Spinal intradural pseudocyst formation in central nervous system superficial siderosis.

The figure shows tissue samples taken from three previous cases, revealing the cause of hemosiderin deposition in the central nervous system because of superficial siderosis.

Phase 3, multicentre, randomised, double-blind, placebo-controlled, parallel-group study of ustekinumab in Japanese patients with active polymyositis and dermatomyositis who have not adequately responded to one or more standard-of-care treatments.

OBJECTIVES: To evaluate the efficacy and safety of ustekinumab (UST) in a multicentre, randomised, double-blind, placebo-controlled trial in adult Japanese patients with active polymyositis (PM) and dermatomyositis (DM). METHODS: Fifty-one Japanese adults diagnosed with active PM/DM who did not respond adequately to one or more standard-of-care treatments were randomised 1:1 to receive UST (n=25) or placebo (n=26). Participants received body weight-range based intravenous administration of UST (6 mg/kg) or placebo at week 0 followed by 90 mg subcutaneous (SC) administration of UST or placebo every 8 weeks from week 8 to week 24. At week 24, placebo group crossed over to receive body weight-range based intravenous administration of UST, and thereafter, all participants received/were to receive SC administration of UST 90 mg every 8 weeks (week 32 through to week 72). The primary efficacy endpoint was the proportion of participants who achieved minimal improvement (≥20) in the International Myositis Assessment and Clinical Studies Total Improvement Score (IMACS TIS) at week 24. RESULTS: No statistically significant difference was seen in the proportion of participants who achieved minimal improvement (≥20) in IMACS TIS at week 24 between the treatment groups (UST 64.0% vs placebo 61.5%, p=0.94) based on the primary estimand of the primary endpoint analysis. CONCLUSIONS: UST was safe and well tolerated but did not meet the primary efficacy endpoint in adult Japanese participants with active PM/DM based on the primary analysis at week 24 in the study. TRIAL REGISTRATION NUMBER: NCT03981744.

Intramedullary Schwannoma of the Spinal Cord: A Nationwide Analysis by the Neurospinal Society of Japan.

OBJECTIVE: This study was aimed to report the clinical characteristics of intramedullary schwannomas and discuss imaging findings and treatment strategies. METHODS: The inclusion criterion was consecutive patients with intramedullary schwannomas who were surgically treated at 8 centers between 2009 and 2020. Clinical characteristics included age, sex, clinical presentation, disease duration, and follow-up period. The modified McCormick scale was used to compare the preoperative and postoperative conditions. Pre- and postoperative magnetic resonance images (MRI) of each case were analyzed. RESULTS: The mean age of the total 11 patients at the operation was 50.2 years. The mean duration of the symptoms was 23 months, with limb paresthesia being the most common clinical presentation. The cervical spine was the most common localization level of the tumor in 6 cases. The mean follow-up duration was 49.4 months. Gross total resection (GTR) and subtotal resection (STR) was achieved in 9 and 2 cases, respectively. According to the modified McCormick scale at 6 months postoperatively, 7 cases (63.6%) had improved and 4 cases (36.3%) had unchanged grades. Typical MRI findings of the intramedullary schwannoma included ring-like enhancement, syringomyelia, cystic formation, intramedullary edema, and hemosiderin deposition. Gadolinium enhancement was homogenous in 8 cases (72.7%). The tumor margins were well demarcated in all cases. CONCLUSION: Intramedullary schwannoma should be considered when sharp margins and well-enhanced tumors are present at the cervical spine level and the initial symptoms are relatively mild, such as dysesthesia. When GTR cannot be achieved, STR for tumor decompression is recommended.

Anterior horn damage in brachial multisegmental amyotrophy with superficial siderosis and dural tear: an autopsy case report.

BACKGROUND: Patients with superficial siderosis (SS) rarely show brachial multisegmental amyotrophy with ventral intraspinal fluid collection accompanied with dural tear. CASE PRESENTATION: We describe spinal cord pathology of a 58-year-old man who developed brachial multisegmental amyotrophy with ventral intraspinal fluid collection from the cervical to lumbar spinal levels accompanied with SS, dural tear, and snake-eyes appearance on magnetic resonance imaging (MRI). Radiological and pathological analyses detected diffuse and prominent superficial deposition of hemosiderin in the central nervous system. Snake-eyes appearance on MRI expanded from the C3 to C7 spinal levels without apparent cervical canal stenosis. Pathologically, severe neuronal loss at both anterior horns and intermediate zone was expanded from the upper cervical (C3) to middle thoracic (Th5) spinal gray matter, and these findings were similar to compressive myelopathy. CONCLUSION: Extensive damage of the anterior horns in our patient may be due to dynamic compression induced by ventral intraspinal fluid collection.

Intraoperative Cone-Beam Computed Tomography Assessment of Spinal Pedicle Screws Placement Precision Is in Full Agreement with Postoperative Computed Tomography Assessment.

OBJECTIVE: To assess agreement between pedicle screw placement evaluated on postoperative computed tomography (CT) and on intraoperative cone-beam CT (CBCT) and compare procedure characteristics when using first-generation and second-generation robotic C-arm systems in the hybrid operating room. METHODS: All patients who received pedicle screws for spinal fusion at our institution between June 2009 and September 2019 and underwent intraoperative CBCT and postoperative CT were included. The CBCT and CT images were reviewed by 2 surgeons to assess the screw placement using the Gertzbein-Robbins and the Heary classifications. Intermethod agreement of screw placement classifications as well as interrater agreement were assessed using Brennan-Prediger and Gwet agreement coefficients. Procedure characteristics using first-generation and second-generation generation robotic C-arm systems were compared. RESULTS: Fifty-seven patients were treated with 315 pedicle screws at thoracic, lumbar, and sacral levels. No screw had to be repositioned. On CBCT, accurate placement was found for 309 screws (98.1%) using the Gertzbein-Robbins classification and 289 (91.7%) using the Heary classification and on CT, these were 307 (97.4%) and 293 (93.0%), respectively. Intermethod between CBCT and CT and interrater agreements between the 2 raters were almost perfect (>0.90) for all assessment. There were no significant differences in mean radiation dose (P = 0.83) and fluoroscopy time (P = 0.82), but length of surgery using the second-generation system was estimated at 107.7 minutes (95% confidence interval, 31.9-183.5 minutes; P = 0.006) shorter. CONCLUSIONS: Intraoperative CBCT provides accurate assessment of pedicle screw placement and enables intraoperative repositioning of misplaced screws.

Preoperative assessment of dominant occipital sinus in patients with Chiari malformation type I: anatomical variations and implications for preventing potentially life-threatening surgical complications.

OBJECTIVE: The surgical treatment of Chiari malformation type I (CM-I) frequently involves dural incision at the posterior cranial fossa. In cases of persistent patent occipital sinus (OS), the sinus is usually obliterated and divided. However, there are some patients whose OS is prominent and requires crucial modification of the operative planning to avoid potentially life-threatening massive hemorrhage and disturbance of cerebral venous circulation. In the present study, the anatomical variations of the dominant OS in patients with CM-I were analyzed and the authors attempted to develop treatment recommendations for patients with CM-I with dominant OS. METHODS: The study included 213 patients with CM-I who underwent MR venography (MRV) prior to surgical treatment. OS dominance was assessed using 2D time-of-flight MRV or 3D phase-contrast MRV. Particular attention was paid to the pattern of venous outflow channels. The characteristics of the patients with dominant OS and the surgical outcomes were retrospectively reviewed. RESULTS: Dominant OS was identified in 7 patients (3.3%). The age in those with dominant OS was significantly younger than in those without (p = 0.0202). The incidence of concurrent scoliosis in the patients with dominant OS was significantly higher than in those without (p = 0.0366). All the dominant OSs were found to be of the oblique type. Unilateral oblique OS (OOS) with normal ipsilateral transverse sinus (TS) and hypoplastic contralateral TS was found in 2 patients (0.9%). The authors found 1 patient each (0.5%) who had unilateral OOS with hypoplastic ipsilateral TS and normal contralateral TS, unilateral OOS with bilateral hypoplastic TSs, and bilateral OOSs with bilateral normal TSs. Bilateral OOSs with bilateral hypoplastic TSs were found in 2 patients (0.9%). All these patients had syringomyelia. Instead of performing Y-shaped dural incision and duraplasty, surgical procedures were modified depending on the types of the OOSs to preserve their venous drainage routes. Although massive bleeding from the dominant OS during dural incision occurred in 1 patient, none suffered neurological deterioration. The syrinx volume decreased in all but 1 of the patients postoperatively. CONCLUSIONS: Assessment of the venous drainage pattern using MRV is indispensable for safe surgical treatment in patients with CM-I. The surgical procedure should be modified based on the type of dominant OS to minimize the surgical risks.

Multiple plasma membrane SLC4s contribute to external HCO3- acquisition during CO2 starvation in the marine diatom Phaeodactylum tricornutum.

The availability of CO2 is one of the restrictions on aquatic photosynthesis. Solute carrier (SLC) 4-2, a plasma membrane HCO3- transporter has previously been identified in the marine diatom Phaeodactylum tricornutum. In this study, we discovered two paralogs, PtSLC4-1 and PtSLC4-4, that are both localized at the plasma membrane. Their overexpression stimulated HCO3- uptake, and this was inhibited by the anion channel blocker 4,4´-diisothiocyanostilbene-2,2´-disulfonic (DIDS). Similarly to SLC4-2, PtSLC4-1 specifically required Na+ of ~100 mM for its maximum HCO3- transport activity. Unlike PtSLC4-1 and PtSLC4-2, the HCO3- transport of PtSLC4-4 depended equally on Na+, K+, or Li+, suggesting its broad selectivity for cations. Transcript analyses indicated that PtSLC4-1 was the most abundant HCO3- transporter under CO2 concentrations below atmospheric levels, while PtSLC4-4 showed little transcript induction under atmospheric CO2 but transient induction to comparable levels to PtSLC4-1 during the initial acclimation stage from high CO2 (1%) to very low CO2 (<0.002%). Our results strongly suggest a major HCO3- transport role of PtSLC4-1 with a relatively minor role of PtSLC4-2, and that PtSLC4-4 operates under severe CO2 limitation unselectively to cations when the other SLC4s do not function to support HCO3- uptake.

A Pneumatic Artificial Muscle and Spring Combination System that Assists Ankle Rocker and Transforms Energy into Push-Off Support: A Feasibility Study in Heathy Participants.

Insufficient push-off is a common problem for stroke hemiplegia patients. Assistive systems using extension spring to store energy during stance phase of gait to provide push-off assistance have been developed. However, patients could also suffer poor ankle rocker function; that is, poor dorsiflexion movement in stance phase. In such case, the spring could reversely become a burden for ankle movement. In this research, we proposed a system that combines a pneumatic artificial muscle and a tension spring. The artificial muscle mimics a human's tibialis anterior muscle, while the spring mimicking the Achilles tendon. Upon foot flat event of gait, the artificial muscle contracted to assist ankle rocker function and stretched the spring to store energy simultaneously. After heel off, the artificial muscle extended and the spring was released to provide push-off assistance. A feasibility study in seven healthy participants was conducted to verify assistance effects on their ankle rocker function and push-off movements. The results show significant increase in ankle rocker angle, push-off angle, and push-off torque compared with those during normal walk when the participants were assisted by our system. Therefore, we believe that the proposed system has great potential to assist stroke survivors with problems of poor ankle rocker function and push-off movements.

Use of a Simulation Model to Investigate the Mechanisms of Sports-related Head Injuries.

A simulation model was developed to better understand the mechanisms of brain injuries in sports. A three-dimensional model comprising approximately 1.22 million elements was constructed from cranial computed tomography images of adult male volunteers by the voxel method. To simulate contact sports that permit actions such as tackling, a sinusoidal wave with duration of 10 ms and maximum acceleration of 2000 m/s2 was applied to the lowest point of the model to apply rotational acceleration to the head from different directions. The von Mises stress was then observed at five points in the coronal plane of the brain: cingulate gyrus (CG), corpus callosum (CC), brain stem (BS), lateral temporal lobe (LT), and medial temporal lobe (MT). LS-DYNA universal finite element analysis software with explicit time integration was used for the analysis. Concentrations of stress started to appear in the CC and BS at 10 ms post-impact, after which they also became evident in the CG and MT. The maximum changes in stress at each location occurred 10-15 ms post-impact. The von Mises stress was 9-14 kPa in the CG, 8-24 kPa in the CC, 12-24 kPa in the BS, 7-12 kPa in the LT, and 12-18 kPa in the MT. The highest stress in every part of the brain occurred after lateral impact, followed by oblique impact and sagittal impact. Such simulations may help elucidate the mechanisms of brain injuries in sports and help develop measures to prevent chronic traumatic encephalopathy.

Cervical lateral mass screw length analysis in men versus women.

Posterior fixations with lateral mass screws have become popular. The Roy-Camille and the Magerl techniques have been established and screw length was identified as a particularly important element. Sex and ethnicity are significant factors in cervical spine morphology, but few studies have been performed for screw length. We performed measurements using computed tomography (CT) images of adult patients hospitalized for surgery of the cervical spine, with targeted 3D data analysis. The final number of patients was 47 (33 men, 14 women) and 235 vertebrae. With the Roy-Camille technique, the screw length was longest at C3 (men: 13.0 mm ± 1.9 mm, women: 13.0 mm ± 1.9 mm) and smallest at C7 (men: 10.8 mm ± 1.8 mm, women: 9.4 mm ± 1.2 mm). With the Magerl technique, the screw length was smallest at C3 (men: 14.8 mm ± 1.6 mm, women: 14.3 mm ± 1.6 mm) and longest at C7 for men (16.8 mm ± 2.8 mm), and at C6 for women (15.4 mm ± 3.0 mm). To differ from spinal canal or pedicle, cervical lateral mass showed no obvious morphological differences from that of subjects of other ethnicity. The placement of a standard lateral mass screw would not cause complications in Japanese patients, even with the use of devices designed in North America or Europe. However, the anatomical background is essential because it is important to optimize the selection for each patient to avoid complications considering sex and individual differences.

Effects of Assisted Dorsiflexion Timing on Voluntary Efforts and Compensatory Movements: A Feasibility Study in Healthy Participants.

In previous research, we found that modulating the assistance timing of dorsiflexion may affect a user's voluntary efforts. This could constitute a focus area based on assistive strategies that could be developed to foster patients' voluntary efforts. In this present study, we conducted an experiment to verify the effects of ankle dorsiflexion assistance under different timings using a high-dorsiflexion assistive system. Nine healthy and young participants wore a dorsiflexion-restrictive device that enabled them to use circumduction or steppage gaits. On the basis of the transition from the stance to the swing phase of the gait, the assistance timings of the high-dorsiflexion assistive system were set to have delays, which ranged from 0 to 300 ms. The index results from eight out of nine participants evaluated compensatory movements and revealed positive strong/moderate correlations with assistance delay times (r = 0.627-0.965, p <.001), whereas the other participants also performed compensatory movement when dorsiflexion assistance timing was late. Meanwhile, the results from tibialis anterior surface electromyography from six out of nine participants showed positive strong/moderate correlations with dorsiflexion assistance delay times (r = 0.598-0.922, p <.001), indicating that tuning the assistance timing did foster these participants' voluntary dorsiflexion movements. This result indicates that there should be a trade-off between ensuring voluntary dorsiflexion movements and preventing incorrect gait patterns at different assistance timings. The findings of this feasibility study indicate the potential of developing an adaptive control method to ensure voluntary efforts during robot-assisted gait rehabilitation based on assistance timing modification. A new assistance mechanism should also be required to stimulate and motivate a patient's voluntary efforts and should reinforce the effects of active gait rehabilitation.

Somatosensory contribution to audio-visual speech processing.

Recent studies have demonstrated that the auditory speech perception of a listener can be modulated by somatosensory input applied to the facial skin suggesting that perception is an embodied process. However, speech perception is a multisensory process involving both the auditory and visual modalities. It is unknown whether and to what extent somatosensory stimulation to the facial skin modulates audio-visual speech perception. If speech perception is an embodied process, then somatosensory stimulation applied to the perceiver should influence audio-visual speech processing. Using the McGurk effect (the perceptual illusion that occurs when a sound is paired with the visual representation of a different sound, resulting in the perception of a third sound) we tested the prediction using a simple behavioral paradigm and at the neural level using event-related potentials (ERPs) and their cortical sources. We recorded ERPs from 64 scalp sites in response to congruent and incongruent audio-visual speech randomly presented with and without somatosensory stimulation associated with facial skin deformation. Subjects judged whether the production was /ba/ or not under all stimulus conditions. In the congruent audio-visual condition subjects identifying the sound as /ba/, but not in the incongruent condition consistent with the McGurk effect. Concurrent somatosensory stimulation improved the ability of participants to more correctly identify the production as /ba/ relative to the non-somatosensory condition in both congruent and incongruent conditions. ERP in response to the somatosensory stimulation for the incongruent condition reliably diverged 220 msec after stimulation onset. Cortical sources were estimated around the left anterior temporal gyrus, the right middle temporal gyrus, the right posterior superior temporal lobe and the right occipital region. The results demonstrate a clear multisensory convergence of somatosensory and audio-visual processing in both behavioral and neural processing consistent with the perspective that speech perception is a self-referenced, sensorimotor process.

MRI characteristics of syringomyelia associated with foramen magnum arachnoiditis: differentiation from Chiari malformation.

BACKGROUND: It is important to distinguish foramen magnum arachnoiditis (FMA) from Chiari malformation (CM) before surgery because the operative strategies for these diseases differ. In the current study, we compared pretreatment magnetic resonance imaging (MRI) of FMA with CM and investigated the MRI findings useful to differentiate between these diseases. METHODS: We retrospectively reviewed patients with FMA or CM aged ≥ 18 years who underwent surgeries at our institution between 2007 and 2019. The morphologies of the syrinx, neural elements, and posterior cranial fossa were preoperatively evaluated with MRI. We used the receiver operating characteristic (ROC) curve for the fourth ventricle-to-syrinx distance (FVSD). RESULTS: Ten patients with FMAs and 179 with CMs were included. FVSD in the FMA group was significantly shorter than that in the CM group (7.5 mm [IQR, 2.8-10 mm] in FMA vs. 29.9 mm [IQR, 16.3-52.9 mm] in CM, p < 0.0001). The other MRI findings that showed the height, size, and length of the syrinx; size of the foramen magnum; degree of cerebellar tonsillar descent; shape of the cerebellar tonsil; and dorsal subarachnoid space at the foramen magnum differed significantly between the two groups. The ROC curve analysis showed that patients whose FVSD was less than 11 mm could be diagnosed with FMA with a specificity of 90% and sensitivity of 96%. CONCLUSIONS: A more cranial syrinx development (FVSD < 11 mm) appears to be the characteristic MRI finding in FMA.

Neural Development of Speech Sensorimotor Learning.

The development of the human brain continues through to early adulthood. It has been suggested that cortical plasticity during this protracted period of development shapes circuits in associative transmodal regions of the brain. Here we considered how cortical plasticity during development might contribute to the coordinated brain activity required for speech motor learning. Specifically, we examined patterns of brain functional connectivity (FC), whose strength covaried with the capacity for speech audio-motor adaptation in children ages 5-12 and in young adults of both sexes. Children and adults showed distinct patterns of the encoding of learning in the brain. Adult performance was associated with connectivity in transmodal regions that integrate auditory and somatosensory information, whereas children rely on basic somatosensory and motor circuits. A progressive reliance on transmodal regions is consistent with human cortical development and suggests that human speech motor adaptation abilities are built on cortical remodeling, which is observable in late childhood and is stabilized in adults.SIGNIFICANCE STATEMENT A protracted period of neuro plasticity during human development is associated with extensive reorganization of associative cortex. We examined how the relationship between FC and speech motor learning capacity are reconfigured in conjunction with this cortical reorganization. Young adults and children aged 5-12 years showed distinctly different patterns. Mature brain networks related to learning included associative cortex, which integrates auditory and somatosensory feedback in speech, whereas the immature networks in children included motor regions of the brain. These patterns are consistent with the cortical reorganization that is initiated in late childhood. The result provides insights into the human biology of speech as well as to the mature neural mechanisms for multisensory integration in motor learning.

Thoracic and lumbar spine pedicle morphology in Japanese patients.

PURPOSE: Pedicle morphology is important for intraoperative surgical anatomy and to define pedicle screw design and parameters. However, differences of pedicle size according to ethnicity and gender are not well studied. The purpose of this study is to investigate morphological characteristics of the pedicle in Japanese patients for determining adequate screw size and optimal surgical planning. METHODS: We investigated thoracic and lumbar pedicle morphology in Japanese patients using computed tomography (CT) measurements and analyzed the standard size of pedicles on upper thoracic to lumbar spine CT images in 227 Japanese patients. RESULTS: Gender had a larger impact on the shape and size of pedicles than racial differences. In the distribution of pedicle width, we calculated the ratio of values less than 4.5 mm, that in females resulted to be over 30% for the Th3-Th9 segment, and particularly high, above 60% at Th4 and Th5. CONCLUSION: Our measurement analysis showed that pedicle morphological parameters in Japanese patients showed tendency to be smaller to those found in other studies, and particularly in female patients, they were statistically significantly smaller. Adequate transpedicular instrumentation for Japanese patients will require smaller size pedicle-related devices that will match our anatomical findings to achieve safe device placement. In addition, serving ethnically non-homogenous patient population can require further to spinal morphometric for precise device selection.

Perceptions and Attitudes Toward Telemedicine by Clinicians and Patients in Japan During the COVID-19 Pandemic.

Background: Coronavirus disease 2019 (COVID-19) has spread rapidly worldwide. In Japan, the spread of COVID-19 was recognized and a state of emergency declared in April 2020. In response, public health interventions, such as discouraging people from leaving their homes unnecessarily, were enacted across the country. Under these circumstances, telemedicine has received a great deal of social attention, and it has become necessary to identify the perceptions of and attitudes toward telemedicine by clinicians and patients and to clarify the problems and advantages. Materials and Methods: Ten clinicians and 10 family members (if the patient was pediatric or elderly, a caregiver was included) were invited to participate in individual private interviews in 2020. All interviews were conducted from October to December 2020 using a semistructured interview guide. All transcripts were coded using thematic content analysis. Results: Four categories from clinicians and five from patients were identified as perceptions of and attitudes toward telemedicine. Both evaluated the usefulness and convenience of telemedicine in the same manner, but there was a large gap in the content under the safety and problem categories. Discussion: It is necessary to disseminate information about the communication techniques unique to telemedicine to doctors and to improve the "operation and introduction" and "communication environment and device settings" when starting or using telemedicine for all patients. Conclusions: The perceptions and attitudes identified in this study will be useful for establishing and developing a telemedicine system in Japan.

Changes of orofacial somatosensory attenuation during speech production.

Modulation of auditory activity occurs before and during voluntary speech movement. However, it is unknown whether orofacial somatosensory input is modulated in the same manner. The current study examined whether or not the somatosensory event-related potentials (ERPs) in response to facial skin stretch are changed during speech and nonspeech production tasks. Specifically, we compared ERP changes to somatosensory stimulation for different orofacial postures and speech utterances. Participants produced three different vowel sounds (voicing) or non-speech oral tasks in which participants maintained a similar posture without voicing. ERP's were recorded from 64 scalp sites in response to the somatosensory stimulation under six task conditions (three vowels × voicing/posture) and compared to a resting baseline condition. The first negative peak for the vowel /u/ was reliably reduced from the baseline in both the voicing and posturing tasks, but the other conditions did not differ. The second positive peak was reduced for all voicing tasks compared to the posturing tasks. The results suggest that the sensitivity of somatosensory ERP to facial skin deformation is modulated by the task and that somatosensory processing during speaking may be modulated differently relative to phonetic identity.

Neural Correlates of Vocal Pitch Compensation in Individuals Who Stutter.

Stuttering is a disorder that impacts the smooth flow of speech production and is associated with a deficit in sensorimotor integration. In a previous experiment, individuals who stutter were able to vocally compensate for pitch shifts in their auditory feedback, but they exhibited more variability in the timing of their corrective responses. In the current study, we focused on the neural correlates of the task using functional MRI. Participants produced a vowel sound in the scanner while hearing their own voice in real time through headphones. On some trials, the audio was shifted up or down in pitch, eliciting a corrective vocal response. Contrasting pitch-shifted vs. unshifted trials revealed bilateral superior temporal activation over all the participants. However, the groups differed in the activation of middle temporal gyrus and superior frontal gyrus [Brodmann area 10 (BA 10)], with individuals who stutter displaying deactivation while controls displayed activation. In addition to the standard univariate general linear modeling approach, we employed a data-driven technique (independent component analysis, or ICA) to separate task activity into functional networks. Among the networks most correlated with the experimental time course, there was a combined auditory-motor network in controls, but the two networks remained separable for individuals who stuttered. The decoupling of these networks may account for temporal variability in pitch compensation reported in our previous work, and supports the idea that neural network coherence is disturbed in the stuttering brain.

Total Spinal Epidural "Blood Patch" Application Through a Racz Catheter in Spontaneous Intracranial Hypotension.

BACKGROUND: Epidural "blood patch" (EBP) is a standard treatment of spontaneous intracranial hypotension (SIH). In recent years, there are some reports of Racz catheter use for EBP performance at upper cervical spine levels. However, the practical use of Racz catheter for single-entry multisite EBP has never been reported until now. CASE DESCRIPTION: We treated a 60-year-old man diagnosed with SIH presenting with cerebrospinal fluid leaks from the cervical to the sacral segments. We discuss the advantages of the single-entry multisite EBP and the convenience of Racz catheter use in such cases. CONCLUSIONS: The Racz catheter can be a convenient means to deliver large-volume EBPs from a single entry point in the treatment of SIH.

Recalibration of auditory perception of speech due to orofacial somatosensory inputs during speech motor adaptation.

Speech motor control and learning rely on both somatosensory and auditory inputs. Somatosensory inputs associated with speech production can also affect the process of auditory perception of speech, and the somatosensory-auditory interaction may play a fundamental role in auditory perception of speech. In this report, we show that the somatosensory system contributes to perceptual recalibration, separate from its role in motor function. Subjects participated in speech motor adaptation to altered auditory feedback. Auditory perception of speech was assessed in phonemic identification tests before and after speech adaptation. To investigate a role of the somatosensory system in motor adaptation and subsequent perceptual change, we applied orofacial skin stretch in either a backward or forward direction during the auditory feedback alteration as a somatosensory modulation. We found that the somatosensory modulation did not affect the amount of adaptation at the end of training, although it changed the rate of adaptation. However, the perception following speech adaptation was altered depending on the direction of the somatosensory modulation. Somatosensory inflow rather than motor outflow thus drives changes to auditory perception of speech following speech adaptation, suggesting that somatosensory inputs play an important role in tuning of perceptual system.NEW & NOTEWORTHY This article reports that the somatosensory system works not equally with the motor system, but predominantly in the calibration of auditory perception of speech by speech production.