Gait asymmetrical evaluation of lower limb amputees using wearable inertial sensors.

This study presents an analysis and evaluation of gait asymmetry (GA) based on the temporal gait parameters identified using a portable gait event detection system, placed on the lateral side of the shank of both lower extremities of the participants. Assessment of GA was carried out with seven control subjects (CS), one transfemoral amputee (TFA) and one transtibial amputee (TTA) while walking at different speeds on overground (OG) and treadmill (TM). Gait cycle duration (GCD), stance phase duration (SPD), swing phase duration (SwPD), and the sub-phases of the gait cycle (GC) such as Loading-Response (LR), Foot-Flat (FF), and Push-Off (PO), Swing-1 (SW-1) and Swing-2 (SW-2) were evaluated. The results revealed that GCD showed less asymmetry as compared to other temporal parameters in both groups. A significant difference (p < 0.05) was observed between the groups for SPD and SwPD with lower limb amputees (LLA) having a longer stance and shorter swing phase for their intact side compared to their amputated side, resulting, large GA for TFA compared to CS and TTA. The findings could potentially contribute towards a better understanding of gait characteristics in LLA and provide a guide in the design and control of lower limb prosthetics/orthotics.

Utilization and Findings of Flexible Naso-Pharyngo-Laryngoscopy in Upper Airway Disorders: A Clinic Audit.

Background: Flexible naso-pharyngo-laryngoscopy (NPL) has become an essential clinic tool for evaluating patients with upper airway disorders in otorhinolaryngology. It has been established to be a simple, cost-effective, and minimally invasive technique with good diagnostic yields. This study aimed to audit the procedure of flexible NPL done in our clinic over 2 years and analyse the technique, indications, and findings of the procedure. Methodology: A retrospective cross-sectional study among all the patients who presented to our ENT clinic in ABUTH Zaria, from July 2021 to June 2023 with upper airway symptoms or neck swelling who had flexible NPL done in the clinic. The records of these patients were reviewed, and information extracted including age, sex, use of anaesthesia, indications and findings of the procedure were entered in SPSS and analysed. Results: Flexible NPL was done in 266 patients aged 4 months to 85 years. Only 3% of the patients required local anaesthesia. The commonest indications were for preoperative evaluation of goitre (26.7%), suspected adenoid hypertrophy (18.4%), complaints of hoarseness (18.8%), and foreign body sensation (12%). The commonest diagnoses made were adenoid hypertrophy (19.9%), laryngeal tumour (5.3%), nasopharyngeal tumour (4.9%), vocal cord palsy (4.9%), rhinitis (4.5%) and pharyngitis (4.1%), laryngitis (3.0%), laryngopharyngeal reflux disease (3.0%) and vocal cord nodule (2.3%). Conclusions: Office flexible NPL was done commonly for preoperative evaluation of goitre, suspected adenoid hypertrophy, hoarseness, and foreign body sensation. The commonest pathologies were adenoid hypertrophy, laryngeal tumour, nasopharyngeal tumour, vocal cord palsy, rhinitis, pharyngitis, and laryngitis.

Association between the expression of epithelial-mesenchymal transition (EMT)-related markers and oncologic outcomes of colorectal cancer.

BACKGROUND: Epithelial-mesenchymal transition (EMT) is a key step in the development of colorectal cancer (CRC) that confers metastatic capabilities to cancer cells. The present study aimed to assess the immunohistochemical (IHC) expression and impact of EMT markers, including E-cadherin, Vimentin, ß-catenin, and SMAD4, on the oncologic outcomes of CRC. METHODS: This was a retrospective review of 118 CRC patients. Tissue slides were retrieved from the slide archive and five tissue microarray construction blocks were constructed. IHC for E-cadherin, Vimentin, ß-catenin, and SMAD4 was done. The main outcome was the association between abnormal marker expression and overall survival (OS), and disease-free survival (DFS). RESULTS: Adenocarcinomas accounted for 71.2% of tumors, whereas 25.4% and 3.4% were mucinous and signet ring cell carcinomas. The rates of lymphovascular invasion and perineural invasion were 72.9% and 20.3%, respectively. There was a positive, significant correlation, and association between the four markers. Abnormal expression of E-cadherin was associated with significantly lower OS (p < 0.0001) and similar DFS (p = 0.06). Abnormal Vimentin expression was associated with a significantly higher rate of distant metastasis (p = 0.005) and significantly lower OS and DFS (p < 0.0001). Abnormal expression of ß-catenin was associated with significantly lower OS (p < 0.0001) and similar DFS (p = 0.15). Abnormal expression of SMAD4 was associated with significantly lower OS and DFS (p < 0.0001). Abnormal expression of all four markers was associated with a higher disease recurrence, lower OS, and lower DFS. CONCLUSION: Abnormal expression of each marker was associated with lower OS, whereas abnormal expression of Vimentin and SMAD4 only was associated with lower DFS.

Efficacy of Ozone, UV Radiation, Herbal and Glutaraldehyde Method for Sterilisation of Elastomeric Impression Materials for Orthodontic and Prosthodontic procedures.

Objectives: The objectives of the current study was to evaluate the disinfection efficacy of ozone, ultraviolet (UV) radiation, herbal and glutaraldehyde method for sterilization of elastomeric impression materials. Materials and Methods: Disinfection of elastomeric impression material was performed with each of the disinfection methods: ozone, UV radiation, herbal, and glutaraldehyde. Later microbiological analysis was performed and the colony-forming units were evaluated and compared. Results: The highest disinfection efficacy was found with glutaraldehyde, followed by ozone and UV radiation, and the least with neem herbal rinse. Intergroup comparison was highly significant. Conclusion: Dry gaseous ozone and UV radiation can be used effectively for the disinfection of impressions.

Assessment of Various Post Systems' Fracture Resistance after Endodontic Treatment.

Objectives: The study's objective is to evaluate the fracture resistance of a tooth that has had endodontic treatment and has been rebuilt using various post and core systems. Materials and Methods: Thirty-six extracted premolar teeth of similar sizes were picked, and at random, they were separated into three groups: group A received stainless-steel posts, group B received zirconia fiber posts, and group C received glass fiber posts. Dual-cured resin cement was used to cement each post. The acrylic resin blocks have samples imbedded in them. Additionally, fracture loads were measured while a compressive force was given to the tooth at a crosshead speed of 1 mm/minute. The one-way analysis of variance F-test and post hoc Tukey's test were then used to analyze the results. Results: When the mean values and standard deviation were compared, it was found that glass fiber posts had the highest fracture resistance, followed by posts made of zirconia fiber, while stainless-steel posts had the lowest fracture resistance. Conclusion: When compared to zirconia posts and stainless-steel posts, glass fiber posts had the highest level of fracture resistance.

Chemosensory changes during chemotherapy.

BACKGROUND: Chemosensory changes that occur during chemotherapy can significantly impact food enjoyment, quality of life and recovery. AIM: To investigate chemosensory changes reported by oncology patients during chemotherapy. METHODS: A mixed-method cross-sectional study design was used to explore 100 cancer patients' experiences of chemosensory changes during chemotherapy. All patients completed a questionnaire assessing their taste and smell preferences. A purposive sample of 30 patients underwent a semi-structured interview to elicit their thoughts on their experienced chemosensory changes. Descriptive statistics and themes were examined. FINDINGS: The mean age of the sample was 50.56 years, and the majority of participants were female. The most stated taste alteration was bitter, while altered food preferences were also commonly experienced. Furthermore, most patients experienced unpleasant odours around food, while some experienced these odours even when food was not present. Overall, five themes were identified: changes in taste, changes in smell, changes in social life, altered comfort and food preferences. CONCLUSION: Chemosensory changes related to cancer and its treatment impact a person's nutrient intake, food-related behaviours, quality of life and treatment response. Patients who experience chemotherapy-associated chemosensory changes require specialised nutritional therapy to increase their eating-related pleasure. As part of the nutritional assessment, chemosensory alterations should be evaluated regularly.

Changes in social care after major emergency general surgery procedures.

BACKGROUND: Emergency general surgery (EGS) is a major part of the provision of healthcare, and patients undergoing EGS are at elevated risk of morbidity and mortality. This study aimed to determine factors contributing to patients losing their independence and being discharged to residential and nursing homes having previously lived in their own residences. METHODS: Our local data uploaded to the National Emergency Laparotomy Audit (NELA) (2014-2022) were analyzed. This national database encompasses all major EGS cases undertaken in the United Kingdom. The variables considered were patient demographics, American Society of Anesthesiologists score, admission and discharge dates, presenting pathology, operation type, and discharge destination. Comparative analyses segmented patients based on postdischarge EGS destinations. Multivariable logistic regression identified factors linked to residential/nursing home placement after discharge. Significance was set at P < .05. RESULTS: Data from all patients in the NELA database (n = 1611) were analyzed. Approximately 1 in 10 patients older than 70 years never returned home. Patients requiring additional support were on average 8.6 years older (P = .008). At older than 80 years, the need for extra social support increased substantially with each increasing year in age, and those older than 85 years were more than twice as likely to require extra support than 80-year-olds (P < .001). Patients who died were 11.4 years older than those discharged without additional support (P < .001). CONCLUSION: A significant proportion of patients, particularly the elderly, do not return to their usual place of residence and require a higher level of care postemergency surgery. These important social factors need to be considered before operating given that they may have significant quality of life and economic implications.

Exogenous glutathione protected wheat seedling from high temperature and water deficit damages.

High temperatures (HT) and drought are two major factors restricting wheat growth in the early growth stages. This study investigated the role of glutathione (GSH) amendment (0.0, 0.5, 1.0, and 2.0 mM) to soil in mitigating the adverse effect of HT (33 °C, with 25 °C as a control), water regimes (60% of field capacity and control), and their combinations. HT decreased the length, project area, surface area, volume, and forks of the root, while drought had the reverse effect. Shoot length, leaf area, leaf relative water content, and shoot and root dry matter were significantly decreased by HT and drought, and their combined impact was more noticeable. GSH significantly promoted the root system, shoot growth, and leaf relative water content. The combined treatment reduced chlorophyll a, chlorophyll b, and total chlorophyll. However, 0.5 mM GSH raised chlorophyll a, chlorophyll b, and total chlorophyll by 28.6%, 41.4%, and 32.5%, respectively, relative to 0.0 mM GSH. At combined treatment, 0.5 mM GSH decreased malondialdehyde (MDA) by 29.5% and increased soluble protein content by 24.1%. GSH meaningfully enhanced the activity of superoxide dismutase, catalase, and ascorbate peroxide in different treatments. This study suggested that GSH could protect wheat seedlings from the adverse effects of HT and/or drought stresses.

Ecotoxicological effects of cypermethrin on indigenous climbing perch (Anabas testudineus).

Pesticides including cypermethrin (10% EC) are commonly used pesticide in tea gardens of Bangladesh possess distinct harmful effects on an aquatic community. The experiment was carried out to assess the ecotoxicological effects of cypermethrin (10%) concentrate on indigenous Climbing Perch (Anabas testudineus). A total of 120 A. testudineus (mean length 16 ± 2.67 cm and mean weight 31.6 ± 3.56 g) were exposed to the acute toxicity test when the lethal concentration 50 value (LC50) for 96 h was maintained at 1.00 ppm. Three different sub-lethal concentrations of 0.05 ppm (5%), 0.10 ppm (10%), and 0.20 ppm (20%) were used respectively as three treatments and a control of 0 ppm with three replicates each. Restlessness, erratic movement, increased opercular activities, loss of equilibrium, and irregular response to feeding were observed in all the treatments compared to control one. Concerning histopathological alterations, all the analyzed organs showed highest changes in the T3 (cypermethrin conc. 20%) compared to other treatments while T0 (0 ppm) had normal structure. The major changes in the gill were epithelial cell hyperplasia, necrosis, severe lamellar fusion and epithelial lifting; while necrotic proximal tubules, glomerular shrinkage, disrupted renal corpuscle of the kidney and nuclear pyknosis, degenerated hepatic cells and vacuolation were observed in the liver. Severe melanomacrophage centre (MMC), haemosiderosis and vacuolation were found in spleen. The effect of cypermethrin on the hematological parameters of experimental fish was also studied. Red blood cells, hemoglobin and hematocrit were decreased in the experimental groups and lowest value was in T3 while values of white blood cells were increased in the experimental groups compared to control one. Hence, the present observation revealed that pesticides even at low concentrations can cause harmful effects on A. testudineus.

Asymmetric impact of patents on green technologies on Algeria's Ecological Future.

This study examines how patents on green technologies impact Algeria's ecological footprint from 1990 to 2022 while controlling for economic growth and energy consumption. The objectives are to analyze the asymmetric effects of positive and negative shocks in these drivers on ecological footprint and provide policy insights on leveraging innovations and growth while minimizing environmental harm. Given recent major structural shifts in Algeria's economy, time series data exhibits nonlinear dynamics. To accommodate this nonlinearity, the study employs an innovative nonlinear autoregressive distributed lag approach. The findings indicate that an upsurge in green technologies (termed as a positive shock) significantly reduces the ecological footprint, thereby enhancing ecological sustainability. Interestingly, a decline in green technologies (termed as a negative shock) also contributes to reducing the ecological footprint. This highlights the crucial role of clean technologies in mitigating ecological damage in both scenarios. Conversely, a positive shock in economic growth increases ecological footprint, underscoring the imperative for environmentally friendly policies in tandem with economic expansion. Negative shocks, however, have minimal impact. In a similar vein, positive shock in energy consumption increases ecological footprint, underlining the importance of transitioning towards cleaner energy sources. Negative shock has a smaller but still noticeable effect. The results confirm asymmetric impacts, with positive and negative changes in the drivers affecting Algeria's ecological footprint differently. To ensure long-term economic and ecological stability, Algeria should prioritize eco-innovation and green technology development. This will reduce dependence on fossil fuels and create new, sustainable industries.

Outcome of Hypofractionated Palliative Radiotherapy Regimens for Patients With Advanced Head and Neck Cancer in Tikur Anbessa Hospital, Ethiopia: A Prospective Cohort Study.

PURPOSE: Head and neck cancers (HNCs) are the third most commonly treated cancer with radiation in Ethiopia. Most patients present with advanced stage and are not candidates for curative treatment. The objective of our study is to assess the outcome of hypofractionated palliative radiotherapy (RT) for advanced HNCs in a resource-limited setting. MATERIALS AND METHODS: Patients with histology-proven advanced HNC candidates for hypofractionated palliative RT were enrolled. Three regimens were allowed: 44.4 Gy in 12 fractions, 30 Gy in 10 fractions, and 20 Gy in five fractions. Response to treatment was assessed at baseline and at 4 weeks after treatment completion. The Kaplan-Meier curve was used to measure the survival. RESULTS: Between January 2022 and January 2023, 52 patients were enrolled and 25 patients were eligible for outcome assessment. Index symptoms include pain, bleeding, dysphagia, respiratory distress, and others in 25, 13, 10, 6, and 17 patients, respectively. Complete relief of the top three symptoms include pain in 52% of patients, hemostasis in 84% of patients, and dysphagia in 30% of patients. Objectively, 64% of patients attained partial response. For 48% of patients, their quality of life (QoL) improved in one parameter of the physical scores. Moreover, 64% of patients showed improvement in three parameters. The global functional score improved in 80% of patients. One patient had grade 3 xerostomia. At the end of the study period, 44% of patients died. The median survival after radiation was 9 months (95% CI, 7.2 to 10.8). CONCLUSION: All palliative hypofractionated regimens used were effective in terms of symptom control, tumor response rate, and QoL, and were well tolerated. This makes it appropriate for our setup because the majority of patients require palliation.

Impact of immunohistochemical expression of kinesin family member 18A (Kif18A) and ß-catenin in infiltrating breast carcinoma of no special type.

BACKGROUND: KIF18A is a regulator of the cell cycle that stimulates the proliferation of cancer cells. The Wnt/ß-catenin pathway is involved in different issues' carcinogenesis and is being examined as a therapeutic target. The relationship between KIF18A and ß-catenin in breast cancer was not previously investigated. Therefore, this work aims to study the immunohistochemical expression and correlation of KIF18A and ß-catenin in breast-infiltrating duct carcinoma (IDC) and their relation to prognosis. MATERIAL AND METHODS: Slides cut from paraffin blocks of 135 IDC and 40 normal breast tissues were stained by KIF18A and ß-catenin antibodies. KIF18A cytoplasmic or nucleocytoplasmic staining and ß-catenin aberrant expression either nucleo-cytoplasmic or cytoplasmic staining were considered. RESULTS: Normal breast tissue and IDC showed a significant difference regarding KIF18A and aberrant ß-catenin expression. High KIF18A and ß-catenin H score values were associated with poor prognostic factors such as high grade, advanced stage, distant metastasis, high Ki67 status, and Her2neu-enriched subtype. There was a significant direct correlation between KIF18A and ß-catenin as regards percent and H score values. Prolonged overall survival (OS) was significantly associated with mild intensity and low H score of KIF18A, and low ß-catenin H score. CONCLUSIONS: KIF18A could be involved in breast carcinogenesis by activating ß-catenin. Overexpression of KIF18A and aberrant expression of ß-catenin are considered proto-oncogenes of breast cancer development. KIF18A and ß-catenin could be poor prognostic markers and predictors of aggressive behavior of breast cancer.

Performance evaluation of PSO-PID and PSO-FLC for continuum robot's developed modeling and control.

Continuum robots are complex structures that require sophisticated modeling and control methods to achieve accurate position and motion tracking along desired trajectories. They are highly coupled, nonlinear systems with multiple degrees of freedom that pose a significant challenge for conventional approaches. In this paper, we propose a system dynamic model based on the Euler-Lagrange formulation with the assumption of piecewise constant curvature (PCC), where we accounts for the elasticity and gravity effects of the continuum robot. We also develop and apply a particle swarm optimization (PSO) algorithm to optimize the parameters of our developed controllers: an inverse dynamic proportional integral derivative (PID) controller and an inverse dynamic fuzzy logic controller (FLC), where we use the integral time of absolute error (ITAE) as the objective function for the PSO algorithm. We validate our proposed model and optimized controllers through different designed trajectories, simulated using our developed unique animated MATLAB simulation. The results show that the PSO-PID controller improves the rise time, overshoot percentage, and settling time by 16.3%, 31.1%, and 64.9%, respectively, compared to the PID controller without PSO. The PSO-FLC controller shows the best performance among all controllers, with a settling time of 0.7 s and a rise time of 0.4 s, leading to the highest level of precision in trajectory tracking. The ITAE error for the PSO-FLC controller is 11.4% and 29.9% lower than that of the PSO-PID and FLC controllers, respectively.

Toll-like receptor 7 and tumor necrosis factor alpha polymorphisms in Egyptian patients with autoimmune thyroid diseases.

Hashimoto's thyroiditis (HT) and Graves' disease (GD) susceptibility depends on a complex interaction between environmental and genetic factors. Genes for tumor necrosis factor alpha (TNF-α) and toll-like receptors (TLRs) have been incorporated into the pathophysiology of autoimmune disorders. Our aim is to assess the association between TLR7 (rs179009) and TNF-α (rs1800629) polymorphisms and susceptibility to autoimmune thyroid disorders. One-hundred ninety-nine individuals, divided into 68 HT patients in group I, 57 GD patients in group II, and 74 age- and gender-matched healthy subjects in group III, underwent laboratory investigations, including the detection of TLR7 and TNF-α polymorphisms using real-time PCR technique. TLR7 (rs179009) genotypes, A/G and G/G, were significantly more prevalent in HT patients (group I) compared to normal controls. Meanwhile, TNF-α (rs1800629) genotypes in GD patients (group II) showed a six fold increase in the risk of the disease in the G/A and A/A genotypes. Our findings propose the fact that the polymorphisms of TLR7 (rs179009) play a role in the susceptibility and the development of Hashimoto's thyroiditis, whereas TNF-α (rs1800629) polymorphisms play a role in the susceptibility and development of Graves' disease.

Optimizing power consumption and position control in an electro-hydraulic system with cylinder bypass and NN-MPC.

This study introduces an innovative approach to enhance the energy efficiency and position control performance of electro-hydraulic systems, employing a comprehensive comparative analysis. It presents and evaluates three control techniques: Proportional-Integral-Derivative (PID) control, Model Predictive Control (MPC), and Neural Network Model Predictive Control (NN-MPC). These methods are systematically assessed across varying load conditions. Notably, our research unequivocally establishes the exceptional performance of the NN-MPC approach, even when confronted with load variations. Furthermore, the study conducts an exhaustive examination of energy consumption by comparing a conventional system, where a flow control valve is not utilized as a hydraulic cylinder bypass, with a proposed system that employs a fully open Flow Control Valve (FCV). The results underscore the remarkable energy savings achieved, reaching up to 9% at high load levels.

The importance, benefits, and future of nanobiosensors for infectious diseases.

Infectious diseases, caused by pathogenic microorganisms such as bacteria, viruses, parasites, or fungi, are crucial for efficient disease management, reducing morbidity and mortality rates and controlling disease spread. Traditional laboratory-based diagnostic methods face challenges such as high costs, time consumption, and a lack of trained personnel in resource-poor settings. Diagnostic biosensors have gained momentum as a potential solution, offering advantages such as low cost, high sensitivity, ease of use, and portability. Nanobiosensors are a promising tool for detecting and diagnosing infectious diseases such as coronavirus disease, human immunodeficiency virus, and hepatitis. These sensors use nanostructured carbon nanotubes, graphene, and nanoparticles to detect specific biomarkers or pathogens. They operate through mechanisms like the lateral flow test platform, where a sample containing the biomarker or pathogen is applied to a test strip. If present, the sample binds to specific recognition probes on the strip, indicating a positive result. This binding event is visualized through a colored line. This review discusses the importance, benefits, and potential of nanobiosensors in detecting infectious diseases.

Assessment of phosphorus status in a calcareous soil receiving long-term application of chemical fertilizer and different forms of swine manures.

The continuous use of organic inputs in crop production calls for an improved understanding of how these inputs might alter soil phosphorus (P). This study assessed how the continuous application of different forms of swine manure influences the mechanism of P transformation and release potential. Soil samples were collected from a clay loam soil receiving no P or 100 kg P ha-1 applied as either chemical fertilizer (CHEM), swine liquid manure (SWL), composted swine manure (SWC), or solid swine manure (SWS) every other year for 16 years in a corn-soybean rotation. Available P increased in soils treated with the chemical and organic fertilizers. The greatest increase was found in the SWC and SWS and was closely related to a 1% increase in the organic C content, and 1.3- and 1.2-unit increase in the soil pH for SWC and SWS treatment, respectively. Nonlabile HCl-P form was also higher in SWC- and SWS-treated soils. Despite the similarities between SWS and SWC, SWS significantly had a lower maximum P sorption (Qmax ) and higher equilibrium P concentration at zero net sorption (EPCO) probably related to the higher organic NaOH-P. Similarly, higher organic NaOH-P together with lower cation exchange capacity, aluminum, and calcium explained the lower Qmax in SWL. This suggests that increase in organic NaOH-P forms limits the soil potential to retain P. Overall, the SWL treatment presents a unique effect on changes in soil property and P chemistry that warrants further investigation.

Supplementation with vitamins D3 and a mitigates Parkinsonism in a haloperidol mice model.

BACKGROUND: Earlier reports suggest that vitamin D3 (Vit D3) supplementation attenuates Parkinsonism in drug-induced motor deficits. Moreover, the function of Vit D3 may be optimized by co-administration with vitamin A (Vit A). In line with the synergistic interplay between vitamins, we hypothesized that the efficacy of Vit D3 to attenuate Parkinsonism in a haloperidol-induced mouse model of motor deficits would be more potent when concomitantly administered with Vit A. METHODS: Thirty-six (36) adult male mice were randomly divided into six groups of six animals each: the control group, the PD model (haloperidol-treated only group) (-D2), and four other groups treated with haloperidol together with either one or two of the following vitamin supplementations: Vit D3, Vit A, Vit D3 +VA, or bromocriptine a known PD drug respectively. Motor functions were assessed using a battery of neurobehavioral tests in experimental animals, after which brain tissues were harvested and processed for biochemical and histomorphological analysis. RESULTS: We recorded a significant decline in motor activity in the PD mice model treated with haloperidol alone compared to other experimental groups that received vitamin supplementations. The significant decrease in motor activity observed in the PD mice model corresponded with marked neurodegenerative features in the cytoarchitecture of the pyramidal cells in the striatum and primary motor cortex (M1). Furthermore, the haloperidol-induced PD mice model treated with Vit D3 +Vit A showed significant improvement in motor activity and attenuation of oxidative stress levels and neurodegenerative features compared to other groups treated with Vit A, Vit D3 and bromocriptine alone. CONCLUSION: Altogether, our findings suggest that concomitant administration of both Vit D3 and Vit A prevents the development of Parkinsonism features in the haloperidol mouse model of motor deficit. Thus, supplementation with Vit D3 +Vit A may be a viable option for slowing the onset and progression of motor deficits.