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Introduction/Aims Methods Results Discussion The single simple question (SSQ), “What percentage of normal (0%–100%) do you feel regarding your disease?” has proven feasible and valid in assessing myasthenia gravis and a heterogeneous spectrum of neuropathies. This study explores the utility of the SSQ in axonal polyneuropathies (PNPs), encompassing diabetic neuropathy, and evaluates its responsiveness to scale changes.A retrospective chart review of 150 patients with axonal PNP responding to the SSQ was performed. Patients underwent clinical and electrophysiological evaluations, and were evaluated by clinical and disability scales, including the Medical Research Council sum score, modified Toronto Clinical Neuropathy score (mTCNS), Overall Neuropathy Limitation Scale, and Rasch‐built Overall Disability Scale (RODS).The SSQ total scores correlated moderately with both the RODS score (r = .59, p < .001) and the mTCNS symptom score (r = −.43, p < .001), maintaining significance after adjustment for multiple comparisons. Longitudinally, after adjusting for multiple comparisons, the change in mTCNS symptom score retained statistical significance (adjusted p = .048). The SSQ did not show any association with electrophysiological parameters or sensory symptoms, other than a lower score in those with pain (100% with SSQ <40%, 85% with SSQ 40%–70%, and 34% with SSQ >70%).The SSQ is a feasible, valid scale that may be utilized to assess and follow patients with length‐dependent axonal PNPs. Given that the SSQ is not strongly associated with clinical and disability scales or electrophysiological findings, additional investigations are required for a comprehensive assessment of PNP. [ABSTRACT FROM AUTHOR]

Botulism is a serious condition that carries with it a high rate of morbidity and mortality. This review highlights the pearls and pitfalls of botulism, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. Botulism is a neuromuscular disorder caused by toxin production of clostridium species bacteria and is a challenging diagnosis that mimics several other conditions. Children account for the majority of patients, with a foodborne source most common, followed by wound sources, typically from intravenous drug injection. Classically, patients with botulism develop bilateral cranial nerve palsies and symmetric, bilateral, descending paralysis. However, patients may initially present with vague symptomatology, such as weakness and dry mouth, which can make diagnosis challenging. A careful history elucidating exposures such as intravenous drug use or consumption of non-commercial canned products can help differentiate botulism from other disorders causing neuromuscular weakness. If suspected, the Centers for Disease Control should be notified to mobilize antitoxin for treatment as soon as the diagnosis is suspected even prior to confirmatory testing. Antibiotics should be avoided in these patients, as they can potentiate toxin release, unless there is a concomitant infection requiring antibiotic therapy. Patients with botulism can develop respiratory compromise requiring emergent airway management. Prolonged neuromuscular blockade from botulism will lead to a variety of symptoms that require comprehensive intensive care unit level care. An understanding of botulism and its many potential mimics can assist emergency clinicians in diagnosing and managing this deadly disease. [ABSTRACT FROM AUTHOR]

This article, based on network science, aims to contribute to overcoming its geometric and technological phases. The novelty consists in considering links of networks as linked by superimposed networks, termed here multiple superimposed soft networks (MSSN), which is introduced as a research issue. Such links of links (termed here as passive links) concern, for instance, correspondences, incompatibilities, and temporal synchronizations between the occurrences of pairs of active links of effective networks, such as those based on electrical and telecommunication. A possible constitutive mechanism of such passive linkage consists of linkage representations for practices and histories of use expressed by their validating statistical reoccurrences. We consider the possible emergent nature of the passive linkage. The reason for introducing the design and usage of MSSN properties as a research issue involves making new approaches to profile and manage networks available. Correspondence between active linkage and MSSN properties should be a matter for an experiential, machine-learning approach. Research issues relate their possible usage on the active linkage such as for classification, comparations, detection of criticalities, diagnosis, performance evaluation, and regulatory as weak forces. Furthermore, the possible identification of standard corresponding configurations of passive and active linkage is finalized to avoid their establishment or, conversely, in facilitating their establishment and keeping their replication in different contexts (or partially and in combinations) and identifying related standardized approaches (also for classes of configurations having significant levels of equivalence). This research project has methodological generalizing aspects of trans-disciplinarity. We conclude by mentioning related research issues. [ABSTRACT FROM AUTHOR]

Background: A nonvolitional diagnostic method based on FES‐Cycling technology has recently been demonstrated for mechanically ventilated patients. This method presents good sensitivity and specificity for detecting muscle dysfunction and survival prognosis, even in unconscious patients. As the clinical relevance of this method has already been reported, we aimed to evaluate its safety and feasibility. Methods: An observational prospective study was carried out with 20 critically ill, mechanically ventilated patients. The FES‐cycling equipment was set in a specific diagnostic mode. For safety determination, hemodynamic parameters and peripheral oxygen saturation were measured before and immediately after the diagnostic protocol, as well as venous oxygen saturation and blood lactate. The creatine phosphokinase level (CPK) was measured before and 24, 48, and 72 h after the test. The time taken to carry out the entire diagnostic protocol and the number of patients with visible muscle contraction (capacity of perceptive muscular recruitment) were recorded to assess feasibility. Results: Heart rate [91 ± 23 vs. 94 ± 23 bpm (p = 0.0837)], systolic [122 ± 19 vs. 124 ± 19 mm Hg (p = 0.4261)] and diastolic blood pressure [68 ± 13 vs. 70 ± 15 mm Hg (p = 0.3462)], and peripheral [98 (96–99) vs. 98 (95–99) % (p = 0.6353)] and venous oxygen saturation [71 ± 14 vs. 69 ± 14% (p = 0.1317)] did not change after the diagnostic protocol. Moreover, blood lactate [1.48 ± 0.65 vs. 1.53 ± 0.71 mmol/L (p = 0.2320)] did not change. CPK did not change up to 72 h after the test [99 (59–422) vs. 125 (66–674) (p = 0.2799) vs. 161 (66–352) (p > 0.999) vs. 100 (33–409) (p = 0.5901)]. The time taken to perform the diagnostic assessment was 11.3 ± 1.1 min. In addition, 75% of the patients presented very visible muscle contractions, and 25% of them presented barely visible muscle contractions. Conclusions: The FES cycling‐based muscular dysfunction diagnostic method is safe and feasible. Hemodynamic parameters, peripheral oxygen saturation, venous oxygen saturation, and blood lactate did not change after the diagnostic protocol. The muscle damage marker (CPK) did not increase up to 72 h after the diagnostic protocol. [ABSTRACT FROM AUTHOR]

Purpose: Survival rates for children diagnosed with acute lymphoblastic leukemia (ALL) have increased significantly over recent decades, and thus attention shifted toward understanding the adverse effects of cancer treatment. Chemotherapy has side effects that could affect muscle state and diminish motor performance. This scoping review was conducted to map the breadth of evidence for different tools used in fine motor skills assessment, the extent of upper extremity strength, and fine motor performance, highlighting the potential risk factors that may influence these skills. Methods: In March 2023, full-text studies that examined fine motor performance and/or upper extremity strength were identified via searches in PubMed, Science Direct, Scopus, Web of Science, and PEDro databases. The titles and abstracts of selected studies were screened according to the inclusion and exclusion criteria. Results: The search yielded initial 418 citations and 26 peer-reviewed articles were finally included in the review. Considerable heterogeneity was observed regarding the methods of evaluating fine motor skills. The results of this review indicate that children and adolescents with ALL experienced fine motor limitations and upper extremity weakness either during or after cessation of treatment. Conclusion: This scoping review presents a broad overview of the literature addressing fine motor difficulties in the pediatric population with ALL. Results accentuate the need to incorporate strengthening and occupational therapy training to preserve muscle strength and minimize future fine motor problems along the course of chemotherapeutic treatment. Little evidence was reported regarding the risk factors that may impair muscle strength and motor performance. [ABSTRACT FROM AUTHOR]

A vocation to serving in severely medically under-resourced settings invariably means facing of our own weakness in realizing that vocation. Christian teaching proclaims that God’s strength in made perfect in weakness, which is both a comfort and a mystery to many in facing their weaknesses. Without diminishing the mystery, experience demonstrates several ways in which this promise plays out in reality, providing an imaginative stimulus for how it may also be true in ways where it is less understood. Believing such teaching forms part of a necessary theological framework for Christians serving in areas of immense suffering as well as encouraging transparency and vulnerability in regards to their own weaknesses.

Faced with the ecological crisis, environmental scientists are asking what else besides providing evidence can they do to steer needed processes of substantive change. We argue that such an exploration should start by recognizing their weakness regarding the forces aiming at slowing down the pace of change. Recognizing this weakness should lead scientists to a change of tactics, embracing forms of strategic action used for centuries by groups on the weaker side of power struggles: that is, guerrilla strategies. Avoiding simplistic celebrations of guerrillas—historically a form of warfare that has produced as much pain as gain—an appraisal of some of its strategic tenets could help scientists to sketch alternative forms of engagement with the ecological crisis. Instead of grand gestures and direct confrontations, they could focus on carrying out epistemic strategic actions, or initiatives centered on the strategic usage of environmental knowledge and knowledge infrastructures to reduce, neutralize, and/or redress the impact of the organizations and regulations blocking, diverting, or slowing down decisive action regarding the ecological crisis. These actions could involve producing novel forms of knowledge, exposing facts that are currently hidden, refusing to engage in the production of contentious knowledge or, in extreme cases, disrupting specially damaging knowledge infrastructures. Please refer to Supplementary Material for a full text Spanish version of this article. Ante la gravedad de la crisis ecológica, científicos de distintas áreas se están preguntando qué más podemos hacer -además de aportar evidencia- para motivar procesos sustantivos de transformación socioambiental. En este artículo, sostenemos que la exploración de formas alternativas de acción debería empezar por reconocer la posición de debilidad de los científicos frente a las fuerzas que buscan ralentizar o frenar los procesos de transformación. Reconocer esta debilidad debería llevarnos a un cambio de táctica, adoptando formas de acción estratégica utilizadas durante siglos por grupos en el lado más débil de las luchas de poder: las guerrillas. Evitando una celebración simplista de la guerrilla -históricamente una forma de conflicto armado que ha producido más dolor que logros- analizamos cómo algunos de sus principios estratégicos nos pueden servir para desde las ciencias esbozar formas alternativas de acción en relación con la crisis ecológica. En lugar de declaraciones públicas y enfrentamientos directos, los científicos deberíamos desarrollar novedosas acciones epistémicas estratégicas, es decir, iniciativas centradas en el uso estratégico del conocimiento ambiental y sus infraestructuras para reducir, neutralizar y/o corregir el impacto de organizaciones y normativas que bloquean, desvían o ralentizan las transformaciones urgentes en relación con la crisis ecológica. Estas acciones podrían implicar la producción de formas novedosas de conocimiento, la exposición de conocimiento actualmente oculto, la negativa a participar en la producción de conocimiento controversial o, en casos extremos, la disrupción de infraestructuras o procesos de conocimiento especialmente dañinos. La versión en español de este artículo se puede encontrar en Material Suplementarias.

Introduction: Weakness is a common symptom that within itself does not indicate a specific diagnosis. Recreational inhalant use such as nitrous oxide (NO) may not often be disclosed. Additionally, professional or occupational history, such as being a dentist or dental assistant, should be determined because of higher reported rates of NO misuse.1 Nitrous oxide can cause vitamin B12 deficiency and resulting neuropathy. Nitrous oxide toxicity can have a wide variation of presentations with or without laboratory abnormalities or remarkable imaging findings, which can further complicate a diagnosis of weakness secondary to NO use. Case Report: A 33-year-old female presented to the emergency department with progressive bilateral leg numbness and objective weakness after repeated recreational NO use. After an extensive workup, she was found to have vitamin B12 deficiency and an electromyography study consistent with myeloneuropathy, despite normal imaging. She was prescribed high-dose vitamin B12 therapy and stopped using NO. One year after diagnosis, our patient maintained NO sobriety and had near-complete resolution of prior neurologic deficits. Conclusion: The use of recreational inhalant and the patient’s occupation should be considered when a patient presents with weakness. Obtaining vitamin B12 and methylmalonic acid levels should be considered for diagnosis. However, NO-induced neuropathy can be seen in patients with normal vitamin B12 and methylmalonic levels and patients do not always have abnormal imaging findings. The healthcare team should consider the varied presentations and findings of substance-induced conditions such as NO toxicity.

Accompanied by the continuous growth of China′s demand for seafood and the increasing number of problems arising from offshore aquaculture, the deep-sea aquaculture industry came into being, becoming a new industry in the process of structural adjustment and industrial upgrading of China′s mariculture industry, accelerating the transformation and upgrading of aquaculture methods, and forming a new pattern of development of the marine aquaculture model. Currently, China′s deep-sea aquaculture industry has the industrial characteristics of high dependence on advanced technology, strong interconnectivity between industrial chains, and occupying market share with unique product positioning. This paper is based on the current development status of aquaculture scale, aquaculture equipment and aquaculture mode in the deep-sea industry, introduces the definition of deep-sea aquaculture, compares the development mode of foreign countries, analyzes the weakness of China′s deep-sea aquaculture industry in detail, and puts forward suggestions to improve the risk early warning mechanism, broaden the aquaculture industry chain, overcome the key technical problems, introduce preferential policies and enhance the level of scientific breeding, etc., to provide references to the high-quality development of China′s deep-sea aquaculture mode. The analysis also provides recommendations on improving the risk warning mechanism, broadening the aquaculture industry chain, attacking key technical problems, introducing preferential policies and improving the level of scientific breeding, so as to provide reference for the high-quality development of China′s deep-sea aquaculture model.

This article critically examines the question of whether a prophetic Hadith can be considered weak if it conflicts with intellect. The research employs analytical and library research methods, drawing on a range of scholarly works including books, academic articles, and writings by Muslim scholars spanning both the classical and contemporary eras.This study reveals that when the authenticity of a Hadith is uncertain and it contradicts intellect, it can be deemed weak. However, if a Hadith is deemed authentic by Hadith scholars despite its contradiction with intellect, two distinct theories emerge among Muslim scholars. The first theory, supported by many classical scholars and their contemporary followers, argues that a correct Hadith never opposes the intellect. According to this perspective, a sound and clear intellect will never contradict an authentic Hadith. In contrast, the second theory, advocated by modern Muslim scholars and some classical scholars, posits that a prophetic Hadith should be considered weak if it conflicts with intellect.The findings of this paper indicate that a prophetic Hadith, when narrated through a strong chain of narrators tracing back to the Prophet Muhammad, cannot inherently contradict the intellect. However, if a Hadith contradicts sound intellect, it can serve as a valid reason to question its authenticity and consider it weak. Through a comprehensive analysis of the scholarly discourse surrounding this topic, this study provides a deeper understanding of the complex relationship between prophetic Hadith and intellect. It underscores the importance of rigorous authentication processes, emphasizing the need to consider the reliability of the Hadith chain and the principles of intellectual reasoning when assessing the strength or weakness of a prophetic Hadith

Abstract A 38‐year‐old pathologist developed multiple evanescent white dot syndrome (MEWDS). He documented his visual impairment in detail utilizing a light microscope for pathological diagnosis. Notably, the subjective defects illustrated by the patient were in good spatiotemporal agreement with diagnostic outcomes. The present report enhances the understanding of visual impairment associated with MEWDS through a comparative analysis of subjective experiences and objective clinical findings.

Key points Mitochondrial dysfunctions are thought to contribute to muscle atrophy and weakness that develop during ageing and mechanical unloading caused by immobilization, bed rest and microgravity. Older adults are at greater risk of developing muscle and mitochondrial dysfunctions in response to unloading. Although exercise is well known to promote muscle and mitochondrial health, its protective effect during mechanical unloading in older adults remains largely unexplored. Here, we investigated the impact of 14 days of head‐down tilt bed rest (HDBR) with and without a multimodal exercise countermeasure in older men and women (55–65 years). Leg muscle volume was assessed using magnetic resonance imaging. Biopsies of the vastus lateralis were performed to assess markers of mitochondrial content, respiration, reactive oxygen species (ROS) production and calcium retention capacity (mCRC). Indices of mitochondrial quality control (MQC), including markers of fusion (MFN1 and 2), fission (Drp1), mitophagy (Parkin) and autophagy (p62 and LC3I and II) were measured using immunoblots. Muscle cross‐sections were stained for neural cell adhesion molecule (NCAM, a marker of denervation). HDBR triggered muscle atrophy, decreased mitochondrial content and respiration and increased mitochondrial ROS production. HDBR had no impact on mCRC or MQC markers but increased markers of autophagy and denervation. Exercise prevented the deleterious effects of HDBR on leg muscle volume, mitochondrial ROS production and markers of autophagy and denervation. Exercise also increased mitochondrial content and respiration without altering mCRC and MQC markers. Collectively, our results indicate that an exercise countermeasure that can be performed in bed is effective in protecting muscle and mitochondrial health during HDBR in older adults. Conditions associated with muscle unloading, such as immobilization, bed rest or microgravity, result in muscle atrophy and weakness, particularly in older adults. Mitochondrial dysfunctions are thought to contribute to muscle atrophy caused by unloading and ageing. However, whether exercise can counteract the deleterious effects of unloading in older adults remains largely unexplored. Here, we report that older adults exposed to 14 days of head‐down tilt bed rest (HDBR) displayed upper leg muscle atrophy, a decrease in mitochondrial content and respiration, an increase in H2O2 emission, and an increase in autophagy and denervation markers. No impact of HDBR on mitochondrial quality control was observed. A multimodal exercise countermeasure prevented the deleterious effects of HDBR on upper leg muscle volume, mitochondrial reactive oxygen species emission, and markers of autophagy and denervation and increased mitochondrial content and respiration. These findings highlight the effectiveness of exercise in promoting muscle and mitochondrial health in older adults undergoing bed rest. [ABSTRACT FROM AUTHOR]

In this paper, we explore the price dynamics of 16 representative records of USA Education Group stocks, encompassing two non-overlapping periods (before, during, and after COVID-19). Based on information theory and cluster analysis techniques, our study provides insights into disorder, predictability, efficiency, similarity, and resilience/weakness, considering the most diverse financial stakeholders. Our findings contribute significantly to understanding price dynamics in the education sector, encompassing non-crisis and crisis periods, and provide valuable information for financial risk management, highlighting the importance of considering financial assets' efficiency and resilience/weakness during economic turbulence, such as the COVID-19 crisis. [ABSTRACT FROM AUTHOR]

The older population is growing exponentially causing greater demands on healthcare. Malnutrition, dysphagia, sarcopenia and weakness are highly prevalent diseases in the older population. Previous research (Byun et al. in BMC Geriatr 19(356):1–7, 2019; Fujishima et al. in Geriatr Gerontol Int 19:91–97, 2019; Hernandez et al. in Nutr Hosp 32(4):1830–1836, 2015; Nagano et al. in J Nutr Health Aging 23(3):256–265.5, 2019; Nishioka et al. in Clin Nutr 36(4):1089–1096, 2017; Robinson et al. in Clin Nutr 37(4):1121–1132, 2018, https://doi.org/10.1016/j.clnu.2017.08.016) has shown that these disorders are frequently associated, in many cases, preventable using screenings and intervention. This study utilized the National Hospital Discharge Survey of 2008 from the National Center of Health Statistics as secondary data to examine the associations amongst these four variables as well as possible correlations with age, days of care in the acute care hospital setting and frequency of rehabilitative and nutritional interventions received by these patients. Out of 165,630 cases, a sample size of 59,029 cases ages 65 and above were filtered by the researchers for desired diagnoses and procedure codes. After this, all neurological diagnoses were filtered and excluded by the researchers, resulting in 2458 cases. Using the Chi square test of independence, findings revealed significant associations between the variables of malnutrition and dysphagia (χ2 (1) = 1882.618, p = 0.001), dysphagia and weakness (χ2 (1) = 21.069, p = 0.001) and malnutrition weakness (χ2 (1) = 88.434, p = 0.001). The point biserial correlation coefficient was calculated to examine possible associations between these four conditions and age as well as days of care. A significant negative correlation was found between malnutrition and age (rpb (2456) = − 0.043, p = 0.05). In addition, days of care were significantly correlated with malnutrition (r(2456) = 0.138, p = 0.001) and inversely significantly correlated with dysphagia (r(2456) = − 110, p = 0.001), weakness (r(2456) = − 0.060, p = 0.001) and sarcopenia (r(2456) = − 0.041, p = 0.05). Lastly, the study found a large disparity between cases that received rehabilitative and nutritional intervention and those that didn't. [ABSTRACT FROM AUTHOR]

The weakness of the tibialis anterior remains to be a controversial topic. There has been no study that used electrophysiological assessment of the function of the lumbar and sacral peripheral motor nerves. The aim is to evaluate surgical outcomes in patients with weakness of the tibialis anterior using neurological and electrophysiological assessments. We enrolled 53 patients. Tibialis anterior weakness was quantified by muscle strength, as assessed using a manual muscle test on a scale of 1 through 5, with scores <5 indicating weakness. Postoperative improvement in muscle strength was classified as excellent (5 grades recovered), good (more than one grade recovered), or fair (less than one grade recovered). Surgical outcomes for tibialis anterior function were categorized as "excellent" in 31, "good" in 8, "fair" in 14 patients. Significant difference in outcomes were observed depending on diabetes mellitus status, type of surgery, and the compound muscle action potentials amplitudes of the abductor hallucis and extensor digitorum brevis (p < 0.05). Surgical outcomes were classified into two groups, patients with excellent and good outcomes (Group 1) and patients with fair outcome (Group 2). Using the forward selection stepwise method, sex and the compound muscle action potentials amplitudes of the extensor digitorum brevis were identified as significant factors for their positive association with Group 1 status. The diagnostic power of the predicted probability was as high as 0.87 in terms of area under curve of the receiver operating characteristic curve. There was a significant correlation between the prognosis of tibialis anterior weakness and sex and the compound muscle action potentials amplitude of extensor digitorum brevis, suggesting that recording the compound muscle action potentials amplitude of extensor digitorum brevis will aid the outcome assessment of future surgical interventions for tibialis anterior weakness. [ABSTRACT FROM AUTHOR]

A 38‐year‐old pathologist developed multiple evanescent white dot syndrome (MEWDS). He documented his visual impairment in detail utilizing a light microscope for pathological diagnosis. Notably, the subjective defects illustrated by the patient were in good spatiotemporal agreement with diagnostic outcomes. The present report enhances the understanding of visual impairment associated with MEWDS through a comparative analysis of subjective experiences and objective clinical findings. [ABSTRACT FROM AUTHOR]

In the context of theological interpretations of disabilities, I am arguing for the concept of "strength in weakness." So far, a "theology of weakness," which portrays people with disabilities as pointedly illustrating universal human weakness, has played a very prominent role in the field. I argue that this theological interpretation of disabilities should not be the dominant one. I trace the alternative model of "strength in weakness" in discussing writings by the apostle Paul and describe how it is supported by the anthropological concept of intercorporeality. Yet first, the article discusses Stanley Hauerwas's theology of disability, which is not only a very pointed theology of weakness but also repeatedly associates disabilities with suffering. Since at least the latter aspect is in contrast with widespread self-perceptions among people with disabilities, a theology of weakness amounts to a "narrative prosthesis" (David Mitchell and Sharon Snyder). By contrast, Paul suggests that weakness can allow for distinct strengths. To flesh out distinctive competences of people with intellectual disabilities, I then discuss Maurice Merleau-Ponty's concept of intercorporeality. Intercorporeality denotes a human competence more generally, but I suggest that it is often partly eclipsed by social norms. However, people with intellectual disabilities often pay less attention to social norms, which helps explain a distinctive intercorporeal competence among people with intellectual disabilities. Reduced attention to social norms can imply a distinctive strength. [ABSTRACT FROM AUTHOR]

Background Older adults have the highest rates of head injury and are at the greatest risk for subsequent dysfunction, yet research on subsequent physical decline is limited. We sought to examine cross-sectional and prospective associations of head injury with physical functioning and frailty among older adults. Methods A total of 5 598 Atherosclerosis Risk in Communities Study participants from Visit 5 (2011–13) underwent assessments of physical functioning (Short Physical Performance Battery [SPPB], comprised of gait speed, chair stands, and balance) and frailty (defined using established criteria) were followed through Visit 7 (2018–19). Head injury was self-reported or based on ICD-9 codes. Adjusted linear and multinomial logistic regression models were used to estimate associations. Prospective models incorporated inverse probability of attrition weights to account for death or attrition. Results Participants were a mean age of 75 years, 58% were women, 22% were Black, and 27% had a prior head injury. Compared to individuals without head injury, individuals with head injury had worse physical functioning (SPPB total score, β-coefficient = −0.22, 95% CI: −0.35 to −0.09) and were more likely to be pre-frail (OR = 1.19, 95% CI: 1.04 to 1.35) or frail (OR = 1.40, 95% CI: 1.08 to 1.80) compared to robust. Prospectively, head injury was associated with a 0.02 m/s greater decline (95% CI: −0.04 to −0.01) in gait speed over a median of 5 years. Among baseline robust individuals (n  = 1 847), head injury was associated with increased odds of becoming pre-frail (OR = 1.32, 95% CI: 1.04 to 1.67) or frail (OR = 1.92, 95% CI: 1.05 to 3.51) compared to robust. Conclusions Older adults with prior head injury had worse physical functioning and greater frailty at baseline and were more likely to become frail and walk slower over time, compared to individuals without head injury. [ABSTRACT FROM AUTHOR]

ABSTRACT:Emphysematous pyelonephritis (EPN) is a rare and life-threatening sequalae of a urinary tract infection marked by a gas-producing necrotizing infection of the renal parenchyma requiring prompt treatment. It has been found to be correlated with uncontrolled diabetes mellitus and is more common in females due to their increased susceptibility to urinary tract infections. Early recognition and treatment of EPN are essential to improve the patient's prognosis and prevent further complications. In this case we highlight a progressive case of pyelonephritis complicated by emphysematous abscess formation requiring surgical management. A 49-year-old female with a history of diabetes, hypertension, asthma, and lupus who presented to the emergency department (ED) for evaluation of generalized weakness. Lactate was elevated and urinalysis was suggestive of infection. A computed tomography (CT) scan of the abdomen and pelvis revealed a large subcapsular fluid collection with multiple gas and air-fluid levels along the right kidney, as well as another suspected fluid collection adjacent to the upper pole of the right kidney. The findings suggested complicated pyelonephritis with emphysematous abscess formation. Urology was consulted and they suggested a perinephric drain be placed by interventional radiology (IR). The patient progressed well and was ultimately discharged days later in stable condition. Despite its rarity, healthcare providers should consider infectious processes such as EPN in the differential for generalized weakness and promptly initiate appropriate diagnostic and therapeutic measures.Topics: Weakness, sepsis, urology, CT scan.

Objective To analyze the risk factors of bleeding after subcutaneous injection of low-molecular-weight heparin in elderly patients with unstable angina pectoris and weakness. Methods Elderly patients with unstable angina pectoris and weakness who were hospitalized in the Department of Geriatrics and the Department of Cardiology of Nanjing Hospital Affiliated to Nanjing Medical University(Nanjing First Hospital) from June 2020 to June 2023, they were randomly divided into subcutaneous hemorrhage group(n=90) and control group(n=90) according to whether subcutaneous hemorrhage occurred.General data such as age, gender, body mass index(BMI), as well as combined diseases and injection methods were compared between the two groups.Multivariate logistic regression was performed to analyze the risk factors for subcutaneous hemorrhage after subcutaneous injection of low-molecular-weight heparin. Results The BMI, proportion of patients who underwent compression after injection of low-molecular-weight heparin, and subcutaneous fat thickness of patients in the subcutaneous hemorrhage group were significantly lower than those in the control group, with statistical significance(P

This study employs a case study approach in the Batu City Region, East Java Province, Indonesia. Over time, Batu City has undergone a significant transformation, particularly in the tourism sector, leading to the growth of a large service industry. This study aims to propose a comprehensive development strategy for the Batu City area integrating economic, social, and environmental elements into the spatial layout of Batu City, with the ultimate goal of establishing an environmentally friendly Tourism City. Strengths, weaknesses, opportunities, threats analysis and analytic hierarchy process were employed to assess data from interviews, questionnaires, and agency sources. The stages of analysis are as follows: 1) data collection, 2) analysis, and 3) strategic prioritizing. This study recommends the main priority strategy for the development of a sustainable environmentally friendly tourism city is committing to implementing the principles of sustainable urban development and environmentally friendly tourism citiy through Regional Regulations. Considering the unique attributes of each city, such us their economy, resources, policies, and environment, among other factors, this paper considers contextual relevance issues. By doing so, it assists cities in developing sustainable cities based on their own strengths, weaknesses, opportunities, and threats.

The application of the concept of asymmetry in the domain of security enables a comprehensive overview of the strategic relations between the opposing parties, as well as the methods used by the adversaries in an effort to turn this type of inequality into a permanent strategic advantage. As a process, asymmetry can most often be reduced to the creation or exploitation of power inequality between adversaries, with the ultimate goal of generating strategic or political asymmetry. By skilfully exploiting the political and security asymmetry that arose after the NATO aggression in 1999, Pristina and its allies constantly constantly built statehood of the so-called "Republic of Kosovo". At the same time, they undertook various political, security and economic activities in order to reduce the effectiveness of the instruments of power of the Republic of Serbia in Kosovo and Metohija and neutralize Serbia's influence in the southern Serbian province. In addition to building institutions and developing various instruments of power, the Albanian political elite in Kosovo and Metohija worked intensively on building internal and external legitimacy. The key results of such activities of Pristina certainly represent: the extortion of the international community foreign policy attitude on the irreversibility of Kosovo's independence, the support of the USA, the EU and NATO members to the self-proclaimed independence, the relocation of Belgrade-Pristina negotiations outside the UN and the mediation of the European Union, the pressure of its international allies on Belgrade to "normalize" relations and stop the "de-recognition" campaign, in order to maintain the foreign policy asymmetry in international relations. In the domain of internal politics, Prishtina constantly exploits Serbia's key weakness, which is its inability to ensure security and normal living conditions for the local Serbian population in Kosovo and Metohija. A large part of the concessions that the Albanian side received, through a series of agreements with Belgrade, were achieved with combination of US and EU pressure on Serbia and internal political, security and socio-economic pressure on the Serbian population in the southern Serbian province. The above-mentioned activities of Pristina were especially intensified after the beginning of the war in Ukraine. Increasingly frequent instrumentalization of violence and demonstration of force and the undertaking of unilateral and provocative moves are evident. The authorities in Pristina are obviously counting on the preoccupation of the USA, the EU and NATO with the war in Ukraine. Albanian political elite from Kosovo and Metohija are actively exploiting US and EU efforts to prevent the aforementioned conflict from spilling over into the Balkan region. The analysis of Prishtina's actions so far, shows the implementation of the their's attrition strategy towards the USA, the European Union and Belgrade. At the same time they are gradually strengthening the institutions of the new Albanian state and establishing the new political order in the entire territory of the Kosovo and Metohija, with intention to strengthen the internal and build external legitimacy of the so-called "Republic of Kosovo". In this long-term process, violence is skilfully used to exploit the weaknesses of the policies of the European Union and the USA in the region and to reduce and neutralize the influence of the Republic of Serbia in Kosovo and Metohija. The strategy of the so-called "Republic of Kosovo" is not basically different from the rebel strategies of other non-state actors. The longterm goal of Pristina's strategy is to gradually build its own legitimacy and state institutions, while at the same time reducing the legitimacy and destroying political order of its opponents. In the last phase of this strategy, from the second half of 2023, the so-called "Kosovo Government", following Western counterinsurgency models, openly engaged on the complete dismantling of the "parallel" political system in the north of Kosovo and Metohija, using various instruments of political, security and economic coercion. Considering the weak reaction of the USA and the European Union, even more robust and energetic action by the government of the so-called "Republic of Kosovo" can be expected in order to completely remove any presence and influence of Serbia in the north of Kosovo. On the other hand, in the short term, Prishtina strives to make the concessions to the Serbian side as small and symbolic as possible. The formation of the Community/Association of Serbian Municipalities in Kosovo and Metohija with symbolic powers and responsibilities for them is a condition for the de-facto recognition of the so-called "Republic of Kosovo". In the long term, the constant and irreversible outflow of the Serbian population from Kosovo and Metohija, indicates that the actions of the so-called "Republic of Kosovo" on the ground are gradual assimilation, constant segregation and narrowing of the socio-economic and cultural space for Serbs, so that they would "voluntarily" leave Kosovo and Metohija and thus solve the Serbian problem according to the "Croatian model".

Background: Evidence suggests that COVID-19 infection can cause lasting health consequences. Multidisciplinary rehabilitation services have been recommended to reduce the sequalae. However, the effectiveness of physical exercise interventions remains insufficiently documented. The aim of this study was to develop and implement a specific and well-tolerated protocol-based intervention to reduce muscle weakness in older adults impacted by COVID-19. Methods: Forty-six older adults were randomized into intervention and control groups. Isometric and isokinetic strength assessments were conducted for selected muscle groups using a JBA Staniak® torquemeter and Biodex System 3 dynamometer. Functional abilities were evaluated with the Time Up and Go test and Chair Stand Tests. Results: Men in the intervention group demonstrated a significant improvement in static conditions for knee flexors (KFs), trunk extensors (TEs) and trunk flexors (TFs) and in dynamic conditions for knee extensors (KEs). Women in the intervention group showed a significant improvement in static conditions for EFs, KFs, TEs and TFs and in dynamic conditions for a KE and a KF. The interaction GROUP × TESTING SESSION was significant for the Chair Test (s) and Chair Test (n). Conclusions: Our results demonstrate the effectiveness of a well-tolerated, protocol-based approach that can be used to diminish long-lasting functional deficits in post-COVID survivors. [ABSTRACT FROM AUTHOR]

Background: Intensive care acquired muscle weakness is a common feature in critically ill patients. Beyond the therapeutic uses, FES‐cycling could represent a promising nonvolitional evaluation method for detecting acquired muscle weakness. Objectives: To assess whether FES‐cycling is able to identify muscle dysfunctions, and to evaluate the survival rate in patients with detected muscle dysfunction. Methods: A prospective observational study was carried out, with 29 critically ill patients and 20 healthy subjects. Maximum torque and power achieved were recorded, in addition to the stimulation cost, and patients were followed up for six months. Results: Torque (2.64 [1.53 to 4.81] vs 6.03 [4.56 to 6.73] Nm) and power (3.31 [2.33 to 6.37] vs 6.35 [5.22 to 10.70] watts) were lower and stimulation cost (22 915 [5069 to 37 750] vs 3411 [2080 to 4024] μC/W) was higher in patients compared to healthy people (p < 0.05). Surviving patients showed a nonsignificant difference in power and torque in relation to nonsurvivors (p > 0.05), but they had a lower stimulation cost (4462 [3598 to 11 788] vs 23 538 [10 164 to 39 836] μC/W) (p < 0.05). In total, 34% of all patients survived during the six months of follow‐up. Furthermore, 62% of patients with a stimulation cost below 15 371 μC/W and 7% of patients with a stimulation cost above 15 371 μC/W survived. Conclusions: FES‐cycling has good sensitivity and specificity for detecting muscle disorders. Critical patients have low torque and power and a high stimulation cost. Stimulation cost is related to survival. A low stimulation cost was related to a 3 times greater chance of survival. [ABSTRACT FROM AUTHOR]

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According to Spinoza, "... if we suppose that a person perceives his own lack of power because he recognizes that something is more powerful than himself... then we conceive that the person is simply understanding himself distinctly... " (Ethics IV, Demonstration to Proposition 53, my italics). What does Spinoza mean by 'something' here? Given that there are two kinds of adequate cognition for Spinoza, which one is at stake when we understand that something is more powerful than ourselves? This paper addresses these underexamined questions by considering different ways of conceiving our weakness against the backdrop of Spinoza's epistemological and metaphysical commitments. [ABSTRACT FROM AUTHOR]

Background: Aging is an unavoidable process characterized by a progressive decline in body organs and skeletal muscle. Sarcopenia is defined as low muscle mass and function; it is diagnosed according to the working group of sarcopenia definition; also, it can predict the adverse disability outcome and subsequent functional deterioration. Objectives: This study aims to estimating the prevalence of sarcopenia in old Iraqi adults and determines some sociodemographic factors that may be related. Methods: A descriptive cross-sectional study was conducted on 500 elderly aged ≥60 years in a community-dwelling and senior citizen center in Baghdad. The data were obtained from a questionnaire (sociodemographic and behavioral data) in addition to anthropometry measurements. The cut-off point score was derived from the European Working Group on Sarcopenia in Older People 2. Results: Sarcopenia was present in 15%, 21.5% in males and 8.2% in females. It was positively associated with aging, significantly associated with males, marital state, retirement, nonsmoker, alcoholic, fall history, normal body mass index, and elderly. While it was negatively related to educational level and physical activity. Conclusions: Sarcopenia prevalence was presented with a considerable prevalence among old adults, as well as had a great association with all behavioral and lifestyle variants studied. [ABSTRACT FROM AUTHOR]

Spinal epidural abscess is a rare but serious condition with poor outcomes. It's classic triad of new back pain, neurological deficit and fever is only present in 15% of cases at presentation and is initially misdiagnosed in 75-89%. 6,7 Delaying treatment is associated with worse outcomes. Delirium is itself a risk factor for mortality but the disturbance in cognition and memory can also complicate clinical assessment. 1-5 We present a case of delirium caused by, and obscuring, a spinal epidural abscess. This case highlights the difficulties in diagnosing spinal epidural abscesses, the need for a high index of suspicion for the condition and timely action to minimise morbidity. In addition, it demonstrates the value of treating unexplained delirium as an emergency and the danger of diagnostic premature closure. Finally, the importance of persistent clinical examination of the confused and non-cooperative patient. [ABSTRACT FROM AUTHOR]

Introduction: The outbreak of Coronavirus Disease-19 (COVID19) was a global disaster that greatly impacted the education system. The Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis can be used to identify favourable and unfavourable factors and conditions in offline and e-learning systems, and to address problems in a targeted manner. Aim: To evaluate the understanding and perception of students regarding the online learning system through SWOT analysis. Materials and Methods: This cross-sectional study was conducted at a tertiary care teaching hospital in the Department of Pharmacology at a tertiary care teaching hospital in Tamil Nadu, India for a duration of one month in October 2021. The study included 589 undergraduate students from medical, dental, and allied health sciences. A preformed questionnaire using Google Forms was used to assess the students’ perception of the online teaching methodology during the COVID-19 pandemic. Data was assessed using a five-point Likert scale, and results were expressed as numbers and percentages. Results: The present study reported that 52.46% of the study participants had a strong positive opinion about the convenience and flexibility of online learning methods, as they can be accessed from anywhere and at any time. However, 214 (36.33%) participants agreed that monitoring students during online teaching was more difficult compared to classroom teaching. During the pandemic, when all educational institutions were closed, 412 (69.95%) students felt that completing a course within a stipulated period was made possible by the online method. On the other hand, 401 (68.08%) students believed that some countries do not recognise certificates from online learning systems, as they may not provide sufficient practical experiences compared to classroom teaching. Conclusion: The current study showed that more than half of the study participants had a very favourable assessment of the portability and adaptability of online learning techniques. However, they also strongly felt that it was more challenging to keep track of students during online learning compared to traditional classroom methods. Online learning has both benefits and drawbacks, and it is important for individuals to decide how best to utilise it for their own gain while avoiding any negative side effects. Based on the experiences of the pandemic, it is crucial to find innovative solutions that are appropriate for different learning contexts.

Abstract There is increasing evidence that neurodegenerative disorders including the Parkinsonian syndromes are associated with impaired skeletal muscle health, manifesting as wasting and weakness. Many of the movement problems, lack of muscle strength and reduction in quality of life that are characteristic of these syndromes can be attributed to impairments in skeletal muscle health, but this concept has been grossly understudied and represents an important area of unmet clinical need. This review describes the changes in skeletal muscle health in idiopathic Parkinson's disease and in two atypical Parkinsonian syndromes, the most aggressive synucleinopathy multiple system atrophy, and the tauopathy progressive supranuclear palsy. The pathogenesis of the skeletal muscle changes is described, including the contribution of impairments to the central and peripheral nervous system and intrinsic alterations. Pharmacological interventions targeting the underlying molecular mechanisms with therapeutic potential to improve skeletal muscle health in affected patients are also discussed. Although little is known about the mechanisms underlying these conditions, current evidence implicates multiple pathways and processes, highlighting the likely need for combination therapies to protect muscle health and emphasizing the merit of personalized interventions for patients with different physical capacities at different stages of their disease. As muscle fatigue is often experienced by patients prior to diagnosis, the identification and measurement of this symptom and related biomarkers to identify early signs of disease require careful interrogation, especially for multiple system atrophy and progressive supranuclear palsy where diagnosis is often made several years after onset of symptoms and only confirmed post‐mortem. We propose a multidisciplinary approach for early diagnosis and implementation of personalized interventions to preserve muscle health and improve quality of life for patients with typical and atypical Parkinsonian syndromes.

Simple Summary: Sarcopenia is a serious clinical condition experienced by many oncology patients as a disease and/or treatment-related adverse event that threatens their quality of life and survival. However, the assessment of body composition has not been incorporated into daily clinical practice and sarcopenia is either underdiagnosed or diagnosed at an advanced stage. Physical exercise offers significant benefits against sarcopenia, in terms of both prevention and treatment. In this review, the ways of assessing sarcopenia and sarcopenic obesity, their prognostic value, and their relation to the toxicity of the anticancer treatments are discussed. We also describe mechanisms by which exercise can counteract sarcopenia, and the potential role of myokines in the preservation of muscle mass. One of the most common adverse effects of cancer and its therapeutic strategies is sarcopenia, a condition which is characterised by excess muscle wasting and muscle strength loss due to the disrupted muscle homeostasis. Moreover, cancer-related sarcopenia may be combined with the increased deposition of fat mass, a syndrome called cancer-associated sarcopenic obesity. Both clinical conditions have significant clinical importance and can predict disease progression and survival. A growing body of evidence supports the claim that physical exercise is a safe and effective complementary therapy for oncology patients which can limit the cancer- and its treatment-related muscle catabolism and promote the maintenance of muscle mass. Moreover, even after the onset of sarcopenia, exercise interventions can counterbalance the muscle mass loss and improve the clinical appearance and quality of life of cancer patients. The aim of this narrative review was to describe the various pathophysiological mechanisms, such as protein synthesis, mitochondrial function, inflammatory response, and the hypothalamic–pituitary–adrenal axis, which are regulated by exercise and contribute to the management of sarcopenia and sarcopenic obesity. Moreover, myokines, factors produced by and released from exercising muscles, are being discussed as they appear to play an important role in mediating the beneficial effects of exercise against sarcopenia. [ABSTRACT FROM AUTHOR]

Emery-Dreifuss muscular dystrophy (EDMD) is a rare disease characterized by early contractures, progressive muscle weakness, and cardiac abnormalities. Different subtypes of EDMD have been described, with the two most common forms represented by the X-linked EDMD1, caused by mutations in the EMD gene encoding emerin, and the autosomal EDMD2, due to mutations in the LMNA gene encoding lamin A/C. A clear definition of the magnetic resonance imaging (MRI) pattern in the two forms, and especially in the rarer EDMD1, is still lacking, although a preferential involvement of the medial head of the gastrocnemius has been suggested in EDMD2. We report a 13-year-old boy with mild limb girdle muscle weakness, elbow and ankle contractures, with absence of emerin at muscle biopsy, carrying a hemizygous frameshift mutation on the EMD gene (c.153dupC/p.Ser52Glufs*9) of maternal inheritance. Minor cardiac rhythm abnormalities were detected at 24-hour Holter electrocardiogram and required β-blocker therapy. MRI scan of the thighs showed a mild diffuse involvement, while tibialis anterior, extensor digitorum longus, peroneus longus, and medial gastrocnemius were the most affected muscles in the leg. We also provide a review of the muscular MRI data in EDMD patients and highlight the relative heterogeneity of the MRI patterns found in EDMDs, suggesting that muscle MRI should be studied in larger EDMD cohorts to better define disease patterns and to cover the wide disease spectrum. [ABSTRACT FROM AUTHOR]

Myasthenia gravis presents with progressive skeletal muscle weakness. The disease can affect any group of muscles, along with the proximal limb and neck musculature. Elderly patients, especially those over 60 y of age, frequently face extensive delays in diagnosis, or are misdiagnosed, as the symptoms may be erroneously attributed to different other causes frequently seen in this age group, such as degenerative joint disease, disk herniation, osteoporotic vertebral fractures, or metastases. We present a case of a 61-year-old male patient with significant medical records of hypertension, who presented with neck pain for a few months, posted for cervical disc surgery at C6-7 with cage fixation. Two attempts for general anesthesia induction were complicated by severe hypotension. He was evaluated with low-frequency repetitive stimulation, Acetyl-choline receptor antibody, and P/Q calcium channel antibodies. The low-frequency Repetitive Nerve Stimulation (RNS) showed a severe reduced response that was corrected after rest, which was consistent with the diagnosis of myasthenia gravis. [ABSTRACT FROM AUTHOR]

Introduction: The outbreak of Coronavirus Disease-19 (COVID-19) was a global disaster that greatly impacted the education system. The Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis can be used to identify favourable and unfavourable factors and conditions in offline and e-learning systems, and to address problems in a targeted manner. Aim: To evaluate the understanding and perception of students regarding the online learning system through SWOT analysis. Materials and Methods: This cross-sectional study was conducted at a tertiary care teaching hospital in the Department of Pharmacology at a tertiary care teaching hospital in Tamil Nadu, India for a duration of one month in October 2021. The study included 589 undergraduate students from medical, dental, and allied health sciences. A preformed questionnaire using Google Forms was used to assess the students' perception of the online teaching methodology during the COVID-19 pandemic. Data was assessed using a five-point Likert scale, and results were expressed as numbers and percentages. Results: The present study reported that 52.46% of the study participants had a strong positive opinion about the convenience and flexibility of online learning methods, as they can be accessed from anywhere and at any time. However, 214 (36.33%) participants agreed that monitoring students during online teaching was more difficult compared to classroom teaching. During the pandemic, when all educational institutions were closed, 412 (69.95%) students felt that completing a course within a stipulated period was made possible by the online method. On the other hand, 401 (68.08%) students believed that some countries do not recognise certificates from online learning systems, as they may not provide sufficient practical experiences compared to classroom teaching. Conclusion: The current study showed that more than half of the study participants had a very favourable assessment of the portability and adaptability of online learning techniques. However, they also strongly felt that it was more challenging to keep track of students during online learning compared to traditional classroom methods. Online learning has both benefits and drawbacks, and it is important for individuals to decide how best to utilise it for their own gain while avoiding any negative side effects. Based on the experiences of the pandemic, it is crucial to find innovative solutions that are appropriate for different learning contexts. [ABSTRACT FROM AUTHOR]

At the onset of Covid-19 lockdowns in March 2020, companies sent many workers home for what was expected to be a two-week effort to “flatten the curve.” The purpose of this study is to explore the strengths and weaknesses of remote work that was mandated because of Covid-19 and provide a synthesis of the findings to further the discussion of the organizational policies for the post-Covid-19 workforce. This research seeks to identify and highlight the impact of remote work implemented during Covid-19 through a literature review to further the discussion of remote work policies in a post-Covid-19 workforce. Key themes for employee strengths are productivity, flexibility, commutes, skills, work-life balance, collaboration, and autonomy. Key themes for employee weaknesses are work-life balance, stress, workload, isolation, workspace, technology, flexibility, communication, collaboration, change, burnout, and anxiety. Key themes for employer strengths are productivity, technology, costs, recruiting and retention, and collaboration. Key themes for employer weaknesses are technology, management, productivity, flexibility, and collaboration. [ABSTRACT FROM AUTHOR]

Introduction: Traditional classroom teaching is being replaced by newer modalities where multimedia technologies are involved in the teaching process. The advantages of online learning were proven in the literature. However, the limitations in carrying out online classes for undergraduate dental education need to be sought. Objective: The objective is to conduct a strength, weakness, opportunity, threat (SWOT) analysis on online teaching and learning as perceived by teachers and students. Materials and Methods: Two different pro formas on online teaching and learning were given to all teaching faculty and students in Government Dental College, Thiruvananthapuram, Kerala. Data were collected using online Google Forms. Descriptive statistics were used to assess the perspective of teaching faculty and students in online classes. A semi-quantitative content analysis was done for open-ended items. Results: SWOT of Online teaching and learning were identified based on the quantitative and qualitative findings. A total of 164 students and 44 teaching faculty responded to our pro forma. More interactive online sessions and procuring technical support from institutions were perceived as opportunities for online teaching and learning. Accessibility issues and health issues were perceived as threats in online classes as a teaching–learning method by students. Conclusion: Well-outlined course content with proper scheduling, free Wi-Fi access, well-prepared and committed teaching faculty, creating a sense of responsible online learning, and supplying devices to access online classes to all students in the state are the few areas of implementation for better learning outcomes in online learning. [ABSTRACT FROM AUTHOR]

Although in recent years we have seen an increasing number of dentists in the country, unfortunately, the quality of education of students has not changed much during these years. The final goal of the dental education system is to prepare and create the necessary skills in students to provide the most appropriate and excellent dental treatment to society. One of the major problems is the inconsistency of the capacity of accepting students with the capacities of universities (facilities, equipment, professors, educational space, and the number of patients). Being apart from the size of the treatment departments and the presentation of the treatment plan by the university professors without defining any role for the students is one of the main reasons that cause the students to lack a comprehensive view and the ability to make decisions regarding the treatment of patients. The excessive separation of the departments takes away the opportunity for comprehensive education from the students so that they are not familiar with inter-departmental consultations, which ultimately affects their capabilities. The need to change the attitude of professors and students toward education and guidance towards providing a health-oriented treatment plan can cause many reforms in the educational system. One of the most important solutions is creating motivation and empowering students with new educational methods and involving students in the entire patient treatment process. It is easy to increase the educational quality of universities by considering simple solutions even despite many structural problems and at the same time provide better quality medical services to the people. The more attention we pay to educating students and solving the problems of the dental education system, in the not-too-distant future we will have a society with higher oral health and better quality dental services.

Abstract Background Antisynthetase syndrome is an inflammatory myopathy that is characterized by the presence of anti-aminoacyl-tRNA synthetase antibodies. Only 30% of those who suffer from the disease can be identified. We present three Hispanic cases of antisynthetase syndrome with unusual clinical pictures were extended myositis panel results enable disease diagnosis and treatment. Case presentation A 57-year-old Hispanic/Latino female with an erythematous scaly plaque, unresolved fever and non-immune haemolytic anaemia in whom inpatient work-up for fever of unknown origin was positive for anti-PL12 positive myositis extended panel. A 72-year-old Hispanic/Latino male with amyopathic weakness syndrome and mechanic hands in whom impatient work-up was relevant for proximal muscle uptake and anti-PM75 and AntiPL-12 myositis extended panel. And a 67-year-old Hispanic/Latino male with progressive interstitial lung disease and unresolved fever ended in myositis extended panel positive for antiPL-7. After systemic immunosuppressor treatment, patients had favourable clinical and paraclinical responses during outpatient follow-up. Conclusions The high variability of the antisynthetase syndrome in these cases demonstrates the importance of identification through an expanded panel and highlights the probability that this is a variable disease and that we need to include emerging molecular tests to promote the timely treatment of patients.

Background: Females are typically less fatigable than males during sustained isometric contractions at lower isometric contraction intensities. This sex difference in fatigability becomes more variable during higher intensity isometric and dynamic contractions. While less fatiguing than isometric or concentric contractions, eccentric contractions induce greater and longer lasting impairments in force production. However, it is not clear how muscle weakness influences fatigability in males and females during sustained isometric contractions. Methods: We investigated the effects of eccentric exercise-induced muscle weakness on time to task failure (TTF) during a sustained submaximal isometric contraction in young (18–30 years) healthy males (n = 9) and females (n = 10). Participants performed a sustained isometric contraction of the dorsiflexors at 35° plantar flexion by matching a 30% maximal voluntary contraction (MVC) torque target until task failure (i.e., falling below 5% of their target torque for ≥2 s). The same sustained isometric contraction was repeated 30 min after 150 maximal eccentric contractions. Agonist and antagonist activation were assessed using surface electromyography over the tibialis anterior and soleus muscles, respectively. Results: Males were ∼41% stronger than females. Following eccentric exercise both males and females experienced an ∼20% decline in maximal voluntary contraction torque. TTF was ∼34% longer in females than males prior to eccentric exercise-induced muscle weakness. However, following eccentric exercise-induced muscle weakness, this sex-related difference was abolished, with both groups having an ∼45% shorter TTF. Notably, there was ∼100% greater antagonist activation in the female group during the sustained isometric contraction following exercise-induced weakness as compared to the males. Conclusion: This increase in antagonist activation disadvantaged females by decreasing their TTF, resulting in a blunting of their typical fatigability advantage over males.

Context: Side bridge exercises strengthen the hip, trunk, and abdominal muscles and challenge the trunk muscles without the high lumbar compression associated with trunk extension or curls. Previous research using electromyography (EMG) reports that performance of the side bridge exercise highly activates the gluteus medius (Gmed). However, to the best of our knowledge, no previous research has investigated EMG amplitude in the hip and trunk muscles during side bridge exercise in subjects with Gmed weakness. Objective: The purpose of this study was to examine the EMG activity of the hip and trunk muscles during 3 variations of the side bridge exercise (side bridge, side bridge with knee flexion, and side bridge with knee flexion and hip abduction of the top leg) in subjects with Gmed weakness. Design: Repeated-measures experimental design. Setting: Research laboratory. Patients: Thirty subjects (15 females and 15 males) with Gmed weakness participated in this study. Intervention: Each subject performed 3 variations of the side bridge exercise in random order. Main Outcome Measures: Surface EMG was used to measure the muscle activities of the rectus abdominis, external oblique, longissimus thoracis, multifidus, Gmed, gluteus maximus, and tensor fasciae latae (TFL), and Gmed/TFL muscle activity ratio during 3 variations of the side bridge exercise. Results: There were significant differences in Gmed (F2,56 = 110.054, P <.001), gluteus maximus (F2,56 = 36.416, P <.001), and TFL (F2,56 = 108.342, P <.001) muscles among the 3 side bridge exercises. There were significant differences in the Gmed/TFL muscle ratio (F2,56 = 20.738, P <.001). Conclusion: Among 3 side bridge exercises, the side bridge with knee flexion may be effective for the individuals with Gmed weakness among 3 side bridge exercises to strengthen the gluteal muscles, considering the difficulty of the exercise and relative contribution of Gmed and TFL. [ABSTRACT FROM AUTHOR]