Concomitant Occurrence of Acute Motor Axonal Neuropathy in Systemic Lupus Erythematosus.

ABSTRACT: Few case reports exist on the association of acute motor axonal neuropathy, a subtype of the Guillain-Barré syndrome (GBS), with systemic lupus erythematosus. Standard therapeutic guidelines for concomitant acute motor axonal neuropathy and systemic lupus erythematosus in the acute phase are not established, and no studies have reported physical medicine and rehabilitation perspective management in the plateau and recovery phases. A 50-yr-old woman with systemic lupus erythematosus presented with upper and lower limb weakness that progressed to an inability to walk. Neurological examination, radiologic evaluation, serologic analysis, and electrodiagnostic study were conducted, and she was diagnosed with acute motor axonal neuropathy. Subsequently, intravenous immunoglobulin therapy was administered. She complained of residual upper and lower extremity weakness and an inability to walk 3 mos after symptom onset. She underwent an intensive inpatient rehabilitation program for 6 wks and showed remarkable recovery in muscle strength and functional status (Berg Balance Scale, modified Barthel index, and Guillain-Barré syndrome disability scale). To our knowledge, this is the first reported case that focused on the functional outcomes after the rehabilitation program in acute motor axonal neuropathy with a history of systemic lupus erythematosus. This case report emphasizes the need for rehabilitation intervention for functional recovery in the plateau and recovery phases.

Clinical impact and benefits of a simultaneous cardio-pulmonary rehabilitation in a COVID-19-infected patient following cardiac arrest: A case report.

Since the advent of the pandemic, cardio-pulmonary rehabilitation (CR) has been shown to be an effective treatment. However, there are no studies showing data to substantiate its simultaneous application. A 62-year-old man was resuscitated for asystole during the work-up after presenting with a 2-day history of difficulty breathing. PCR test was positive for COVID-19. He was intubated and admitted to a negative pressure zone. Symptoms improved in response to acute treatment. Following extubation, respiratory distress persisted, and CR was implemented. Clinical indicators of cardiopulmonary function improved resulting in a successful return to community participation. The decline in cardiopulmonary function has been on the rise among COVID-19 survivors. The simultaneous application of CR treatment in our patient resulted in improved clinical indicators of cardiopulmonary function. The patient regained full function for independent community participation.

Peripheral neuropathy after extra-corporeal membrane oxygenation therapy in children: A case report.

RATIONALE: In recent years, the use of extracorporeal membrane oxygenation (ECMO) treatment for pediatric patients with cardiorespiratory failure has increased, with emphasis being given to the prevention of complications in ECMO-treated patients. Several studies have reported ECMO-related central nervous system complications, such as intracranial hemorrhage, cerebral infarction, and seizure. However, few cases of peripheral nerve injury have been reported in ECMO-treated adults; there have also been no reported cases of peripheral nerve injury in the pediatric population. PATIENT CONCERNS: Two pediatric patients aged 16 and 6 experienced motor weakness in the extremities after the insertion of ECMO equipment. DIAGNOSES: They were diagnosed with peripheral nerve injuries through an electrodiagnostic study that showed femoral/sciatic neuropathies and brachial plexopathy. Arteriography and doppler sonography was performed to find the cause of peripheral nerve injury, and this may be the results of vascular compromise and compressive injuries, respectively. INTERVENTIONS: Surgical embolectomy was performed to remove thrombus in one patient. Two patients received orthosis, and physical therapy and occupational therapy were performed to prevent contracture and improve strength and functional use. OUTCOMES: Two pediatric patients showed a gradual improvement in motor power and function. LESSONS: Through this case report, we present rare ECMO-related complications and emphasize the importance of early diagnosis and monitoring of peripheral nerve injury in ECMO-treated children.

An observational study substantiating the statistical significance of cardiopulmonary exercise with laboratory tests during the acute and subacute phases of center and home-based cardiac rehabilitation.

ABSTRACT: Cardiac rehabilitation (CR) can improve clinical indicators in patients with cardiovascular diseases. The literature reports a 20% reduction in all-cause mortality and a 27% reduction in heart-disease mortality following CR. Although its clinical efficacy has been established, there is uncertainty whether center-based (CBCR) is more effective than home-based (HBCR) programs in acute and subacute phases. We aimed to verify significant differences in their effectiveness for the improvement of cardiopulmonary function by analyzing cardiopulmonary exercise (CPX) with laboratory tests following both CR programs.A single-center cohort study of 37 patients, recently diagnosed with underlying cardiovascular diseases, underwent CBCR(18) and HBCR(19). CBCR group performed a supervised exercise regimen at the CR center, for 1 hour, 2 to 3 days a week, for a total of 12 to18 weeks. HBCR group completed a self-monitored exercise program at home under the same guidelines as CBCR. Participants were evaluated by CPX with laboratory tests at 1- and 6-month, following the respective programs.There was no statistical significance in clinical characteristics and laboratory findings. Pre-post treatment comparison showed significant improvement in VO2/kg, minute ventilation/carbon dioxide production slope, breathing reserve, tidal volume (VT), heart rate recovery, oxygen consumption per heart rate, low-density lipoprotein (LDL), LDL/HDL ratio, total cholesterol, ejection fraction (EF) (P < .05). CBCR approach showed greater improvement with significance in VO2/kg, metabolic equivalents, and EF on between groups analysis (P < .05).The time effect of CPX test and laboratory data showed improvement in cardiopulmonary function and serum indicators for both groups. VO2/kg, metabolic equivalents, and EF were among the variables that showed significant differences between groups. In the acute and subacute phases of 1 to 6 months, the CBCR group showed a greater cardiac output improvement than the HBCR group.

Measuring stress-induced martensite microstructures using far-field high-energy diffraction microscopy.

Modern X-ray diffraction techniques are now allowing researchers to collect long-desired experimental verification data sets that are in situ, three-dimensional, on the same length scales as critical microstructures, and using bulk samples. These techniques need to be adapted for advanced material systems that undergo combinations of phase transformation, twinning and plasticity. One particular challenge addressed in this article is direct analysis of martensite phases in far-field high-energy diffraction microscopy experiments. Specifically, an algorithmic forward model approach is presented to analyze phase transformation and twinning data sets of shape memory alloys. In the present implementation of the algorithm, the crystallographic theory of martensite (CTM) is used to predict possible martensite microstructures (i.e. martensite orientations, twin mode, habit plane, twin plane and twin phase fractions) that could form from the parent austenite structure. This approach is successfully demonstrated on three single- and near-single-crystal NiTi samples where the fundamental assumptions of the CTM are not upheld. That is, the samples have elastically strained lattices, inclusions, precipitates, subgrains, R-phase transformation and/or are not an infinite plate. The results indicate that the CTM still provides structural solutions that match the experiments. However, the widely accepted maximum work criterion for predicting which solution of the CTM should be preferred by the material does not work in these cases. Hence, a more accurate model that can simulate these additional structural complexities can be used within the algorithm in the future to improve its performance for non-ideal materials.

Cationic Ordering Coupled to Reconstruction of Basic Building Units during Synthesis of High-Ni Layered Oxides.

Metal (M) oxides are one of the most interesting and widely used solids, and many of their properties can be directly correlated to the local structural ordering within basic building units (BBUs). One particular example is the high-Ni transition metal layered oxides, potential cathode materials for Li-ion batteries whose electrochemical activity is largely determined by the cationic ordering in octahedra (e.g., the BBUs in such systems). Yet to be firmly established is how the BBUs are inherited from precursors and subsequently evolve into the desired ordering during synthesis. Herein, a multimodal in situ X-ray characterization approach is employed to investigate the synthesis process in preparing LiNi0.77Mn0.13Co0.10O2 from its hydroxide counterpart, at scales varying from the long-range to local individual octahedral units. Real-time observation corroborated by first-principles calculations reveals a topotactic transformation throughout the entire process, during which the layered framework is retained; however, due to preferential oxidation of Co and Mn over Ni, significant changes happen locally within NiO6 octahedra. Specifically, oxygen loss and the associated symmetry breaking occur in NiO6; as a consequence, Ni2+ ions become highly mobile and tend to mix with Li, causing high cationic disordering upon formation of the layered oxides. Only through high-temperature heat treatment, Ni is further oxidized, thereby inducing symmetry reconstruction and, concomitantly, cationic ordering within NiO6 octahedra. Findings from this study shed light on designing high-Ni layered oxide cathodes and, more broadly, various functional materials through synthetic control of the constituent BBUs.