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Documenting upper extremity and thoracic paraspinal involvements are key to diagnose ALS, in combination with profuse fasciculation potentials in EMG. NCS plays a key role in diagnosing entrapment and demyelinating neuropathies. Electrodiagnostic tests are also useful for confirming functional neurological disorders.The cauda equina itself is an unsuitable site for radiological diagnostic imaging because the cauda equina is anatomically a small structure, and magnetic resonance imaging is of limited value to accurately detect lesions in this area. Therefore, in addition to the imaging findings of the cauda equina itself, it is necessary to consider findings in the spinal cord and other areas, as well as clinically correlate these data. In this article, we discuss diseases that cause cauda equina disorders and describe the characteristic imaging findings in such cases.Spinal dural arteriovenous fistulas (SDAVF) are rare and most commonly affect men aged >50 years. Patients with SDAVF develop an abnormal vascular dural shunt between the dural branch of a segmental artery and a subdural radicular vein that drains the perimedullary venous system, leading to venous hypertension and secondary congestive myelopathy. Most SDAVFs are located in the thoracolumbar region, and usually patients present with slowly progressive paraparesis and urinary disturbances. SDAVF is diagnostically challenging; this condition may be misdiagnosed as lumbar spinal stenosis or myelitis. Clinicians should be aware of fluctuating symptoms in the early stages to avoid misdiagnosis of SDAVF. Claudication is associated with various activities including walking, bathing, drinking, and singing. On T2-weighted magnetic resonance imaging of the spinal cord, SDAVFs show a high signal intensity with a low signal intensity peripherally and dilated spinal cord veins in the subarachnoid space.Currently, intermittent claudication is classified into the vascular (mainly secondary to peripheral arterial disease) and neurogenic (mainly secondary to lumbar canal stenosis) types. Intermittent claudication due to spinovascular insufficiency (myelopathy) has rarely been reported since it was first described by J. Dejerine in 1894. However, currently, intrinsic (vascular diseases of the spinal cord) and extrinsic (disorders causing cervicothoracic cord compression) factors are implicated as contributors to this condition. No internationally accepted, transdisciplinary and standardized definition, technical terminology, and classification of intermittent claudication are currently available. I propose a new classification in this article. I have focused on intermittent claudication secondary to spine and/or spinal cord diseases, with regard to its epidemiology, symptomatology, and differential diagnosis.The most caudal part of the spinal cord shows special anatomical characteristics and it contains epiconus (L4-S2 segments), the conus medullaris (S3-S5 segments), and surrounding nerve roots. Lesions of the thoracolumbar junction cause epiconus or conus syndrome. Epiconus syndrome is characterized by segmental muscular weakness and atrophy of one or both lower extremities, often accompanied by foot drop. It may manifest as motor neuron disease in the absence of sensory loss. Ossification of the ligamentum flavum is an important cause of epiconus syndrome. Conus syndrome is characterized by urinary and rectal disturbances, usually accompanied by some motor and sensory symptoms involving the lower extremities. Both syndromes are often misdiagnosed as lumbar radiculopathy or cauda equina lesions. A thorough understanding of the anatomical features and pathophysiology is important for early and accurate diagnosis of epiconus or conus syndrome.

This study aimed to provide information about the clinical and physiochemical effects of pill splitting training in elderly cardiac patients in Hong Kong.

A parallel study design was adopted. Patients taking lisinopril, amlodipine, simvastatin, metformin, or perindopril who needed to split pills were recruited from the Prince of Wales Hospital. Patients were divided into two groups at their first visit. Patients in group A split drugs using their own technique, whereas patients in group B used pill cutters after relevant training until their next follow-up visit. The primary outcome was the change in drug content between before and after the pill splitting training. Assays were performed to determine the drug content. Secondary outcomes were the changes in clinical outcomes, patients' attitudes and acceptance towards pill splitting, and patients' knowledge about pill splitting.

A total of 193 patients were recruited, and 101 returned for the follow-up visit. The percentage of split tablets falling within the assay limits increased from 39.13% to 47.82% (P=0.523) in group A and from 48.94% to 51.06% (P=1.000) in group B. see more The changes did not reach statistical significance. As for clinical outcomes, the mean triglyceride level decreased from 1.62±1.05 to 1.36±0.80 (P=0.049), whereas the mean heart rate increased significantly from 73.97±11.01 to 77.92±12.72 (P=0.026). Changes in other parameters were not significant.

This study highlights the high variability of drug content after pill splitting. Pills with dosages that do not require splitting would be preferable, considering patients' preference. Patients should be educated to use pill cutters properly if pill splitting is unavoidable.

This study highlights the high variability of drug content after pill splitting. Pills with dosages that do not require splitting would be preferable, considering patients' preference. Patients should be educated to use pill cutters properly if pill splitting is unavoidable.

Breathlessness is a major cause of suffering and disability globally. The symptom relates to multiple factors including asthma and lung function, which are influenced by hereditary factors. No study has evaluated potential inheritance of breathlessness itself across generations.

We analysed the association between breathlessness in parents and their offspring in the Respiratory Health in Northern Europe, Spain and Australia generation study. Data on parents and offspring aged ≥18 years across 10 study centres in seven countries included demographics, self-reported breathlessness, asthma, depression, smoking, physical activity level, measured Body Mass Index and spirometry. Data were analysed using multivariable logistic regression accounting for clustering within centres and between siblings.

A total of 1720 parents (mean age at assessment 36 years, 55% mothers) and 2476 offspring (mean 30 years, 55% daughters) were included. Breathlessness was reported by 809 (32.7%) parents and 363 (14.7%) offspring. Factors independently associated with breathlessness in parents and offspring included obesity, current smoking, asthma, depression, lower lung function and female sex.