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The distribution of ALS cases across the neuropathological stages is outlined in Table 2: one case had Stage 1 (motor cortex pathology only), 8 had Stage 2 (Stage 1 + brainstem pathology), 16 had Stage 3 (Stage 2 + sensory or striatal pathology), and 9 had Stage 4 (Stage 3 + hippocampal pathology in 6, and hippocampal pathology in 3).
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Moreover, the human motor cortex, although critical to ALS pathology and physiologically altered in most forms of the disease, has not been screened systematically for therapeutic targets.
As limited pTDP-43 oligodendrocyte pathology in deep corticospinal and other white matter tracts from the motor cortex was observed, the propagation of pathology between neurons may not involve oligodendrocytes and the interpretation of the changes observed on neuroimaging should be modified accordingly.
In their series of 6 cases (4 with FALS) Hewitt et al. described minimal FUS pathology in the motor cortex [ 9].
Assessment of affected neurons in the motor cortex revealed limited oligodendrocytic pTDP-43 pathology in satellite oligodendrocytes (C, arrowheads), even when neurons contained pTDP-43 immunorectivity (A-C).
Pathology in the motor cortex of patients is remarkable and CSMN loss is evident by P65 with pronounced degeneration in the UCHL1−/− mice.
Despite this, in Mackenzie et al.'s series the paucity of UMN features did not appear to correlate with the relatively severe FUS pathology in the motor cortex.
The severity of Betz cell loss was variable across all stages and did not influence the severity of pTDP-43 pathology in the motor cortex.
Three adjacent sections of these regions were cut in five cases with the most severe pathology in the motor cortex to ensure immunopositive oligodendrocytes were not missed due to the use of 10 μm sections.
The severity of pathology in the motor cortex (Fig. 2a) and its subcortical white matter (Fig. 2b) was graded semi-quantitatively, and the distribution of severity grades across the four stages plotted.
Examples of the semi-quantitative scoring for pTDP-43 immunoperoxidase pathology in the motor cortex (A-D) and underlying white matter (E-G): sparse in cortex (A) and white matter (E); mild in cortex (B) and white matter (F); moderate in cortex (C) and white matter (G); severe in cortex (D).
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com