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OBJECTIVE: To describe the protocol of a prospective study to test the validity of intermuscular coherence (IMC) as a diagnostic tool and biomarker of upper motor neuron degeneration in amyotrophic lateral sclerosis (ALS). METHODS: This is a multicenter, prospective study. IMC of muscle pairs in the upper and lower limbs is gathered in ∼650 subjects across three groups using surface electrodes and conventional electromyography (EMG) machines. The following subjects will be tested: 1) neurotypical controls; 2) patients with symptomatology suggestive for early ALS but not meeting probable or definite ALS by Awaji Criteria; 3) patients with a known ALS mimic. The recruitment period is between 3/31/2021 and 12/31/2025. Written consent will be sought from the subject or the subjects legally authorized representative during enrollment. RESULTS: The endpoints of this study include: 1) whether adding IMC to the Awaji ALS criteria improve its sensitivity in early ALS and can allow for diagnosis earlier; 2) constructing a database of IMC across different ages, genders, and ethnicities. SIGNIFICANCE: This study may validate a new inexpensive, painless, and widely available tool for the diagnosis of ALS.

Competence in research is an attractive feature that should be established for all practitioners because specialists with training and expertise in research will recognize strategic thinking, interpretation, and synthesizing more easily. Hence, this study aimed to describe the knowledge competency among junior high school mathematics teachers on the research processes applied on the contents of the various sections of a quantitative research paper. The descriptive method of research has been used to characterize the knowledge competence of 108 junior high school teachers on the research processes. The study used the research skill test, which was a researcher-made instrument, consisting of 50 multiple choice items with four choices each. The instrument went through the process of validity and reliability analysis obtaining a good result of 0.81. This study revealed that they were "novice" or had achieved the learning level of competency on the research processes applied on the contents of the different parts of a quantitative research paper. More so, they identified that interpretation of statistical results was a challenging part of doing a research paper.

ObjectiveTo describe the protocol of a prospective study to test the validity of intermuscular coherence (IMC) as a diagnostic tool and biomarker of upper motor neuron degeneration in amyotrophic lateral sclerosis (ALS).MethodsThis is a multicenter, prospective study. IMC of muscle pairs in the upper and lower limbs is gathered in ∼650 subjects across three groups using surface electrodes and conventional electromyography (EMG) machines. The following subjects will be tested: 1) neurotypical controls; 2) patients with symptomatology suggestive for early ALS but not meeting probable or definite ALS by Awaji Criteria; 3) patients with a known ALS mimic. The recruitment period is between 3/31/2021 and 12/31/2025. Written consent will be sought from the subject or the subject's legally authorized representative during enrollment.ResultsThe endpoints of this study include: 1) whether adding IMC to the Awaji ALS criteria improve its sensitivity in early ALS and can allow for diagnosis earlier; 2) constructing a database of IMC across different ages, genders, and ethnicities.SignificanceThis study may validate a new inexpensive, painless, and widely available tool for the diagnosis of ALS.

Only recently, primary education institutions in the Philippines started to embrace research, resulting in few investigations into research productivity and affecting factors. This mixed method triangulation study measures senior high school scientific research productivity and influencing factors. A total of 130 students, 68 papers, nine faculty, and ten evaluators were the participants in the study. Results showed low research productivity in the quantity and quality of papers. Results also revealed a significant relationship between student and teacher scientific research skills (SRS) and research policy to the quality of research. In conclusion, there is a need for improvement in primary education research productivity by increasing student and teacher SRS and holistically formulating a research policy.

Introduction Mechanical thrombectomy (MT) has become the standard of care for acute ischemic stroke (AIS) caused by large‐vessel occlusion. However, the extent of its benefits in elderly populations remains uncertain, as most landmark trials on MT have focused on younger individuals. This single‐center case series aims to shed light on the advantages and disadvantages of MT in higher age groups, particularly within the context of low‐ or middle‐income countries. Methods Between January 2018 and June 2023, we conducted a chart review of five patients aged ≥80 years who underwent MT for stroke. The study analyzed the patients' premorbid comorbidities, time to treatment, revascularization rates, procedural complications, mortality, and 90‐day modified Rankin Scale (mRS) scores. Results The five cases included individuals aged between 81 and 94 years. Among them, two had mild baseline disability (mRS score 0‐1), and three had moderate baseline disability (mRS score 2‐4). Upon admission, the National Institutes of Health Stroke Scale (NIHSS) scores ranged from 14 to 24. Three of the patients received pre‐thrombectomy intravenous thrombolysis with Alteplase and subsequently underwent MT within 4 to 7 hours of symptom onset. Successful recanalization (TICI score 2b‐3) was achieved in all five patients. However, two patients developed symptomatic intracranial hemorrhage post‐thrombectomy, and one of them succumbed to the complication. Three out of the four discharged patients attained favorable clinical outcomes with a 90‐day mRS score of 0‐2 or equivalent to their prestroke disability. Conclusion Our case series suggests that elderly individuals can potentially achieve favorable functional outcomes after MT. Nevertheless, this potential is influenced by stroke severity and the success of the treatment. As the elderly population, including octogenarians, nonagenarians, and centenarians, is expected to grow in the future, cautious patient selection should be exercised when considering thrombectomy in this age group. Further research comparing endovascular and conventional treatments in the elderly is imperative to inform better clinical decisions.

Neurological immune-related adverse events are potentially life-threatening complications of immune checkpoint inhibitors. Myasthenia gravis (MG) is a rare complication of treatment with inhibitors of programmed cell death protein 1 (PD)-1 and PD ligand 1 (PD-L1). We present a patient who developed seronegative MG resulting in respiratory failure while being treated with avelumab for metastatic, treatment-refractory ovarian cancer. Her MG went into remission following steroids and maintenance intravenous immunoglobulin treatment. We conclude that MG is a rare, but potentially life-threatening immune-related adverse event of avelumab therapy. This case provides support to the hypothesis that PD-1/PD-L1 signaling may have a protective role in MG.

The Philippines frequently experiences natural disasters and occasionally man-made ones. As such, Republic Act No. 10121, also known as the Philippine Disaster Risk Reduction and Management Act of 2010, provides designated lead agencies to respond to different stages of disaster management. Despite this, the Philippine government has resorted to the creation of inter-agency task forces (IATFs) to deal with these disasters. These task forces were designed to expedite the implementation of rehabilitation programs and projects. However, in the cases of Task Force Yolanda and Task Force Bangon Marawi, the completion of such programs for typhoon Yolanda and Marawi siege affected areas has been delayed tremendously despite the presence of IATFs. Through an assessment on the effectiveness of the IATFs’ clusters using the multiple case study approach, this paper aims to determine whether or not IATFs were necessary for the recovery and rehabilitation phase of Typhoon Yolanda and the Marawi siege. Upon carrying out the assessment, the lack of timeliness and planning of rehabilitation programs, inconsistencies in the NEDA and OCD reports, insufficient community participation, and the mismatch of services and needs were observed. As such, this paper recommends the creation of criteria for the selection of task force leadership along with other measures that can increase the government’s transparency and accountability through periodical auditing and encourage community participation in rehabilitation initiatives.

Cancer immunotherapy with checkpoint inhibitors may result in neuromuscular immune-related adverse reactions, including Guillain-Barré syndrome (GBS)-like disease. On the other hand, checkpoint inhibitor therapy may result in exacerbation of underlying autoimmune diseases such as myasthenia gravis and multiple sclerosis. We present a patient who developed a severe and fatal relapse of postvaccination GBS after he was treated with nivolumab, a monoclonal antibody directed to programmed death-1 (PD-1), during a GBS treatment-related fluctuation. We recommend that caution be exercised in starting treatment with PD-1 inhibitors in the acute stage or early in the recovery period of GBS.

The augmented immune response caused by immune checkpoint inhibitors leads to the emergence of a class of side effects called immune-related adverse events (irAEs). Facial palsy (FP) is rarely reported as an irAE. In this retrospective study, we reviewed the records of 353 patients treated with immunotherapy in our center from 2015-2018. We identified 4 male patients and 1 female patient with FP. Four had metastatic melanoma and were treated with ipilimumab either as monotherapy or in combination with nivolumab or pembrolizumab. The remaining patient had metastatic bladder cancer, treated with atezolizumab. FP was unilateral and occurred 1-23 weeks after starting immunotherapy. FP was part of a more diffuse neuropathic process in 3 of our patients. Lymphocytic pleocytosis was seen in the cerebrospinal fluid of 3 patients who had lumbar punctures. Magnetic resonance imaging showed enhancement of the intracranial portion of the affected facial nerve in 4 patients. The outcome was favorable in all of the patients noting that 1 patient had incomplete recovery. We conclude that FP, in isolation or as a part of a polyneuropathy, is common among neurological irAEs associated with checkpoint inhibitors and generally has a good prognosis.

Coffee is one of the world’s most popular beverages, with the global coffee capsule market worth over USD 4 billion and growing. The incidence of coffee fraud is estimated to be up to one in five coffees being contaminated with cheaper blends of coffee. Given the worsening extent of climate change, coffee crop yields are harder to maintain, while demand is increasing. The 2021 Brazil frost delaying or destroying many coffee crops is an example. Hence, the incidence of coffee fraud is expected to increase, and as the market becomes more complex, there needs to be faster, easier, and more robust means of real-time coffee authentication. In this study, we propose the use of novel approaches to postcolumn derivatization (termed herein as in-column derivatization) to visualize the antioxidant profiles of coffee samples, to be later used as indicators for authentication purposes. We propose three simple mathematical similarity metrics for the real-time identification of unknown coffee samples from a sample library. Using the CUPRAC assay, and these metrics, we demonstrate the capabilities of the technique to identify unknown coffee samples from within our library of thirty.

There has been an increasing incidence of stroke cases among SARS-CoV-2 (COVID-19) patients who were deeply sedated and underwent proning positioning. We reviewed the association of proning and sedations used to the development of stroke, including demographic profiles of patients with COVID-19 infection in the critical care unit. There was a significant association seen among COVID-19 patients in the ICU who underwent proning to the development of stroke, with up to 15 times risk of having stroke (p value = 0.007) than those who were not proned during their course of ICU stay. Patients who were given propofol and fentanyl as sedation during proning for more than 24 hours was significantly associated with the development of stroke (p value = 0.004). Patient risk factors were also studied (age variability, hypertension, diabetes, smoking, and alcoholism) and showed that patients who were alcoholic beverage drinkers were significantly associated to the development of stroke during proning (p value =

Rapid diagnosis and treatment of infectious meningitis and encephalitis are critical to minimize morbidity and mortality. Comprehensive testing of cerebrospinal fluid (CSF) often includes Gram stain, culture, antigen detection, and molecular methods, paired with chemical and cellular analyses. These methods may lack sensitivity or specificity, can take several days, and require significant volume for complete analysis. The FilmArray Meningitis/Encephalitis (ME) Panel is a multiplexed in vitro diagnostic test for the simultaneous, rapid (∼1-h) detection of 14 pathogens directly from CSF specimens: Escherichia coli K1, Haemophilus influenzae, Listeria monocytogenes, Neisseria meningitidis, Streptococcus pneumoniae, Streptococcus agalactiae, cytomegalovirus, enterovirus, herpes simplex virus 1 and 2, human herpesvirus 6, human parechovirus, varicella-zoster virus, and Cryptococcus neoformans/Cryptococcus gattii We describe a multicenter evaluation of 1,560 prospectively collected CSF specimens with performance compared to culture (bacterial analytes) and PCR (all other analytes). The FilmArray ME Panel demonstrated a sensitivity or positive percentage of agreement of 100% for 9 of 14 analytes. Enterovirus and human herpesvirus type 6 had agreements of 95.7% and 85.7%, and L. monocytogenes and N. meningitidis were not observed in the study. For S. agalactiae, there was a single false-positive and false-negative result each, for a sensitivity and specificity of 0 and 99.9%, respectively. The specificity or negative percentage of agreement was 99.2% or greater for all other analytes. The FilmArray ME Panel is a sensitive and specific test to aid in diagnosis of ME. With use of this comprehensive and rapid test, improved patient outcomes and antimicrobial stewardship are anticipated.

Abstract Background Cancer Anorexia Cachexia Syndrome (CACS) is a distinct atrophy disease negatively influencing multiple aspects of clinical care and patient quality of life. Although it directly causes 20% of all cancer‐related deaths, there are currently no model systems that encompass the entire multifaceted syndrome, nor are there any effective therapeutic treatments. Methods A novel model of systemic metastasis was evaluated for the comprehensive CACS (metastasis, skeletal muscle and adipose tissue wasting, inflammation, anorexia, anemia, elevated protein breakdown, hypoalbuminemia, and metabolic derangement) in both males and females. Ex vivo skeletal muscle analysis was utilized to determine ubiquitin proteasome degradation pathway activation. A novel ketone diester (R/S 1,3‐Butanediol Acetoacetate Diester) was assessed in multifaceted catabolic environments to determine anti‐atrophy efficacy. Results Here, we show that the VM‐M3 mouse model of systemic metastasis demonstrates a novel, immunocompetent, logistically feasible, repeatable phenotype with progressive tumor growth, spontaneous metastatic spread, and the full multifaceted CACS with sex dimorphisms across tissue wasting. We also demonstrate that the ubiquitin proteasome degradation pathway was significantly upregulated in association with reduced insulin‐like growth factor‐1/insulin and increased FOXO3a activation, but not tumor necrosis factor‐α‐induced nuclear factor‐kappa B activation, driving skeletal muscle atrophy. Additionally, we show that R/S 1,3‐Butanediol Acetoacetate Diester administration shifted systemic metabolism, attenuated tumor burden indices, reduced atrophy/catabolism and mitigated comorbid symptoms in both CACS and cancer‐independent atrophy environments. Conclusions Our findings suggest the ketone diester attenuates multifactorial CACS skeletal muscle atrophy and inflammation‐induced catabolism, demonstrating anti‐catabolic effects of ketone bodies in multifactorial atrophy.

Diverse neurological disorders are associated with a deficit in brain energy metabolism, often characterized by acute or chronic glucose hypometabolism. Ketones serve as the brain's only significant alternative fuel and can even become the primary fuel in conditions of limited glucose availability. Thus, dietary supplementation with exogenous ketones represents a promising novel therapeutic strategy to help meet the energetic needs of the brain in an energy crisis. Preliminary evidence suggests ketosis induced by exogenous ketones may attenuate damage or improve cognitive and motor performance in neurological conditions such as seizure disorders, mild cognitive impairment, Alzheimer's disease, and neurotrauma.