Prevalence and Clinical Implications of Osteosarcopenia in Patients with Acute Stroke: A Cross-sectional Study.

OBJECTIVE: To investigate the prevalence and risk factors of osteosarcopenia in patients with acute stroke. DESIGN: Overall, 224 patients within 2 weeks of having a stroke were enrolled. Demographic characteristics, National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), modified Barthel Index (MBI), Functional Ambulation Category (FAC), Berg Balance Scale (BBS), and handgrip strength were recorded. Body composition was evaluated using dual-energy X-ray absorptiometry. Patients who met the diagnostic criteria for osteoporosis and sarcopenia were defined as having osteosarcopenia. RESULTS: The overall prevalence of osteoporosis and sarcopenia was 46.9% and 50.9%, respectively. The prevalence of osteoporosis without sarcopenia, sarcopenia without osteoporosis, and osteosarcopenia was 18.3%, 22.3%, and 28.6%, respectively. The proportion of female sex (71.9%), median age, and NIHSS score were significantly higher, and mRS, BBS, MBI, FAC, and grip strength were significantly lower in patients with osteosarcopenia. Older age (≥65-years) (OR, 15.4), female sex (OR, 6.23), and lower BMI (<25 kg/m 2 ) (OR, 43.13) were independently associated with the likelihood of osteosarcopenia. CONCLUSION: Osteosarcopenia may occur in acute stroke survivors. Patients with osteosarcopenia have a significantly higher stroke severity and disability. A comprehensive diagnostic approach is imperative for osteosarcopenia, thereby facilitating implementation of optimal rehabilitative strategies.

CM1, a Chrysin Derivative, Protects from Endotoxin-Induced Lethal Shock by Regulating the Excessive Activation of Inflammatory Responses.

Sepsis, a leading cause of death worldwide, is a harmful inflammatory condition that is primarily caused by an endotoxin released by Gram-negative bacteria. Effective targeted therapeutic strategies for sepsis are lacking. In this study, using an in vitro and in vivo mouse model, we demonstrated that CM1, a derivative of the natural polyphenol chrysin, exerts an anti-inflammatory effect by inducing the expression of the ubiquitin-editing protein TNFAIP3 and the NAD-dependent deacetylase sirtuin 1 (SIRT1). Interestingly, CM1 attenuated the Toll-like receptor 4 (TLR4)-induced production of inflammatory cytokines by inhibiting the extracellular-signal-regulated kinase (ERK)/MAPK and nuclear factor kappa B (NF-κB) signalling pathways. In addition, CM1 induced the expression of TNFAIP3 and SIRT1 on TLR4-stimulated primary macrophages; however, the anti-inflammatory effect of CM1 was abolished by the siRNA-mediated silencing of TNFAPI3 or by the genetic or pharmacologic inhibition of SIRT1. Importantly, intravenous administration of CM1 resulted in decreased susceptibility to endotoxin-induced sepsis, thereby attenuating the production of pro-inflammatory cytokines and neutrophil infiltration into the lung compared to control mice. Collectively, these findings demonstrate that CM1 has therapeutic potential for diverse inflammatory diseases, including sepsis.

Hepatoprotective Effect of Lactiplantibacillus plantarum DSR330 in Mice with High Fat Diet-Induced Nonalcoholic Fatty Liver Disease.

Lactiplantibacillus plantarum DSR330 (DSR330) has been examined for its antimicrobials production and probiotics. In this study, the hepatoprotective effects of DSR330 were examined against non-alcoholic fatty liver disease (NAFLD) in a high-fat diet (HFD)-fed C57BL/6 mouse model. To induce the development of fatty liver, a HFD was administered for five weeks, and then silymarin (positive control) or DSR330 (108 or 109 CFU/day) was administered along with the HFD for seven weeks. DSR330 significantly decreased body weight and altered serum and hepatic lipid profiles, including a reduction in triglyceride, total cholesterol, and low-density lipoprotein cholesterol levels compared to those in the HFD group. DSR330 significantly alleviated HFD-related hepatic injury by inducing morphological changes and reducing the levels of biomarkers, including AST, ALT, and ALP. Additionally, DSR330 alleviated the expression of SREBP-1c, ACC1, FAS, ACO, PPARα, and CPT-1 in liver cells. Insulin and leptin levels were decreased by DSR330 compared to those observed in the HFD group. However, adiponectin levels were increased, similar to those observed in the ND group. These results demonstrate that L. plantarum DSR330 inhibited HFD-induced hepatic steatosis in mice with NAFLD by modulating various signaling pathways. Hence, the use of probiotics can lead to hepatoprotective effects.

Feasibility and Usability of a Robot-Assisted Complex Upper and Lower Limb Rehabilitation System in Patients with Stroke: A Pilot Study.

OBJECTIVE: To evaluate the feasibility and usability of cost-effective complex upper and lower limb robot-assisted gait training in patients with stroke using the GTR-A, a foot-plate based end-effector type robotic device. METHODS: Patients with subacute stroke (n=9) were included in this study. The enrolled patients received 30-minute robot-assisted gait training thrice a week for 2 weeks (6 sessions). The hand grip strength, functional ambulation categories, modified Barthel index, muscle strength test sum score, Berg Balance Scale, Timed Up and Go Test, and Short Physical Performance Battery were used as functional assessments. The heart rate was measured to evaluate cardiorespiratory fitness. A structured questionnaire was used to evaluate the usability of robot-assisted gait training. All the parameters were evaluated before and after the robot-assisted gait training program. RESULTS: Eight patients completed robot-assisted gait training, and all parameters of functional assessment significantly improved between baseline and posttraining, except for hand grip strength and muscle strength test score. The mean scores for each domain of the questionnaire were as follows: safety, 4.40±0.35; effects, 4.23±0.31; efficiency, 4.22±0.77; and satisfaction, 4.41±0.25. CONCLUSION: Thus, the GTR-A is a feasible and safe robotic device for patients with gait impairment after stroke, resulting in improvement of ambulatory function and performance of activities of daily living with endurance training. Further research including various diseases and larger sample groups is necessary to verify the utility of this device.

Post-COVID-19 vaccination arm pain diagnosed as complex regional pain syndrome: A case report.

As the vaccination efforts against the coronavirus disease-2019 (COVID-19) continue, more patients are likely to present with complications related to COVID-19 vaccination. We describe the first reported case of complex regional pain syndrome (CRPS), involving the upper extremities, that occurred after COVID-19 vaccination. The patient presented with acute-onset severe arm pain and swelling following vaccine administration. Based on the clinical, electrodiagnostic, and radionuclide three-phase bone scan findings, the patient was diagnosed with postvaccination CRPS. The COVID-19 vaccine possibly elicited an immune-mediated inflammatory response to the injected antigen in the patient, who was predisposed to CRPS due to inflammatory immunity. The COVID-19 vaccine elicited an immune-mediated inflammatory response to the injected antigen, resulting in CRPS following COVID-19 vaccination.

Botulinum Toxin Injection for Intractable Pain in Cancer Patients With Psoas Muscle Invasion.

Muscle invasion (MI) in patients with far-advanced cancer is often accompanied with pain. Conventional treatments used for pain relief may be associated with several side effects. We describe two cases of botulinum toxin injection (BTI) for relieving intractable pain in patients of far-advanced cancer having MI. The patients presented with persistent intractable pain that did not respond to conventional treatments, such as analgesic medications, epidural steroid injection, and radiotherapy. BTI relieved the intractable pain in these cases for at least 9-12 weeks without any reported side effects. We suggest that BTI can be an alternative method to relieve intractable pain associated with MI in patients with far-advanced cancer.

The significant influences of pH, temperature and fatty acids on meat myoglobin oxidation: a model study.

Colour is one of the important quality traits affecting the meat purchasing decision by consumers, and myoglobin is the principal heme protein responsible for the meat colour. This study aimed to investigate the effects of pH (5.3, 5.8, 6.4 and 7.4) and temperature (4 and 25 °C) on oxymyoglobin (OxyMb) oxidation in model reaction mixtures containing OxyMb, fatty acids (C18:2n-6 and C18:3n-3) and vitamin E. A decrease of the OxyMb concentration with increased acidity was observed for all the reaction mixtures with/without fatty acids and vitamin E. After 48 h of storage at 4 °C, the OxyMb concentration decreased by approximately 60-70%, 61-69%, 53.7-53.9% and 40.93-41.84% in the reaction mixtures containing [OxyMb + C18:2n-6 or C18:3n-3] at pH 5.3, 5.8, 6.4 and 7.4, respectively. While, after 48 h at 25 °C, the OxyMb concentration decreased by 95-98% in all the reaction mixtures containing [OxyMb + C18:2n-6 or C18:3n-3] under all the pH conditions. The presence of vitamin E significantly inhibited the OxyMb oxidation in the reaction mixtures containing fatty acids under acidic conditions, but a higher level of vitamin E may be required for meat(s) containing high n-3 fatty acids content that are stored at high temperature.

Heme Oxygenase-1 Induction by Cobalt Protoporphyrin Ameliorates Cholestatic Liver Disease in a Xenobiotic-Induced Murine Model.

Cholestatic liver diseases can progress to end-stage liver disease and reduce patients' quality of life. Although their underlying mechanisms are still incompletely elucidated, oxidative stress is considered to be a key contributor to these diseases. Heme oxygenase-1 (HO-1) is a cytoprotective enzyme that displays antioxidant action. It has been found that this enzyme plays a protective role against various inflammatory diseases. However, the role of HO-1 in cholestatic liver diseases has not yet been investigated. Here, we examined whether pharmacological induction of HO-1 by cobalt protoporphyrin (CoPP) ameliorates cholestatic liver injury. To this end, a murine model of 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC) diet feeding was used. Administration of CoPP ameliorated liver damage and cholestasis with HO-1 upregulation in DDC diet-fed mice. Induction of HO-1 by CoPP suppressed the DDC diet-induced oxidative stress and hepatocyte apoptosis. In addition, CoPP attenuated cytokine production and inflammatory cell infiltration. Furthermore, deposition of the extracellular matrix and expression of fibrosis-related genes after DDC feeding were also decreased by CoPP. HO-1 induction decreased the number of myofibroblasts and inhibited the transforming growth factor-ß pathway. Altogether, these data suggest that the pharmacological induction of HO-1 ameliorates cholestatic liver disease by suppressing oxidative stress, hepatocyte apoptosis, and inflammation.

Ultrasound Evaluation of the Rectus Femoris for Sarcopenia in Patients with Early Subacute Stroke.

We investigated the ultrasound characteristics of the rectus femoris for sarcopenia detected by dual-energy X-ray absorptiometry (DEXA) in the early subacute stroke phase. Physical features (age, sex, body mass index, and circumference of thigh) and performances (modified Barthel index in Korean, functional ambulation categories, and mini-mental state examination in Korean) were measured. The thickness of the fat layer, the thickness of the rectus femoris (TRF), echo intensity (EI), EI to TRF ratio, and strain ratio of elastography (SRE) were measured by ultrasound in 30 patients with first-ever stroke (male: n = 20). Appendicular lean body mass was measured by DEXA. Sarcopenia was defined according to the Foundation for the National Institutes of Health Sarcopenia Project. In total, 14 patients were in the sarcopenia group, and 16 were in the non-sarcopenia group. Clinical characteristics were similar between the two groups. In the sarcopenia group, TRF was significantly decreased in the paretic (p < 0.026) and non-paretic sides (p < 0.01), and the EI to TRF ratio on the paretic side was significantly increased (p < 0.049). Multivariate binary logistic regression showed that TRF on the non-paretic side was independently and significantly associated with sarcopenia (OR = 0.616, 95% CI: 0.381-0.996). The EI and SRE were not significant between the two groups. In the early subacute stroke phase, TRF on the non-paretic side is a key factor for quantitative evaluation of sarcopenia, and the EI to TRF ratio on the paretic side is also a meaningful qualitative evaluation of sarcopenia.

Back-fat thickness as a primary index reflecting the yield and overall acceptance of pork meat.

Predicting aspects of lean meat yield and eating quality of pork based on some particular carcass traits become increasingly important from an economic profitability point of view. The present study aimed to determine the relationship between the back-fat (BF) thickness with lean meat yield and meat quality traits of crossbred pigs. A total of 220 crossbred pigs [(Landrace × Yorkshire) ♀ × Duroc ♂] reared under identical conditions and harvested at 180 days old were slaughtered and screened for BF thickness. Four BF thickness groups: 12-15, 16-20, 21-25, and 26-30 mm were classified, and longissimus dorsi (LD) muscles from these groups were used to analyze meat quality characteristics. Results showed that increasing BF thickness decreased the lean meat yield and loin lean area. Increasing BF thickness up to 26-30 mm increased intramuscular fat content and pH of LD muscles. The LD muscles of the thicker BF (21-30 mm) groups received significantly higher flavor, juiciness, and overall acceptability scores than those of the thinner back-fat (12-20 mm) groups. Overall, when all the pre-harvest factors are kept the same, BF thickness could be considered as a primary index for predicting lean meat yield, and the minimal back-fat thickness of 21-30 mm is required to improve the overall acceptability of pork meat.

Relationship between body size traits and carcass traits with primal cuts yields in Hanwoo steers.

OBJECTIVE: This study was conducted to evaluate the correlation between body size traits, carcass traits, and primal cuts in Hanwoo steers. METHODS: Sixty-one beef carcasses were classified for conformation and primal cut weight. Additionally, carcass weight, fat thickness, carcass dimensions, and longissimus muscle area were determined to complement the grading. RESULTS: The average live weight and cold carcass weight were 759 and 469 kg, respectively. The mean carcass meat, fat, and bone proportions were 551, 298, and 151 g/kg, respectively. Primal cuts weights showed significant positive correlations (p<0.001) of 0.42 to 0.82 with live weight, carcass weight, and longissimus muscle area and a significant negative correlation with carcass fat (without shank, -0.38 to -0.10). Primal cut weights were positively correlated (p<0.01) with carcass length (0.41 to 0.77), forequarter length (0.33 to 0.57), 6th lumbar vertebrae-heel length (0.33 to 0.59), 7th cervical vertebrae carcass breadth (0.35 to 0.58), 5th to 6th thoracic vertebrae breadth (0.36 to 0.65), 7th to 8th thoracic vertebrae girth (0.38 to 0.63), and coxae girth (0.34 to 0.56) and non-significantly related to cervical vertebrae length and coxae thickness. CONCLUSION: There was a high correlation among live weight, carcass weight, longissimus muscle area, carcass length, 7th cervical vertebrae carcass breadth, 5th to 6th thoracic vertebrae breadth, and 7th to 8th thoracic vertebrae girth of the primal cuts yield. The correlation between fat and primal cut yields was highly significant and negative. Carcass length and 7th to 8th thoracic vertebrae girth, appear to be the most important traits affecting primal cut yields.

Protective effects of fermented rice extract on ulcerative colitis induced by dextran sodium sulfate in mice.

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD), characterized by the gut mucosal ulceration. Growing evidence indicates that dysregulation of immune response to the commensal microbiota involves the pathogenesis of IBD. Previous studies have demonstrated the favorable probiotic effects of fermented rice extracts through triple fermentation with Saccharomyces cerevisiae and Weissella cibaria (FRe). Thus, the therapeutic potential of FRe for UC was examined. Dextran sodium sulfate UC mice model was orally administered distilled water as a control, sulfasalazine, or FRe at 300, 200, and 100 mg/kg, once a day for a week. The UC control exhibited body weight loss, bloody stools, and colonic shortening. However, the FRe, especially at 300 mg/kg, led to a reduction in weight loss, disease activity index scores, and colon weight, and an increase in colorectal length. The histopathological analyses revealed mild changes involved in the colonic crypt and mucosal damages in the FRe groups, along with inhibited inflammation. Indeed, the FRe reduced neutrophil infiltration and production of proinflammatory cytokines (i.e., tumor necrosis factor-α, interleukin-6/-8). This was accompanied by the down-regulation of nuclear factor-kappa B. The gene expression responsible for the intestinal barrier integrity (i.e., Zonna occludens-1/-2, Claudin-1, Occludin, Mucin-1/-2) was up-regulated in the FRe groups. In addition, the FRe reduced lipid peroxidation and enhanced antioxidant activity. Interestingly, the microbiota dysbiosis was attenuated in the FRe groups, and the number of beneficial bacteria, Lactobacilli and Bifidobacteria, was increased. It suggests that the FRe potently ameliorate UC as a functional food.

KSNR Clinical Consensus Statements: Rehabilitation of Patients with Parkinson's Disease.

Clinical consensus statements (CCSs) aim to improve care for patients with Parkinson's disease (PD) and reduce the variability of rehabilitation methods in clinical practice. A literature search was conducted to find available evidence on the rehabilitation of patients with PD and to determine the scope of CCSs. The selection of PD rehabilitation domains and key questions was done using the modified Delphi method in 43 expert panels. These panels achieved a consensus on 11 key questions regarding rehabilitation assessment and goal setting, gait and balance, activities of daily living, and swallowing and communication disorders. After the completion of an agreement procedure, 11 key consensus statements were developed by the consensus panel. These statements addressed the needs of rehabilitation as a continuum in patients with PD. They included the appropriate rehabilitation initiation time, assessment items, rehabilitation contents, and complication management. This agreement can be used by physiatrists, rehabilitation therapists, and other practitioners who take care of patients with PD. The consensus panel also highlighted areas where a consensus could not be reached. The development of more focused CCS or clinical practice guidelines that target specific rehabilitation approaches is considered the next needed step.

Quality characteristics, fatty acid profiles, flavor compounds and eating quality of cull sow meat in comparison with commercial pork.

OBJECTIVE: Although the slaughter of cull sows (CS) for human consumption and meat products processing appears quite common throughout the world, relatively limited scientific information regarding the meat quality parameters of this pork type is available. The present study aimed at providing the technological quality characteristics and eating quality of CS meat, and comparing with those of commercial pork. METHODS: Longissimus thoracis et lumborum muscle samples of CS and finisher pigs (FP) at 24 h postmortem were collected and used for investigation of the meat quality traits (pH, color, shear force, cooking loss, water holding capacity), fatty acids, flavor compounds and sensory characteristics. RESULTS: The CS meat had significantly higher moisture content (p = 0.0312) and water holding capacity (p = 0.0213) together with lower cooking loss (p = 0.0366) compared to the FP meat. The CS meat also exhibited higher (p = 0.0409) contents of unsaturated fatty acids, especially polyunsaturated fatty acids (PUFA, p = 0.0213) and more desirable PUFA/total saturated fatty acids ratio (p = 0.0438) compared to the FP meat. A total of 56 flavor compounds were identified, amongst the amount of 16 compounds differed significantly between the two pork groups. Most of the PUFA-derived flavor compounds (e.g., hexanal, benzaldehyde, and hydrocarbons) showed higher amounts in the CS meat. While, 3-(methylthio)-propanal and 4-methylthiazole associated with pleasant aromas (meaty and roast odor notes) were only found in the FP meat. Furthermore, no differences were reported by panelists for flavor, juiciness, tenderness, and acceptability scores between the two pork groups studied. CONCLUSION: The sow meat exhibited better technological quality and its eating quality could be comparable to the commercial pork. This study provides meat processors and traders with valuably scientific information which may help to improve the utilization and consumption level of sow meat.

Quality characteristics and flavor compounds of pork meat as a function of carcass quality grade

Objective: The present work aimed at evaluating the effects of carcass quality grade on the quality characteristics of pork meat according to Korean carcass quality grade system. Method: Pork carcasses with varying in quality grades (QG): 1+ (QG1+, n=10), 1 (QG1, n=10) and 2 (QG2, n=10), were used to evaluate the relationship between carcass quality grade and meat quality. The meat quality traits, fatty acid profiles, flavor compounds and sensory qualities were measured on the longissimus dorsi muscle samples of these carcasses. Results: Pork meat of higher quality grade (GQ1+) presented significantly higher fat content (5.43%), C18:2n-6 level (19.03%) and total unsaturated fatty acids (UFA) content (62.72%). Also, the QG1+ meat was significantly higher in levels of classes of flavor compounds such as aldehydes, alcohols and hydrocarbons in comparison to those of the meat samples from the lower GQ groups. The sensory evaluation results (flavor, juiciness, tenderness and acceptability scores) of QG1+ meat was significantly higher than the QG1 and QG2 meats. The pork with lower QG (i.e., QG2) was found positively correlated to redness (r=0.987), C18:1n-9 level (r=1.000) but negatively correlated to the fat content (r=-0.949), and flavor (r=-0.870), juiciness (r=-0.861), tenderness (r=-0.862) and acceptability (r=-0.815) scores. Conclusion: The pork with higher quality grade had higher fat content, total unsaturated fatty acids and better eating quality, thus producing pork with higher quality grades should be considered in order to satisfy the consumer's expectation.

Live weights at slaughter significantly affect the meat quality and flavor components of pork meat.

One-hundred-twenty crossbred pigs finished at 175-185 days of age were used to investigate the effects of live weights at slaughter on the meat quality, volatile flavor compounds, and sensory attributes of pork meat. Based on the live weights at slaughter, three weight groups (n = 36 per group) were classified as follows: light weight (LW: 100 kg), medium weight (MW: 110 kg), and heavy weight (HW: 120 kg). After slaughter, longissimus dorsi muscle samples were taken and used for the analyses of aforementioned parameters. The HW group had higher fat content and water holding capacity compared to the LW or MW group (p < 0.05). The HW group also showed higher levels for majority of unsaturated fatty acids and total polyunsaturated fatty acids than the LW group (p < 0.05). The slaughter weight significantly affected the amounts of 11 among the 47 flavor compounds identified. Significantly higher amounts of fatty acids oxidation-derived flavor compounds (aldehydes) were found in the HW group than in the other groups. Noticeably, increasing slaughter weight was associated with higher sensorial scores for flavor, juiciness, and acceptance scores (p < 0.05). Based on the obtained results, 120 kg body weight is recommended as the market weight for this commercial breed without compromising the meat quality.

The fates of microbial populations on pig carcasses during slaughtering process, on retail cuts after slaughter, and intervention efficiency of lactic acid spraying.

This study was conducted to detect and identify microbial populations on pig carcasses at different slaughtering stages and on retail pork cuts at 24 h after slaughter as well as to evaluate the intervention efficiency of sprays containing different concentrations (2% and 4%) of lactic acid. The sprays were applied to the carcass surfaces at the end of the slaughter line. Microbial samples were collected from carcass surfaces after bleeding and after eviscerating, and from retail cuts at 24 h after chilling/spraying. The detected microorganisms were identified through using a Microflex identification instrument and 16S rRNA gene sequencing. The diversity of the bacterial genera; Staphylococcus, Salmonella, Shigella, Enterococci, Escherichia, Acinetobacter and Corynebacterium spp. showed counts ranging from 2.70 to 4.91 log10 cfu/100 cm2 on the carcasses during slaughter. Most of these genera were also detected on the carcasses after 24 h of chilling. Three species (Staphylococcus hyicus, Acinetobacter albensis, and Corynebacterium xerosis) were also found on the retail cuts of non-sprayed carcasses but not on those of the sprayed groups. Significantly greater reductions in all bacterial species were observed on the carcasses and retail cuts that were sprayed with lactic acid, particularly at the 4% level. Thus, spraying with 4% lactic acid may be an effective intervention for controlling bacterial contamination on pig carcasses to improve the microbiological safety of pork meat.

The effects of pre-and post-slaughter spray application with organic acids on microbial population reductions on beef carcasses.

As an attempt to control bacterial cross-contamination of beef carcasses, in the present investigation acetic acid and lactic acid (3% v/v) were used for bacterial decontamination. For the decontamination, cows were sprayed with each above acid at two different stages; (i) on live animal's hides, (ii) on carcass surfaces immediately after slaughter. Microbiological samples were taken on different hide areas of animals before spraying and on carcass surfaces at 24h after spraying. Meat quality traits were also analyzed on the sprayed animals. The detected microorganisms were identified using 16SrRNA gene sequencing. A diversity of bacterial species such as Staphylococcus, Shigella, Bacillus, Escherichia and Salmonella etc. were found on both external hide and carcass surface samples. The decontamination sprays significantly reduced the numbers (2-5 log unit) of all aforementioned bacterial species on carcass surfaces as compared with non-sprayed control. Thus, the two times-spray applications with the acid could be an effective tool for reducing bacterial cross-contaminations of beef carcass without adverse effect on meat quality.

Reduced Diaphragm Excursion During Reflexive Citric Acid Cough Test in Subjects With Subacute Stroke.

BACKGROUND: Diaphragm excursion is limited during respiratory maneuvers after a stroke. How the diaphragm is limited during reflexive coughs and affects the effectiveness of cough in stroke patients is unclear. This study aimed to measure reflexive cough strength by cough peak flow (CPF) induced by citric acid nebulization (2.8 mol/L), record diaphragm excursions during reflexive coughs in stroke subjects at risk of silent aspiration, and compare these values with those of stroke subjects without risk of aspiration or dysphagia. METHODS: Twenty-one subjects with subacute stroke (mean stroke onset, 13.6 d) at risk of silent aspiration (penetration-aspiration scale, 8) and 21 stroke subjects without dysphagia or aspiration (controls) were included. Diaphragmatic excursions were assessed using real-time sonography in all subjects; the main outcome measure was reflexive CPF induced by citric acid nebulization. RESULTS: The median (interquartile range) values of citric acid-induced CPF values were significantly more reduced in the 21 subjects with silent aspiration (45 [0-83] L/min) than in the control subjects (97 [66-162] L/min) (P = .004). Diaphragmatic excursions during the reflexive coughs were also significantly reduced (P < .001), although both groups had a similar range in the initial National Institutes of Health Stroke Scale scores and level of disability, as measured by the modified Barthel index. Citric acid-induced CPF was significantly correlated with the number of generated coughs (rs = 0.69), voluntary cough CPF (rs = 0.85), and degree of diaphragm excursion on both sides (rs = 0.50 [hemiplegic] and rs = 0.55 [nonhemiplegic]) but not correlated with the degree of hemiparesis, National Institutes of Health Stroke Scale score, or modified Barthel index scores. The 6-month follow up revealed that 7 subjects in group A experienced aspiration pneumonia. CONCLUSIONS: Stroke subjects at risk of silent aspiration showed reduced CPF and more limited diaphragm excursion during the citric acid-induced reflexive cough test. (ClinicalTrials.gov registration NCT02080988.).

Lipoma Compressing the Sciatic Nerve in a Patient With Suspicious Central Post-stroke Pain.

Lipomas are mostly located in the subcutaneous tissues and rarely cause symptoms. Occasionally, peripheral nerve compression by lipomas is reported. We describe a case of a 59-year-old man with a left-middle cerebral artery infarction who was newly diagnosed as right basal ganglia and thalamic intracranial hemorrhage. He had neuropathic pain in the left arm and leg that was suspected to be central post-stroke pain. The administration of pain medication brought only temporary symptom relief. Nerve conduction and electromyography studies revealed left L5 radiculopathy and he showed a positive 'sign of the buttock' in the left hip. Left-hip magnetic resonance imaging revealed an intermuscular lipoma compressing the sciatic nerve. After surgery, the range of motion in the left hip joint was significantly increased, and the patient's pain was relieved.