Sixteen syndrome: a rare presentation of central demyelination.

This case illustrates two diagnostic challenges for clinicians: the rarely described sixteen syndrome and the relationship between tumour necrosis factor (TNF)-alpha inhibitors and central demyelination. Sixteen syndrome affects horizontal eye movements and the facial nerve bilaterally reflecting a lesion in the posterior pontine tegmentum, adjacent to the fourth ventricle. Given its rarity and complexity of clinical signs, this syndrome risks misdiagnosis and mismanagement. The relationship between TNF-alpha inhibitors and demyelination is a complex issue in which causality is yet to be established. This diagnostic challenge poses a management dilemma for clinicians.

A distal external focus of attention facilitates compensatory coordination of body parts.

Many studies have shown that focusing on an intended movement effect that is farther away from the body (distal external focus) results in performance benefits relative to focusing on an effect that is closer to the body (proximal external focus) or focusing on the body itself (internal focus) (see, Chua, Jimenez-Diaz, Lewthwaite, Kim & Wulf, 2021). Furthermore, the advantages of a distal external focus seem to be particularly pronounced in skilled performers (Singh & Wulf, 2020). The present study examined whether such benefits of more distal attentional focus may be associated with enhanced functional variability. Volleyball players (n = 20) performed 60 overhand volleyball serves to a target. Using a within-participants design, the effects of a distal external focus (bullseye), proximal external focus (ball) and an internal focus (hand) were compared. The distal focus condition resulted in significantly higher accuracy scores than did the proximal and internal focus conditions. In addition, uncontrolled manifold analysis showed that functional variability (as measured by the index of synergy) was greatest in the distal focus condition. These findings suggest that a distal external focus on the task goal may enhance movement outcomes by optimising compensatory coordination of body parts.

Inter-limb asymmetries and kicking limb preference in English premier league soccer players.

The aims of this study were: (1) to quantify interlimb asymmetries in EPL soccer players in the context of kicking limb preference and (2) to establish the relationship between interlimb asymmetries and measures of physical performance. Twenty-two players (age: 21.8 ± 4.4 years) from an EPL club performed a running gait assessment (20 km/h) and unilateral countermovement jumps, a CoD assessment (modified 505 test), and an isokinetic knee extension/flexion protocol using each leg. Asymmetries were quantified using the percentage difference method and Pearson's correlations were used to quantify the association between variables. Players displayed the greatest level of asymmetry in isokinetic strength measures (5.9-12.7%) and lower levels of asymmetry in gait (1.6-7.7%), jump (0.9-7.0%) and CoD (1.9-3.5%) assessments. The influence of the preferred kicking limb was most evident in the isokinetic assessment with the players showing dominance in the preferred limb for knee flexor strength and in the non-preferred limb for knee extensor strength. These manifested in the asymmetry values calculated for the hamstring:quadricep (H:Q) ratios at 60°/s (8.80 ± 7.82%) and 240°/s (11.22 ± 7.04%) and in the functional H:Q ratio (12.67 ± 8.25%). The asymmetry values for peak extensor moment at 240°/s showed a significant correlation (ρ = -0.55, p = 0.034) with 10 m time in the CoD assessment. These findings provide benchmark asymmetry data for soccer practitioners and reveal that kicking limb preferences may bring about interlimb differences in the H:Q ratio which raises important considerations in the design of testing batteries and injury reduction interventions.

The surgical management of metastatic pancreatic acinar cell carcinoma and associated pancreatic panniculitis-A case report and literature review.

INTRODUCTION: Pancreatic panniculitis is a rare manifestation of benign and malignant pancreatic disease. The presentation of pancreatic panniculitis is non-specific and thus diagnosis is often delayed. When associated with malignancy, pancreatic panniculitis confers a poor prognosis. This case demonstrates the successful surgical management of this paraneoplastic phenomenon following resection of the underlying pancreatic acinar cell carcinoma and associated liver metastasis. PRESENTATION OF CASE: A 71-year-old female with debilitating subcutaneous lower limb lesions had a delayed diagnosis of pancreatic panniculitis. A formal diagnosis of pancreatic acinar cell carcinoma with liver metastasis was established and the disease was determined to be resectable. Pre-operatively, serum lipase measured 10,825 U/L. The patient proceeded to an open left hemihepatectomy and radical distal pancreatectomy with complete resection of malignant disease. Six days post-operatively the serum lipase levels normalised, and the panniculitis began to settle. The patient proceeded to adjuvant FOLFORINOX chemotherapy. Twenty months post-surgery, the patient remains disease-free and without any evidence of panniculitis. DISCUSSION: Due to the rarity of pancreatic acinar cell carcinoma, guidelines based on prospective data do not exist. Most management is based on retrospective analyses. A survival benefit may be achieved with more aggressive surgical management compared to other pancreatic cancer types. Pancreatic acinar cell carcinoma may show a slower rate of disease progression, an increased likelihood of resectability of disease at presentation and is more likely to undergo potentially curative resection. CONCLUSION: Aggressive surgical management of resectable metastatic pancreatic acinar cell carcinoma can treat pancreatic panniculitis and provide sustained disease-free survival from pancreatic cancer.

Phytoliths from Middle Stone Age habitats in the Mozambican Rift (105-29 ka).

The detection of areas suitable for hominins during late Pleistocene drought intervals is currently a priority for Middle Stone Age research. Predicting the location of populations and dispersal pathways through the East African Rift System during the last glacial phase is a challenging task due to scarce direct archaeo-vegetation data. We present a Mozambican phytolith record spanning 105-29 ka and argue for the necessity and utility of using local plant microbotanical data from archaeological sites to understand the past environments in which early modern humans lived. We assess biome structure, spatial variability, and compare phytolith-based to lacustrine environmental reconstructions to conclude that dense wooded landscapes dominated the area over much of the last glacial phase. Archaeological and botanical data suggest the hypothesis of a palaeodispersal along a montane woodland archipelago that could have attracted hominin settlement and facilitated dispersals through an inland bridge that connected southern, central and East Africa, and the two branches of the East African Rift System.

Initial excavation and dating of Ngalue Cave: a Middle Stone Age site along the Niassa Rift, Mozambique.

Direct evidence for a systematic occupation of the African tropics during the early late Pleistocene is lacking. Here, we report a record of human occupation between 105-42ka, based on results from a radiometrically-dated cave section from the Mozambican segment of the Niassa (Malawi/Nyasa) Rift called Ngalue. The sedimentary sequence from bottom to top has five units. We concentrate on the so-called "Middle Beds," which contain a Middle Stone Age industry characterized by the use of the discoidal reduction technique. A significant typological feature is the presence of formal types such as points, scrapers, awls, and microliths. Special objects consist of grinders/core-axes covered by ochre. Ngalue is one of the few directly-dated Pleistocene sites located along the biogeographical corridor for modern human dispersals that links east, central, and southern Africa, and, with further study, may shed new light on hominin cave habitats during the late Pleistocene.

Phytoliths in woody plants from the Miombo woodlands of Mozambique.

BACKGROUND AND AIMS: There are no descriptions of phytoliths produced by plants from the 'Zambezian' zone, where Miombo woodlands are the dominant element of the largest single phytochorion in sub-Saharan Africa. The preservation of phytoliths in fossil records of Africa makes phytoliths a tool to study early plant communities. Paleo-ethnobotanical interpretation of phytoliths relies on the comparison of ancient types with morphotypes extracted from living reference collections. METHODS: Phytoliths were extracted from plant samples representing 41 families, 77 genera and 90 species through sonic cleaning, dry ashing and acid treatment; and phytoliths thus extracted were quantified. For each species, an average of 216 phytoliths were counted. The percentage of each morphotype identified per species was calculated, and types were described according to the descriptors from the International Code for Phytolith Nomenclature. Phytolith assemblages were subject to discriminant analysis, cluster analysis and principal component analysis. KEY RESULTS: Phytoliths were grouped into 57 morphotypes (two were articulated forms and 55 were discrete shapes), and provide a reference collection of phytolith assemblages produced by Miombo woody species. Common and unique morphotypes are described and taxonomic and grouping variables are looked into from a statistical perspective. CONCLUSIONS: The first quantitative taxonomy of phytoliths from Miombos is presented here, including new types and constituting the most extensive phytolith key for any African ecoregion. Evidence is presented that local woody species are hypervariable silica producers and their phytolith morphotypes are highly polymorphic. The taxonomic significance of these phytoliths is largely poor, but there are important exceptions that include the morphotypes produced by members from >10 families and orders. The typical phytolithic signal that would allow scientists to identify ancient woodlands of 'Zambezian' affiliation comprises only half of the original number of phytoliths originally produced and might favour the more resilient blocky, cylindroid, globular and tabular forms.