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This study investigated whether the individual and combined effects of using biomass energy and living in the neighborhood of a cement plant were associated with the risk of COPD and respiratory symptoms among Congolese women. A total of 235 women from two neighborhood communities of a cement plant participated in this cross-sectional study. Participants were classified into the more exposed group (MEG = 137) and a less exposed group (LEG = 98), as well as into biomass users (wood = 85, charcoal = 49) or electricity users (101 participants). Participants completed a questionnaire including respiratory symptoms, sociodemographic factors, medical history, lifestyle, and household characteristics. In addition to spirometry performance, outdoor PM2.5 (μg/m3) was measured. Afternoon outdoor PM2.5 concentration was significantly higher in MEG than LEG (48.8 (2.5) μg/m3 vs 42.5 (1.5) μg/m3). Compared to electricity users, wood users (aOR: 2.6, 95%CI 1.7; 5.9) and charcoal users (aOR: 2.9, 95%CI 1.4; 10.7) were at risk of developing airflow obstruction. Combined effects of biomass use and living in the neighborhood of a cement plant increased the risk of COPD in both wood users (aOR: 4, 95%CI 1.3; 12.2) and charcoal users (aOR: 3.1, 95%CI 1.7; 11.4). Exposure to biomass energy is associated with an increased risk of COPD. In addition, combined exposure to biomass and living near a cement plant had additive effects on COPD.

Objective To investigate the effect of alpha-linolenic acid-rich diacylglycerol (ALA-DAG) compared with alpha-linolenic acid-rich triacylglycerol (ALA-TAG) on visceral fat area (VFA) in people with overweight. Methods Subjects with overweight were recruited to a randomized, double-blind, controlled, parallel-group designed trial and randomly allocated to two groups that consumed either 2.5 g/d ALA-TAG or ALA-DAG for 12 weeks. Two 4-week nontreatment periods were placed before and after the treatment period. One hundred fourteen subjects (n = 57 in the ALA-TAG group, n = 57 in the ALA-DAG group) were enrolled into the analysis set for efficacy evaluation. Results The VFA and BMI were significantly decreased by the ALA-DAG treatment with a treatment-by-time interaction compared with the ALA-TAG treatment (P

Objectives The aim of the present study was to investigate the effect of crocetin on sleep architecture and subjective sleep parameters in healthy adult participants with mild sleep complaints. Design A randomized, double-blind, placebo-controlled, crossover study with two intervention periods of 14 days each, separated by a 14-day wash-out period. Interventions Thirty participants were randomly assigned to one of two sequence groups. Each group was given crocetin at 7.5 mg/day, or placebo. We measured objective sleep parameters using single-channel electroencephalography and assessed subjective sleep parameters using the Oguri–Shirakawa–Azumi Sleep Inventory, Middle-age and Aged version (OSA-MA). Main outcome measures Differences between crocetin and placebo in an objective sleep parameter (delta power), and OSA-MA scores. Results Delta power was significantly increased with crocetin compared with placebo. There were no significant differences in the other sleep parameters, including sleep latency, sleep efficiency, total sleep time, and wake after sleep onset. Subjective scores for sleepiness on rising and feeling refreshed were significantly improved with crocetin compared with placebo. Conclusions The findings of the present study suggest that crocetin supplementation contributes to sleep maintenance, leading to improved subjective sleep quality.

The purpose of the present study was to elucidate the relative frequencies of fasciculations assessed by sonography in a large number of muscles in patients with amyotrophic lateral sclerosis (ALS). The patients diagnosed as having ALS were retrospectively assessed by muscle sonography. The frequencies of having fasciculations were compared among the 15 muscles and the subtypes according to the initially affected body region. Overall, approximately half of the muscles had fasciculations (48.8%), in the average of 11.4 muscles per patient. The frequency of fasciculations tended to be lower in the patients with longer disease durations upon testing. Biceps brachii had the highest frequency, followed by extensor digitorum communis, whereas sternocleidomastoid and rectus abdominis had the lowest frequencies. The frequencies of fasciculations were similar among the clinical subtypes. In conclusion, in patients with ALS, fasciculations were detected most frequently in proximal arm muscles by sonography, whereas truncal muscles had lower frequencies. Fasciculations tended to be less evident in the advanced disease stage, possibly reflecting muscle degeneration. Appropriate selection of muscles to observe fasciculations is important for diagnosis of ALS.

Background and purpose Differential diagnosis of sporadic inclusion body myositis (s-IBM) and polymyositis (PM)/dermatomyositis (DM) is difficult and can affect proper disease management. Detection of heterogeneous muscular involvement in s-IBM by muscle sonography could be a unique diagnostic feature. Methods Sonography of the lower leg and forearm was performed in patients with s-IBM, PM/DM and control subjects (n = 11 each). Echo intensities (EIs) of the adjacent muscles [medial head of the gastrocnemius versus soleus and the flexor digitorum profundus (FDP) versus flexor carpi ulnaris (FCU)] were scored by three blinded raters. The mean EIs of these muscles were compared using computer-assisted histogram analysis. Results Both evaluation methods showed high echoic signals in the gastrocnemius of patients with s-IBM. EIs were significantly different between the gastrocnemius and soleus in patients with s-IBM, but not in those with DM/PM and the controls. In the forearm, although the EI of the FDP was higher in the s-IBM group than in the other groups, the EI differences between the FDP and FCU did not differ significantly between disease groups. The difference in area under the curves to differentiate between s-IBM and DM/PM was greatest between the gastrocnemius−soleus EIs (0.843; P = 0.006). Conclusions High echoic signals in the medial gastrocnemius compared with those of the soleus are suggestive of s-IBM over PM/DM.

Objective To elucidate the mechanism of focal conduction slowing in the median nerve in ALS. Methods The patients with ALS and CTS and normal control subjects were tested with sonography of the median and ulnar nerves. The cross-sectional areas (CSAs) and the wrist–forearm CSA ratios were compared with the parameters of nerve conduction study. Results The median motor distal latency was frequently prolonged in ALS and CTS. CSA and the wrist–forearm ratio of the median nerve were smaller in ALS than in CTS. The ulnar nerve sonography was similar in all the groups. Conclusions Selective conduction slowing of the median nerve at the wrist in ALS is unlikely due to secondary compressive neuropathy, as seen in carpal tunnel syndrome. Significance Unique vulnerability of the median nerve in ALS may explain the selective conduction slowing.

Vasa nervorum is a collective term for a complex microcirculation that provides nutrients to peripheral nerves. Vasa nervorum is known to be disturbed in diabetic neuropathy, mononeuritis multiplex, vasculitic neuropathy and few cases of facial nerve paralysis.1 Sonography has been used to detect focally increased intraneural blood flow in carpal tunnel syndrome.2 In neurolymphomatosis, enlarged nerves showed qualitatively increased blood flow within the area of thickening.3 Similar findings of increased blood flow signals were observed in leprosy.4 As inflammatory vasodilation increases intraneural blood flow in an acute postdenervation period,5 we hypothesised that intraneural blood flow in inflammatory neuropathies becomes abnormal, by employing a quantitative method. We conducted a prospective study from June 2015 to December 2015. Institutional Review Board approved this study. The participants signed a written consent. The first group was the control group, which includes healthy non-smoking participants without clinical signs by neurological examination or symptoms of a neurological disease, no known comorbidities such as hypertension, dyslipidaemia and diabetes mellitus and without a history of traumatic injuries. The second group was the inflammatory neuropathy group, which includes participants diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP), Guillain-Barre syndrome (GBS) and multifocal motor neuropathy (MMN). The third was grouped as other peripheral nerve diseases as disease control, which includes participants diagnosed with amyotrophic lateral sclerosis (ALS) and Charcot-Marie-Tooth Disease type 1A …

Purpose To assess the multiple texture features of skeletal muscles in neurogenic and myogenic diseases by using ultrasonography (US). Materials and Methods After institutional review board approval, muscle US studies of the medial head of the gastrocnemius were performed prospectively in patients with neurogenic diseases (n = 25 [18 men]; mean age, 66.0 years ± 12.3 [standard deviation]), in patients with myogenic diseases (n = 21 [12 men]; mean age, 68.3 years ± 11.5), and in healthy control subjects (n = 21 [11 men]; mean age, 70.5 years ± 8.4) between January 2013 and May 2016. Written informed consent was obtained. Muscle texture parameters were obtained, and five algorithms were used to classify the groups. Results The neurogenic and myogenic disease groups showed higher echo intensities than the control subjects. The histogram-derived texture parameters had overlaps between the neurogenic and myogenic groups and thus had a low discrimination rate. With assessment of more classes of texture parameters, three groups were correctly classified (100% correct, according to four of five classification algorithms). Tenfold cross validation showed 93.5%-95.7% correct classification between the neurogenic and myogenic groups. The run-length matrix, autoregressive model, and co-occurrence matrix were particularly useful in distinguishing the neurogenic and myogenic groups. Conclusion Texture analysis of muscle US data can enable differentiation between neurogenic and myogenic diseases and is useful in noninvasively assessing underlying disease mechanisms. © RSNA, 2017 Online supplemental material is available for this article.

Morphological assessment of peripheral nerves in amyotrophic lateral sclerosis (ALS) has been available by sonography. Detection of possible axonal atrophy could be important in predicting progression. Research on correlation between sonographic findings and clinical presentation has been sparse. The aim of the study was to assess possible motor axon loss in patients with ALS by sonography and to correlate the imaging features with clinical subtypes. Patients with either definite or probable ALS and control subjects had sonographic evaluation of the cervical nerve roots (C5, C6, and C7). Each diameter and their sums were measured. The ALS patients were classified by their clinical onset and progression (arm-onset, leg-onset, bulbar, and flail-arm variant) and the sonographic features were compared. Overall, the cervical nerve roots were thinner in ALS than in the controls, but the diagnostic sensitivity was low. The patients with arm dysfunctions tended to show thinner nerve roots than those with normal or relatively preserved arm functions. The four ALS subtypes showed similar diameters of the nerve roots. There was no correlation between the disease duration and the diameters of the nerve roots. Sonography of the cervical nerve roots showed axonal atrophy in ALS and potentially reflects subtle arm dysfunctions.

Takotsubo syndrome (TTS) is an acute cardiac syndrome characterized by regional left ventricular dysfunction with a peculiar circumferential pattern, which typically results in apical ballooning. Evidence indicates a pivotal role of catecholamines in TTS, and researchers have discussed multiple hypotheses on the etiology, including multivessel coronary spasm, myocardial stunning, excessive transient ventricular afterload, and cardiac sympathetic overactivity with local noradrenaline spillover. Although central nervous system disorders, such as stroke and epilepsy, are known to trigger TTS, the incidence and clinical features of TTS in neurodegenerative disorders are poorly understood. Here, we retrospectively examined TTS cases in a single-center cohort composed of 250 patients with amyotrophic lateral sclerosis (ALS) and 870 patients with synucleinopathies [582 patients with Parkinson's disease (PD), 125 patients with dementia with Lewy bodies (DLB), and 163 patients with multiple system atrophy (MSA)] and identified 4 (1.6%, including 2 women) cases with ALS and no cases with synucleinopathies. Two ALS patients underwent autopsy and the pathological findings were compatible with the chronological changes identified in catecholamine-induced cardiomyopathy. A literature review identified 16 TTS cases with ALS, 1 case each with PD and DLB, and no cases with MSA. When current and previous TTS cases with ALS were concatenated: 55% (11/20) were female; 35% (7/20) had a bulbar-onset and 45% (9/20) had a limb-onset; the mean age of TTS onset was 63.3 ± 9.0 years and the mean interval time from ALS onset to TTS development was 4.9 ± 3.0 years; no (0/16) patients developed TTS within 12 months after ALS onset; 50% (10/20) underwent artificial ventilations; the mortality was 17% (3/18); and most cases had precipitating factors, and TTS development was associated with gastrostomy, tracheostomy, or infections in 45% (9/20) of the patients. This study demonstrated that ALS is a considerable predisposing factor of TTS and that synucleinopathies rarely cause TTS. The distinct TTS incidence between ALS and synucleinopathies may be due to cardiac sympathetic overactivity in ALS and may also be affected by cardiac sympathetic denervation in synucleinopathies. Moreover, the etiology of TTS in ALS may be reasonably explained by the two-hit theory.

Threshold tracking testing has provided novel insights of peripheral nerve excitability in normal and pathologic conditions. However, little has been known on the nerve excitability properties of axons with different stimulation thresholds and the effects of aging and peripheral neuropathy to those. We performed multiple nerve excitability tests in normal controls divided into three age groups and in patients with diabetic neuropathy, which were recorded at three target levels (10%, 40%, and 60% of the maximum motor response amplitudes). In all the control groups, tracking at low target level shows smaller threshold change by hyperpolarizing stimuli and greater threshold change by depolarizing stimuli, suggestive of greater transient Na current. Normal elderly showed greater threshold change by hyperpolarizing pulse than younger subjects at high target level, likely reflecting decrease of axon diameters. Patients with diabetic neuropathy showed smaller threshold changes by both depolarizing and hyperpolarizing pulses ("fanning-in"), more noticeably at the lower target level, suggestive of the combined effects of membrane depolarization and greater decrease of axonal diameters in smaller fibers. Given the reported unpredictable electrical recruitment order in the diseased conditions and difference of nerve excitability measures in threshold electrotonus at different target levels, comparing threshold electrotonus values between normal and diseased axons may be problematic by comparing axons with different nerve excitability characteristics.

Cystic lymphangioma, a vascular anomaly considered to be a lymph sac derived from the fetal jugular vein remaining as a mass, is frequently noted in the lateral natal neck. It is classified as a vascular malformation by the International Society for the Study of Vascular Anomalies (ISSVA). While most cases are asymptomatic, it may grow into an unwieldy mass. We report a case of cystic lymphangioma and abnormal subclavian vein distribution incidentally identified during trauma treatment. A 2-year-old boy, with left supraclavicular fossa swelling, had fallen from a 120 cm height in a park and struck his left shoulder, which was left untreated due to the absence of pain. His family noted a slowly growing left supraclavicular fossa mass the following day. When first seen, he had a 30×40 mm mass in the left supraclavicular fossa. Palpation indicated a smooth, slightly soft, undulating, surface a cystic lesion containing a septum. Computed tomography (CT), magnetic resonance imaging (MRI), ultra sonography (US) needle aspirate of the cyst was bloody and malformation of the left subclavian vein distributing in the left supraclavicular region was noted. The mass was excised due to its rapid growth, together with part of the platysma muscle to which the mass strongly adhered. The two blood vessels entering the mass, were ligated and excised en bloc with the mass, which was diagnosed pathologically as cystic lymphangioma. No recurrence has occurred in the 4 years since surgery.

Objectives/Hypothesis: We present the case of a 21-year-old woman who underwent endoscopy-assisted surgery with topical mitomycin for a large cholesterol granuloma in the petrous apex that involved the eustachian tube. Study Design: Case report. Methods: Minimally invasive surgery was performed on the cholesterol granuloma with endoscopic assistance, and topical mitomycin (0.4 mg/mL) was administered to prevent scarring of the newly created drainage/ventilation route. With the endoscopic approach, the drainage/ventilation route was secured not only from the tympanic cavity, but also using a guidewire inserted from the pharyngeal orifice of the eustachian tube. Results: The drainage/ventilation route between the nasopharynx and middle ear cavity involving the cholesterol granuloma has been preserved more than for 9 months postoperatively. Her hearing has recovered. Conclusions: This less invasive technique is a surgical option for patients with a large cholesterol granuloma in the petrous apex involving the eustachian tube. Laryngoscope, 2009

This study aimed to characterize the excitability changes in peripheral motor axons caused by hindlimb unloading, which is a model of disuse neuromuscular atrophy. Hindlimb unloading was performed in normal 6-week-old male mice by fixing the proximal tail by a clip connected to the top of the animal’s cage for 3 weeks. Axonal excitability studies were performed by stimulating the sciatic nerve at the ankle and recording the compound muscle action potential from the foot. The amplitudes of the motor responses of the unloading group were 51% of the control amplitudes (2.2 ± 1.3 mV [HLU] vs. 4.3 ± 1.2 mV [Control], P = 0.03). Multiple axonal excitability analysis showed that the unloading group had a smaller strength-duration time constant (SDTC) and late subexcitability (recovery cycle) than the controls (0.075 ± 0.01 [HLU] vs. 0.12 ± 0.01 [Control], P < 0.01; 5.4 ± 1.0 [HLU] vs. 10.0 ± 1.3 % [Control], P = 0.01, respectively). Three weeks after releasing from HLU, the SDTC became comparable to the control range. Using a modeling study, the observed differences in the waveforms could be explained by reduced persistent Na+ currents along with parameters related to current leakage. Quantification of RNA of a SCA1A gene coding a voltage-gated Na+ channel tended to be decreased in the sciatic nerve in HLU. The present study suggested that axonal ion currents are altered in vivo by hindlimb unloading. It is still undetermined whether the dysfunctional axonal ion currents have any pathogenicity on neuromuscular atrophy or are the results of neural plasticity by atrophy.

Background Sonography of peripheral nerves can depict alteration of nerve sizes that could reflect inflammation and edema in inflammatory and demyelinating neuropathies. Guillain-Barre syndrome (GBS). Information on sonographic comparison of an axonal subtype (acute motor [and sensory] axonal neuropathy [AMAN and AMSAN]) and a demyelinating subtype (acute inflammatory demyelinating polyneuropathy [AIDP]) has been sparse. Material and Methods Sonography of peripheral nerves and cervical nerve roots were prospectively recorded in patients with GBS who were within three weeks of disease onset. Results Five patients with AIDP and nine with AMAN (n = 6)/AMSAN (n = 3) were enrolled. The patients with AIDP showed evidence of greater degrees of demyelination (e.g., slower conduction velocities and increased distal latencies) than those with AMAN/AMSAN. The patients with AIDP tended to show enlarged nerves in the proximal segments and in the cervical roots, whereas the patients with AMAN/AMSAN had greater enlargement in the distal neve segment, especially in the median nerve ( P = 0.03; Wrist-axilla cross-sectional ratio). Conclusion In this small study, two subtypes of GBS showed different patterns of involvement that might reflect different pathomechanisms.

Objectives:(1) Estimate the degree of postoperative aeration in the middle ear after canal wall down tympanoplasty with soft-wall reconstruction (CWD tympanoplasty with SWR) for cholesteatoma. (2) Characterize the relationship between postoperative middle ear aeration and hearing outcome. (3) Propose an ideal state of middle ear aeration in order to obtain satisfactory hearing outcome after CWD tympanoplasty with SWR.Methods:This retrospective study was conducted in our tertiary referral hospital between 2001 and 2013. Seventy-eight ears with cholesteatoma treated surgically at our hospital by planned two-stage CWD tympanoplasty and SWR were included. Postoperative middle ear aeration was scored one year after second-stage surgery by computed tomography (CT). The patients were divided into 4 bins according to postoperative audiometric air-bone (A-B) gaps: 0-10, 11-20, 21-30, and >30 dB.Results:Postoperative middle ear aeration was significantly greater in the smaller A-B gap bins (0-10 and 11-20 dB) compa...

The IgG1 mouse monoclonal antibody (MAb) KHRI-3, binds to an antigen of 65–68 kDa expressed on inner ear supporting cells in guinea pigs. We previously showed [Nair et al. (1995) Monoclonal antibody induced hearing loss. Hear. Res. 83, 101–113] that mice carrying the KHRI-3 hybridoma develop high frequency hearing loss and loss of hair cells in the basal turn suggesting that this MAb causes immune-mediated sensorineural hearing loss. To evaluate the specificity of this effect, sterile KHRI-3 and control IgG1 preparations were infused directly into the guinea pig cochlea using Alzet® mini-osmotic pumps. Assessments included: (1) hearing, measured by click auditory brain stem responses (ABRs); (2) in vivo antibody binding; and (3) the structural integrity of the organ of Corti. Nine animals were infused with KHRI-3 preparations and 5 controls were infused with control IgG1. Four guinea pigs given KHRI-3 developed 25–55 dB hearing loss. Control animals showed no difference from baseline. In vivo binding of KHRI-3 was detected in the organ of Corti in 6 of the 9 animals, including all 4 that had hearing loss. No staining was observed with control antibody. Confocal microscopy revealed that the in vivo KHRI-3 antibody binding pattern was identical to that obtained by incubating fixed tissue in vitro with KHRI-3. Histologic examination revealed an increased frequency of hair cell loss in KHRI-3 treated ears when compared to either the contralateral ears of the same guinea pigs or the IgG1 treated ears of control animals. The lesions in the infused ears of guinea pigs were scattered throughout the cochlea from base to apex. These experiments demonstrate the following points: (1) Antibodies can be chronically infused directly into the cochlea of living animals. (2) The KHRI-3 antibody binds to live supporting cells within the organ of Corti. (3) Infusion of an inner ear specific antibody affects auditory function. (4) The infusion of irrelevant antibody had no effect on the structure or function of the ear. This system provides an animal model for further studies of antibody-induced sensorineural hearing loss.

Objective Progressive atrophy and loss of motor axons is a hallmark of amyotrophic lateral sclerosis (ALS). Limited sonographic data are available on potential detection of atrophy of peripheral nerves and nerve roots in ALS. Methods Patients with either definite or probable ALS and control subjects underwent sonographic evaluation of the cervical roots (C5, C6, and C7) and peripheral nerves (median and ulnar nerves) on the right. These diameters and cross-sectional areas (C6, median, and ulnar nerves) were compared. Results The diameters and cross-sectional areas were consistently smaller in ALS than in controls. No correlation was present between the sonographic parameters and the disease severity, disease duration, age, or gender. The overall sensitivity and specificity tended to be greater in the cervical nerve roots than in the peripheral nerves. Conclusions This study shows atrophy of cervical nerve roots and peripheral nerves in ALS detected by sonography. Cervical nerve roots might be more appropriate to detect motor axon loss than peripheral nerves. Significance Sonographic evaluation of nerve roots and peripheral nerves may be a useful disease marker in ALS to confirm the diagnosis and to potentially monitor the disease progression.

Objective: 1) Discuss the effects of ventilation tube placement on postoperative mastoid growth in children with otitis media with effusion (OME). 2) Show an incidence of postoperative complication, for example, spontaneous extrusion, permanent tympanic membrane perforation.Method: In total, 177 tubes were inserted in 148 ears in 81 children with OME with a mean age of 5.5 years at our hospital from 2001 to 2009. Long-term tubes were used: The T-Tube (Goode) in 87 cases or the Type II tube (Paparella) in 90 cases.Results: The tubes fell out spontaneously in 46%: 61% in the T-Tube group and 32% in the Type II tube group. Postoperative permanent tympanic membrane perforation occurred in 10%. No relationship was observed between the incidence of tympanic membrane perforation and tube type or duration of tube insertion. Postoperative mastoid growth compared to preoperative condition estimated from X-rays was 42%, 55%, 59%, and 65% at 1, 2, 3, and 4 years after surgery, respectively. Retaining the tube in plac...

A 70-year-old right-handed woman developed left hemineglect. Her memory, insight, and judgment were normal, but dressing apraxia, acalculia, and Balint syndrome were observed, consistent with posterior cortical dementia (PCD).1 MRI demonstrated atrophy of the parieto-occipital cortices (figure, A), where cortical hyperintensity by …