Metoclopramide-induced Acute Dystonia Misdiagnosed as an Epileptic Seizure in a Lupus Patient

Acute dystonic reactions are the most prevalent extrapyramidal adverse effects associated with metoclopramide. It could be mistaken for a variety of other conditions, such as seizures, tetanus, and encephalitis, to name a few possibilities. We present a case of a 26-year-old female misdiagnosed as having an epileptic seizure who was rushed to the emergency unit with an involuntary bilateral upward deviation of the eyes, spasm, stiffness, lateral deviation of the neck, and protrusion of the tongue. Symptoms occurred 36 hours after the commencement of metoclopramide, used to treat nausea and vomiting in the referring hospital. All the laboratory work was normal. The drug was discontinued and 5 mg of intravenous biperiden was administered. The symptoms subsided in about 10 minutes with no recurrence. Metoclopramide-induced acute dystonia not only creates an anxious environment for patients but may also be life-threatening. Due to the high probability of misdiagnosis, detailed drug history and a high index of suspicion are critical in making the correct diagnosis.

Wheel Deflection Control of Agricultural Vehicles with Four-Wheel Independent Omnidirectional Steering

Due to the Fharsh working environment of wheeled agricultural vehicles in the field, it is difficult to ensure that all wheels make contact with the ground at the same time, which is easy to unequally distribute the yaw moments of each independent wheel. The commonly used vehicle lateral control methods are mostly controlled by coordinating the individual torque between different wheels. Obviously, this control method is not suitable for agricultural four-wheeled vehicles. The goal of this study was to provide a wheel steering angle control method that uses electric push rods as actuators that can cope with this problem. The design of a four-wheel steering controller generally adopts the linear PID control method, but the research object of this paper is difficult to establish an accurate and linear mathematical model due to the complex working environment. Therefore, fuzzy adjustment is added on the basis of PID control, which can meet the requirements of model difficulty and control accuracy at the same time. In order to verify the feasibility and rationality of the designed wheel steering mechanism, the model dynamics simulation based on ADAMS software and the response analysis of the electric linear actuator thrust were completed. Based on the kinematics model of the controlled object, the rotation angle of the actuator motor is used as the control target, the lateral deviation e and deviation variation ec are taken as input variables and the parameters KP, KI and KD are taken as output variables, thereby establishing a fuzzy PID controller. Then, this controller is constructed in the Matlab/ Simulink simulation environment to analyze the lateral deviation and response stability during the process of vehicle path tracking. From the verification results of the linear path walking test under the fuzzy PID control method, the maximum lateral deviation of vehicle chassis is 2.7 cm when the driving speed is set as 1 m/s, and the deviation adjustment stable time of the system is 0.15 s. It can be seen that the proposed steering control strategy has good response performance and effectively increases the steering stability.

Trajectory Tracking Control of Intelligent Electric Vehicles Based on the Adaptive Spiral Sliding Mode

Aiming at the multi-objective control problem of the tracking effect and vehicle stability in the process of intelligent vehicle trajectory tracking, a coordinated control strategy of the trajectory tracking and stability of intelligent electric vehicles is proposed based on the hierarchical control theory. The vehicle dynamics model and trajectory tracking model are established. In order to tackle the chattering problem in the traditional sliding mode controller, an Adaptive Spiral Sliding Mode controller is designed by taking the derivative of the controller as the upper controller, which is intended to reduce the heading deviation and lateral deviation in the trajectory tracking process whilst ensuring the stability of the vehicle itself. In the lower controller, a four-wheel tire force optimal distribution method is designed. According to the requirements of the upper controller, combined with the yaw stability of the vehicle, the directional control distribution of the four-wheel tire force is realized. A joint simulation model was built based on CarSim and Simulink, and simulation experiments were performed. The results show that the proposed control strategy can effectively control the heading deviation and lateral deviation in the vehicle trajectory tracking while ensuring the lateral stability of the vehicle.

New method of surgical correction of lesser toes deformity

Background. Patients’ dissatisfaction with the results of surgical correction of lesser toes deformities, the shortcomings of methods aimed at eliminating the lateral deviation of the toe in the metatarsophalangeal joint necessitated the development of a new surgical method.The aim. To evaluate short-term results of the new surgical method for the treatment of patients with lesser toes deformity, accompanied with deviation of the toe.Materials and methods. A method of surgical treatment of deviated deformity of the small toes is proposed. The method includes precise marking of the metatarsal osteotomy line according to the previously calculated parameters of optimal shortening and displacement of the metatarsal bone, performing oblique diaphyseal osteotomy of the metatarsal bone, displacing its distal part along the osteotomy plane. According to the proposed method, nine patients were operated on who had a syndrome of nonrigid hammer-like deformity of the second toe with lateral deviation of the toe in the metatarsophalangeal joint. In all patients, the deformity of the second toe was associated with hallux valgus.Results. As a result of the application of the proposed method, it was possible to achieve deformity correction, eliminate the lateral deviation of the second toe in the metatarsophalangeal joint, restore congruence in the joint, achieve consolidation of bone fragments without loss of correction, and improve the appearance and function of the foot. Three months after the operation, a statistically significant improvement was determined, according to the AOFAS LMIS scale, having reached 94.5 ± 4.64 points, which made it possible to speak about the achievement of a good functional result of treatment. Patients noted the opportunity to wear standard footwear, to carry out their labor activity, to engage in physical culture, were satisfied with the result.Conclusion. The use of the proposed new surgical method for deflected deformity of the lesser toes makes it possible to correct the deformity, eliminate lateral deviation of the toe, relieve pain syndrome, achieve a good cosmetic and functional result, restoring the patients’ ability to wear standard shoes.

Incidence and Effects of Posterior Cranial Vault Deformation in Adult Females With Skeletal Class III Malocclusion

BackgroundThe precise characteristics of posterior cranial vault deformation are difficult to identify using a two-dimensional analysis. Recently, three-dimensional analysis using computed tomography (CT) data and software analysis has enabled us to examine the craniofacial structure precisely. To identify the deformation in the cranial vaults by a three-dimensional analysis and examine its effects on other structures, CT data of skeletal mandibular protrusion cases without lateral deviation of pogonion (Pog) were examined.MethodsThirty-two adult female patients with skeletal mandibular protrusion who visited Meikai University Hospital were included in this study. CT images were taken before orthognathic surgeries, and the craniofacial structures were examined threedimensionally.The lateral deviation of Pog was less than 3 mm in all cases.Genetic/congenital anomaly cases, endocrine disorders, or cases with severe trauma or temporomandibular disorder were excluded.ResultsMany cases had three-dimensional deformations in the cranial vaults. The cranial vaults with unilateral posterior deformation had posteriorly positioned mandibular fossae on the same sides. Mandibular body lengths were related to the position of the mandibular fossae, and the posterior mandibular fossae tended to have longer mandibular body lengths on the same sides. Masseter muscles with larger volumes were related to longer mandibular body lengths.ConclusionsMandibular body lengths can compensate for the bilateral difference in the position of the mandibular fossae to avoid lateral deviation of the Pog. The masseter muscles are likely one of the factors related to the bilateral differences in the mandibular body length.

Mueller Weiss syndrome, a less elucidated and unusual cause of midfoot pain: A case report

Mueller Weiss Syndrome is a rare, under-diagnosed cause of chronic mid foot pain despite having well-described imaging features. It is historically described as spontaneous adult-onset osteonecrosis of the navicular bone. The disease commonly affects bilateral navicular bones in women in the fifth decade of life. Nearly a century after its first description as a disease entity, the exact etiopathogenesis is still not well understood. From a radiographic point of view weight-bearing radiographs of the foot remains the mainstay in diagnosis. Characteristic imaging findings include the lateral collapse of navicular, dorsomedial subluxation of the remnant navicular, and lateral deviation of the talus (hind-foot varus). Progressive disease leads to pes planus and secondary osteoarthritis of the talonavicular joint with or without the involvement of other midfoot joints. Severe disease may show “listhesis navicularis” and talo-cuneiform neo-articulation. Computed tomography and magnetic resonance imaging can be used as adjuncts, especially to detect changes in the initial stage of the disease and early osteoarthritic features.

Optimal torque distribution of distributed driving AGV under the condition of centroid change

The torque distribution is researched under the condition of the centroid position of distributed drive automatic guided vehicle (AGV) with load platform and is uncertain due to the unknown movable load. The whole vehicle model under centroid variation, the efficiency model of the hub motor and the torque distribution control strategy based on a PID neural network are established. A hierarchical controller is designed to accurately ensure the economy and stability of the vehicle. Simulations of the proposed control strategy are conducted, the results show that the total power and lateral deviation distance of the driving wheels are reduced by 17.63% and 61.54% under low load conditions and 15.54% and 61.39% under high load conditions, respectively, compared with those of the driving wheels under the average torque distribution, and the goal of close slip rates of the driving wheels is achieved. A system prototype is developed and tested, and the experimental results agree with the simulation within error permissibility. The margin of error is less than 5.8%, the results demonstrate that the proposed control strategy is effective. This research can provide a theoretical and experimental basis for the torque optimization distribution of distributed drive AGVs under centroid variation conditions.

Metaphyseal Osteopathy in a Caucasian Shepherd Crossbred Dog

A six-month old, 24 kg, intact male Caucasian Shepherd crossbred dog was presented at the Sokoine University of Agriculture Teaching Animal Hospital with a history of difficulty standing and walking, and bilateral swelling of the distal antebrachial and crural metaphyeal region. The owner also reported prior calcium supplementation in form of dietary tablets. Upon physical examination; the animal was lethargic with fever, bilateral ocular discharge, tachypnea and reduced appetite. Hard painful bilateral swelling of the distal antebrachial and crural metaphyseal region was observed. Differential cell count showed neutrophilia and monocytosis. Sclerosis and paracortical cuffing of the distal antebrachial and crural metaphyseal region were seen on radiographic examination. Similar changes were also visualised in the proximal crural metaphyseal region. Further, cranial bowing of the radius with lateral deviation of the foot (carpal valgus) were also observed. Metaphyseal osteopathy was diagnosed based on the history, clinical and radiographic findings. The exact cause of metaphyseal osteopathy is unknown, however there have been reports linking it to breed predisposition and mineral over supplementation. Administration of corticosteroids and supportive care are recommended in dogs with metaphyseal osteopathy. However, a bony change that is paracortical cuffing requires several months for resorption.

A study of the compression stability of a coupler under initial asymmetric conditions

In practice, due to the influence of assembly deviation, clearance, vibration and other objective factors, the coupler will inevitably work under asymmetrical conditions in the buffing state. However, the existing theoretical studies on the compression stability of couplers did not pay enough attention to this condition, and most of the studies are based on the premise of ideal symmetry conditions. In this paper, the initial lateral deviation between the ends of a coupling coupler is taken as a typical asymmetrical condition, and the influence of the initial asymmetrical condition on the compression stability of the coupler is analysed by theoretical analysis and dynamic simulation. The results show that with the increase of the initial lateral deviation, the rotation angle of the coupler will also increase when it reaches the self-stabilizing equilibrium point. Therefore, the initial asymmetry will reduce the stability margin of the coupler, and then weaken the self-stabilizing ability and compression stability of the coupler. Improving the symmetry of the coupler is also one of the effective methods to guarantee the compression stability of the coupler and the running safety of the locomotive. When the static friction coefficient of the coupler tail can reach 0.3, the initial lateral deviation of the coupler should be limited to less than 7 mm, and the smaller the static friction coefficient, the higher the requirements for the initial lateral deviation.

Assessment of Body Posture of Children With Chest Pain

Objective: An increase in the appearance of chest pain among children is observed globally. The authors present various reasons for their appearance. As can be seen from numerous observations, the majority of cases are not related to the pathology of the circulatory system. Increasingly, studies on the causes of chest pain in children show their association with musculoskeletal disorders.Aim: of the work was assessment of body posture in children with chest pain using the Diers Formetric 4D system.Methods: The study involved a group of 184 female and male children, aged 7–12 years. The study group consisted of 64 patients with chest pain. The children from this group were diagnosed with functional chest pain by a cardiologist. The control group consisted of 120 patients without chest pain. The study included the assessment of body posture using the DIERS Formetric system.Results: The analysis of the results obtained during the study showed that among the children with chest pain, there are statistically significant irregularities in the parameters determining body posture compared to the control group.Comparing the study group with the control group, there is a statistically significant difference in the lateral deviation of VPDM (rms) (mm) (p = 0.001). Both children from the test group aged 9–10 and 11–12 obtained higher results than their peers from the control group. In the group of the youngest children in terms of the lateral deviation of VPDM (rms) (mm), increasing the number of children under study would contribute to significant differences in this variable.In the study group, among children aged 9–10 years, there were also statistically significant abnormalities regarding trunk imbalance and pelvic skewness compared to the children of the same age in the control group.Conclusions: Irregularities in the parameters determining body posture may cause chest pain in children.