to define the natural history of the disease and develop outcome measures that accurately capture its complexity. As several therapeutic strategies are currently under investigation and both the FDA and EMA have recently approved the first medical treatment for SMA, there is a critical need to identify the right association of responsive outcome measures and biomarkers for individual patient follow-up. As an approved treatment becomes available, untreated patients will soon become rare, further intensifying the need for a rapid, prospective and longitudinal study of the natural history of SMA Type 2 and 3. Here we present the baseline assessments of 81 patients aged 2 to 30 years of which 19 are non-sitter SMA Type 2, 34 are sitter SMA Type 2, 9 non-ambulant SMA Type 3 and 19 ambulant SMA Type 3. Collecting these data at nine sites in France, Germany and Belgium established the feasibility of gathering consistent data from numerous and demanding assessments in a multicenter SMA study. Most assessments discriminated between the four groups well. This included the Motor Function Measure (MFM), pulmonary function testing, strength, electroneuromyography, muscle imaging and workspace volume. Additionally, all of the assessments showed good correlation with the MFM score. As the untreated patient population decreases, having reliable and valid multi-site data will be imperative for recruitment in clinical trials. The pending two-year study results will evaluate the sensitivity of the studied outcomes and biomarkers to disease progression. Trial Registration: ClinicalTrials.gov (NCT02391831).
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Affiliation(s)
| | | | - Aurore Daron
- Centre de Référence des Maladies Neuromusculaires, CHU de Liège, Belgium
| | - Yann Péréon
- Centre de Référence Maladies Neuromusculaires Atlantique-Occitanie-Caraïbes, Hôpital Hôtel-Dieu, Nantes, France
| | - Claude Cances
- Centre de Référence des Maladies Neuromusculaires, Hôpital des Enfants, Toulouse, France
- Unité de neurologie pédiatrique, Hôpital des Enfants, Toulouse, France
| | - Carole Vuillerot
- Service de rééducation pédiatrique infantile”L’Escale”, Hôpital Mère Enfant, CHU-Lyon, Lyon, France
| | - Liesbeth De Waele
- Department of Pediatric Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven Kulak Kortijk, Kortrijk, Belgium
| | - Jean-Marie Cuisset
- Centre de Référence des Maladies Neuromusculaires, Hôpital Roger Salengro, Lille, France
- Service de Neuropédiatrie, Hôpital Roger Salengro, Lille, France
| | - Vincent Laugel
- Neuropédiatrie/INSERM CIC 1434, CHU Strasbourg Hautepierre, Strasbourg, France
| | - Ulrike Schara
- Paediatric neurology and neuromuscular center, University of Essen, Essen, Germany
| | - Teresa Gidaro
- Institute of Myology, GH Pitié Salpêtrière, Paris, France
| | | | | | - Pierre-Yves Baudin
- Consultants for Research in Imaging and Spectroscopy (CRIS), Tournai, Belgium
| | - Pierre Carlier
- Institute of Myology, GH Pitié Salpêtrière, Paris, France
| | | | - Linda Pax Lowes
- Center for Gene Therapy, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Nicole Hellbach
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center, Basel, Switzerland
| | - Timothy Seabrook
- Roche Pharmaceutical Research and Early Development, Roche Innovation Center, Basel, Switzerland
| | | | | | - Laurent Servais
- Institute of Myology, GH Pitié Salpêtrière, Paris, France
- Centre de Référence des Maladies Neuromusculaires, CHU de Liège, Belgium
- Service de Pédiatrie, CHU de Liège, Liège, Belgium
- * E-mail:
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Goudriaan M, Van den Hauwe M, Simon-Martinez C, Huenaerts C, Molenaers G, Goemans N, Desloovere K. Gait deviations in Duchenne muscular dystrophy-Part 2. Statistical non-parametric mapping to analyze gait deviations in children with Duchenne muscular dystrophy. Gait Posture 2018; 63:159-164. [PMID: 29751322 DOI: 10.1016/j.gaitpost.2018.04.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 03/21/2018] [Accepted: 04/25/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Prolonged ambulation is considered important in children with Duchenne muscular dystrophy (DMD). However, previous studies analyzing DMD gait were sensitive to false positive outcomes, caused by uncorrected multiple comparisons, regional focus bias, and inter-component covariance bias. Also, while muscle weakness is often suggested to be the main cause for the altered gait pattern in DMD, this was never verified. RESEARCH QUESTION Our research question was twofold: 1) are we able to confirm the sagittal kinematic and kinetic gait alterations described in a previous review with statistical non-parametric mapping (SnPM)? And 2) are these gait deviations related to lower limb weakness? METHODS We compared gait kinematics and kinetics of 15 children with DMD and 15 typical developing (TD) children (5-17 years), with a two sample Hotelling's T2 test and post-hoc two-tailed, two-sample t-test. We used canonical correlation analyses to study the relationship between weakness and altered gait parameters. For all analyses, α-level was corrected for multiple comparisons, resulting in α = 0.005. RESULTS We only found one of the previously reported kinematic deviations: the children with DMD had an increased knee flexion angle during swing (p = 0.0006). Observed gait deviations that were not reported in the review were an increased hip flexion angle during stance (p = 0.0009) and swing (p = 0.0001), altered combined knee and ankle torques (p = 0.0002), and decreased power absorption during stance (p = 0.0001). No relationships between weakness and these gait deviations were found. SIGNIFICANCE We were not able to replicate the gait deviations in DMD previously reported in literature, thus DMD gait remains undefined. Further, weakness does not seem to be linearly related to altered gait features. The progressive nature of the disease requires larger study populations and longitudinal analyses to gain more insight into DMD gait and its underlying causes.
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Affiliation(s)
- Marije Goudriaan
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; University Hospitals Leuven, Clinical Motion Analysis Laboratory, Pellenberg, Belgium.
| | - Marleen Van den Hauwe
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; University Hospitals Leuven, Department of Child Neurology, Leuven, Belgium
| | | | - Catherine Huenaerts
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; University Hospitals Leuven, Clinical Motion Analysis Laboratory, Pellenberg, Belgium
| | - Guy Molenaers
- University Hospitals Leuven, Clinical Motion Analysis Laboratory, Pellenberg, Belgium; KU Leuven - Department of Development and Regeneration, University of Leuven, Leuven, Belgium; University Hospitals Leuven, Department of Orthopedics, Pellenberg, Belgium
| | - Nathalie Goemans
- University Hospitals Leuven, Department of Child Neurology, Leuven, Belgium; KU Leuven - Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Kaat Desloovere
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; University Hospitals Leuven, Clinical Motion Analysis Laboratory, Pellenberg, Belgium
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Bala U, Leong MPY, Lim CL, Shahar HK, Othman F, Lai MI, Law ZK, Ramli K, Htwe O, Ling KH, Cheah PS. Defects in nerve conduction velocity and different muscle fibre-type specificity contribute to muscle weakness in Ts1Cje Down syndrome mouse model. PLoS One 2018; 13:e0197711. [PMID: 29795634 PMCID: PMC5967806 DOI: 10.1371/journal.pone.0197711] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 05/07/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Down syndrome (DS) is a genetic disorder caused by presence of extra copy of human chromosome 21. It is characterised by several clinical phenotypes. Motor dysfunction due to hypotonia is commonly seen in individuals with DS and its etiology is yet unknown. Ts1Cje, which has a partial trisomy (Mmu16) homologous to Hsa21, is well reported to exhibit various typical neuropathological features seen in individuals with DS. This study investigated the role of skeletal muscles and peripheral nerve defects in contributing to muscle weakness in Ts1Cje mice. RESULTS Assessment of the motor performance showed that, the forelimb grip strength was significantly (P<0.0001) greater in the WT mice compared to Ts1Cje mice regardless of gender. The average survival time of the WT mice during the hanging wire test was significantly (P<0.0001) greater compared to the Ts1Cje mice. Also, the WT mice performed significantly (P<0.05) better than the Ts1Cje mice in the latency to maintain a coordinated motor movement against the rotating rod. Adult Ts1Cje mice exhibited significantly (P<0.001) lower nerve conduction velocity compared with their aged matched WT mice. Further analysis showed a significantly (P<0.001) higher population of type I fibres in WT compared to Ts1Cje mice. Also, there was significantly (P<0.01) higher population of COX deficient fibres in Ts1Cje mice. Expression of Myf5 was significantly (P<0.05) reduced in triceps of Ts1Cje mice while MyoD expression was significantly (P<0.05) increased in quadriceps of Ts1Cje mice. CONCLUSION Ts1Cje mice exhibited weaker muscle strength. The lower population of the type I fibres and higher population of COX deficient fibres in Ts1Cje mice may contribute to the muscle weakness seen in this mouse model for DS.
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Affiliation(s)
- Usman Bala
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Genetics and Regenerative Medicine Research Centre (GRMRC), Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Department of Human Anatomy, College of Medical Sciences, Gombe State University, Gombe, Nigeria
| | - Melody Pui-Yee Leong
- Genetics and Regenerative Medicine Research Centre (GRMRC), Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Chai Ling Lim
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Genetics and Regenerative Medicine Research Centre (GRMRC), Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Hayati Kadir Shahar
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Fauziah Othman
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Genetics and Regenerative Medicine Research Centre (GRMRC), Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mei-I Lai
- Genetics and Regenerative Medicine Research Centre (GRMRC), Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Zhe-Kang Law
- Department of Medicine, UKM Medical Centre, Jalan Yaakob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur
| | - Khairunnisa Ramli
- Tissue Engineering Centre, UKM Medical Centre, Jalan Yaakob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur
| | - Ohnmar Htwe
- Department of Orthopaedic and Traumatology, UKM Medical Centre, Jalan Yaakob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur
| | - King-Hwa Ling
- Genetics and Regenerative Medicine Research Centre (GRMRC), Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Pike-See Cheah
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Genetics and Regenerative Medicine Research Centre (GRMRC), Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Yoshida T, Yoshida M, Mitsuyo K, Jonosono M, Higuchi I. Dropped Head Syndrome and the Presence of Rimmed Vacuoles in a Muscle Biopsy in Scleroderma-polymyositis Overlap Syndrome Associated with Anti-Ku Antibody. Intern Med 2018; 57:887-891. [PMID: 29151520 PMCID: PMC5891533 DOI: 10.2169/internalmedicine.9363-17] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 66-year-old woman with a history of interstitial lung disease presented with a 3-month history of dropped head syndrome (DHS), followed by camptocormia and extremity weakness. A clinical examination revealed Raynaud phenomenon, arthralgia, distal skin sclerosis, and microbleeds in the nailfold capillaries. An anti-Ku antibody test was positive. A muscle biopsy revealed inflammatory myopathy with rimmed vacuoles (RVs). The diagnosis of scleroderma-polymyositis (SSc-PM) overlap syndrome was made. RVs on a muscle biopsy in a patient with inflammatory myositis involving axial muscles may be seen either in inclusion body myositis or SSc-PM overlap syndrome. The examination of the skin and autoantibody testing help determine the diagnosis and treatment strategy.
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Affiliation(s)
- Takeshi Yoshida
- Department of Internal Medicine, Division of Neurology, Okinawa Chubu Hospital, Japan
| | - Mai Yoshida
- Department of Internal Medicine, Division of Neurology, Okinawa Chubu Hospital, Japan
| | - Kinjo Mitsuyo
- Department of Internal Medicine, Division of Rheumatology, Okinawa Chubu Hospital, Japan
| | - Manabu Jonosono
- Department of Internal Medicine, Division of Neurology, Okinawa Chubu Hospital, Japan
| | - Itsuro Higuchi
- School of Health Sciences, Faculty of Medicine, Kagoshima University, Japan
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Sudo M, Wada Y, Narita I, Mba B, Houchens N. A Strong Diagnosis of Weakness. J Hosp Med 2017; 12:989-993. [PMID: 29236098 DOI: 10.12788/jhm.2858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Masanori Sudo
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoko Wada
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Benjamin Mba
- Department of Medicine, Stroger Hospital of Cook County, Chicago, Illinois, USA
- Rush University Medical Center, Chicago, Illinois, USA
| | - Nathan Houchens
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Orces CH. Prevalence of clinically relevant muscle weakness and its association with vitamin D status among older adults in Ecuador. Aging Clin Exp Res 2017; 29:943-949. [PMID: 27838830 DOI: 10.1007/s40520-016-0678-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 09/09/2016] [Accepted: 11/03/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Muscle weakness and 25-hydroxyvitamin D (25(OH)D) deficiency have been associated with adverse outcomes among older adults. However, little is known about the relationship between clinically relevant muscle weakness and 25(OH)D levels in Ecuador. AIMS To examine the prevalence of muscle weakness and its association with 25(OH)D status among subjects aged 60 years and older in Ecuador. METHODS The present study was based on data from 2205 participants in the first National Survey of Health, Wellbeing, and Aging. The Foundation for the National Institute of Health Sarcopenia Project criteria was used to examine muscle weakness prevalence rates. Gender-specific general linear and logistic regression models adjusted for potential confounders were created to compare mean 25(OH)D concentrations and 25(OH)D deficiency across muscle strength categories, respectively. RESULTS An estimated 32.2% of women and 33.4% of men had evidence of clinically relevant muscle weakness in Ecuador. In general, increased muscle weakness prevalence rates were present among Indigenous, residents in the rural Andes Mountains, underweight subjects, and those with a sedentary lifestyle. Muscle strength was significantly and directly correlated with mean 25(OH)D levels. After controlling for potential confounders, 25(OH)D deficiency prevalence rates were 31 and 43% higher among men and women with muscle weakness than those with normal strength, respectively. CONCLUSIONS One-third of older adults nationwide had evidence of muscle weakness. While the present study found a significant correlation between muscle strength and 25(OH)D concentrations, further research is needed to examine whether optimizing 25(OH)D levels may improve muscle weakness among older adults.
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Affiliation(s)
- Carlos H Orces
- Department of Medicine, Laredo Medical Center, 1700 East Saunders, Laredo, TX, 78041, USA.
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Ntuk UE, Celis-Morales CA, Mackay DF, Sattar N, Pell JP, Gill JMR. Association between grip strength and diabetes prevalence in black, South-Asian, and white European ethnic groups: a cross-sectional analysis of 418 656 participants in the UK Biobank study. Diabet Med 2017; 34:1120-1128. [PMID: 28144980 DOI: 10.1111/dme.13323] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2017] [Indexed: 12/01/2022]
Abstract
AIMS To quantify the extent to which ethnic differences in muscular strength might account for the substantially higher prevalence of diabetes in black and South-Asian compared with white European adults. METHODS This cross-sectional study used baseline data from the UK Biobank study on 418 656 white European, black and South-Asian participants, aged 40-69 years, who had complete data on diabetes status and hand-grip strength. Associations between hand-grip strength and diabetes were assessed using logistic regression and were adjusted for potential confounding factors. RESULTS Lower grip strength was associated with higher prevalence of diabetes, independent of confounding factors, across all ethnicities in both men and women. Diabetes prevalence was approximately three- to fourfold higher in South-Asian and two- to threefold higher in black participants compared with white European participants across all levels of grip strength, but grip strength in South-Asian men and women was ~ 5-6 kg lower than in the other ethnic groups. Thus, the attributable risk for diabetes associated with low grip strength was substantially higher in South-Asian participants (3.9 and 4.2 cases per 100 men and women, respectively) than in white participants (2.0 and 0.6 cases per 100 men and women, respectively). Attributable risk associated with low grip strength was also high in black men (4.3 cases) but not in black women (0.4 cases). CONCLUSIONS Low strength is associated with a disproportionately large number of diabetes cases in South-Asian men and women and in black men. Trials are needed to determine whether interventions to improve strength in these groups could help reduce ethnic inequalities in diabetes prevalence.
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Affiliation(s)
- U E Ntuk
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - C A Celis-Morales
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - D F Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - N Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - J P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - J M R Gill
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Bello R, Bertorini T. A Man With Distal Asymmetric Leg Weakness. J Clin Neuromuscul Dis 2017; 18:235-243. [PMID: 28538255 DOI: 10.1097/cnd.0000000000000147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
EDUCATIONAL OBJECTIVES To discuss a case of adult-onset asymmetric distal leg weakness in a patient who presented with weakness and atrophy of the posterior compartment of the left leg. KEY QUESTIONS 1. What is the differential diagnosis of asymmetric distal leg weakness?2. How would a clinician approach diagnostic testing for such a patient?3. What is the final diagnosis for this patient?4. How to treat this patient?
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Affiliation(s)
- Rey Bello
- *Clinical Neurophysiology-EMG/Neuromuscular Diseases, Memphis, TN; and †Department of Neurology, University of Tennessee Health Science Center, Memphis, TN
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McGrath R, Vincent BM, Al Snih S, Markides KS, Peterson MD. The Association Between Muscle Weakness and Incident Diabetes in Older Mexican Americans. J Am Med Dir Assoc 2017; 18:452.e7-452.e12. [PMID: 28330635 PMCID: PMC5401795 DOI: 10.1016/j.jamda.2017.01.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 08/25/2016] [Revised: 01/27/2017] [Accepted: 01/27/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVES A natural decline of muscle strength occurs during the aging process; however, preserving muscle strength may lower the rate of many preventable diseases such as diabetes, especially in higher risk populations. The purpose of this study was to examine the sex-specific association between muscle weakness and incident diabetes in older Mexican Americans. DESIGN Observational, longitudinal study. SETTING Urban and rural households in the Southwestern United States. PARTICIPANTS A subsample of 1903 Mexican Americans aged at least 65 years without diabetes at baseline were followed for 19 years. MEASUREMENTS Muscle weakness was assessed with a hand-held dynamometer and was normalized to body weight (normalized grip strength). Male and female participants were categorized as weak if their normalized grip strength was ≤0.46 and ≤0.30, respectively. Sex-stratified Cox proportional hazard regression models were used to determine the association between muscle weakness and incident diabetes (self-reported) when using age as an entry variable and after adjusting for education, employment status, instrumental activities of daily living disability, interview language, marital status, and obesity. A sensitivity analysis was performed to account for influential outliers for the outcome variable (incident diabetes) and the model was re-run. RESULTS The hazard ratio for incident diabetes was 1.05 (95% confidence interval: 1.02-1.09; P < .001) in weak vs not-weak male participants and 1.38 (95% confidence interval: 1.35-1.41; P < .001) in weak vs not-weak female participants, after adjusting for relevant covariates. CONCLUSIONS Muscle weakness was associated with an increased rate of diabetes in older male and female Mexican Americans. Health professionals should encourage activities that preserve muscle strength, thereby preventing the incidence of diabetes in older Mexican Americans.
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Affiliation(s)
- Ryan McGrath
- Department of Physical Medicine and Rehabilitation, University of Michigan Medicine, Ann Arbor, MI
| | - Brenda M. Vincent
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Soham Al Snih
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX
| | - Kyriakos S. Markides
- Department of Preventative Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
| | - Mark D. Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan Medicine, Ann Arbor, MI
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Almurdhi MM, Reeves ND, Bowling FL, Boulton AJM, Jeziorska M, Malik RA. Distal lower limb strength is reduced in subjects with impaired glucose tolerance and is related to elevated intramuscular fat level and vitamin D deficiency. Diabet Med 2017; 34:356-363. [PMID: 27278802 PMCID: PMC5316421 DOI: 10.1111/dme.13163] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 12/30/2022]
Abstract
AIM To quantify muscle strength and size in subjects with impaired glucose tolerance (IGT) in relation to intramuscular non-contractile tissue, the severity of neuropathy and vitamin D level. METHODS A total of 20 subjects with impaired glucose tolerance and 20 control subjects underwent assessment of strength and size of knee extensor, flexor and ankle plantar and dorsi-flexor muscles, as well as quantification of intramuscular non-contractile tissue and detailed assessment of neuropathy and serum 25-hydroxy vitamin D levels. RESULTS In subjects with impaired glucose tolerance, proximal knee extensor strength (P = 0.17) and volume (P = 0.77), and knee flexor volume (P = 0.97) did not differ from those in control subjects. Ankle plantar flexor strength was significantly lower (P = 0.04) in the subjects with impaired glucose tolerance, with no difference in ankle plantar flexor (P = 0.62) or dorsiflexor volume (P = 0.06) between groups. Intramuscular non-contractile tissue level was significantly higher in the ankle plantar flexors and dorsiflexors (P = 0.03) of subjects with impaired glucose tolerance compared with control subjects, and it correlated with the severity of neuropathy. Ankle plantar flexor muscle strength correlated significantly with corneal nerve fibre density (r = 0.53; P = 0.01), a sensitive measure of small fibre neuropathy, and was significantly lower in subjects with vitamin D deficiency (P = 0.02). CONCLUSIONS People with impaired glucose tolerance have a significant reduction in distal but not proximal leg muscle strength, which is not associated with muscle atrophy, but with increased distal intramuscular non-contractile tissue, small fibre neuropathy and vitamin D deficiency.
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Affiliation(s)
- M M Almurdhi
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - N D Reeves
- School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - F L Bowling
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - A J M Boulton
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - M Jeziorska
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - R A Malik
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Weill-Cornell Medicine-Qatar, Doha, Qatar
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Chapman A, Meyer C, Renehan E, Hill KD, Browning CJ. Exercise interventions for the improvement of falls-related outcomes among older adults with diabetes mellitus: A systematic review and meta-analyses. J Diabetes Complications 2017; 31:631-645. [PMID: 27765575 DOI: 10.1016/j.jdiacomp.2016.09.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/26/2016] [Accepted: 09/28/2016] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Falls as a complication of diabetes mellitus (DM) can have a major impact on the health of older adults. Previous reviews have demonstrated that certain exercise interventions are effective at reducing falls in older people; however, no studies have quantified the effectiveness of exercise interventions on falls-related outcomes among older adults with DM. METHODS A systematic search for all years to September 2015 identified available literature. Eligibility criteria included: appropriate exercise intervention/s; assessed falls-related outcomes; older adults with DM. Effect sizes were pooled using a random effects model. Positive effect sizes favoured the intervention. RESULTS Ten RCTs were eligible for the meta-analyses. Exercise interventions were more effective than the control condition for static balance (0.53, 95% CI: 0.13 to 0.93), lower-limb strength (0.63, 95% CI: 0.09 to 1.18), and gait (0.59, 95% CI: 0.22 to 0.96). No RCTs assessed falls-risk; one RCT reported 12month falls-rate, with no differential treatment effect observed. CONCLUSION Exercise interventions can improve certain falls-related outcomes among older adults with DM. Substantial heterogeneity and limited numbers of studies should be considered when interpreting results. Among older adults, where DM burden is increasing, exercise interventions may provide promising approaches to assist the improvement of falls-related outcomes.
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Affiliation(s)
- Anna Chapman
- RDNS Institute, Victoria 3182, Australia; School of Primary Health Care, Monash University, Victoria 3168, Australia.
| | - Claudia Meyer
- RDNS Institute, Victoria 3182, Australia; Centre for Health Communication, School of Public Health and Human Biosciences, La Trobe University, Victoria 3086, Australia.
| | | | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Western Australia 6102, Australia.
| | - Colette J Browning
- RDNS Institute, Victoria 3182, Australia; School of Primary Health Care, Monash University, Victoria 3168, Australia.
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JurcuŢ RO, Bastian AE, Militaru S, Popa A, Manole E, Popescu BA, Tallila J, Popescu BO, Ginghină CD. Discovery of a new mutation in the desmin gene in a young patient with cardiomyopathy and muscular weakness. Rom J Morphol Embryol 2017; 58:225-230. [PMID: 28523323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 25-year-old woman with a five years history of syncope, mild left ventricular hypertrophy and moderately enlarged atria, was diagnosed with third degree atrioventricular heart block alternating with atrioventricular heart block 2:1, and received a dual chamber pacemaker. After three years of evolution, she developed atrial fibrillation, marked biatrial enlargement, severely depressed longitudinal myocardial velocities, associated with mild girdle weakness and slight increase in creatine kinase level. The diagnosis of restrictive cardiomyopathy with mild skeletal myopathy imposed the screening for a common etiology. Skeletal muscle biopsy revealed the morphological picture of myofibrillar myopathy with sarcoplasmic aggregates, immunoreactive for desmin and other ectopic proteins on immunohistochemistry, appearing as granulofilamentous material at ultrastructural level. Western blot analysis confirmed the desmin overexpression. Genetic testing identified a heterozygous missense variant DES rs869025381, c.1297C>A, p.(Pro433Thr), not previously reported. This is not only the first confirmed Romanian patient with myofibrillar myopathy with clinical features of severe restrictive cardiomyopathy associated with mild skeletal myopathy, but also a case which adds up to the known mutational spectrum in desminopathy.
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Affiliation(s)
- Ruxandra Oana JurcuŢ
- Department of Cardiology, "Prof. Dr. C. C. Iliescu" Institute of Emergency for Cardiovascular Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania;
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Affiliation(s)
- Carmina A Domingo
- *Department of Neurology, Walter Reed National Military Medical Center, Bethesda, MD †Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD
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Honig A, Eliahou R, Auriel E. Confined anterior cerebral artery infarction manifesting as isolated unilateral axial weakness. J Neurol Sci 2016; 373:18-20. [PMID: 28131184 DOI: 10.1016/j.jns.2016.11.061] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 11/14/2016] [Accepted: 11/23/2016] [Indexed: 11/19/2022]
Abstract
We describe isolated unilateral axial weakness in three patients eventually diagnosed with anterior cerebral artery infarction (ACAI), a new clinical observation. Files of three ACAI patients (2 females, 1 male, ages 55-80) were retrospectively reviewed. All three presented to the ED with sudden unsteadiness. On initial neurological examination, all three patients manifested unilateral truncal deviation to the side contralateral to the weakness, even while seated. There was significant unilateral hypotonia due to substantial paravertebral weakness. None had pyramidal signs or increased limb tone. Speech, language, and cognitive performance were intact during admission examination. In all three patients, initial diffusion-weighted imaging (DWI) MRI showed small confined regions of restriction involving the posterolateral border of ACA territory; CT angiography was normal in one patient with a newly diagnosed atrial fibrillation but showed atherosclerotic vasculature with severe narrowing of the A3 segment of the ACA in two. Awareness of ACAI presenting as unilateral axial weakness is warranted. We suggest that optimal diagnostic management should include examination of axial tone. Ischemic involvement of distal ACA branches may herald a more extensive ACAI. Prompt diagnosis may enable thrombolysis or endovascular treatment, and blood pressure maintenance may allow adequate perfusion to damaged tissue.
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Affiliation(s)
- Asaf Honig
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Ruth Eliahou
- Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Eitan Auriel
- Department of Neurology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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