The authors investigated the lesions and symptoms of five patients who presented with monoparesis of an upper limb due to cortical infarction. The location of the cortical motor hand area seems to be in the middle to lower portion of the anterior wall of the central sulcus. Severity of finger paralysis associated with impairment of this area varied in different fingers and occurred in two patterns: one variant predominantly affected the radial side, and the other predominantly affected the ulnar side.

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Context: In clinical and sports settings, static stretching (SS) is usually performed to increase range of motion (ROM) and decrease passive muscle stiffness. Recently, the shear elastic modulus was measured by ultrasonic shear wave elastography as an index of muscle stiffness. Previous studies reported that the shear elastic modulus measured by ultrasound shear wave elastography decreased after SS, and the effects of SS on shear elastic modulus were likely affected by rest duration between sets of SS. Objective: To investigate the acute effects of SS with different rest durations on ROM and shear elastic modulus of gastrocnemius and to clarify whether the rest duration between sets of SS decreases the shear elastic modulus. Design: A randomized, repeated-measures experimental design. Setting: University laboratory. Participants: Sixteen healthy males volunteered to participate in the study (age 21.3 [0.8] y; height 171.8 [5.1] cm; weight 63.1 [4.5] kg). Main Outcome Measures: Each participant underwent 3 different rest interval durations during SS (ie, long rest duration: 90 s; normal rest duration: 30 s; and short rest duration: 10 s). This SS technique was repeated 10 times, thus lasting a total of 300 seconds with different rest durations in each protocol. The dorsiflexion ROM and shear elastic modulus were measured before and after SS. Results: Our results revealed that dorsiflexion ROM and shear elastic modulus were changed after 300-second SS; however, no effects of the rest duration between sets of SS were observed. Conclusions: In terms of decreasing the shear elastic modulus, clinicians and coaches should not focus on the rest duration when SS intervention is performed.

When recording with a palm electrode, a premotor potential (PMP) precedes the compound muscle action potential that is evoked from the second lumbrical muscle following median nerve stimulation. The origin of this PMP has been uncertain. We demonstrate that median sensory nerve action potentials (SNAPs) can be recorded orthodromically with the palm electrode and conclude that the origin of the PMP is a median SNAP arising from antidromically activated digital sensory branches.

BackgroundChemoradiation therapy (CRT) has been increasingly reported as a possible alternative to total cystectomy (TC) for localized bladder cancer (BC). Pembrolizumab is the standard of care for platinum-refractory metastatic urothelial carcinoma, although it is unknown whether the efficacy of pembrolizumab in patients previously treated with curative CRT varies from the results of benchmark trials.MethodsWe retrospectively assessed whether the survival benefit of pembrolizumab differs between patients previously treated with TC or CRT as radical treatment. A total of 212 patient records were collected for a logistic regression propensity score model. An independent dataset with next-generation sequencing (n=289) and PD-L1 Combined Positive Score (CPS: n=266) was analyzed to assess whether CRT-recurrent tumor harbors distinct CD274/PD-L1 profiles.ResultsPropensity score matching was performed using putative clinical factors, from which 30 patients in each arm were identified as pair-matched groups. There was no significant difference in overall survival from the initiation of pembrolizumab (p=0.80) and objective response rate (p=0.59) between CRT and TC treatment groups. In the independent 289 BC cohort, 22 samples (7.6%) were collected as CRT-recurrent tumors. There was no significant difference in CD274 mRNA expression level between CRT-naïve and CRT-recurrent tumors. The compositions of CD274 isoforms were comparable among all isoforms detected from RNAseq between CRT-naïve (n=267) and CRT-recurrent (n=22) tumors. No actionable exonic mutation in CD274 was detected in CRT-recurrent tumors. PD-L1 CPS was positively correlated with CD274 mRNA expression level, and PD-L1 CPS was comparable between CRT-naïve and CRT-recurrent tumors.ConclusionsThe efficacy of pembrolizumab for patients previously treated with CRT was similar to those treated with TC. The enhanced tumor regression by combining programmed cell death protein 1/PD-L1 inhibitor and CRT might be expected only in the concurrent administration.