Notes

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educational support for their educational outcomes.
To compare 1-year and 5-year clinical outcomes in 2 groups of combat-deployed service members without brain injury to those of 2 groups with combat-related concussion to better understand long-term clinical outcome trajectories.

This prospective, observational, longitudinal multicohort study examined 4 combat-deployed groups controls without head injury with or without blast exposure and patients with combat concussion arising from blast or blunt trauma. One-year and 5-year clinical evaluations included identical batteries for neurobehavioral, psychiatric, and cognitive outcomes. Abivertinib EGFR inhibitor A total of 347 participants completed both time points of evaluation. link2 Cross-sectional and longitudinal comparisons were assessed. Overall group effect was modeled as a 4-category variable with rank regression adjusting for demographic factors using a 2-sided significance threshold of 0.05, with post hoc Tukey
values calculated for the pairwise comparisons.

Significant group differences in both combat concussion groups were ins for chronic trajectories of concussion outcome in combat-deployed service members.
There was an evolution, not resolution, of symptoms from 1- to 5-year evaluation, challenging the assumption that chronic stages of concussive injury are relatively stable. Even some of the combat-deployed controls worsened. The evidence supports new considerations for chronic trajectories of concussion outcome in combat-deployed service members.
To determine whether the incidence and risk factors of restless legs syndrome (RLS) in pregnancy differ by race/ethnicity, we estimated relative risks of demographic, socioeconomic, and nutritional factors in association with risk of any incident RLS in pregnancy in a cohort of 2,704 healthy pregnant women without prior RLS.

Using data from the multicenter, multiracial National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies-Singletons, we examined the incidence of RLS from early pregnancy to near delivery through up to 6 assessments. Multivariable Poisson models with robust variance were applied to estimate relative risks (RRs).

The cumulative incidence of RLS in pregnancy was 18.1% for all women, 20.3% for White women, 15.4% for Black women, 17.1% for Hispanic women, and 21.1% for Asian women. Among Hispanic women, older age (RR [reference ≤25 years] 25-35 years, 1.51; 95% confidence interval [CI] 1.05-2.16; ≥35 years, 1.58; 95% CI 0.93-2.68), anemia (RR [reference no] yes, 2.47; 95% CI 1.31-4.64), and greater total skinfolds of the subscapular and triceps sites, independent of body mass index (RR [reference quartile 1] quartile 5, 2.54; 95% CI 1.30-4.97;
trend = 0.01) were associated with higher risk of RLS, while multiparity was associated with a lower risk (RR [reference nulliparity] 0.69; 95% CI 0.50-0.96). In Black women, greater skinfolds and waist circumference were associated with higher risk of pregnancy RLS, although the trends were less clear.

The incidence of RLS in pregnancy was high and differed by race/ethnicity, which is likely accounted for by differences in other risk factors, such as age, parity, and nutritional factors.
The incidence of RLS in pregnancy was high and differed by race/ethnicity, which is likely accounted for by differences in other risk factors, such as age, parity, and nutritional factors.
To test the hypothesis that the impaired body orientation with respect to gravity (lateropulsion) would play a key role in post-stroke balance and gait disorders.

Cohort study of 220 individuals consecutively admitted to a neurorehabilitation ward after a first hemisphere stroke (Cohort DOBRAS 2012-2018, ClinicalTrials.gov NCT03203109), with clinical data systematically collected at 1 month, then at discharge. Primary outcomes were balance and gait disorders, quantified by the Postural Assessment Scale for Stroke (PASS) and the modified Fugl-Meyer Gait Assessment (mFMA), to be explained by all deficits on day 30, including lateropulsion assessed with the Scale for Contraversive Pushing (SCP). link3 Statistics comprised linear regression analysis, uni- and multivariate analyses, and receiver operating characteristic curves.

Lateropulsion was frequent, especially after right hemisphere stroke (RHS, D30, 48%; discharge 24%), almost always in right-handers. Among all deficits, impaired body orientation (lateropulsion) had the most detrimental effect on balance and gait. After RHS, balance disorders were proportional to lateropulsion severity, which alone explained almost all balance disorders at initial assessment (90%; 95% confidence interval [CI] [86-94], p<0.001) and at discharge (92%, 95%CI [89-95], p<0.001) and also the greatest part of gait disorders at initial assessment (66%, 95%CI [56-77], p<0.001) and at discharge (68%, 95%CI [57-78], p<0.001).

Lateropulsion is the primary factor altering post-stroke balance and gait at the subacute stage and therefore should be systematically assessed. Post-stroke balance and gait rehabilitation should incorporate techniques devoted to misorientation with respect to gravity.
Lateropulsion is the primary factor altering post-stroke balance and gait at the subacute stage and therefore should be systematically assessed. Post-stroke balance and gait rehabilitation should incorporate techniques devoted to misorientation with respect to gravity.
To study the effect of stable treatment with sodium oxybate (SO) on nocturnal REM sleep behavior disorder (RBD) and REM sleep without atonia (RSWA) that severely affected children with type 1 narcolepsy (NT1).

Nineteen children and adolescents with NT1 (9 female, mean age 12.5 ± 2.7 years, mean disease duration 3.4 ± 1.6 years) underwent neurologic investigations and video-polysomnography (v-PSG) at baseline and after 3 months of stable treatment with SO. v-PSG was independently analyzed by 2 sleep experts to rate RBD episodes. RSWA was automatically computed by means of the validated REM sleep atonia index (RAI).

Compared to baseline, RAI significantly improved (
< 0.05) and complex movements during REM sleep were remarkably reduced after stable treatment with SO. Compared to baseline, children also reported improvement in clinical complaints and showed a different nighttime sleep-stage architecture.

RBD and RSWA improved after treatment with SO, pointing to a direct role of the drug in modulating motor control during REM sleep.

This study offers Class IV evidence of the positive effect of SO on modulation of muscle atonia during REM sleep in children with NT1 because of the absence of a control group.
This study offers Class IV evidence of the positive effect of SO on modulation of muscle atonia during REM sleep in children with NT1 because of the absence of a control group.
To describe clinical features relevant to diagnosis, mechanism, and etiology in patients with "scan-negative" cauda equina syndrome (CES).

We carried out a prospective study of consecutive patients presenting with the clinical features of CES to a regional neurosurgery center comprising semi-structured interview and questionnaires investigating presenting symptoms, neurologic examination, psychiatric and functional disorder comorbidity, bladder/bowel/sexual function, distress, and disability.

A total of 198 patients presented consecutively over 28 months. A total of 47 were diagnosed with scan-positive CES (mean age 48 years, 43% female). A total of 76 mixed category patients had nerve root compression/displacement without CES compression (mean age 46 years, 71% female) and 61 patients had scan-negative CES (mean age 40 years, 77% female). An alternative neurologic cause of CES emerged in 14/198 patients during admission and 4/151 patients with mean duration 25 months follow-up. Patients with scan-negative CES had more positive clinical signs of a functional neurologic disorder (11% scan-positive CES vs 34% mixed and 68% scan-negative,
< 0.0001), were more likely to describe their current back pain as worst ever (41% vs 46% and 70%,
= 0.005), and were more likely to have symptoms of a panic attack at onset (37% vs 57% and 70%,
= 0.001). Patients with scan-positive CES were more likely to have reduced/absent bilateral ankle jerks (78% vs 30% and 12%,
< 0.0001). There was no significant difference between groups in the frequency of reduced anal tone and urinary retention.

The first well-phenotyped, prospective study of scan-negative CES supports a model in which acute pain, medication, and mechanisms overlapping with functional neurologic disorders may be relevant.
The first well-phenotyped, prospective study of scan-negative CES supports a model in which acute pain, medication, and mechanisms overlapping with functional neurologic disorders may be relevant.
The posterior lumbar plexus block (LPB) has been used for decades to provide acute pain management after hip surgery. Unfamiliarity with the technique and its perceived difficulty, potential risks, and possible adverse effects such as quadriceps weakness have limited broader use. The quadratus lumborum block (QLB) has been reported to be effective for postoperative pain control following hip surgery and may thus offer another regional alternative for practitioners. This study hypothesized that the QLB type 3 (QLB3) can produce a non-inferior analgesic effect compared with LPB for primary hip replacement.

This double-blinded, non-inferiority trial randomized 46 patients undergoing primary hip replacement to receive either QLB3 or LPB. Outcomes were assessed on postanesthesia care unit arrival and at postoperative hours 6, 12, and 24. The primary outcome measured was numeric rating scale (NRS) pain score 24 hours after surgery. Secondary outcomes included opioid consumption, presence of quadriceps weakness at first postoperative physical therapy (PT) session, and time to achieve 100 feet of walking.

The QLB3 did not cross the non-inferiority delta of 2 points on the NRS pain score (mean difference -0.43 (95% CI -1.74 to 0.87)). There were no significant differences between groups in total opioid consumption at 24 hours or in time to achieve 100 feet of walking. Quadriceps weakness at first PT session was less common with QLB3 (26% vs 65%) and time to perform the block was significantly less with QLB3 (10 min vs 5 min).

This trial supported the hypothesis that the QLB3 yields non-inferior analgesia compared with LPB for hip replacement surgery.

NCT03801265.
NCT03801265.The APSES transcription factor (TF) in Aspergillus species is known to govern diverse cellular processes, including growth, development, and secondary metabolism. Here, we investigated functions of the rgdA gene (Afu3g13920) encoding a putative APSES TF in the opportunistic human-pathogenic fungus Aspergillus fumigatus The rgdA deletion resulted in significantly decreased hyphal growth and asexual sporulation. Consistently, transcript levels of the key asexual developmental regulators abaA, brlA, and wetA were decreased in the ΔrgdA mutant compared to those in the wild type (WT). Moreover, ΔrgdA resulted in reduced spore germination rates and elevated transcript levels of genes associated with conidium dormancy. The conidial cell wall hydrophobicity and architecture were changed, and levels of the RodA protein were decreased in the ΔrgdA mutant. Comparative transcriptomic analyses revealed that the ΔrgdA mutant showed higher mRNA levels of gliotoxin (GT)-biosynthetic genes and GT production. While the ΔrgdA mutant exhibited elevated production of GT, ΔrgdA strains showed reduced virulence in the mouse model.
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