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Frontiers in Neurology 2024Transcranial Direct Current Stimulation (tDCS) of the cerebellum shows promise for the treatment of dystonia. Specific motor rehabilitation programs have also been...
BACKGROUND
Transcranial Direct Current Stimulation (tDCS) of the cerebellum shows promise for the treatment of dystonia. Specific motor rehabilitation programs have also been developed in this context. However, the combination of these two approaches has not yet been evaluated to determine their therapeutic potential.
METHODS
We report a series of 5 patients with cervical dystonia (CD) poorly controlled by botulinum toxin injections. They were initially treated by a protocol of repeated daily sessions (for 3 or 5 days) of cerebellar anodal tDCS (cer-atDCS) applied alone. In a second time, additional protocols of cer-atDCS were performed in combination with a program of goal-oriented motor training exercises (Mot-Training), specifically developed for the treatment of CD. The clinical impact of the procedures was assessed on the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS).
RESULTS
Compared to baseline, the maximum percentage of TWSTRS total score improvement was 37% on average after cer-atDCS performed alone ( = 0.147, not significant) and 53% on average after cer-atDCS combined with Mot-Training ( = 0.014, significant). The TWSTRS pain and functional handicap subscores also improved after the combined protocol. A score of (+3) to (+5) was rated on the TWSTRS response scale after cer-atDCS performed alone or the combined protocol, corresponding to a moderate to striking improvement on dystonia and pain. This improvement lasted longer after the combined protocol than after cer-atDCS alone (3.4 vs. 1.4 months on average, = 0.011).
CONCLUSION
The combination of cer-atDCS with Mot-Training produced a greater and more prolonged improvement than the application of cer-atDCS alone. Such a combined therapeutic procedure is easy to perform and opens important perspectives in the long-term treatment of CD. These results remain to be confirmed by a randomized sham-controlled trial on a larger sample.
PubMed: 38746658
DOI: 10.3389/fneur.2024.1381390 -
JAAD Case Reports May 2024
PubMed: 38737619
DOI: 10.1016/j.jdcr.2024.03.010 -
Maedica Mar 2024To evaluate subcutaneous Botulinum toxin type A (BTX-A) efficacy in alleviating severe allodynia in complex regional pain syndrome (CRPS) type II post-digit...
To evaluate subcutaneous Botulinum toxin type A (BTX-A) efficacy in alleviating severe allodynia in complex regional pain syndrome (CRPS) type II post-digit reconstruction. After surgical debridement and flap reconstruction for post-traumatic necrosis, a CRPS type II patient received subcutaneous BTX-A. Assessments tracked symptom changes and daily life improvements. There are various CRPS management modalities, including rehabilitation and pharmacology. The limited efficacy of conventional non-steroidal antiinflammatory drugs contrasts with promising subcutaneous BTX-A, offering rapid pain relief. Our case underscores the efficacy of subcutaneous BTX-A in CRPS type II, prompting further research and safe outpatient protocol development.
PubMed: 38736925
DOI: 10.26574/maedica.2024.19.11.182 -
Journal of Clinical Medicine Apr 2024Vocal fold motion impairment (VFMI) is the inappropriate movement of the vocal folds during respiration, leading to vocal fold adduction and/or abduction problems and... (Review)
Review
Vocal fold motion impairment (VFMI) is the inappropriate movement of the vocal folds during respiration, leading to vocal fold adduction and/or abduction problems and causing respiratory and vocal impairments. Neurodegenerative diseases (NDDs) are a wide range of disorders characterized by progressive loss of neurons and deposition of altered proteins in the brain and peripheral organs. VFMI may be unrecognized in patients with NDDs. VFMI in NDDs is caused by the following: laryngeal muscle weakness due to muscular atrophy, caused by brainstem and motor neuron degeneration in amyotrophic lateral sclerosis; hyperactivity of laryngeal adductors in Parkinson's disease; and varying degrees of laryngeal adductor hypertonia and abductor paralysis in multiple system atrophy. Management of VFMI depends on whether there is a presence of glottic insufficiency or insufficient glottic opening with/without severe dysphagia. VFMI treatment options for glottic insufficiency range from surgical interventions, including injection laryngoplasty and medialization thyroplasty, to behavioral therapies; for insufficient glottic opening, various options are available based on the severity and underlying cause of the condition, including continuous positive airway pressure therapy, botulinum toxin injection, tracheostomy, vocal fold surgery, or a combination of interventions. In this review, we outline the mechanisms, clinical features, and management of VFMI in NDDs and provide a guide for physicians who may encounter these clinical features in their patients. NDDs are always progressive; hence, timely evaluation, proper diagnosis, and appropriate management of the patient will greatly affect their vocal, respiratory, and swallowing functions as well as their quality of life.
PubMed: 38731036
DOI: 10.3390/jcm13092507 -
Arthroscopy : the Journal of... May 2024Orthoregeneration is defined as a solution for orthopaedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and...
Nonoperative and Operative Soft Tissue, Cartilage, and Bony Regeneration and Orthopaedic Biologics of the Elbow and Upper Extremity: An Orthoregeneration Network (ON) Foundation Review Authors.
Orthoregeneration is defined as a solution for orthopaedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and optimally, provide an environment for tissue regeneration. Options include drugs, surgical intervention, scaffolds, biologics as a product of cells, and physical and electromagnetic stimuli. The goal of regenerative medicine is to enhance the healing of tissue after musculoskeletal injuries as both isolated treatment and adjunct to surgical management, using novel therapies to improve recovery and outcomes. Various orthopaedic biologics (orthobiologics) have been investigated for the treatment of pathology involving the elbow and upper extremity including the tendons (lateral epicondylitis, medial epicondylitis, biceps tendonitis, triceps tendonitis), articular cartilage (osteoarthritis, osteochondral lesions), and bone (fractures, non-unions, avascular necrosis, osteonecrosis). Promising and established treatment modalities include hyaluronic acid (HA); botulinum toxin; corticosteroids; leukocyte-rich and leukocyte-poor platelet-rich plasma (PRP); autologous blood; bone marrow aspirate (BMA) comprising mesenchymal stromal cells (alternatively termed medicinal signaling cells and frequently mesenchymal stem cells) and BMA concentrate (BMAC); MSC harvested from adipose and skin (dermis) sources; vascularized bone grafts; bone morphogenic protein (BMP) scaffold made from osteoinductive and -conductive -tricalcium phosphate (-TCP) and poly-ε- caprolactone (PCL) with hydrogels, human MSC, and matrix metalloproteinases (MMPs); and collagen sponge. Autologous blood preparations such as autologous blood injections and platelet-rich plasma show positive outcomes for non-responsive tendinopathy. In addition, cellular therapies such as tissue-derived tenocyte-like cells and MSC show a promising ability to regulate degenerative processes by modulating tissue response to inflammation and preventing continuous degradation and support tissue restoration.
PubMed: 38723874
DOI: 10.1016/j.arthro.2024.04.022 -
Frontiers in Microbiology 2024is an anaerobic spore-forming bacterium genetically related to but lacks toxin genes. The sporulation mechanism and spore structures of anaerobic bacteria, including ,...
is an anaerobic spore-forming bacterium genetically related to but lacks toxin genes. The sporulation mechanism and spore structures of anaerobic bacteria, including , have not been comprehensively analyzed. Based on 16S rRNA gene analysis, it has been determined that NBRC 14293 belongs to Group I. Moreover, SpoIVA is highly conserved in and species. Therefore, the aim of the present study is to investigate the mechanism of spore formation in by performing a functional analysis of encoding SpoIVA, a protein involved in the early development of the spore coat and cortex in . Inactivation of in resulted in the loss of resistance of sporulating cells to lysozyme and heat treatments. Phase-contrast microscopy indicated that the inactivation of caused the development of abnormal forespores and production of only a few immature spores. In the mutant, abnormal swirl structures were detected in the mother cell using both phase-contrast and transmission electron microscopy. These swirls were stained with auramine O, pararosaniline hydrochloride, and 2-(4-aminophenyl)benzothiazole to examine the surface of mature spores of the wild-type strain. We found that the spore coat and exosporium proteins were misassembled and that they accumulated in the mother cells of the mutant. The results of this study indicate that SpoIVA is a spore morphogenetic protein, providing novel insights into spore morphogenesis in .
PubMed: 38721605
DOI: 10.3389/fmicb.2024.1338751 -
British Journal of Sports Medicine May 2024
PubMed: 38719575
DOI: 10.1136/bjsports-2023-107413 -
Case Reports in Critical Care 2024Clostridium botulinum produces the most potent bacterial toxin, botulinum toxin A (BTXA), which has various therapeutic and cosmetic indications. Intragastric BTXA...
Clostridium botulinum produces the most potent bacterial toxin, botulinum toxin A (BTXA), which has various therapeutic and cosmetic indications. Intragastric BTXA injection is a new obesity treatment method that was argued to be safe due to the inactivation of BTXA through the liver or metabolization within the gastric wall. However, a 36-year-old woman was admitted to the intensive care unit (ICU) due to developing botulism as a result of an intragastric injection of BTXA. The diplopia, headaches, ptosis, decreased muscle force, and respiratory distress two days after injection were her first chief complaints, and also, she experienced significant dysphagia, hoarse voice, thick tongue, constipation, hyposmia, and hypogeusia after two weeks. This case report highlights the necessity for physicians to have sufficient information about this method and consider possible life-threatening adverse effects including botulism.
PubMed: 38716476
DOI: 10.1155/2024/8183127 -
Communications Biology May 2024Cell stiffness is regulated by dynamic interaction between ras-related C3 botulinum toxin substrate 1 (Rac1) and p21 protein-activated kinase 1 (PAK1) proteins, besides...
Cell stiffness is regulated by dynamic interaction between ras-related C3 botulinum toxin substrate 1 (Rac1) and p21 protein-activated kinase 1 (PAK1) proteins, besides other biochemical and molecular regulators. In this study, we investigated how the Placental Growth Factor (PlGF) changes endometrial mechanics by modifying the actin cytoskeleton at the maternal interface. We explored the global effects of PlGF in endometrial stromal cells (EnSCs) using the concerted approach of proteomics, atomic force microscopy (AFM), and electrical impedance spectroscopy (EIS). Proteomic analysis shows PlGF upregulated RhoGTPases activating proteins and extracellular matrix organization-associated proteins in EnSCs. Rac1 and PAK1 transcript levels, activity, and actin polymerization were significantly increased with PlGF treatment. AFM further revealed an increase in cell stiffness with PlGF treatment. The additive effect of PlGF on actin polymerization was suppressed with siRNA-mediated inhibition of Rac1, PAK1, and WAVE2. Interestingly, the increase in cell stiffness by PlGF treatment was pharmacologically reversed with pravastatin, resulting in improved trophoblast cell invasion. Taken together, aberrant PlGF levels in the endometrium can contribute to an altered pre-pregnancy maternal microenvironment and offer a unifying explanation for the pathological changes observed in conditions such as pre-eclampsia (PE).
Topics: Female; rac1 GTP-Binding Protein; Humans; Pre-Eclampsia; Pregnancy; Endometrium; Placenta Growth Factor; Signal Transduction; Stromal Cells; p21-Activated Kinases; Microscopy, Atomic Force
PubMed: 38704457
DOI: 10.1038/s42003-024-06220-7