Macroglossia in advanced amyotrophic lateral sclerosis.

INTRODUCTION: An enlarged tongue (macroglossia) has been reported in advanced-stage patients with amyotrophic lateral sclerosis (ALS). METHODS: In this study we examined the prevalence of macroglossia and analyzed clinical correlations in 65 ALS patients on tracheostomy-invasive ventilation (TIV). RESULTS: Macroglossia was found in 22 patients (33.8%). Compared with those without macroglossia, patients with macroglossia had a younger age of onset, longer duration of disease and TIV use, lower ALS Functional Rating Scale score, higher body mass index, lower energy intake, more severe communication impairment, and lower oral function. Logistic multivariate analysis showed that body mass index (BMI; P = 0.007) and communication impairment (P = 0.029) were significantly correlated with macroglossia. The duration of TIV use was at the cut-off level of significance (P = 0.05). CONCLUSIONS: Macroglossia may be the result of overfeeding and replacement by fat during long-term TIV use in patients with advanced ALS. Muscle Nerve, 2016 Muscle Nerve 54: 386-390, 2016.

A pseudo-outbreak of COVID-19 associated pulmonary aspergillosis: a microbiological investigation of both the patients and the environment.

Background: We experienced a pseudo-outbreak of aspergillosis in a newly constructed COVID-19 ward. Within the first 3 months from the commencement of the ward, six intubated patients of COVID-19 developed probable or possible pulmonary aspergillosis. We suspected an outbreak of pulmonary aspergillosis associated with ward construction and launched air sampling for the investigation of the relationship between these. Methods: The samples were collected at 13 locations in the prefabricated ward and three in the general wards, not under construction, as a control. Results: The results from samples revealed different species of Aspergillus from those detected by the patients. Aspergillus sp. was detected not only from the air samples in the prefabricated ward but also in the general ward. Discussion: In this investigation, we could not find evidence of the outbreak that links the construction of the prefabricated ward with the occurrence of pulmonary aspergillosis. It might suggest that this series of aspergillosis was more likely occurred from fungi that inherently colonized patients, and was associated with patient factors such as severe COVID-19 rather than environmental factors. Once an outbreak originating from building construction is suspected, it is important to conduct an environmental investigation including an air sampling.

In vivo three-dimensional analysis of hindfoot kinematics.

BACKGROUND: Knowledge of normal bone motion of the foot is important for understanding the gait as well as for various pathologies; however, the pattern of 3D motion is not completely understood. The aim of this study was to quantify the in vivo motion of the tibiotalar joint, talocalcaneal joint, and talonavicular joint in normal adult feet using a noninvasive (e.g., nonsurgical) measurement technique. MATERIALS AND METHODS: CT images were taken of both feet of ten normal young adults (six males, four females) in neutral, plantarflexion, and dorsiflexion positions of the ankle joint, from which 3D virtual models were made of each mid-hind foot bones. The 3D bone motion of these models was calculated using volume merge methods in three major planes. These data were used to analyze the relationship between the motion of the ankle joint and each other joint. RESULTS: Tibiotalar rotation was observed in dorsiflexion, abduction, and eversion during maximal dorsiflexion of the ankle joint. Talocalcaneal and talonavicular rotation was very small because the ankle joint motion was limited to the sagittal plane. Tibiotalar rotation was also observed in plantarflexion and adduction during maximal plantarflexion of the ankle joint, and talocalcaneal rotation was very small. Talonavicular rotation was observed in plantarflexion and inversion. The motion of the x-axis and the z-axis of tibiotalar joint, and the x-axis and the y-axis of the talonavicular and talocalcaneal joint were associated with the ankle motion. CONCLUSION: Bone motion could be easily and accurately calculated using volume merge methods more effectively than it could with other methods. CLINICAL RELEVANCE: The data elucidates the baseline segmental motion for comparison with symptomatic subjects which could help us to better understand pathokinematics of various foot and ankle pathologies.

Validity of radial magnetic resonance imaging to determine the extent of Bankart lesions.

PURPOSE: The objectives were to compare conventional oblique coronal and axial images with radial images to determine the capacities of these modalities for visualizing sites in the glenoid labrum. MATERIALS AND METHODS: The glenoid labra of 45 patients without a labrum injury and 30 patients with Bankart lesions were examined by magnetic resonance imaging using three different sections. RESULTS: The radial images permitted a greater range of assessment of the morphology of the glenoid labrum than the conventional images. CONCLUSION: Radial magnetic resonance imaging is a useful method for evaluation of the glenoid labrum and enables wider visualization than conventional methods.

[Risk management of ALS patients who depend on home mechanical ventilation (HMV) while away from home].

Analyses were done on the health-related problems occurring among 12 Amyotrophic Lateral Sclerosis (ALS) patients who depend on Home Mechanical Ventilation (HMV) while social activities outside the home. The health-related problems were initially categorized according to differing scenarios of incidents. 115 incidents (50.7%) were related to do with ventilator systems. 112 incidents (49.3%) were related to do with human systems that were other than the respiratory system. Further categorization was done according to such causal factors related to environments, caregivers, attached devices, and other causes. Analyses were also done by each stage of activities: going out, while out, and on the way back home. When going out of the house, most health-related problems were caused by environmental factors such as obstacles in the house or limited spaces. During social activities, outside the home main causal factors were related to the outside environment or caregivers. When returning home, main causal factors were related to caregivers. Above findings indicate: Improvements in the home environment contribute to the decrease in the incidents that occur when going out. Skilled caregivers with the ability to deal with unexpected situations are desirable during outside activities. Support systems should be prepared for both patients and caregivers whenever they are fatigued after social activities outside the home.

Computational analysis and functional expression of ancestral copepod luciferase.

We recently reported the cDNA sequences of 11 copepod luciferases from the superfamily Augaptiloidea in the order Calanoida. They were classified into two groups, Metridinidae and Heterorhabdidae/Lucicutiidae families, by phylogenetic analyses. To elucidate the evolutionary processes, we have now further isolated 12 copepod luciferases from Augaptiloidea species (Metridia asymmetrica, Metridia curticauda, Pleuromamma scutullata, Pleuromamma xiphias, Lucicutia ovaliformis and Heterorhabdus tanneri). Codon-based synonymous/nonsynonymous tests of positive selection for 25 identified copepod luciferases suggested that positive Darwinian selection operated in the evolution of Heterorhabdidae luciferases, whereas two types of Metridinidae luciferases had diversified via neutral mechanism. By in silico analysis of the decoded amino acid sequences of 25 copepod luciferases, we inferred two protein sequences as ancestral copepod luciferases. They were expressed in HEK293 cells where they exhibited notable luciferase activity both in intracellular lysates and cultured media, indicating that the luciferase activity was established before evolutionary diversification of these copepod species.