The development of nasal polyps involves early middle meatus mucous remodeling via TGF-β1 mediated PAI-1 reduction

Abstract Objective Our study aimed to elucidate the effect of PAI-1 (Plasminogen Activator Inhibitor-1) and t-PA (Tissue-type Plasminogen Activator) in tissue remodeling in nasal polyps patients. Methods Samples were streamed as early Nasal Polyps (eNP, n = 10) and inferior tissue from the same patient, mature Nasal Polyps (mNP, n = 14), and Control group (n = 15), respectively. Immunohistochemistry and immunofluorescence were applied to detect localization. Quantitative Real-Time Polymerase Chain Reaction (qRT-PCR) and Western blot were used to measure different levels among three groups. The mNP tissue was cultured in vitro and treated with TGF-β1 (Transforming Growth Factor-beta 1) activator, TGF-β1 inhibitor (SB431542), and PAI-1 inhibitor (TM5275); then Western blot, qRT-PCR, and ELISA were used to assess changes. Results The immunohistochemistry and immunofluorescence showed that PAI-1 expression decreased in eNP and mNP, mainly in epithelium and glands. The transcriptional expression and protein level of TGF-β1/t-PA/PAI-1/Collagen1 were lower in eNP than IT while mNP group demonstrated lower mRNA expression and protein level of TGF-β1/t-PA/PAI-1/Collagen1 than Control group. In mNP tissue culture in vitro, TGF-β1 activator elevated t-PA, PAI-1, and Collagen1 with higher release of PAI-1 and Collagen1 in supernatant, whereas SB431542 suppressed above reactions; TM5275 lowered transcriptional and protein level of Collagen1 in supernatant. Conclusion Early Nasal polyps' formation in middle meatus mucous is related with fibrillation system PAI-1/t-PA and tissue remodeling; moreover, nasal polyps' development is regulated by TGF-β1-mediated PAI-1 reduction. Level of evidence 3b.

Historical and More Common Nongenetic Movement Disorders From Asia

Nongenetic movement disorders are common throughout the world. The movement disorders encountered may vary depending on the prevalence of certain disorders across various geographical regions. In this paper, we review historical and more common nongenetic movement disorders in Asia. The underlying causes of these movement disorders are diverse and include, among others, nutritional deficiencies, toxic and metabolic causes, and cultural Latah syndrome, contributed by geographical, economic, and cultural differences across Asia. The industrial revolution in Japan and Korea has led to diseases related to environmental toxin poisoning, such as Minamata disease and β-fluoroethyl acetate-associated cerebellar degeneration, respectively, while religious dietary restriction in the Indian subcontinent has led to infantile tremor syndrome related to vitamin B12 deficiency. In this review, we identify the salient features and key contributing factors in the development of these disorders.

Nine Hereditary Movement Disorders First Described in Asia: Their History and Evolution

Clinical case studies and reporting are important to the discovery of new disorders and the advancement of medical sciences. Both clinicians and basic scientists play equally important roles leading to treatment discoveries for both cures and symptoms. In the field of movement disorders, exceptional observation of patients from clinicians is imperative, not just for phenomenology but also for the variable occurrences of these disorders, along with other signs and symptoms, throughout the day and the disease course. The Movement Disorders in Asia Task Force (TF) was formed to help enhance and promote collaboration and research on movement disorders within the region. As a start, the TF has reviewed the original studies of the movement disorders that were preliminarily described in the region. These include nine disorders that were first described in Asia: Segawa disease, PARK-Parkin, X-linked dystonia-parkinsonism, dentatorubral-pallidoluysian atrophy, Woodhouse-Sakati syndrome, benign adult familial myoclonic epilepsy, Kufor-Rakeb disease, tremulous dystonia associated with mutation of the calmodulin-binding transcription activator 2 gene, and paroxysmal kinesigenic dyskinesia. We hope that the information provided will honor the original researchers and help us learn and understand how earlier neurologists and basic scientists together discovered new disorders and made advances in the field, which impact us all to this day.

Gastrointestinal Dysfunction in Parkinson’s Disease: Neuro-Gastroenterology Perspectives on a Multifaceted Problem

Patients with Parkinson’s disease (PD) face a multitude of gastrointestinal (GI) symptoms, including nausea, bloating, reduced bowel movements, and difficulties with defecation. These symptoms are common and may accumulate during the course of PD but are often under-recognized and challenging to manage. Objective testing can be burdensome to patients and does not correlate well with symptoms. Effective treatment options are limited. Evidence is often based on studies in the general population, and specific evidence in PD is scarce. Upper GI dysfunction may also interfere with the pharmacological treatment of PD motor symptoms, which poses significant management challenges. Several new less invasive assessment tools and novel treatment options have emerged in recent years. The current review provides an overview and a practical approach to recognizing and diagnosing common upper and lower GI problems in PD, e.g., dyspepsia, gastroparesis, small bowel dysfunction, chronic constipation, and defecatory dysfunction. Management aspects are discussed based on the latest evidence from the PD and general populations, with insights for future research pertaining to GI dysfunction in PD.

Research progress on oligodendrocyte progenitor cells participated neuroimmunomodulation / 解剖学报

[Abstract] Oligodendroglial lineage cells (OLGs) are important cell reserves for myelination and remyelination. Recent studies of central nervous system (CNS) indicated that besides traditional CNS immune cells like microglia, primitive cells of oligodendroglial lineage, oligodendrocyte progenitor cells (OPCs) can also actively participate immune responses. Simulated by physiological or pathological factors, OPCs can express a series of receptors,signaling and/ or regulatory molecules et al, in this way,OPCs can play a critical role in both development and maintenance of the blood-cerebrospinal fluid barrier (BCB), and most essentially, in initial stage for recruitment of peripheral immune cells and initial immune activation. Besides, in neurological disorders, recent research has revealed that OPCs can transform to disease-specific cell states, characterized by activation of immune cell exclusive genes. These findings may provide the basis for a new insight into the therapeutic strategy of neuron disorders and neurovascular diseases by effectively regulating OPCs.

A KMT2B Frameshift Variant Causing Focal Dystonia Restricted to the Oromandibular Region After Long-Term Follow-up

KMT2B-linked dystonia (DYT-KMT2B) is a childhood-onset dystonia syndrome typically beginning in the lower limbs and progressing caudocranially to affect the upper limbs with eventual prominent craniocervical involvement. Despite its recent recognition, it now appears to be one of the more common monogenic causes of dystonia syndromes. Here, we present an atypical case of DYT-KMT2B with oromandibular dystonia as the presenting feature, which remained restricted to this region three decades after symptom onset. This appears to be the first reported case of DYT-KMT2B from Southeast Asia and provides further supporting evidence for the pathogenic impact of the KMT2B c.6210_6213delTGAG variant.

Effect of exercise intervention and rehabilitation on patients with depression / Efeito da intervenção do exercício e reabilitação em pacientes com depressão / Efecto de la intervención del ejercicio y rehabilitación en pacientes con depresión

ABSTRACT Introduction: The increase in the number of students experiencing depression severely impacts the physical and mental health of college students. Objective: Explore the effect of an exercise intervention on patients with depression by analyzing its rehabilitation effect. Methods: Physical education combined with extracurricular activities were chosen. The experimental physical education group completed about 45 minutes of low-intensity running, performing physical recovery and rest under teacher guidance. The sport form of extracurricular activity was basketball, twice a week. Physical education combined with extracurricular activities totaled a total of 4 times a week, lasting six weeks. Results: The exercise intervention reduced the participants' psychological test scores, relieving them of their psychological conditions. The exercise intervention improved somatization factors (obsessive-compulsive, depression, interpersonal, paranoid, anxiety, and negative symptoms). Conclusion: The personalized exercise plan is recommended for students with depression, with the promotion of corresponding physical exercise out of class, aiming to improve students' psychological state and mental health. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: O aumento no número de estudantes que sofrem depressão tem um impacto negativo severo na saúde física e mental dos estudantes universitários. Objetivo: Explorar o efeito da intervenção do exercício em pacientes com depressão, analisando o seu efeito de reabilitação. Métodos: Elegeu-se a forma de educação física combinada com atividades extracurriculares. O grupo experimental de educação física completou cerca de 45 minutos de corrida de baixa intensidade, realizando a recuperação física e o descanso sob orientação dos professores. A forma esportiva de atividades extracurriculares foi o basquete, duas vezes por semana. A educação física combinada com as atividades extracurriculares totalizou um total de 4 vezes semanais, com duração total de seis semanas. Resultados: A intervenção no exercício teve efeito redutor nos escores do teste psicológico dos participantes, revelando um alívio de suas condições psicológicas. A intervenção no exercício apresentou efeitos evidentes sobre a melhoria dos fatores de somatização (sintomas obsessivo-compulsivos, depressão, interpessoais, paranoicos, de ansiedade e hostis). Conclusão: O plano de exercício personalizado é recomendado para os alunos com depressão, sendo a promoção do exercício físico correspondente extraclasse, visando melhorar o estado psicológico dos alunos e melhorar sua saúde mental. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: El aumento del número de estudiantes que sufren depresión tiene un grave impacto negativo en la salud física y mental de los universitarios. Objetivo: Explorar el efecto de la intervención de ejercicio en pacientes con depresión analizando su efecto de rehabilitación. Métodos: Se eligió la forma de educación física combinada con actividades extraescolares. El grupo experimental de educación física realizó unos 45 minutos de carrera de baja intensidad, realizando recuperación física y descanso bajo la dirección de los profesores. La forma deportiva de las actividades extracurriculares era el baloncesto, dos veces por semana. La educación física combinada con las actividades extraescolares se realizaba un total de 4 veces por semana, con una duración total de seis semanas. Resultados: La intervención de ejercicio tuvo un efecto reductor en las puntuaciones de las pruebas psicológicas de los participantes, revelando un alivio de sus condiciones psicológicas. La intervención del ejercicio mostró efectos evidentes en la mejora de los factores de somatización (síntomas obsesivo-compulsivos, de depresión, interpersonales, paranoides, de ansiedad y hostiles). Conclusión: Se recomienda el plan de ejercicio personalizado para los alumnos con depresión, con la promoción del correspondiente ejercicio físico extra clase dirigido a mejorar el estado psicológico de los alumnos y a mejorar su salud mental. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

The effect of percutaneous transluminal angioplasty in the treatment of autogenous arteriovenous fistula stenosis and influencing factors of restenosis/loss of function after PTA / 中国医师杂志

Objective:To analyze the effect of percutaneous transluminal angioplasty (PTA) in the treatment of autogenous arteriovenous fistula (AVF) stenosis and influcing factors of restenosis/loss of function after PTA.Methods:The medical records of 104 patients with AVF stenosis treated by PTA in People′s Hospital of Huadu District from March 2019 to July 2020 and the 1-year follow-up were retrospectively analyzed. Kaplan-meier curves were used to analyze the primary patency rates at 3 months, 6 months and 1 year. COX regression was used to analyze the influencing factors of restenosis/loss of function after PTA.Results:The primary patency rates of AVF at 3, 6 and 12 months after PTA were 86.2%, 83.2% and 64.7%, respectively. Guide wire entry into the distal end of radial artery, the use of two balloons in stepwise mode, postoperative dilatation diameter, and dialysis blood flow after PTA were independent risk factors for restenosis/loss of fuction after PTA for AVF stenosis (all P<0.05). Conclusions:The guide wire into the distal end of the artery and passive use of more than two balloons are important factors affecting AVF restenosis/loss of function after PTA .

Significance of combination of targeted therapy and immunotherapy in conversion therapy of biliary tract cancer / 中华外科杂志

Biliary tract cancer has insidious onset and high degree of malignancy, and radical resection is often impossible when it is diagnosed.Conversion therapy can achieve tumor downgrading, so that patients who were initially unresectable have a chance to achieve R0 resection.However, due to the high heterogeneity and complex immune microenvironment of biliary tract cancer, conversion therapy is still in the stage of active exploration.As a new type of conversion therapy, combination of targeted therapy and immunotherapy is of great significance to effectively improve the efficiency of conversion therapy.Further exploration of combination mechanism and improvement of immune microenvironment are expected to become the future direction of combination of targeted therapy and immunotherapy.

Fecal Calprotectin in Parkinson’s Disease and Multiple System Atrophy

Objective@#Converging evidence suggests that intestinal inflammation is involved in the pathogenesis of neurodegenerative diseases. Previous studies on fecal calprotectin in Parkinson’s disease (PD) were limited by small sample sizes, and literature regarding intestinal inflammation in multiple system atrophy (MSA) is very scarce. We investigated the levels of fecal calprotectin, a marker of intestinal inflammation, in PD and MSA. @*Methods@#We recruited 169 subjects (71 PD, 38 MSA, and 60 age-similar nonneurological controls). Clinico-demographic data were collected. PD and MSA were subtyped and the severity assessed using the MDS-UPDRS and UMSARS, respectively. Fecal calprotectin and blood immune markers were analyzed. @*Results@#Compared to controls (median: 35.7 [IQR: 114.2] μg/g), fecal calprotectin was significantly elevated in PD (median: 95.6 [IQR: 162.1] μg/g, p = 0.003) and even higher in MSA (median: 129.5 [IQR: 373.8] μg/g, p = 0.002). A significant interaction effect with age was observed; between-group differences were significant only in older subjects (i.e., ≥ 61 years) and became more apparent with increasing age. A total of 28.9% of MSA and 18.3% of PD patients had highly abnormal fecal calprotectin levels (≥ 250 μg/g); however, this difference was only significant for MSA compared to controls. Fecal calprotectin correlated moderately with selected blood immune markers in PD, but not with clinical features of PD or MSA. @*Conclusions@#Elevated fecal calprotectin suggests a role for intestinal inflammation in PD and MSA. A more complete understanding of gut immune alterations could open up new avenues of research and treatment for these debilitating diseases.

Glucocerebrosidase genetic variants in Malays with early and late-onset Parkinson’s disease

@#Background: Mutations in glucocerebrosidase (GBA) have been associated with the risk of developing Parkinson’s disease (PD) in different ethnic populations. The prevalence of GBA mutations among Malay PD patients is unknown. Thus, the aim of this study was to determine the frequency of GBA mutations among Malay PD patients, focusing on early (EOPD) and late-onset (LOPD) patients. Methods:EOPD (n = 50) and LOPD (n = 50) patients along with 50 ethnically and age-matched control wererecruited. The GBA exons of these patients were sequenced using the Ion Torrent PGMTM System. Results: Five heterozygous mutations exclusive to EOPD patients were identified; c.-203A>G,p.S146L, p.R159Q, p.L483P and p.L483R+c.-145G>A. In LOPD patients, c.543C>T(p.(F181=)), c.28-10C>A and p.R202Q were identified in which this p.R202Q was also present in a control subject. In addition, c.259C>A(p.(R87=)) and c.-145G>A were identified in two control subjects. In summary, we observed GBA mutations in 8% and 6% of Malay PD cases and control subject, respectively. The prevalence of GBA mutations was higher in EOPD (10%) than LOPD (6%). However, these differences were not statistically significant; [PD vs. controls: OR = 1.36, 95%CI 0.35-5.38, p = 0.752] and [EOPD vs. LOPD: OR = 1.74, 95%CI 0.39-7.71, p = 0.715]. Conclusion: We identified five exclusive heterozygous GBA mutations in EOPD patients which might predict the increase susceptibility of Malays to develop PD at young age. These findings could add knowledge into the existing evidences linking genetic alterations in GBA and PD.

Short-term complications and long-term outcomes of spleen-preserving distal pancreatectomy in pediatric pancreatic tumors / 中华普通外科杂志

Objective To analyze the short-term complications and long-term outcomes of spleenpreserving distal pancreatectomy (SPDP) in pediatric pancreatic tumors.Methods A retrospective analysis was conducted on 43 patients with tumors of the body and tail of the pancreas in Beijing Children's Hospital from Jan 2007 to Jan 2018.Results There were 17 boys (39.53％) and26girls (60.47％),with a median age of 123 (80,141) months.The median maximum diameter of primary tumor was 7.60 cm.Diagnoses included solid pseudopapillary tumor (n =28),pancreatoblastoma (n =10),neuroendocrine tumor (n =4),and pancreatic cyst (n =1).Two cases (4.65％) received tumor enucleation,4 cases (9.30％) did distal pancreatectomy plus splenectomy,and 37 cases (86.05％) did SPDP.16 cases (37.21％) had short-term complications,including pancreatic fistula (n =13),delayed gastric emptying (n =3),abdominal infection (n =7) and postoperative bleeding (n =2).After a median follow-up of 46 (23,71) months,38 cases (88.37％) were disease-free;two cases (4.65％) with tumor recurrence;one case of pancreatoblastoma died of tumor recurrence.Two cases lost to follow-up.Three patients had long-term complications,including chronic fatty diarrhea (n =2) and hypoglycemia (n =1).Three patients underwent second operation for recurrent tumor (one pancreatoblastoma and two solid pseudopapillary tumor).Conclusions SPDP is safe and effective in the treatment of tumors of the body and tail of the pancreas in children.

Clinical and prognostic characteristics of aggressive fibromatosis in children:A report of 27 cases / 中国实用儿科杂志

OBJECTIVE: To investigate the clinical characteristics,treatment strategies,and prognosis of aggressive fibromatosis in children. METHODS: A retrospective analysis was performed in 27 cases of aggressive fibromatosis from January 2007 to January 2018 in Beijing Children's Hospital,Capital Medical University. RESULTS: There were 16 males and 11 females in 27 cases of aggressive fibromatosis,with a median age of 65(35,96)months at diagnosis. Tumor locations were as follows: abdominal wall(n=3),abdominal cavity(n=5),and extra-abdominal(n=19). Preoperative imaging examination showed that the median maximum diameter of primary tumors was 9.8(5.3,12.1)cm. Upfront surgery was performed in all of the cases,and 10 cases received adjuvant chemotherapy combined with methotrexate and vinorelbine. Among the 27 cases,9 cases survived without disease,15 cases survived with disease,and 3 cases died of tumor recurrence or progression. The 5-year overall survival and event-free survival rates were 85.8% and 32.6%,respectively.Further analysis of survival showed that positive surgical margin was associated with tumor recurrence. CONCLUSION: Aggressive fibromatosis is a rare,intermediate tumor in children. It is easy to relapse after incomplete surgical resection.Chemotherapy plays a role in controlling the growth of tumors. Most of the children have good prognosis,but some of them may be disabled or even die because of persistent,fast-growing tumors.

Hyperglycemia-Associated Hemichorea-Hemiballismus with Predominant Ipsilateral Putaminal Abnormality on Neuroimaging

No abstract available.

Alternating Hemiplegia of Childhood in a Person of Malay Ethnicity with Diffusion Tensor Imaging Abnormalities

No abstract available.

Pharmacokinetics mechanism of ABC efflux proteins-mediated seven features of compatibility / 中国中药杂志

ABC efflux proteins are a kind of transporters mediating diversified endogenous and exogenous efflux protein substrates across the plasma membrane by depending on the chemical energy released by ATP hydrolysis. As a vitally important functional membrane, it is widely found in various tissues and organs. The drug changes the expressions and/or functions of the transport proteins, which will affect the disposal process of substrate drugs corresponding to transporters , and finally lead to the pharmacokinetic interactions. The efflux proteins take part in the absorption, distribution, metabolism and excretion of drugs, and mainly consist of P-glycoprotein(P-gp), multidrug resistance associated protein(MRP) and breast cancer resistance protein(BCRP). The induction effect or inhibition effect of drugs on efflux protein plays a greatly significant role in the drug interaction produced by the compatibility of traditional Chinese medicine, which may be one of the important mechanisms of the theory of seven features of compatibility. In this article, the effects of seven features of compatibility on the ABC efflux transporters were reviewed, in order to reveal the roles of efflux protein in the herb-pairs compatibility, and provide new ideas for the mechanism and rationality of herb compatibility.

Predictive value of age and serum neuron enolase analysis in the pathological prognosis of histopathology sub-group in intermediate and high-risk neuroblastoma / 中华实用儿科临床杂志

Objective To improve substantially the prediction accuracy of histopathology subgroup through combined analysis of clinical and biological features,and accordingly build a decision tree to predict the histopathology subgroup in intermediate and high - risk neuroblastoma. Methods A total of 62 intermediate and high - risk neuro-blastoma patients were included retrospectively in this study,who received chemotherapy and surgery at Beijing Chil-dren's Hospital (BCH),Capital Medical University between January 2015 and January 2017. The fin-dings of urinary vanillylmandelic acid (VMA),and homovanillic acid (HVA),serum neuron - specific enolase (NSE),lactate dehy-drogenase (LDH)and ferritin,ultrasound,CT,MRI,positron emission tomography - computed tomography (PET -CT),bone marrow aspiration and biopsy,MYCN gene,and histopathology were collected and analyzed retrospectively. Statistical analysis was performed by using SAS 9. 4. Univariate and multivariate Logistic regression analysis were con-ducted to select potentially useful characteristics for prediction. Based on the results of Logistic regression analysis,a classification tree was developed to predict histopathology subgroup. Results To identify the characteristics related to histopathology,tumor markers and six clinico - pathologic factors were evaluated by univariate analysis. The results showed that unfavorable histopathology(UH)was more frequently associated with bone marrow metastasis,older age,as well as higher serum NSE,ferritin and LDH levels. The result of multivariate analysis showed that age and NSE were significant independent predictors of histopathology. The adjusted odds ratio(OR)of NSE and age was 33. 2 and 13. 0, respectively. The area under the receiver - operating - characteristic (AUC)of the prediction mo-del was 0. 889. The sensitivity and specificity were 91. 90％ and 76. 00％,respectively. Furthermore,to provide a visua-lization of the sig-nificant predictors found by Logistic regression analysis,a decision tree was developed for predicating of histopathology. Conclusions Age and NSE are significant independent predictors of histopathology subgroup. The decision tree based on age and NSE can help to predict the histopathology subgroup in intermediate and high - risk neuroblastoma effective-ly.

Study on the affection of TLR of aralia in renal tissue of diabetic mice / 国际中医中药杂志

Objective To investigate the protective effect of aralia total saponins on renal injury induced by streptozotocin (STZ) in type 2 diabetic mice, meanwhile to explore its protective mechanism. Methods Fifty male Kunming mice were randomly divided into the normal group, the model group and the aralia total saponins low, middle and high does groups. All the rats were given high fat diet 8 weeks and then received STZ 45 mg/kg to built type 2 diabetic mice model, except the noraml group. After the models establishment,the aralia total saponins low, middle and high does groups were given the aralia total saponins 30, 60, 120 mg/kg treatment, andthe normal group and the model group were given the equal normal saline, once each day. After 4th and 8th week administration, the urinary protein levels of 24 h in each group were detected. After the last treatment, all the mice were sacrificed to detected the changes of blood glucose, insulin and inflammatory related factors. Immunohistochemistry, Western blotting and real-time quantitative PCR were used to observe the expression of TLR2 and TLR2 in the kidney tissue. Results Compared with the model group, the low, middle and high does groups in 24-hour proteinuria, blood glucose, insulin resistance index decreased (P<0.05), the insulin increased(P<0.05). The serum TNF-α (16.66 ± 0.20 ng/L, 14.49 ± 0.27 ng/L, 13.52 ± 0.22 ng/L vs.20.33 ± 0.56 ng/L),IL-1β(0.46 ± 0.04 ng/L,0.44 ± 0.04 ng/L,0.37 ± 0.04 ng/L vs.0.55 ± 0.05 ng/L),NF-κB (28.71 ± 6.14 ng/L, 26.26 ± 5.48 ng/L, 25.69 ± 5.61 ng/L vs. 36.55 ± 8.90 ng/L) significantly decreased (P<0.05).The kidney TLR2 mRNA(1.92 ± 0.18,1.46 ± 0.23,1.28 ± 0.21 vs.2.69 ± 0.22),TLR4 mRNA(2.20 ± 0.19,2.08 ± 0.27,1.57 ± 0.22 vs.2.78 ± 0.23),TLR2 porteins(0.82 ± 0.11,0.52 ± 0.06,0.44 ± 0.07 vs.0.77 ± 0.13),TLR4 proteins(0.52 ± 0.04,0.42 ± 0.09,0.26 ± 0.06 vs.0.86 ± 0.12)significantly decreased(P<0.05). Conclusions The aralia total saponins can significantly reduce the blood glucose, insulin resistance index and 24-hour urinary protein in type 2 diabetic nephropathy of mice, increase the insulin, and analyzing its mechanism may be total saponins can inhibit the expression of TLR2 and TLR4 protein in the kidney, and further reduce the inflammatory response.

Chorea in Sporadic Creutzfeldt-Jakob Disease

No abstract available.

Purposeless Groaning in Parkinson's Disease

Purposeless groaning has been reported in advanced progressive supranuclear palsy. We present a case of purposeless groaning occurring as a primary complaint in a patient with advanced Parkinson's disease. Purposeless groaning is thought to be a manifestation of disinhibition and perseveration due to frontal-subcortical dysfunction. Proper recognition of this phenomenon will help clinicians to avoid unnecessary investigations and treatment (e.g., prescription of opioid medications).