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Takotsubo syndrome (TS) is a reversible form of cardiomyopathy characterized by transient systolic dysfunction with regional wall motion abnormalities and absence of coronary artery obstruction, which can be precipitated by severe emotional or physical stress. Its clinical presentation is similar to that of acute coronary syndrome. However, TS presenting with atrioventricular (AV) block with ventricular asystole is rarely reported. In this article, we describe the case of a postmenopausal woman who experienced near cardiac arrest due to high-degree AV block. Although transthoracic echocardiography revealed left ventricular dysfunction with severe global hypokinesia, coronary angiography and cardiac magnetic resonance imaging showed normal coronary arteries without myocardial scarring. The patient's condition improved after permanent pacemaker implantation and medical treatment for heart failure. Echocardiography and pacemaker analysis at two-month follow-up revealed normalization of heart function and cardiac rhythm, and the patient was finally diagnosed with TS.

The objectives of this study were to determine whether 4 days of dry immersion (DI) induced similar arterial aging as spaceflight and to test the impact of thigh cuffs. Eighteen subjects underwent DI; nine wore thigh cuffs. Cardiac and arterial targets were assessed by ultrasound. No significant differences were found between the groups. The left ventricle volume, stroke volume (SV), and ejection fraction decreased with DI (p p p

Background: Bradykinesia is the defining motor feature of Parkinson’s disease (PD). There are limitations to its assessment using standard clinical rating scales, especially in the early stages of PD when a floor effect may be observed. Objective: To develop a quantitative method to track repetitive tapping movements and to compare people in the early stages of PD, healthy controls, and individuals with idiopathic anosmia. Methods: This was a cross-sectional study of 99 participants (early-stage PD = 26, controls = 64, idiopathic anosmia = 9). For each participant, repetitive finger tapping was recorded over 20 seconds using a smartphone at 240 frames per second. From each video, amplitude between fingers, frequency (number of taps per second), and velocity (distance travelled per second) was extracted. Clinical assessment was based on the motor section of the MDS-UPDRS. Results: People in the early stage of PD performed the task with slower velocity (p

Myocarditis can cause ventricular wall thickening due to myocardial edema. If the condition improves, the ventricular wall thickening should gradually decrease; a persistent thickening of the patient's ventricular wall indicates the coexistence of hypertrophic cardiomyopathy (HCM) and myocarditis. A 30-year-old man was referred to our hospital with continuous chest pain accompanied by profuse sweating. He suffered from fever for two days (the maximum body temperature: 38 °C) and the conditions improved following the use of antipyretics as self-administered medication before admission. Electrocardiogram exhibited ST-segment elevation in leads I and avL, and ST-T wave changes in leads II, III, avF, and V1-V6. Marked elevation of cardiac troponin I was found on laboratory testing. Respiratory tract infection testing showed negative results. A TORCH screen revealed positive herpes simplex virus (HSV), rubella virus (RV), and cytomegalovirus (CMV) IgG but all with negative IgM titer. Ultrasonic echocardiography showed thickness of the interventricular septum (17 mm) and diffuse left ventricular (LV) hypokinesia, without LV outflow tract obstruction. After consultation with the cardiology team, a diagnosis of myocarditis with HCM was made. Patients with myocarditis should be alerted to the possibility of HCM when there is persistent ventricular wall thickening.

During the last decade, pediatric nonalcoholic liver disease has reached epidemic proportions, becoming one of the most frequent chronic liver diseases in the global child population. Purpose: to study the relationship of the functional state of the gallbladder with structural changes in the liver in children with nonalcoholic fatty liver disease. Materials and methods. We examined 34 children aged from 8 to 17 years old. Hepatic steatosis was determined using the FibroScan® 502 touch with controlled attenuation parameter (CAP). According to the results of transient elastometry and ultrasound of the abdomen with the gallbladder function study, patients were divided into 4 groups: the 1st group consisted of 7 patients with steatosis and hypofunction of gallbladder (20.5 %), group 2 included 6 patients with steatosis and gallbladder normofunction (17.65 %), group 3 consisted of 11 patients without hepatic steatosis with hypofunction of gallbladder (32.35 %), group 4 included 10 patients without hepatic steatosis with gallbladder normofunction (29.4 %). Results. The sonographic studies demonstrated children of the 1st group (steatosis with gallbladder hypokinesia) to have significantly larger sizes of liver lobes compared to group 4 (children without steatosis with gallbladder normofunction). Also, the stiffness of the liver parenchyma was highest in patients with hepatic steatosis and gallbladder hypokinesia. Discussion. The combination of hepatic steatosis and hypokinesia of the gallbladder in children is accompanied by a significant increase in liver size, increased stiffness of the liver parenchyma and increasing degree of steatosis. The data indicate the relationship of the gallbladder function and the liver structural changes.

Objective To assess nocturnal hypokinesia using the Korean version of the Nocturnal Hypokinesia Questionnaire (NHQ-K) in Parkinson’s disease (PD) patients across disease stages.Methods We developed the NHQ-K and performed questionnaire-based interviews with 108 PD patients from three referral hospitals. Clinical associations of nocturnal hypokinesia and its impact on health-related quality of life (HRQoL) were also analyzed.Results The NHQ-K showed acceptable internal consistency (0.83) and interrater reliability (0.95). Nocturnal hypokinesia significantly affected HRQoL in PD patients at both the early and advanced stages (adjusted p < 0.001). Increased severity of nocturnal hypokinesia was associated with dyskinesias, off-period disability, apathy, and anxious mood in PD patients (adjusted p < 0.01) after controlling for disease severity and medication dose.Conclusion The NHQ-K is useful for screening nocturnal hypokinesia in PD patients. Given the high impact of nocturnal hypokinesia on HRQoL, comprehensive management of nocturnal disability is needed for PD patients.

A 60 years male patient underwent permanent pacemaker [DDDR -with dual chamber pacing (D) with dual chamber sensing (D) with dual mode of response (D) with rate responsive pacing(R) -St Jude's medical (Abbott- Endurity 2160)] implantation for complete heart block (CHB). After 4 months patient was admitted for congestive heart failure. 12 Lead electrocardiograms (ECG) was suggestive of tachycardia at 130 beats per minute (regular rhythm), with ventricular complexes preceded by pacing spikes and maintenance of 1:1 atrio-ventricular relationship. Echocardiography showed global hypokinesia of left ventricular (LV) myocardium with reduced LV ejection fraction. LV dysfunction and heart failure were attributed to tachy-cardiomyopathy. Pacemaker telemetry data demonstrated that the tachycardia was likely to be pacemaker-mediated endless loop tachycardia (ELT). ELT in this case was perpetuated secondary to shortening of post ventricular atrial refractory period (PVARP), intact retrograde ventriculo-atrial (VA) conduction and addition of antiarrhythmic drugs prolonging retrograde VA conduction. Rate response (Dynamic) PVARP was reprogrammed allowing PVARP extension. Following this ELT was terminated. LV ejection fraction was normalized on subsequent follow up visit after seven days.

Management of motor symptoms in Parkinson's Disease(PD) relies on subjective information provided by patients, the quality of which can be affected by many factors.Objective data collected during daily life could complement this information and improve management of motor symptoms.To assess the usefulness of the Personal KinetiGraph (PKG) in characterizing the intensity and timing of motor symptoms in PD patients.Retrospective study of all PD patients followed at a tertiary academic movement disorders center assessed by PKG between December 1, 2016 and October 30, 2018. PKG was worn for 7 days prior to the clinical visit. We compared the information obtained from the interview and the clinical visit, and assessed the impact of the PKG on treatment decision making.170 PKG results were reviewed. PKG complemented patient input in 82.9%(141/170) and led to medication changes in 71%(100/141) of the complemented inputs. PKG contributed the least to correcting or complementing patients' input when patients self-reported as undertreated (22%) and the most when patient were unable to answer all questions regarding motor response to individual doses (100%) (Fisher, p 0.0001). The majority of patient undergoing 3 or 4 PKG encounters did not reach a controlled state as defined by PKG until the 3rd or 4th encounter, suggesting that repeated use of the PKG might be needed to help optimize motor control as therapy changes done after one encounter might not be enough.PKG might be useful in supplementing patient-provided information for accurate assessment and treatment plan.

The authors describe a case of a patient admitted to the emergency department with diabetic ketoacidosis. Although there were no symptoms attributable to the cardiovascular system, lab tests revealed elevated troponin I and natriuretic peptides, coupled with repolarization abnormalities on the ECG. The transthoracic echocardiogram (TTE) showed a non-dilated left ventricle with severe left ventricular systolic dysfunction due to diffuse hypokinesia, and a concomitant diagnosis of profile L heart failure was proposed. Etiologic investigation was negative, and when a new TTE was performed seven days after the first, left ventricular function was normal. Although rarely considered, metabolic and electrolyte disorders, especially diabetic ketoacidosis, can be a cause of left ventricular systolic dysfunction, and should be considered in the differential diagnosis. This is another way diabetes can have an impact on the cardiovascular system.

A 57-year-old non-obese female patient with a history of heavy smoking, chronic obstructive pulmonary disease and hypertension was admitted to the hospital as an emergency for acute hemoptysis and signs of congestive heart failure. To assess the source of hemoptysis, computed tomography (CT) pulmonary angiography was performed, which confirmed a bilateral pulmonary embolism of the apical branches. The routinely performed transthoracic echocardiography (TTE) revealed an enlarged left ventricle with severely reduced ejection fraction (EF = 25%) due to global hypokinesia and multiple, mobile, echogenic masses. To increase the diagnostic accuracy, real-time three-dimensional (Live 3D) imaging of the masses was added which described multiple left ventricular (LV) thrombi. Successful resolution of intraventricular thrombi was noticed after treatment with oral anticoagulant therapy (acenocumarol), despite the lack of regular INR control.

The narrative review addresses the evidence that physical activity can improve the results of prevention and treatment and of the conditions that feature increased risks of their development with aging. The main attention is paid to cancer and problems arising because of physical activity limitations associated with COVID-19 pandemic. To promote physical activity, which is known to reduce the risks of COVID-19 complications and of cancer, it is important to help patients and physicians in understanding the reasons why physical activity can be beneficial, more than the pharmacological means thought to reproduce some of its effects, in cancer prevention and treatment upon all differences between the locations of tumors and the pathways of carcinogenesis. Therefore, the physiological and molecular mechanisms behind the usefulness of physical activity in oncology are discussed. Based on this discussion, data on quantitative relationships between oncological risks, physical activity, and the use of its alleged pharmacological mimetics are addressed. © 2021 Izdatel'stvo Meditsina. All rights reserved.

Some patients with Parkinson’s disease (PD) present with pareidolia, an illusion of a meaningless stimulus as a familiar object known to the observer. Since the striatum is associated with processing of visual information, we investigated correlations of pareidolia with motor symptoms and striatal dopaminergic function. A noise pareidolia test, assessment of motor symptoms using MDS-UPDRS and 123I-Ioflupane SPECT were performed in 58 drug-naive PD patients. A number of images in which a participant noticed an illusory face (number of illusory responses) were compared with motor assessment scores and uptake of 123I-ioflupane in the striatum. Of the 58 participants, 22 had at least one illusory response. Mean scores for MDS-UPDRS part III (p

Topicality. Hypokinesia is a condition of insufficient motor activity of the body with limited pace and volume of movement, and is currently the fourth leading cause of endemic death in the world. It is known that hypokinesia can affect the metabolism of components of bone and cartilage, which is the basis for the development of pathological processes, but there are no biochemical markers of this process in the literature. Thus, currently, there is insufficient number of experimental scientific works devoted to the study of biochemical parameters characterizing the state of the connective tissue in the experiment to assess the impact of hypokinesia on the body, and this fact determines the relevance of the study. Aim. To study the dynamics of the main metabolites characterizing the state of the connective tissue in the blood serum in hypokinesia in rats of different ages. Materials and methods. The studies were performed on 42 white male rats aged 3 and 12 months, kept in the vivarium of the Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv. The conditions of hypokinesia were reproduced using a specially designed device that limited the mobility of the animal without disturbing the ventilation of the body. Animals were removed from the experiment by decapitation in Day 7 and 30 of immobilization under thiopental anesthesia. The content of sialic acids in the serum was determined by the Hess method, chondroitin sulfate – by Nemeth-Csoka method modified by L. I. Slutsky, the fractional composition of glycosaminoglycans (GAG) – by the reaction with resoquine. Results and discussion. In the study of the rat serum, it was found that in intact animals of 3 and 12 months of age the content of sialic acids was different; it was 2.94 ± 0.16 and 1.98 ± 0.09 mmol/L, respectively. After 7 days of hypokinesia, their concentration in young animals did not change, but in older animals, this figure increased. By Day 30, the serum sialic acid levels suddenly increased compared to intact animals. In animals of 12 months of age, the concentration of sialic acids in the blood serum increased by both Day 7 and Day 30 of hypokinesia, especially at the end of the experiment. Hypokinesia also showed a significant increase in serum concentrations of chondroitin sulfates on Day 7 of the experiment in animals of both age groups. At the same time, the level of these metabolites on Day 30 was at the same level. In young rats on Day 7 the fraction of GAG remained unchanged, but on Day 30 there was a significant decrease. During this period, the second fraction of GAG increased. In animals aged 12 months on Day 7 and 30, the content of most GAG fractions was lower than the values characterizing the fractional composition of GAG in intact rats. Conclusions. Thus, the determination of sialic acids, GAG fractions and chondroitin sulfates in the serum can be presented as a set of biochemical tests to assess disorders of the connective tissue metabolism while limiting the motor activity of the body. It has been found that the 30-day hypokinesia causes significant disorders of the connective tissue, and it is reflected in changes in the biochemical parameters of the serum of experimental rats.

Background and purpose: Biomarkers for future adaptive deep brain stimulation still need evaluation in clinical routine. Here, we aimed to assess stimulation-induced modulation of beta-band activity and clinical symptoms in a Parkinson's disease patient during chronic neuronal sensing using a novel implantable pulse generator. Methods: Subthalamic activity was recorded OFF and ON medication during a stepwise increase of stimulation amplitude. Off-line fast fourier transfom -based analysis of beta-band activity was correlated with motor performance rated from blinded videos. Results: The stepwise increase of stimulation amplitude resulted in decreased beta oscillatory activity and improvement of bradykinesia. Mean low beta-band (13-20 Hz) activity correlated significantly with bradykinesia (ρ = 0.662, p < 0.01). Conclusions: Motor improvement is reflected in reduced subthalamic beta-band activity in Parkinson's disease, supporting beta activity as a reliable biomarker. The novel PERCEPT neurostimulator enables chronic neuronal sensing in clinical routine. Our findings pave the way for a personalized precision-medicine approach to neurostimulation.

Background: Subtle changes in left ventricular wall motionpatterns have diagnostic and prognostic values in patientswith Coronary Artery Disease (CAD).Aim of Study: The aim of this studywasto highlightthediagnostic role of Cardiac Magnetic Resonance imaging (CMR) in assessment of the myocardial wall motion abnor-malities in Myocardial Infarction (MI) patients.Material and Methods: This retrospective research wasperformed in 50 patients classified into two groups: Group 1(25 patients with Acute Myocardial Infarction (AMI) (23males and 2 females) and group 2 (25 patients with ChronicMyocardial Infarction (CMI) (22 males and 3 females). Bothclasses were diagnosed based on medical, echocardiography,and other approaches of cardiologist investigation. The meanage was 52.16±6.884 years for group 1 and 51.04±12.341years in group 2. All patients underwent CMR evaluationusing Cine Steady State Free Precession (SSFP) in short axisand 4 chamber views.Results: Hypokinesia was the most commonly observedwall motion abnormality among the study groups. It was seen in 13 (52%) patients in group 1 and the same in group 2. Akinesia was seen in 12 (48%) patients in group 1 and 10(48%) patients in group 2 and dyskinesia was observed in 2 (8%) patients in group 2 and not observed in group 1.Conclusion: Identification of wall motion abnormalitiesin MI patients may help to identify higher risk patients thatwould benefit from an earlier invasive strategy. We concludethat CMR detected the wall motion abnormality precisely andshould be added to the routine investigation of MI patientsfor better evaluation and assessment.

Aromatic L-amino acid decarboxylase (AADC) deficiency is an autosomal recessive metabolic disorder resulting from disease-causing pathogenic variants of the dopa decarboxylase (DDC) gene. The neurological features of AADC deficiency include early-onset hypotonia, oculogyric crises, ptosis, dystonia, hypokinesia, impaired development, and autonomic dysfunction. In this article, we reported a patient with genetically confirmed AADC deficiency presenting with developmental epileptic encephalopathy (DEE). Our patient was a boy with severe intractable epileptic spasms and DEE. The patient was evaluated for cognitive and neurologic impairment. Exome sequencing revealed a homozygous mutation (NM_000790.4:c.121C > A; p.Leu41Met) in the DDC gene. This case expands the clinical spectrum of AADC deficiency and strengthens the association between dopa decarboxylase deficiency and epilepsy. Additional studies are warranted to clarify the mechanisms linking dopa decarboxylase dysfunction to DEE.

There is no indication when to perform thrombolytic or anticoagulant therapy in patients with moderate-high risk of early death in accordance with the stratification of the European society of cardiology. The purpose of the study: to establish clinical, laboratory, and instrumental criteria for the choice of therapy volume optimization in patients with moderate-high risk of early death. Material and methods. The study included 154 patients with pulmonary embolism (PE) of high, moderate-high, moderate-low risk of death. An analysis was performed to determine the most significant indications for thrombolytic therapy in PE. Results. The presence of established «undoubted» criteria indicates the need for thrombolytic therapy. These include an increase in the size of the right ventricle compared to the left, paradoxical movement of the interventricular septum, hypokinesia of the right ventricle on еchocardiography. «Questionable» criteria were also identified: more than 50 mm Hg increased pulmonary artery pressure, more than 20 mm dilation of the inferior Vena cava, more than 3 cm dilatation of the right ventricle on еchocardiography, deep SIQIII on ECG, syncopal states in the anamnesis, increased NT-proBNP values, less than 90% arterial blood saturation. Thrombolytic therapy is indicated for patients with a combination of 2 or more of these criteria, in other cases anticoagulant therapy is prescribed. Conclusion. The use of established criteria makes it possible to differentiate treatment of patients with moderate-high risk of early death and reduce the likelihood of developing chronic post-thromboembolic pulmonary hypertension by 2.9 times.

Background Sleep disturbances are common in Parkinson’s Disease (PD), with nocturnal akinesia being one of the most burdensome. Levodopa is frequently used in clinical routine to improve nocturnal akinesia, although evidence is not well proven. Methods We assessed associations of Levodopa intake with quality of sleep and perception of nocturnal akinesia in three PD cohorts, using the Parkinson’s Disease Sleep Scale (PDSS-2) in two cohorts and a question on nocturnal immobility in one cohort. In one cohort also objective assessment of mobility during sleep was performed, using mobile health technology. Results In an independent analysis of all three cohorts (in total n = 1124 PD patients), patients taking Levodopa CR reported a significantly higher burden by nocturnal akinesia than patients without Levodopa. Higher Levodopa intake and MDS-UPDRS part IV scores (indicating motor fluctuations) predicted worse PDSS-2 and higher subjective nocturnal immobility scores, while disease duration and severity were not predictive. Levodopa intake was not associated with objectively changed mobility during sleep. Conclusion Our results showed an association of higher Levodopa intake with perception of worse quality of sleep and nocturnal immobility in PD, indicating that Levodopa alone might not be suitable to improve subjective feeling of nocturnal akinesia in PD. In contrast, Levodopa intake was not relevantly associated with objectively measured mobility during sleep. PD patients with motor fluctuations may be particularly affected by subjective perception of nocturnal mobility. This study should motivate further pathophysiological and clinical investigations on the cause of perception of immobility during sleep in PD.

Objective Although a number of clinical factors have been linked to falls in Parkinson’s disease (PD), the diagnostic value of gait parameters remains subject to debate. The objective of this retrospective study was to determine to what extent the combination of gait parameters with clinical characteristics can distinguish between fallers and non-fallers. Methods Using a video motion system, we recorded gait in 174 patients with PD. The patients’ clinical characteristics (including motor status, cognitive status, disease duration, dopaminergic treatment and any history of falls or freezing of gait) were noted. The considered kinematic gait parameters included indices of gait bradykinesia and hypokinesia, asymmetry, variability, and foot clearance. After a parameters selection using an ANCOVA analysis, support vector machine algorithm was used to build classification models for distinguishing between fallers and non-fallers. Two models were built, the first included clinical data only while the second incorporated the selected gait parameters. Results The “clinical-only” model had an accuracy of 94% for distinguishing between fallers and non-fallers. The model incorporating additional gait parameters including stride time and foot clearance performed even better, with an accuracy of up to 97%. Conclusion Although fallers differed significantly from non-fallers with regard to disease duration, motor impairment or dopaminergic treatment, the addition of gait parameters such as foot clearance or stride time to clinical variables increased the model’s discriminant power. Significance: This predictive model now needs to be validated in prospective cohorts.

BACKGROUND: Knowing the epidemiological profile is relevant for improving healthcare practices. Movement disorders are neurological disorders characterized by the presence of involuntary movements. They have a negative impact on patients’ quality of life. OBJECTIVES: To outline the frequencies of the different diagnoses seen among patients, along with their demographic characteristics, at a hospital in São Paulo (SP), Brazil, and to highlight the clinical aspects of those with Parkinson’s disease. DESIGN AND SETTING: Retrospective descriptive epidemiological analysis at a specialized outpatient clinic in a state public hospital in São Paulo. METHODS: Patients treated at this clinic over a four-year period were analyzed. Diagnoses, demographic variables and associations with clinical aspects of Parkinson’s disease were evaluated. RESULTS: Out of the 680 medical records analyzed, 58.4% related to females. Most patients were over 60 years of age, white, married and teachers. The most frequent diagnosis was Parkinson’s disease, followed by essential tremor and dystonia. Parkinson’s disease presented in the mixed clinical form; the most common initial symptom was tremor. The akinetic-rigid clinical form occurred in younger individuals and mostly presented with postural instability and freezing of gait in the early years of disease. CONCLUSIONS: Parkinson’s disease, essential tremor and dystonia were the most frequent diagnoses. Characteristics like sex, frequency of other pathological conditions and the clinical and demographic aspects of Parkinson’s disease were consistent with the data in the relevant literature.

Drooling is characterized by an excessive pooling of saliva in the oral cavity. The exact pathophysiological mechanism of drooling in Parkinson’s disease (PD) is not yet fully understood. To identify the relationship between drooling and other clinical features in people diagnosed with PD. Research on the topic was carried out on the PubMed and ScienceDirect electronic databases. Articles published between March 2015 and March 2020 were selected. Search terms and inclusion and exclusion criteria were previously defined. The articles included met those requirements. Sixteen articles were included for analysis. The prevalence of drooling varies between 9.26 and 70% and can occur at any stage of the disease. Higher prevalence of drooling is related to disease duration, disease severity, older age, male, levodopa equivalent dose, hypomimia, dysphagia, dysarthria, cognition, sleep, non-dominant tremor, motor fluctuations, bradykinesia, more symmetric pattern, gastrointestinal and urinary problems, sexual dysfunction, obstipation, and orthostatic hypotension. However, it is not related to hallucinations, rapid eye movement sleep behavior disorder, akinetic-rigid PD, mixed, nor dyskinesias. Drooling is not caused by a single factor; it is influenced and related to several clinical features. Some clinical factors participate in the onset of drooling while others are concomitant.

Objective: To report pharmacogenomics post-related bradykinesia secondary to phenoconversion in an elderly post-bilateral lung transplant patient. Summary: The patient was a 68-year-old double lung transplant patient taking the immunosuppressant and CYP3A4/5 substrate tacrolimus concomitantly with 2 CYP3A4/5 inhibitor medications, fluconazole and diltiazem. This drug combination post-dosing resulted in debilitating bradykinesia 1-2 hours after dosing, increasing the risk of falls and possible increased mortality and morbidity risk. Conclusion: Taking tacrolimus in combination with CYP3A4/5 inhibitors may increase neurologic adverse effects resulting in increased fall and associated increased mortality and morbidity risk.

The current study was carried out to evaluate the effect of motor activity (hypokinesia) limitation on the body and organ systems. Hypokinesia contributes to changes in the work of many adaptive systems of the body, which leads to disorders in the musculoskeletal system, respiratory, muscular, and cardiovascular systems. Of particular relevance and practical interest is the effect on the body not only of hypokinesia, but also the processes during the transition from it to an active motor regime (recovery period). The study was carried out on 2 groups of white outbred rats: group 1 - animals growing under limited motor activity for 30 days, group 2 - animals in the recovery period after 30 days of hypokinesia. The study of the functional parameters of the Langendorff heart of rats (LVP, HR, CF) was carried out on the selected groups. Results of the study revealed that after 30 days of hypokinesia and 14 days recovery period, the heart rate decreased 1.2 times and the coronary flow decreased 2 times. Further, the current study has shown a tendency to restore the heart rate parameters of an isolated heart but the restoration of the coronary flow and cardiac contractility has not been identified. The result of the study suggested that 14 days is not a full-fledged period for the restoration of the functional parameters of the body. This study devoted the effect of motor activity (hypokinesia) limitation on the body and organ systems are relevant and significant.

Introduction Primary progressive apraxia of speech (PPAOS) is a neurodegenerative syndrome in which patients present with an isolated motor speech disorder. Some PPAOS patients develop parkinsonism and other features of progressive supranuclear palsy (PSP) and/or corticobasal syndrome (CBS) over time. We aimed to assess the evolution of parkinsonian characteristics in PPAOS patients who had been followed yearly for at least six years. Methods From a large cohort of 46 PPAOS patients, eight were followed yearly for > 6-years in multiple NIH-funded grants. Parkinsonian and other features, including bradykinesia, tremor, rigidity, postural instability, apraxia, ocular motor function and cognition were assessed at each visit, and research criteria applied for PSP and CBS diagnosis. Neurological, speech-language test scores, and [18F]fluorodeoxyglucose PET (FDG-PET) and MRI midbrain volumes were assessed. Results A Parkinson's plus syndrome developed in all eight patients (100%). Bradykinesia was the earliest feature, followed by rigidity and postural instability. Tremor was not a significant feature. Parkinsonism, limb apraxia and ocular motor impairment tended to develop four-to-five years after onset with some patients having slight asymmetric parkinsonism. Six patients (75%) met research criteria for probable PSP, although only one for PSP-Richardson's syndrome; three patients met criteria for possible CBS. Slightly asymmetric, left-sided, hypometabolism was observed on FDG-PET, not matching asymmetry of Parkinsonism. Midbrain hypometabolism was absent-minimal. Three patients had progressive midbrain volumes in the PSP-Richardson's syndrome range. Conclusions A Parkinson's plus syndrome may inevitably develop in PPAOS supporting PPAOS as an early presentation of a Parkinson's plus disorder.

This study investigated the impact of white matter hyperintensities (WMHs) on the progression from mild parkinsonian signs (MPS) to parkinsonism and Parkinson's disease (PD). Participants with MPS completed 5 years of follow-up. WMHs were divided into periventricular WMHs and deep WMHs according to magnetic resonance imaging scans. The diagnosis of MPS, parkinsonism, and PD was based on the motor portion of the Unified Parkinson's Disease Rating Scale. Cox proportional hazard models were used to identify the association between WMHs and MPS progression. Of the 636 participants, 166 (26.1%) with MPS developed parkinsonism and PD after follow-up. After adjusting for potential factors, severe WMHs were associated with an increased risk of MPS progression, moderate and severe periventricular WMHs and severe deep WMHs were associated with the risk of MPS progression, and severe WMHs were associated with the progression of gait/balance impairment, bradykinesia, and rigidity. Additionally, participants treated for vascular risk factors such as hypertension, diabetes mellitus, and hypercholesterolemia had a lower risk of MPS progression.

Descrevemos o caso de um paciente jovem com histórico de embolia pulmonar e aborto espontâneo no primeiro trimestre, tendo apresentado dor torácica de início súbito e dispneia. Após revisão retrospectiva sistemática do histórico clínico e avaliação da paciente, ela foi diagnosticada com infarto do miocárdio sem doença coronariana obstrutiva secundário a trombose coronariana. Fundamento: O infarto do miocárdio sem doença coronariana obstrutiva (MINOCA) é um desafio diagnóstico e terapêutico para os médicos, pois um grande espectro de causas pode resultar nessa apresentação clínica, várias entidades podem mimetizá-la e há relativamente poucas recomendações baseadas em evidências para sua avaliação. Discussão: Um diagnóstico preciso da etiologia subjacente à MINOCA requer uma avaliação sistemática e dinâmica do histórico clínico e avaliação de cada paciente, bem como o uso de ferramentas diagnósticas adicionais que permitem uma caracterização mais aprofundada da anatomia cardíaca e da função coronariana, como ressonância magnética cardíaca, imagem vascular coronariana (ultrassom intravascular, tomografia de coerência óptica) e avaliações funcionais coronarianas. O prognóstico dessa entidade depende muito de sua causa subjacente e, portanto, é necessário o diagnóstico preciso de sua etiologia.

The psychomotor retardation that may be seen in major depression represents an interesting parallel to bradykinesia, a core feature of Parkinson's disease. Psychomotor retardation has been correlated with the severity of depression and is a predictor of response to electroconvulsive therapy (ECT). Psychomotor retardation has typically been assessed by subjective clinical judgement including clinical rating scales. Gross activity levels have also been measured with actigraphy previously. The Parkinson's KinetiGraph (PKG) was developed to assess bradykinesia, dyskinesia and tremor in Parkinson's disease and allows for an objective assessment of motor symptoms over time. It has not been used previously to assess motor symptoms in depression. The aim of the current pilot study was to use the PKG to objectively measure both bradykinesia and immobility in depressed inpatients undergoing ECT before, during and at the end of therapy and review correlations with depressive symptomatology and treatment response. The majority of patients (9/12) had PKG defined bradykinesia at baseline and 7/9 of these improved with ECT. All patients with bradykinesia who remitted clinically demonstrated improvements in bradykinesia scores. PKG defined immobility was present at baseline in 11/12 total patients and improved in the majority of these patients (9/11) post ECT. Correlations between clinically assessed melancholia and PKG measures were significant (r = 0.701, p 0.011 at baseline to rs = 0.655, p 0.021 at end). A strong association between bradykinesia and immobility scores and depression severity was not seen. The PKG is a potentially useful wearable technology to objectively assess motor symptoms in depression.

Idiopathic rapid eye movement sleep behaviour (iRBD) is considered as a risk factor for Parkinson's disease (PD) development. Evaluation of repetitive movements with finger tapping, which serves as a principal task to measure the extent of bradykinesia in PD, may undercover potential PD patients. The aim of this study was to explore whether finger tapping abnormalities, evaluated with a 3D motion capture system, are already present in RBD patients.Finger tapping data was acquired using a contactless 3D motion capture system from 40 RBD subjects and compared to 25 de-novo PD patients and 25 healthy controls. Objective assessment of amplitude decrement, maximum opening velocity and their combination representing finger tapping decrement was performed in the sequence of the first ten tapping movements. The association between instrumental finger tapping data and semi-quantitative clinical evaluation was analyzed.While significant differences between PD and controls were found for all investigated finger tapping measures (p 0.002), RBD differed from controls in finger tapping amplitude (p = 0.004) and velocity (p = 0.007) decrement but not in maximal opening velocity. A significant relationship between the motor score from the Movement Disorders Society - Unified Parkinson's Disease Rating Scale and finger tapping decrement was shown for both patient groups, ie RBD (r = 0.36, p = 0.02) and PD (r = 0.60, p = 0.002).In our group of RBD patients we demonstrated amplitude decrement of repetitive movements, which may correspond with prodromal bradykinesia. Our findings suggest instrumental analysis of finger tapping abnormalities as a potential novel clinical marker reflecting subclinical motor disturbances in RBD.

Background: Diagnosis of pharyngeal dysphagia in patients with Parkinson’s disease is often difficult as reliable screening methods are lacking so far and clinical examination fails to adequately assess the pharyngeal phase of swallowing. Objective: To identify clinical predictors indicating the presence of pharyngeal dysphagia in patients at risk. Methods: We examined pharyngeal dysphagia in a large cohort of patients with Parkinson’s disease (n = 200) divided in three clinical subtypes (tremor-dominant (TD), mainly bradykinetic (BK) and early postural instability and gait difficulty PIGD)) by using flexible endoscopic evaluation of swallowing. ANOVA-multivariance analysis and following t-tests as well as binary logistic regression analysis were performed to detect group differences and to identify clinical predictors for dysphagia. Results: Statistically significant differences were found in the dysphagic group: age, male gender, disease duration, stage of the disease, Levodopa equivalent dose and higher scores on the Unified Parkinson’s disease rating scale III and II, item 7. The PIGD subtype was affected more frequently than the TD and BK subtype. In a logistic regression model higher age (>63.5 years p 475 mg, p 63.5 years and a daily Levodopa equivalent dose >475 mg show an increased risk for pharyngeal dysphagia. These findings may partly be influenced by presbyphagia but are likely to represent disease progression. The PIGD subtype seems to be a risk factor due to more pronounced dyscoordination of oropharyngeal muscle movements.

Introduction Subthalamic nucleus deep brain stimulation (STN DBS) improves cardinal motor symptoms of Parkinson's disease (PD) but can worsen verbal fluency (VF). An optimal site of stimulation for overall motor improvement has been previously identified using an atlas-independent, fully individualized, field-modeling approach. This study examines if cardinal motor components (bradykinesia, tremor, and rigidity) share this identified optimal improvement site and if there is co-localization with a site that worsens VF. Methods An atlas-independent, field-modeling approach was used to identify sites of maximal STN DBS effect on overall and cardinal motor symptoms and VF in 60 patients. Anatomic coordinates were referenced to the STN midpoint. Symptom severity was assessed with the MDS-UPDRS part III and established VF scales. Results Sites for improved bradykinesia and rigidity co-localized with each other and the overall part III site (0.09 mm lateral, 0.93 mm posterior, 1.75 mm dorsal). The optimal site for tremor was posterior to this site (0.10 mm lateral, 1.40 mm posterior, 1.93 mm dorsal). Semantic and phonemic VF sites were indistinguishable and co-localized medial to the motor sites (0.32 mm medial, 1.18 mm posterior, 1.74 mm dorsal). Conclusion This study identifies statistically distinct, maximally effective stimulation sites for tremor improvement, VF worsening, and overall and other cardinal motor improvements in STN DBS. Current electrode sizes and voltage settings stimulate all of these sites simultaneously. However, future targeted lead placement and focused directional stimulation may avoid VF worsening while maintaining motor improvements in STN DBS.

Background Gait disturbance is one of the most common symptoms among patients with idiopathic Parkinson’s disease (IPD). Nevertheless, Parkinson’s disease subtype clustering according to gait characteristics has not been thoroughly investigated. Research question The aim of this study was to identify subgroups according to gait pattern among patients with IPD. Methods This study included 88 patients with IPD who underwent 18F-fluorinated-N-3-fluoropropyl-2-β-carboxymethoxy-3-β-4-iodophenyl-nortropane positron emission tomography (18F-FP-CIT PET) and three-dimensional gait analysis (3DGA) between January 1, 2014 and December 31, 2016. We performed cluster analysis using temporal-spatial gait variables (gait speed, stride length, cadence, and step width) and divided patients into four subgroups. The kinematic and kinetic gait variables in 3DGA were compared among the four subgroups. Furthermore, we compared the uptake patterns of striatum among the four subgroups using 18F-FP-CIT PET. Results The patients were clustered into subgroups based on gait hypokinesia and cadence compensation. Group 1 had decreased stride length compensating with increased cadence. Group 2 had decreased stride length without cadence compensation and wider step width. Group 3 had relatively spared stride length with decreased cadence. Group 4 had spared stride length and cadence. The uptake of posterior putamen was significantly decreased in Group 3 compared with Group 4. Significance Gait hypokinesia and cadence can help to classify gait patterns in IPD patients. Our subgroups may reflect the different gait patterns in IPD patients.

BACKGROUND The cardinal motor symptoms of Parkinson's disease (PD) include postural instability, bradykinesia, tremor and rigidity. The overall Unified Parkinson's Disease Rating Scale (UPDRS-III) indicates, the gold-standard treatment for PD (dopaminergic-therapy) is very effective in improving these symptoms. However, recent research indicated that 2 of the 4 cardinal symptoms of PD (balance and tremor) remain unimproved by dopaminergic-therapy. This prompts the investigation of other alternative and adjunct treatments such as exercise rehabilitation. Unfortunately, like drug studies, exercise studies often focus on overall symptom improvement yet fail to monitor changes to specific symptoms. This may be problematic for individuals with different symptomatic phenotypes. If tremor/balance were the main concern, then adjunct therapies may be critically important when these symptoms may be dopa-resistant. Thus, it is important for all therapies to examine individual symptomatic-improvement. Interestingly, recent studies show PDSAFEx™ (a sensory integration therapy) to have a significantly improve motor symptoms in comparison to traditional exercise (14). Yet, the effects of PDSAFEx™ on individual PD symptoms is unknown. OBJECTIVE To explore the effects of PDSAFEx™ on PD symptoms in adjunct to medications. METHODS UPDRS-III scores of 229 cases were retrospectively examined and analysed in SPSS using Wilcoxon pairs singed-rank test to evaluate specific symptom-improvements. RESULTS PDSAFEx™ was confirmed to improve overall motor symptoms (p = 0.0001), but more importantly a significant improvement to tremor (p

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Background The recurrent hemizygous 22q11.2 deletion associated with 22q11.2 deletion syndrome has been identified as a genetic risk factor for early‐onset PD. However, little is known about early motor signs in this condition. Objectives We examined the presence, severity and possible factors associated with parkinsonism in adults with 22q11.2 deletion syndrome and without PD. Methods We compared motor signs between 82 adults with 22q11.2 deletion syndrome and 25 healthy controls, using the MDS‐UPDRS part III, and three‐dimensional motion‐tracker technology to quantify components of bradykinesia. Results Median MDS‐UPDRS part III total and bradykinesia subscores were significantly higher in 22q11.2 deletion syndrome (median age: 26 years; range, 17–65) than in controls (P = 0.000; P = 0.000, respectively). Age was a significant contributor to bradykinesia subscore (B = 0.06; P = 0.01) and to the electronic bradykinesia component, velocity (B = –0.02; P = 0.000); psychotic illness did not significantly impact these analyses. In 22q11.2 deletion syndrome, MDS‐UPDRS–defined bradykinesia was present in 18.3%, rigidity in 14.6%, and rest tremor in 12.2%. Conclusions Parkinsonian motor signs appear to be common and age related in 22q11.2 deletion syndrome. Longitudinal studies are needed to investigate possible symptom progression to PD. © 2020 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

The abnormal production of short chain fatty acid (SCFAs) caused by gut microbial dysbiosis plays an important role in the pathogenesis and progression of Parkinson’s disease (PD). This study sought to evaluate how butyrate, one of SCFAs, affect the pathology in a subacute 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine hydrochloride (MPTP) treated mouse model of PD. Sodium butyrate (NaB; 165 mg/kg/day i.g., 7 days) was administrated from the day after the last MPTP injection. Interestingly, NaB significantly aggravated MPTP-induced motor dysfunction (P

Background We present a case with a close temporal association of the first diagnosis of multiple sclerosis and stress cardiomyopathy. Case presentation A 19-year-old man experienced severe dyspnoea. The cardiac biomarkers troponin T and NT-proBNP were elevated, and transthoracic echocardiography showed basal hypokinesia. The man was diagnosed with stress cardiomyopathy after main differential diagnoses such as acute coronary syndrome, myocarditis, and pheochromocytoma were excluded. Furthermore, the patient reported vertigo and paraesthesia. Brain and spinal MRI revealed T2-hyperintense lesions with a prominent acute lesion in the pontomedullary area. Cerebrospinal fluid findings revealed a lymphocytic pleocytosis and intrathecal IgG synthesis. Serum neurofilaments were elevated. The patient was diagnosed with MS, and treatment with intravenous Methylprednisolone was initiated. The brainstem lesion due to multiple sclerosis was assumed to be the cause of stress cardiomyopathy. The patient fully recovered. Conclusion Stress cardiomyopathy may be linked with the first manifestation of multiple sclerosis in the presented case since pontomedullary lesions could affect the sympathetic nervous system. This case highlights the importance of neurological history and examination in young patients with unexplained acute cardiac complaints.

Background and purpose Essential tremor (ET) is a movement disorder primarily characterized by upper limb postural and kinetic tremor. Although still under-investigated, bradykinesia may be part of the phenotypic spectrum of ET. The aim was to evaluate bradykinesia features in ET through clinical examination and kinematic analysis of repetitive finger movements. Data collected in ET patients were compared with those recorded in Parkinson's disease patients and healthy controls. Methods Overall, 258 subjects participated in the study (90 ET patients, 84 Parkinson's disease patients and 84 healthy controls). Repetitive finger tapping was kinematically recorded using a motion analysis system. Movement velocity, amplitude and decrement (sequence effect) were measured. The three groups were first compared by one-way analysis of variance. A cluster analysis was also performed to better address the data variability observed in ET patients. Possible relationships between kinematic and clinical data were assessed in ET patients. Results Essential tremor patients were slower than healthy controls. Movement slowness in ET did not correlate with postural or kinetic tremor severity. It was also found that movement slowness in ET was not associated with a sequence effect, which instead is a common feature in Parkinson's disease. Cluster analysis showed that a proportion of ET patients may have movement abnormalities similar to those observed in Parkinson's disease. Conclusions Movement slowness without sequence effect is a common feature in ET patients. The present findings are relevant when interpreted in the context of the new tremor classification system and in the development of a more accurate bradykinesia definition.

Takotsubo syndrome is transient left ventricles dysfunction presenting as apical ballooning or midventricular enlargement with basal hyperkinesia of the left ventricle, while hemodynamically significant coronary artery stenosis is not found. There is considerable evidence that sympathetic catecholamine stimulation is central to takotsubo syndrome pathogenesis and causes coronary arteries constrictions, additional cardiotoxic effect and myocardial stress. First report about takotsubo syndrome was published 30 years ago by japanese H. Sato and al and was called ‘stress cardiomyopathy’. However, not only psychoemotional, but also physical stressors lead to the development of tacocubo syndrome, which increases the pathology significance. Clinical manifestations of takotsubo syndrome are indistinguishable from acute coronary syndrome, but the coronary arteries are not affected by angiography, there is a rapid positive echocardiographic dynamic. Postmenopausal women are predominantly affected (up to 90% patients). This case demonstrates the possible developing of takotsubo syndrome in a young man. The patient, 40 years old was hospitalized with typical clinical symptoms of ST segment elevation acute coronary syndrome after psycho-emotional stress, complicated by acute left ventricle insufficiency. The coronary artery angiography didn’t reveal of any damage and stenosis, there was normal level of troponins, significant increase of N-terminal propeptide of natriuretic hormone. According to echocardiography it was revealed that regional wall motion abnormality extended beyond a single epicardial vascular distribution and circular lesion of the apical and mid segments. After 3-th day from onset of disease we didn’t reveal left ventricle hypokinesia motion abnormalities by echocardiography, left ventricle ejection fraction became normal. This clinical case discuss includes the compliance of the disease manifestations with the diagnostic criteria of takotsubo syndrome, adopted by experts of the European Society of Cardiologists in 2018. Analysis of patient’s electrocardiograms allows to reveal early stage difference between takotsubo syndrome and anterior myocardial infarction.

With the emergence of affordable, clinical-orientated gait analysis techniques, clinicians may benefit from a general understanding of quantitative gait analysis procedures and their clinical applications. This article provides an overview of the potential of a quantitative gait analysis for decision support in three clinically relevant scenarios of early stage gait disorders: scenario I: gait ataxia and unsteadiness; scenario II: hypokinesia and slow gait; scenario III: apparently normal gait with a specific fall tendency in complex mobility situations. In a first part, we justify the advantages of standardized data collection and analysis procedures including data normalization and dimensionality reduction techniques that facilitate clinical interpretability of instrument-based gait profiles. We then outline typical patterns of pathological gait and their modulation during different walking conditions (variation of speed, sensory perturbation, and dual tasking) and highlight key aspects that are particularly helpful to support and guide clinical decision-making.

The effects of anti-orthostatic hypokinesia on the parameters of vertical posture (orthostatic and postural stability) were studied. Anti-orthostatic hypokinesia was followed by orthostatic instability manifested in a decrease in the tolerance time in the orthostatic test, a significant increase in HR and systolic BP starting from the 11th minute of the test. Significant changes in the parameters reflecting postural stability were observed starting from minutes 10-11 of the stabilometric test. Anti-orthostatic hypokinesia was shown to affect all parameters of postural stability; symmetry in paired stabilometric tests was impairmed.

Background Parkinson’s disease (PD) is a progressive neurological disease, with characteristic motor symptoms such as tremor and bradykinesia. There is a growing interest to continuously monitor these and other symptoms through body-worn sensor technology. However, limited battery life and memory capacity hinder the potential for continuous, long-term monitoring with these devices. There is little information available on the relative value of adding sensors, increasing sampling rate, or computing complex signal features, all of which may improve accuracy of symptom detection at the expense of computational resources. Here we build on a previous study to investigate the relationship between data measurement characteristics and accuracy when using wearable sensor data to classify tremor and bradykinesia in patients with PD. Methods Thirteen individuals with PD wore a flexible, skin-mounted sensor (collecting tri-axial accelerometer and gyroscope data) and a commercial smart watch (collecting tri-axial accelerometer data) on their predominantly affected hand. The participants performed a series of standardized motor tasks, during which a clinician scored the severity of tremor and bradykinesia in that limb. Machine learning models were trained on scored data to classify tremor and bradykinesia. Model performance was compared when using different types of sensors (accelerometer and/or gyroscope), different data sampling rates (up to 62.5 Hz), and different categories of pre-engineered features (up to 148 features). Performance was also compared between the flexible sensor and smart watch for each analysis. Results First, there was no effect of device type for classifying tremor symptoms (p > 0.34), but bradykinesia models incorporating gyroscope data performed slightly better (up to 0.05 AUROC) than other models (p = 0.01). Second, model performance decreased with sampling frequency (p p > 0.47). Finally, model performance for both symptoms was maintained after substantially reducing the feature set. Conclusions Our findings demonstrate the ability to simplify measurement characteristics from body-worn sensors while maintaining performance in PD symptom detection. Understanding the trade-off between model performance and data resolution is crucial to design efficient, accurate wearable sensing systems. This approach may improve the feasibility of long-term, continuous, and real-time monitoring of PD symptoms by reducing computational burden on wearable devices.

Tyrosine hydroxylase deficiency is a rare autosomal recessive, treatable disorder of neurotransmission. Fewer than 100 cases have been reported so far. We present a case of a 10‐month‐old infant who was symptomatic since 5 months of age and who received an initial diagnosis of infantile tremor syndrome. She presented with rest tremor, decreased facial expression, global hypokinesia, and later on with oculogyric crisis and dystonia. This diagnosis was revised after confirmation of tyrosine hydroxylase deficiency by CSF neurotransmitter analysis. Genetic studies revealed one previously reported missense variant, p.Thr399Met, and another large deletion starting upstream of exon 1 and encompassing exon 1. She was started on treatment with escalating doses of L‐Dopa/Carbidopa, with folinic acid supplementation. At 3.5 years of age, her cognitive functioning and development is appropriate for age. There is complete subsidence of dystonia and oculogyric episodes. She has occasional chorieform movements which appear to be drug related.

INTRODUCTION: Parkinson's disease (PD) is a slowly progressive neurodegenerative disorder, being the characteristic neurological sign of the loss of dopaminergic neurons in the compact part of substantia nigra, causing and unknown and affecting elderly people over 65 years. The clinical features published in PD are used for signs and symptoms such as tremor at rest, bradykinesia, hypokinesia, postural alteration, loss of postural reflexes and freezing phenomenon. Because typical postural changes in PD, associated with intercostal muscle stiffness, compromise rib cage mobility, decrease the impact on pulmonary expansion on inspiration, and thoracic changes in respiration, respiratory respiration is affected by respiratory muscle strength, occasionally respiratory muscle strength. . intercostal muscles stiffness and bradykinesia leading to atelectasis, hypoxemia and ventilatory insufficiency. OBJECTIVE: Identify, through systematic review, what are the respiratory dysfunctions in Parkinson's disease. MATERIALS AND METHODS : This is a systematic review study on respiratory dysfunction in Parkinson's disease. Searches were performed in the databases Medline, Pubmed, Lilacs, Scielo, and no language restrictions were imposed for research. For inclusion criteria, studies related to respiratory dysfunction in PD lasting 10 years were selected. The methodological quality of the studies was analyzed using a PEDro scale. RESULT: In the research initiated between 2009 and October 2019, 10 articles were included in this systematic review that demonstrated respiratory dysfunction in Parkinson's disease. CONCLUSION : Studies of Parkinson's disease showed decreased forced expiratory volume in one second, decreased forced vital capacity, increased residual volume and airway resistance.

We studied pharmacokinetics and bioavailability of verapamil, propranolol, and ethacizine in healthy volunteers after single oral administration under normal conditions and on the second day of simulated antiorthostatic hypokinesia modeling some effects of microgravity. Under conditions of antiorthostatic hypokinesia, a tendency to a decrease in half-elimination period, mean retention time, and volume of distribution and an increase in the rate of absorption, ratio of maximum concentrations, and relative rate of absorption of verapamil and propranolol were revealed. For ethacizine, a statistically significant increase in the time of attaining maximum concentration and volume of distribution and a decrease in the maximum concentration, rate of absorption, ratio of maximum concentrations, and relative rate of absorption under conditions of antiorthostatic hypokinesia were found.

Background Hysteroscopic surgery has been used in various gynecological fields. However, massive fluid overload can occur as a complication due to persistent infusion of media for uterine cavity distension. We present the case of a woman who developed cardiomyopathy with pulmonary edema and epistaxis during hysteroscopic surgery. Case A 76-year-old female underwent hysteroscopic septectomy. She manifested abrupt, active nasal bleeding and regurgitation in the intravenous line. Heart rate, SpO2, and PETCO2 decreased from 55 beats/min to 29 beats/min, from 100% to 56%, and from 31 mmHg to 9 mmHg, respectively. After the operation, brain CT showed bilateral prominent superior ophthalmic vein dilation. Echocardiography showed left ventricle apical ballooning and global hypokinesia. The patient recovered after two days of conservative management, with no sequelae. Conclusions Although hysteroscopic surgery is a simple procedure, careful monitoring is necessary to prevent complications from absorption of fluid distending media during the procedure.

Various methods of rehabilitation for dysphagia have been suggested through the experience of treating stroke patients. Although most of these patients recover their swallowing function in a short period, dysphagia in Parkinson's disease (PD) and Parkinson-related disorder (PRD) degenerates with disease progression. Muscle rigidity and bradykinesia are recognized as causes of swallowing dysfunction, and it is difficult to easily apply the strategies for stroke to the rehabilitation of dysphagia in PD patients. Disease severity, weight loss, drooling, and dementia are important clinical predictors. Silent aspiration is a pathognomonic sign that may lead to aspiration pneumonia. Severe PD patients need routine video fluoroscopy or video endoscopy to adjust their food and liquid consistency. Patients with PRD experience rapid progression of swallowing dysfunction. Nutrition combined with nasogastric tube feeding or percutaneous endoscopic gastrostomy feeding should be considered owing to the increased risk of aspiration and difficulty administrating oral nutrition.

Parkinson's disease (PD) is a degenerative, progressive disorder of the central nervous system that mainly affects motor control. The aim of this study was to develop data-driven methods and test their clinimetric properties to detect and quantify PD motor states using motion sensor data from leg agility tests. Nineteen PD patients were recruited in a levodopa single dose challenge study. PD patients performed leg agility tasks while wearing motion sensors on their lower extremities. Clinical evaluation of video recordings was performed by three movement disorder specialists who used four items from the motor section of the unified PD rating scale (UPDRS), the treatment response scale (TRS) and a dyskinesia score. Using the sensor data, spatiotemporal features were calculated and relevant features were selected by feature selection. Machine learning methods like support vector machines (SVM), decision trees, and linear regression, using ten-fold cross validation were trained to predict motor states of the patients. SVM showed the best convergence validity with correlation coefficients of 0.81 to TRS, 0.83 to UPDRS #31 (body bradykinesia and hypokinesia), 0.78 to SUMUPDRS (the sum of the UPDRS items: #26-leg agility, #27-arising from chair, and #29-gait), and 0.67 to dyskinesia. Additionally, the SVM-based scores had similar test-retest reliability in relation to clinical ratings. The SVM-based scores were less responsive to treatment effects than the clinical scores, particularly with regards to dyskinesia. In conclusion, the results from this study indicate that using motion sensors during leg agility tests may lead to valid and reliable objective measures of PD motor symptoms.

Background: Atrioventricular plane displacement (AVPD) reflects global left ventricular function despite left ventricular asymmetry as it is determined in four different regions of left ventricle. The limitations of agreement between left ventricular ejection fraction (LVEF) and AVPD are not close enough for these two measurements to be interchangeable. There is reason to question whether AVPD provides the same information as LVEF. Aim: The aim of this study was to assess relations of AVPD with LVEF and clinical findings in patients left ventricular failure (LVF). Materials and Methods: One hundred patients aged ≥18 years with coronary artery disease admitted with LVF were included in this cross sectional study. Echocardiographic examination was performed. Left ventricular AVPD was evaluated by M mode, in the four and two chamber views. Primary aim was to compare AVPD with LVEF by echocardiography. Secondary outcome measures were comparison of AVPD with traditional risk factors, clinical features, and pro-B-type natriuretic peptide (BNP) levels. Comparison of qualitative and quantitative variables was done by using Chi-square test/Fisher's exact test and unpaired t-test. Pearson's correlation was used to study correlation. Results: Mean AVPD was significantly lower in patients with severe LVEF as compared to mild, and moderate LVEF. Correlation of AVPD with LVEF, pro BNP, septum, anterior, lateral and posterior wall hypokinesia was 0.895. 0.841, 0.898, 0.911, 0.893 and 0.907 respectively. Conclusions: Mean AVPD was significantly lower in patients with severe LVEF. Mean AVPD positively correlated with LVEF, pro BNP, septum, anterior, lateral and posterior wall hypokinesia.

Background Autosomal dominant GCH1 mutations are known to cause dopa-responsive dystonia (DRD). In this case series, we confirm a variant phenotype, characterized by predominant spastic paraplegia at disease onset with development of dystonia and/or parkinsonism only decades later. Methods Clinical trajectories of four patients from three families with pathogenic variants in GCH1 are described, illustrated by videos of the motor phenotype before and during treatment with levodopa. An extensive literature review was performed on previous reports of spasticity in patients with autosomal dominant GCH1 mutations. Results All patients presented during childhood or early adolescence with gait and leg spasticity. Three patients developed basal ganglia signs only in the fifth decade; the youngest patient has not yet developed dystonia, bradykinesia or hypokinesia. All patients responded to levodopa/carbidopa with improvement of gait and of dystonia, hypokinesia and/or rigidity. In all patients, spasticity decreased but did not disappear. Spasticity has been described previously in DRD, but in most cases co-existent basal ganglia signs were identified early in the disease course. Conclusion GCH1 mutations may cause a phenotype initially resembling hereditary spastic paraplegia (HSP) rather than DRD, with basal ganglia signs developing only after decades. In order not to miss this treatable condition, GCH1 should be included in HSP gene panels and its testing is pivotal in patients with spastic paraplegia, especially if there are concomitant basal ganglia signs and/or diurnal fluctuation.